Category Archives: Activity

How to motivate students to come prepared for class?

The flipped classroom is a teaching method where the first exposure to the subject occurs in an individual learning space and time and the application of content is practiced in an interactive guided group space. Freeing up class time by shifting traditional lecture outside of class allows the instructor more time for student-centered activities and formative assessments which are beneficial to students. The flipped teaching model has been shown to benefit students as it allows self-pacing, encourages students to become independent learners, and assists them to remain engaged in the classroom. In addition, students can access content anytime and from anywhere. Furthermore, collaborative learning and peer tutoring can be integrated due to freed-up class time with this student-centered approach. Given these benefits, the flipped teaching method has been shown to improve student performance compared to traditional lecture-based teaching. Compared to the flipped classroom, the traditional didactic lecture is considered a passive type of delivery where students may be hesitant to ask questions and may omit key points while trying to write or type notes.

There are two key components in the flipped teaching model: pre-class preparation by students and in-class student-centered activities. Both steps involve formative assessments to hold students accountable. The importance of the pre-class assessment is mainly to encourage students to complete their assignments and therefore, they are better prepared for the in-class application of knowledge. In-class activities involve application of knowledge in a collaborative space with the guidance of the instructor. Although the flipped teaching method is highly structured, students still come to class unprepared.

Retrieval practice is yet another powerful learning tool where learners are expected to recall information after being exposed to the content. Recalling information from memory strengthens information and forgetting is less likely to occur. Retrieval of information strengthens skills through long-term meaningful learning. Repeated retrieval through exercises involving inquiry of information is shown to improve learning.

The use of retrieval strategy in pre-class assessments is expected to increase the chance of students completing their pre-class assignment, which is often a challenge. Students attending class without having any exposure to the pre-class assignment in the flipped classroom will drastically affect their performance in the classroom. In my flipped classroom, a quiz consisting of lower level of Bloom’s taxonomy questions is given over the pre-class assignment where the students are not expected to utilize any resources or notes but to answer questions from their own knowledge. Once this exercise is completed, a review of the quiz and the active learning portion of the class occurs. I use a modified team-based learning activity where the groups begin answering higher order application questions. Again, no resources are accessible during this activity to promote their preparation beforehand. Since it is a group activity, if one student is not prepared, other students may fill this gap. The group typically engages every student and there is a rich conversation of the topic being discussed in class. The classroom becomes a perfect place for collaborative learning and peer tutoring. For rapid feedback to the students, the group answers to application questions are discussed with the instructor prior to the end of the class session.

Student preparation has improved since the incorporation of the flipped teaching model along with retrieval exercises in my teaching, but there are always some students who are not motivated to come prepared to class. It is possible that there are other constraints students may have that we will not be able to fix but will continue to be searching for and developing newer strategies for helping these students maximize their learning.

Dr. Gopalan received her PhD in Physiology from the University of Glasgow, Scotland. After completing two years of postdoctoral training at Michigan State University, she began her teaching endeavor at Maryville University where she taught Advanced Physiology and Pathophysiology courses in the Physical Therapy and Occupational Therapy programs as well as the two-semester sequence of Human Anatomy and Physiology (A&P) courses to Nursing students. She later joined St. Louis Community College where she continued to teach A&P courses. Dr. Gopalan also taught at St. Louis College of Pharmacy prior to her current faculty position at Southern Illinois University Edwardsville where she teaches Advanced Human Physiology and Pathophysiology for the doctoral degrees in the Nurse Anesthetist and Nurse Practitioner programs. Besides teaching, she has an active research agenda in teaching as well as in the endocrine physiology field she was trained in.
In Defense of the “Real” Thing

Society has moved into the age of virtual reality.  This computer-generated trend has wide-sweeping implications in the classroom.  Specific to anatomy, impressive 3D modeling programs permit students to dissect simulated bodies pixel by pixel.  It is exciting and often more cost-effective.  Virtual dissection, without doubt, can play a significant role in the current learning environment. However, as stated by Rene Descartes, “And so that they might have less difficulty understanding what I shall say about it, I should like those who are unversed in anatomy to take the trouble, before reading this, of having the heart of a large animal with lungs dissected before their eyes (for it is in all respects sufficiently like that of a man)”. This idea leads me to my argument; there is no replacement for the real thing.

