I started writing this blog with the intention to talk about the undergraduate physiology course I revamped this semester. Don’t worry, I still plan to talk about it because it is a fantastic course. However, since this blog is set to be posted around December 31^st, I thought I might start off by reflecting on my past year. If you learn anything from my journey, I hope it’s that even achieving small goals can lead to bigger changes than you might expect.

 

To begin this year, my goal was to attend Experimental Biology (EB). It was one of my favorite conferences to attend as a graduate student and postdoc, but I hadn’t gone since becoming faculty (4yrs). In late 2021, I became acquainted with how helpful the Teaching Section for APS could be for my career as a physiology educator. I thought attending EB would be a good way to network and get new ideas for my courses. Being Non-Tenure track faculty, with 100% teaching effort, I don’t have grants to fund my travel. So, I depend on my department for support. I was a bit scared to ask, but looking back, I don’t know why. I’m not sure if anyone else fears asking their department for travel funds. I guess I didn’t want to be a burden during tight financial times, but my goal was to go to EB, so asking was one very small step. Just a quick email:

Hi Charlie,

I was wondering if I could go to EB this year to learn from the other physiology educators. Is there money in the department’s budget for travel for me?

-Erin

With an even quicker reply:

Yes indeed.

And that was that! So stinking easy! Goal achieved! ✅

Now, I wouldn’t make a big deal about setting small goals leading to bigger changes, if that was the end of the great things 2022 had to offer. No, that was just the beginning. Going to EB set off what seemed to be a rocket-ship of networking that led to an incredible opportunity. The PrEP-E Fellowship. PrEP-E stands for Preparing Effective Physiology Educators. This incredible fellowship is an APS Professional Skills Training Course. Before going to EB, I didn’t even know it existed, let alone that I was the target audience for the course. As a Lecturer who has not yet been promoted, I am still considered a trainee for our section. I had no idea! So many of the wonderful members of the teaching section encouraged me to apply. I had just met them, and they made me feel like I could do anything! I’m not sure I’ve ever felt so welcomed by so many people in such a short amount of time. I am forever grateful (I’m not crying…I swear).  Anyway, as soon as I got back to Florida, I applied. Then I got the notification a month later that I was awarded the fellowship! I couldn’t believe it! I was so proud. It felt like it all happened so fast! This amazing fellowship connected me with peers who are also at the beginning stages of their careers and building incredible courses all over the country. I was also given a mentor, Dr. Lisa Anderson. She gave me career advice specific to teaching faculty. We discussed my Teaching Philosophy, DEI statements (an interesting thing to navigate in Fl, at the time, and another story all together), and my Tenure and Promotion Packet. We began planning an education research project together. The switch from bench science to education research was a difficult transition for me. I honestly didn’t know where to start. Having a mentor to guide me was comforting. Just knowing that you are supported, and you have someone who understands what you are trying to accomplish, can have a major impact on your work. I am so grateful for Lisa and her mentorship.

Additionally, as part of the PrEP-E course, I attended my first Institute on Teaching and Learning (ITL). It was a wonderfully overwhelming experience. I met more physiology educators with similar goals as mine. We all want to make the learning environment for our students robust, engaging, inclusive and equitable. ITL gave us tools to implement these goals. I used these tools when remodeling my advanced undergraduate level physiology course: Human Physiology in Translation. Dr. Kayon Murray-Johnson gave us tools to consider when focusing on race and equity in the classroom (1). Dr. Katelyn Cooper encouraged us to consider how active learning might affect students of the LGBTQ+ community, or those dealing with depression/anxiety, or who may have learning or physical disabilities (2). Both of these extraordinary women showed me that if I can be more open with my students and show compassion when they need it, they might feel more comfortable in my classroom, and thus be more open to learning. I like to think that I made steps in the right direction this semester. While creating the syllabus, I made sure to include a diversity, equity and inclusion (DEI) statement for the first time. On the first day of class, I took the time to get to know my students and asked what was important to them as members of a team. I used their suggestions to create a Rubric they would use for peer grading. This set the tone for the year. The students wanted an equitable and inclusive classroom, and I assured them I would provide that space for them.

 

In addition to a more inclusive and equitable classroom, I was also inspired by my fellow educators to create a more engaging classroom. For years, my course has been a series of didactic lectures taught by a team of professors from our department in four self-contained modules: Endocrinology, Neural and Muscle Physiology, Cardiovascular and Renal Physiology, and Respiratory and Circadian Rhythms. At the end of each module students took a multiple-choice exam, with these 4 exams being the sole assessments for the year. During the 1st year of COVID (2020), I added discussions as a participation grade, which worked when we were fully online. However, when we went to a hybrid classroom in 2021, students mostly posted responses online, and only a few showed up in person. It seemed like a waste of time for the professors to come and sit in a mostly empty room, while I tried to spark some kind of discussion. It was boring and awkward for everyone involved. I knew I needed to change the set up. I wanted a flipped classroom, I just needed to figure out how to engage students better in person.