 

We as teachers must incorporate a variety of learning tools for a student to truly understand and appreciate anatomical structure. Anatomical structure also needs to be related to physiological function. Is there anyone reading this that has not repeated the mantra “form determines function” hundreds or thousands of times during their teaching?  The logistical and financial restrictions to human cadavers, necessitates the frequent incorporation of chemically preserved specimens into our laboratory curriculum. Course facilitators often employ a cat or a pig as a substitute for the human body. I am not advocating against the use of preserved specimens or virtual programs for that matter (and kudos to my fellow facilitators who have learned the arduous techniques required to dissect a preserved specimen). However, it is my opinion that it is a time consuming assignment with limited educational end points. Not to mention the rising specimen costs and limited vendor options. The cost of a preserved cat is now ~$40, while the average cost of a live mouse is only ~$5. Two very important components necessary to understand the concept that form determines function are missing from preserved specimens (even cadavers). These two components are: texture and color. With respect to color, the tissues of preserved specimens are subtle variations of gray, completely void of the Technicolor show of the living organism. Further, texture differences are extremely difficult to differentiate in a preserved specimen. Compare this to a fresh or live specimen and the learning tools are innumerable. You might argue that mice are much smaller, but dissecting microscopes can easily enhance the dissection and in my experience far outweigh the noxious experience of dissecting a chemically preserved organism.

 

To further convince you of the value of dissecting fresh tissue I would like to present a couple of examples. First, why is the color of tissue important? One of the most important bodily pigments is hemoglobin. Hemoglobin, as we all know, is the pigment that gives blood its red color. Therefore the color of a tissue often reflects the level of the tissue vascularity and often (but of course not always) in turn the ability of that tissue to repair or regenerate. Simply compare the color of the patellar tendon (white) to the red color of the quadriceps. Muscles being highly vascularized have a much greater ability to regenerate than non-vascular connective tissue such as the patellar tendon. In addition, muscles contain myoglobin, a red protein very similar to hemoglobin. Two clear examples of teaching opportunities that would be missed with the traditional use of preserved specimens.

 

Texture is completely lost with chemical preservation as tissues become hardened and rubbery. My students are always blown away by the fact you can completely eliminate the overall structure of the brain by pressing it between their two fingers. The tactile experience of holding the delicate brain allows students to explore how form begets function begets pathology. Traumatic brain injury (TBI) has become a hot topic in our culture. We no longer see children riding bicycles without helmets, the National Football League has new rules regarding tackle technique and my 8-year-old soccer player is penalized for headers during game play. What better way to educate a new generation of students just how delicate nervous tissue is than by having them “squash” a mouse brain? Regardless, of the amazing skull that surrounds the brain and the important fluid in which it floats, a hit to the head can still result in localized damage and this tactile experience emphasizes this in a way no virtual dissection could ever accomplish.

 

Finally, I would like to discuss a topic close to my heart that does require a non-preserved large animal specimen. The function of arteries and veins is vastly different based on the structure of elastic or capacitance vessels, respectively. For example, the deer heart allows easy access to the superior or inferior vena cava (veins that are thin and easily collapsed) and the aorta (thick and elastic artery) permitting valuable teaching moments on vessel structural variability for divergent physiological function. These structures on a preserved specimen are usually removed just as they enter the heart making them very difficult to evaluate.

 

These are just some elementary examples. Numerous concepts can be enhanced with the added illustrations of texture and color. When presented with both options, my students always choose the fresh tissue!  The wonder and excitement of handling fresh tissue has become a hallmark of our Anatomy and Physiology course and is regularly mentioned as student’s favorite example of hands-on learning in the classroom.

 

I have to end this with a special shout-out to my dear lab adjunct Professor Elizabeth Bain MSN, RN. Liz has made access to deer heart and lungs an easy task for me.

April Carpenter, PhD is an Assistant Professor in the Health and Exercise Physiology Department at Ursinus College. She received her PhD in Molecular and Cellular Physiology at Louisiana State University Health Sciences Center and completed two postdoctoral fellowships at the Hospital for Special Surgery in New York and Cincinnati Children’s Hospital Medical Center. Her research interests include the molecular regulation of endothelial function and its impact on all phases of skeletal muscle injury.  Dr. Carpenter currently teaches Anatomy and Physiology, Research Methods and a new Pathophysiology course.
What if your students went to a lecture . . . and a concert broke out?

In June I attended the American Physiological Society’s Institute on Teaching and Learning (ITL) for the first time.  It was a fantastic week of presentations, workshops, and networking, from the opening keynote address on “Student-instructor interactions in a large-group environment” by Prem Kumar (University of Birmingham, UK) to the closing plenary talk on “Inclusive practices for diverse student populations” by Katie Johnson (Beloit College).