At ITL, an abstract titled, “Using the ‘flipped classroom’ to promote equity in undergraduate biology courses,” from Drs. Marisol Lopez and Donika Rakacolli gave me the push I needed. I agree with their assessment that providing content for students to study at their own pace outside of the classroom allows for a more equitable learning environment to reinforce the difficult concepts during class time (3). I knew I wanted to use class time for discussions, and Dr. Lopez gave me advice on how to provide more structure, and to ensure buy-in from the students. I did this by adding “Team Based Learning” quizzes (IRAT and TRAT) for each class (4). This ensured students would come to class prepared, and ready for the questions the professors posed. Additionally, the Rubric the students created included “Commitment to the group by coming to class prepared,” and “Contributing quality information to the group for the TRAT, discussions, and projects.” It worked. We had very robust discussions during class time. I learned more about what interested the students as the semester progressed and asked the professors to think about how their system might affect or be affected by exercise and/or pregnancy and come prepared. This was rewarding for everyone. Some of our professors who normally don’t teach or even think about the physiology of pregnancy, now had to answer very thoughtful questions about how their system might have to adapt. I was excited to come to class knowing that we would be having invigorating discussions about our topics in ways we never had before.

You may have noticed that I mentioned ‘projects’ in reference to the student prepared Rubric. This comes from another abstract that inspired me at ITL, “Clinical and Translational Physiology: Student perceptions of processed based learning to create an authentic learning experience.”(5)  Dr. Joseph Rathner walked me through the work he did in his course, and I couldn’t help but notice how similar our courses were. Much like my Human Physiology in Translation course, Dr. Rathner’s course is divided into modules but instead of relying on exams, quizzes, and participation grades, he assigned team projects in each module. I thought this was the solution I needed to address the lack of diverse assessments in my course. For each module, I gave the students a list of pathophysiology’s to choose from and told them they could present on their chosen topic in any way they wanted: social media, websites, infographics, the sky was the limit. They had to designate an “intended audience,” of their choosing. For example, elderly patients that might be affected, or experts in the field wanting updates on the treatment options. The only requirement was to hit each mark from the provided Rubric. Did they specify the audience, and was their presentation appropriate for said audience? Did they show an understanding of the related physiology and pathophysiology? Was their presentation dynamic and engaging? The final rule was that they couldn’t present in the same way twice. With 8 students in the class, we had 2 groups of 4, Team AVORA and Team Sting. In the first module, Sting gave a power-point lecture, and AVORA designed an infographic. In the second module, Sting gave an abstract presentation for “Research Day at UF” (they made it up), and AVORA gave a power-point presentation and a dramatization (more on that later) to “High School Students.” In the third module, both groups recorded videos. This was a perfect example of how these flexible assignments accommodated my students. Three of my 8 students were exchange students from Spain. During the scheduled presentation, they were going to be out of town. With the flexibility of the assignment, they received full marks of participation, despite not being physically present during the presentation. In the final module the students gave the most dynamic presentations. Because they could not do the same format twice, they needed to get more creative. Team AVORA created an Instagram account @shiftworkdisorders (please follow and smash that like). Team Sting created an entire skit with 2 students playing MDs, and the other 2 playing a young patient being diagnosed with Asthma and her mother. It was fantastic! I am so proud of how they progressed through the semester.

It is later…So, time for more on “Dramatization.” At ITL, I attended a workshop given by Drs. Helena Carvalho, Patricia Halpin, and Elke Scholz-Morris, “Teaching strategies/tools: learning how to use dramatization to teach difficult concepts in physiology.” (6) I loved this workshop! We learned how to think of creative ways to ‘dramatize’ common physiological concepts using the students as the ‘parts’ in the system. For example, in dramatizing the cardiac cycle, each student becomes a part of the heart (SA node, myocyte, etc.) and has to contract and relax to pump ‘blood’ (another student) out of the heart.

 

During the workshop, one group came up with a skit to demonstrate insulin signaling and glucose transport. Another group demonstrated steroid hormone signaling. Our group demonstrated sarcomeric contraction. I used each of these examples in my class. I also created a new way to think of action potentials. It wasn’t as big a dramatization, because with only 8 students, we didn’t have enough people to play each part.  So, I used candy. I created a “membrane” with dry erase markers, and the students stood on either side of the table and, as pairs, acted as either a voltage-gated Na+ ion channel, a voltage-gated K+ ion channel, or the Na/K ATPase. The Na+ and K+ ions were different colored candy. The students went through the phases of the action potential, by moving the different ‘ions’ through their channels. One student said, “I have been taught this so many times, but this is the first time I feel like I actually understand it.” Music to my ears!