 

The week is hard to summarize concisely, yet I can easily identify my most memorable moment.  That occurred on Wednesday morning (June 20th).  Robert Bjork, a UCLA psychologist, had just delivered a fascinating plenary talk on learning, forgetting, and remembering information.  He had reviewed several lines of evidence that the memorization process is more complicated than tucking facts into a mental freezer where they persist forever.  Instead, the timing and context of information retrievals can profoundly affect the success of subsequent retrievals.

 

At the end of the lecture, I stood up with a question (or possibly a monologue masquerading as a question). “It seems that maintaining long-term memories is a really active, dynamic process,” I said. “The brain seems to be constantly sorting through and reassessing its memory ‘needs,’ somewhat like the way the kidney is constantly sifting through the plasma to retain some things and discard others. Is that a reasonable analogy?”

 

“Yes it is,” he answered politely.  “Perhaps,” he added, “you could write a paper on the ‘kidney model’ of how the brain learns.”

 

“I can do even better than that,” I said.  “Here’s a song I wrote about it!”  And I launched into an impromptu a cappella rendition of “Neurons Like Nephrons” (http://faculty.washington.edu/crowther/Misc/Songs/NLN.shtml).

 

The audience clapped along in time, then erupted with wild applause!  That’s how I prefer to remember it, anyway; perhaps others who were there can offer a more objective perspective.

 

In any case, singing is not just a mechanism for hijacking Q&A sessions at professional development conferences; it can also be done in the classroom.  And this example of the former, while unusual in and of itself, hints at several useful lessons for the latter.

 

  1. Unexpected music gets people’s attention. In truth, I have no idea whether most ITL attendees found my song fun or helpful. Still, I’m quite sure that they remember the experience of hearing it.  Now think about your own courses.  Are there any particular points in the course where you desperately need students’ undivided attention?  Unexpected singing or rapping is amazingly effective as an attention-grabber, even (especially?) if the performer is not a gifted musician.  Don’t be afraid to use this “nuclear option.”

 

  1. Music is not just for “making science fun” and memorizing facts. Many teachers and students who support the integration of music into science courses do so because they think it’s fun and/or useful as a mnemonic device. Both reasons are legitimate; we do want our courses to be fun, and our students do need to memorize things.  But music can be much more than an “edutainment” gimmick.  “Neurons Like Nephrons” (http://faculty.washington.edu/crowther/Misc/Songs/NLN.shtml), for example, develops an analogy between the way that the brain processes information and the way that the kidney processes plasma.  It’s not a perfect analogy, but one worthy of dissection and discussion (https://dynamicecology.wordpress.com/2016/11/14/imperfect-analogies-shortcuts-to-active-learning/).  Songs like this one can thus be used as springboards to critical thinking.

 

  1. The effectiveness of any musical activity is VERY context-specific. After my musical outburst at ITL, I was flattered to receive a few requests for a link to the song. I was happy, and remain happy, to provide that. (Here it is yet again: http://faculty.washington.edu/crowther/Misc/Songs/NLN.shtml.)  But here’s the thing: while you are totally welcome to play the song for your own students, they probably won’t love it.  To them, it’s just a weird song written by someone they’ve never heard of.  They won’t particularly care about it unless the production quality is exceptional (spoiler: it’s not) or unless they are going to be tested on the specific material in the lyrics.   Or unless you take other steps to make it relevant to them – for example, by challenging them to sing it too, or to explain what specific lines of lyrics mean, or to add a verse of their own.

 

 

In conclusion, music can function as a powerful enhancer of learning, but it is not pixie dust that can be sprinkled onto any lesson to automatically make it better.  As instructors, for any given song, you should think carefully about what you want your students to do with it.  That way, when the music begins, the wide-eyed attention of your incredulous students will be put to good use.

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

Flipped teaching is a hybrid educational format that shifts lectures out of the classroom to transform class time as a time for student-centered active learning. Essentially, typical classwork (the lecture) is now done elsewhere via lecture videos and other study materials, and typical homework (problem solving and practice) is done in class under the guidance of the faculty member. This new teaching strategy has gained enormous attention in recent years as it not only allows active participation of students, but also introduces concepts in a repetitive manner with both access to help and opportunities to work with peers. Flipped teaching paves the way for instructors to use classroom time to engage students in higher levels of Bloom’s taxonomy such as application, analysis, and synthesis. Students often find flipped teaching as busy work especially if they are not previously introduced to this teaching method. Pre-class preparation combined with a formative assessment can be overwhelming especially if students are not used to studying on a regular basis.