With all of the changes I made to this course, I asked one of my students to give me feedback after each module. I wanted to ensure I actually created a robust, inclusive learning environment from the student’s perspective. With this blog coming at the end of the semester, she has graciously agreed to share her feedback with you. The following is a question and answer with my student, Julia Henault.

 

How does this course compare to other courses you have taken?

          This course was completely different from any course I have taken before. While I have taken flipped classrooms before, never have I experienced one as interactive and engaging as this class. Since different chapters of the course were taught by different faculty members, each class discussion came to be a unique experience. We were able to ask the respective professor more personal questions about their field of study and learn the material in a much deeper way than if we just attended a lecture and studied on our own. The fact that there were so few students also created such a collaborative atmosphere. Whether we were acting out a physiological concept or answering quiz questions, we really worked as a team to understand the material.

What was your favorite part of the course? Why?

          While there were so many aspects of the course I really enjoyed, I have to say the dramatization learning activities were the most engaging and memorable. One of my favorite dramatization days was when we were learning about blood flow throughout the heart. Dr. Bruce assigned each of us to heart chambers and connecting valves and we had to figure out ourselves how to correctly assemble in the order of blood flow. When we were ready, Dr. Bruce acted as the blood and moved through our created chambers, coordinated to our “contractions” and directions. These acting activities were my favorite because while they were fun and engaging, they also made me realize gaps in my knowledge I wasn’t aware of. By listening to the lecture on blood flow the day prior, I thought I understood the order of the steps. But acting it out made us think critically. What was stopping the blood from flowing backwards? Why do the ventricles have to contract more forcefully?

We covered a lot of material. What physiological concept do you remember the most? Why?

          I was joking with my parents the other week that my two biggest takeaways from this course are how exercise is one of the best things you could do for your body, and how pregnancy is the craziest. I say this jokingly because in actuality, we dove deep into the physiology of several different body systems, such as respiratory, nervous, cardiac, and muscular. While this information was interesting, I most remember the topics we learned during in-class discussion, where we could go beyond basic physiology and discuss applications, like pregnancy and exercise. These real-life applications are ones that I have never learned about in my other pre-medicine courses, yet I learned such important information that I wish everyone could learn.

What would you improve in the course?

          As I mentioned earlier, the course material was taught by the UF physiology department, which meant different professors taught different material based on their area of expertise. While I loved this format, as it helped me connect with different professors and learn the material in a deeper way, I sometimes felt that the information could have been more cohesive between different professors. In the future, I think this course would benefit by more communication between the professors so they can coordinate their lectures at the same level of depth and difficulty.

Thank you so much, Julia! I sincerely appreciate your feedback, and all of your work this semester.

What I have taken away from Julia’s feedback, as well as my other students, is that the small class size, the dramatizations, and the discussions with professors were the best parts of the course. I could see that my students were comfortable with me, and I felt comfortable with them. Aside from this course, I had a really stressful semester. Coming to this class three days a week was like taking a break from the world and just having fun. I could see the difference our time made in their lives as well. So, when I say, one small goal can lead to bigger changes, this course is my proof. Had I not gone to EB, I would not have applied for, let alone been awarded, the PrEP-E Fellowship or gone to ITL. Without that inspiration, I may not have made the dramatic changes to my course that had such a positive impact on my students. A small pebble can have a wide ripple effect. What will your small goal be this year? I hope you will achieve that goal and see the ripples you will create. Happy New Year!

Resources:

• Murray-Johnson, K. (2022). “Where do we go from here? Race and equity focused teaching in trying times.” Plenary Lecture and Concurrent Workshop 1.
• Cooper, K. (2022). “The opportunities and challenges of active learning for student anxiety/depression, LGBTQ+ students and students with disabilities. Plenary Lecture 2.
• Lopez, M. & Rakacolli, D. (2022). “Using the “flipped classroom” to promote equity in undergraduate biology courses.” Abstract 10.3
• Sibley, J. & Spiridonoff, S. University of British Columbia faculty of Applied Science; Center for Instructional Support. Team Based Learning Collaborative (2022). “A handout on ‘Why and how TBL works’” org/more-resources
• Rathner, J., Tay, J.A., Fong, A., Sevigny, C., (2022). “Clinical and translational physiology: Student perception of processed based learning to create an authentic learning experience.” Abstract 19.4
• Carvalho, H., Halpin, P., Scholz-Morris, E. (2022). “Teaching strategies/tools: learning how to use dramatization to teach difficult concepts in physiology.” Concurrent Workshop 6.

Erin Bruce is a Lecturer at the University of Florida College of Medicine in the Department of Physiology and Aging. She teaches Physiology to Undergraduates, Post-Baccalaureates online, Graduate Students, Medical Students, and Physician Assistant students. Her research interest has moved to Educational Research and looks forward to learning more about the field.