When I flipped my teaching in a large class of 241 students in an Advanced Physiology course in the professional year-1 of a pharmacy program almost a decade ago, the first two class sessions were very discouraging. The flipped teaching format was explained to students as a new, exciting, and innovative teaching method, without any boring lectures in class. Instead they would be watching lectures on video, and then working on challenging activities in class as groups. However, the majority of the students did not complete their pre-class assignment for their first class session. The number of students accessing recorded lectures was tracked where the second session was better than the first but still far from the actual class size. The unprepared students struggled to solve application questions in groups as an in-class activity and the tension it created was noticeable.  The first week went by and I began to doubt its practicality or that it would interfere with student learning, and consequently I should switch to the traditional teaching format. During this confusion, I received an email from the college’s Instructional Technology office wondering what I had done to my students as their lecture video access had broken college’s records for any one day’s access to resources. Yes, students were preparing for this class! Soon, the tension in the classroom disappeared and students started performing better and their course evaluations spoke highly of this new teaching methodology. At least two-thirds of the class agreed that flipped teaching changed the way they studied. This success could be credited to persistence with which flipped teaching was implemented despite student resistance.

I taught another course entitled Biology of Cardiovascular and Metabolic Diseases, which is required for Exercise Science majors and met three times per week. Although students in this course participated without any resistance, their unsolicited student evaluations distinctly mentioned how difficult it was to keep up with class work with this novel teaching approach. Based on this feedback, I set aside one meeting session per week as preparation time for in-class activities during the other two days. This format eased the workload and students were able to perform much better. This student buy-in has helped improve the course design significantly and to increase student engagement in learning. Flexibility in structuring flipped teaching is yet another strategy in improving student preparation.

While one of the situations required persistence to make flipped teaching work, the other situation led me to modify the design where one out of three weekly sessions was considered preparation time. In spite of these adaptations, the completion of pre-class assignment is not always 100 percent. Some students count on their group members to solve application questions. A few strategies that are expected to increase student preparation are the use of retrieval approach to flipped teaching where students will not be allowed to use any learning resources except their own knowledge from the pre-class assignments. Individual assessment such as the use of clickers instead of team-based learning is anticipated to increase student preparation as well.

Dr. Chaya Gopalan earned her Ph.D. in Physiology from the University of Glasgow. Upon her postdoctoral training at Michigan State University, she started teaching advanced physiology, pathophysiology and anatomy and physiology courses at both the undergraduate and graduate levels in a variety of allied health programs. Currently she teaches physiology and pathophysiology courses in the nurse anesthetist (CRNA), nurse practitioner, as well as in the exercise science programs. She practices team-based learning and flipped classroom in her everyday teaching.
Thinking Critically About Critical Thinking

 

A few mornings ago, I was listening to a television commercial as I got ready for work.  “What is critical thinking worth?” said a very important announcer.  “A whole lot” I thought to myself.

But what exactly is critical thinking?  A Google search brings up a dictionary definition.  Critical thinking is “the objective analysis and evaluation of an issue to form a judgement.”  The example sentence accompanying this definition is “professors often find it difficult to encourage critical thinking among their students.” WOW, took the words right out of my mouth!

Have any of you had the following conversation? “Dr. A, I studied and studied for this exam and I still got a bad grade.  I know the material, I just can’t take your tests!”  The student in question has worked hard. He or she has read the course notes over and over, an activity that has perhaps been rewarded with success in the past.  Unfortunately re-reading notes and textbooks over and over is the most common and least successful strategy for studying (4).

In my opinion, as someone who has been teaching physiology for over 20 years, physiology is not a discipline that can be memorized.  Instead, it is a way of thinking and a discipline that has to be understood.

Over the years, my teaching colleague of many years, Sue Keirstead, and I found ourselves during office hours trying repeatedly to explain to students what we meant by thinking critically about physiology.  We asked the same probing questions and drew the same diagrams over and over.  We had the opportunity to formalize our approach in a workbook called Cells to Systems Physiology: Critical Thinking Exercises in Physiology (2).  We took the tough concepts students brought to office hours and crafted questions to help the students work their way through these concepts.

Students who perform well in our courses make use of the workbook and report in student evaluations that they find the exercises helpful. But we still have students who struggle with the critical thinking exercises and the course exams.  According to the comments from student evaluations, students who struggled with the exercises report they found the questions too open ended.  Furthermore, many of the answers cannot be pulled directly from their textbook, or at least not in the format they expect the answer to be in, and students report finding this frustrating.  For example, the text may discuss renal absorption and renal secretion in general and then the critical thinking exercises asks the student to synthesize all the processes occurring in the proximal tubule.  The information is the same but the organization is different.  Turns out, this is a difficult process for our students to work through.

We use our critical thinking exercise as a type of formative assessment, a low stakes assignment that evaluates the learning process as it is occurring.  We also use multiple choice exams as summative assessments, high stakes assessments that evaluate learning after it has occurred.  We use this format because our physiology course enrollment averages about 300 students and multiple choice exams are the most efficient way to assess the class.  We allow students to keep the exam questions and we provide a key a couple of days after the exam is given.

When a student comes to see me after having “blown” an exam, I typically ask him or her to go through the exam, question by question.  I encourage them to try to identify how they were thinking when they worked through the question.  This can be a very useful diagnostic.  Ambrose and colleagues have formalized this process as a handout called an exam wrapper (1).  Hopefully, by analyzing their exam performance, the student may discover a pattern of errors that they can address before the next exam.  Consider some of the following scenarios:

Zach discovers that he was so worried about running out of time that he did not read the questions carefully.  Some of the questions reminded him of questions from the online quizzes.  He did know the material but he wasn’t clear on what the question was asking.

This is a testing issue. Zach, of course, should slow down.  He should underline key words in the question stem or draw a diagram to make sure he is clear on what the question is asking.

Sarah discovers that she didn’t know the material as well as she thought she did, a problem that is called the illusion of knowing (3). Sarah needs to re-evaluate the way she is studying.  If Sarah is cramming right before the exam, she should spread out her studying along with her other subjects, a strategy called interleaving (3).  If she is repeatedly reading her notes, she should put her notes away, get out a blank piece of paper and write down what she remembers to get a gauge of her knowledge, a process called retrieval (3).  If she is using flash cards for vocabulary, she should write out learning objectives in her own words, a process called elaboration (3).

Terry looks over the exam and says, “I don’t know what I was thinking.  I saw something about troponin and I picked it.  This really frustrates me. I study and study and don’t get the grade I want.  I come to lecture and do all the exercises. I don’t know what else to do.” It is a challenge to help this student.  She is not engaging in any metacognition and I don’t claim to have any magic answers to help this student.  I still want to try to help her.

I feel very strongly that students need to reflect on what they are learning in class, on what they read in their texts, and on the activities performed in lab (3).  I have been working on a project in one of my physiology courses in which I have students take quizzes and exams as a group and discuss the answers collaboratively.  Then I have them write about what they were thinking as they approached the question individually and what they discussed in their group.  I am hoping to learn some things about how students develop critical thinking skills.  I hope I can share what I learn in a future blog posting.

  1. Ambrose SA, Bridges MW, DiPietro M, Lovett M, Norman MK. How Learning Works: 7 Research Based Points for Teaching. San Francisco CA: Jossey-Bass, 2010.
  2. Anderson LC, Keirstead SA. Cells to Systems: Critical Thinking Exercises in Physiology (3rd ed). Dubuque, IA: Kendall Hunt Press, 2011.
  3. Brown PC, Roediger HL, McDaniel MA. Make it Stick: The Science of Successful Learning. Cambridge MA: The Belknap Press of Harvard University Press, 2014
  4. Callender AA, McDaniel, MA. The limited benefits of rereading educational text, Contemporary Educational Psychology 34:30-41, 2009. Retrieved from http://ac.els-cdn.com/S0361476X08000477/1-s2.0-S0361476X08000477-main.pdf?_tid=22610e88-61b4-11e7-8e86-00000aacb35e&acdnat=1499281376_e000fa54fe77e7d1a1d24715be4bbf50 , June 22, 2016.

 

 Lisa Carney Anderson, PhD is an Assistant Professor in the Department of Integrative Biology and Physiology at the University of Minnesota. She completed training in muscle physiology at the University of Minnesota. She collaborates with colleagues in the School of Nursing on clinical research projects such as the perioperative care of patients with Parkinson’s disease and assessment of patients with spasticity. She directs a large undergraduate physiology course for pre-allied health students.  She also teaches nurse anesthesia students, dental students and medical students.  She is the 2012 recipient of the Didactic Instructor of the Year Award from the American Association of Nurse Anesthesia.  She is a co-author of a physiology workbook called Cells to Systems: Critical thinking exercises in Physiology, Kendall Hunt Press. Dr. Anderson’s teaching interests include teaching with technology, encouraging active learning and assessment of student reflection.