Category Archives: Classroom Content

Achieving Small Goals Can Lead to Bigger Changes Than You Might Expect

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 31st, 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.
Incorporating Conference-Based Assignments into Coursework

Attending professional conferences is an excellent opportunity for students to network, learn, and gain a greater understanding of how science works. Undergraduate students often attend conferences because they are presenting their work; however, attendance at professional conferences even if not presenting can open a variety of opportunities for students (Gopalan et al., 2018). Potential benefits of participation include content knowledge or application gains, exposure to different ideas, better understanding of how different areas of a field integrate, networking building, career exploration, and practice with professional interactions.

 

Prior to attending the conference, instructors should consider preparing students for attendance. Instructors should explain the purpose of professional conferences, highlighting the importance of the exchange of ideas and building professional networks. First time undergraduate attendees, especially, may be unsure of what to expect and how to interact with others professionally. Just as faculty mentors would practice with student presenters, practicing with and mentoring non-presenting student attendees can optimize the student conference experience. Holding a pre-conference information session with students will help them be prepared and make the most of their experience. Informational session topics can include: how to ask questions, talking to poster presenters, what to expect from grad school admissions tables, how to earn continuing education credits, developing or revising a resume to have on hand, identifying presenters in attendance to connect with, and creating a conference schedule. Additionally, instructors can help students create and practice an “elevator pitch” to describe their work and professional goals (Das & Spring, 2022). Das and Spring (2022) recommend students set goals for the conference in advance so their time at the meeting is intentional. In addition to pre-conference instruction and conference-based assignments, a general follow up with students after the conference can provide insight into what students learned, what challenges they encountered, and what they found interesting. Student insight can be helpful in planning for future meetings.

 

Incorporating conference attendance into a course can significantly add to the student course experience. Using conferences to augment a course is a great opportunity to help students integrate course content with development of professional and communication skills. What follows is a list of potential assignments instructors might consider to encourage student participation in conferences. Many of the suggestions below would work well for in person or virtual conferences. The assignments can be implemented for any type of conference; however, encouraging students to attend smaller, regional conferences first is an excellent way to prepare them for larger, national and international conferences. Conference- based assignments could be evaluated for credit, extra credit, or as an additional demonstration of engagement or understanding.

 

 

  1. Make a spotlight box, similar to one you would find in your textbook, about one of the conference presentations. Include background context, important points from the speaker’s talk, and practical applications. Add relevant figures or graphs from other research papers or the speaker’s presentation to frame the spotlight and make it visually appealing to the reader. Be sure to cite your sources.
  2. Make a short YouTube video that summarizes the general topic presented by one speaker. After summarizing the broader content area, highlight information from the speaker’s presentation. Feel free to be creative- present it as a news story or host a debate with fellow classmates! (Heffernan, 2020)
  3. Design a proposal for a talk for next year’s meeting. Choose an area of exercise science you are interested in learning more about. Describe 3-5 learning objectives of the presentation and identify 3 experts in the field who would serve as your speakers. (Heffernan, 2020)
  4. Tell a young child about what you learned at the conference. Choose one of the keynote speakers’ presentations and make a short children’s story about the topic. Make the content fun and easy to understand. Include illustrations which help kids visualize the ideas you present.
  5. Watch/read 3 poster presentations. For each one, summarize the presentation. What are the strengths and limitations of each study? What would you do differently if you were the researcher? Why? What would your next study be and why? (Heffernan, 2020)
  6. Take visual notes on one of the presentations you watch. Your goal is to make your notes about the content visually appealing and make connections between ideas. Because you are connecting ideas, the notes do not need to be in top to bottom order, but organized according to themes. Include questions asked by the audience members and the speaker responses in your notes. (Google “visual note taking” for some cool ideas and pictures).
  7. Write a 2 page scientific summary of a presentation, locate 2-3 peer reviewed resources (preferably by the speaker) related to the talk and infuse them into the summary. (Heffernan, 2020)
  8. Make an infographic (Try programs like Canva, for example) about one of the presentations- include the main points, supporting evidence, conclusions, and practical applications. Be sure the infographic includes figures, is easy to read, and is visually appealing.
  9. Write a poem or song about one of the presentations. For example, write a series of haiku or use a rhyming scheme in a poem. Put your own song lyrics about the talk or content area to the music of another song or use refrains/verses to your own lyrics. For example: “you’re a vein” to “You’re so vain”.
  10. Create a movie trailer (iMovie works great and has pre-made templates) about one of the talks. Use open access videos and pictures from the internet in the movie or make your own with 2-3 classmates (groups of 4 or less). Include info about the presentation as if you were publicizing the talk. Be sure to include the main ideas or conclusions and relevant contextual information.
  11. Ask one or more of the speakers about their career path(s). Write up a 1-page summary of their responses to the following questions. How did they get to where they are? Did their path change and how? Did their interests change as they moved through their careers and if so, why? Was it different or the same as what they expected at your stage in your career? Why is it important to recognize our paths might take different directions than expected?
  12. Create a “BINGO” style card or scavenger hunt to encourage students to communicate with people or investigate different aspects of the conference. (Gopalan et al., 2018)
  13. Use twitter to react to the presentation. Tweet key points from the talk. Tag the speaker or use the conference hashtags in your tweet. (Heffernan, 2020)
  14. Write a short reflection, 1-2 pages, on what you learned about HOW science works. You may want to think about the following: What is the purpose of a conference like the one you attended? How do different presentation types advance research in the field or clinical practice? Why is dissemination of research important?
  15. After learning about different areas of research, what might you be interested in researching? What new ideas were sparked for you from the presentations you attended?

Professional conference attendance is an important opportunity for presenting and non-presenting students. Conference attendance can easily be integrated into various courses from introductory level courses which may encourage students to develop research later in their college careers to upper-level students who may be interested in building professional networks for graduate or professional school. Conference-based assignments are useful ways for instructors to integrate course content, professional development, and conference attendance into their courses.

References

Das, B., & Spring, K. (2022, September 22). 11 Tips for Instructors Bringing Students to ACSM Regional Chapter Meetings. ACSM_CMS. https://www.acsm.org/home/featured-blogs—homepage

Gopalan, C., Halpin, P. A., & Johnson, K. M. S. (2018). Benefits and logistics of nonpresenting undergraduate students attending a professional scientific meeting. Advances in Physiology Education, 42(1), 68–74. https://doi.org/10.1152/advan.00091.2017

Heffernan, K. (2020). MARC in the Classroom. https://www.acsm.org/docs/default-source/regional-chapter-individual-folders/mid-atlantic/marc-acsm_integrating-into-classroom.pdf?sfvrsn=503ff16e_0

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 and Rehabilitation Science at the University of Minnesota Duluth. Dr. Stenson teaches exercise physiology, metabolism, and nutrition. Her research focuses on recovery from exercise and improving the health of college students. Dr. Stenson mentors undergraduate research students each year and considers teaching and mentoring the most important and fulfilling parts of her work.
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.
The Olympics, sex, and gender in the physiology classroom

Are there sex based difference in athletic performance before puberty?

In the past few years most state legislatures have considered laws stating that only members of the female sex can participate in girl’s and women’s sports (37 states in 2021 alone), and as of April 20, 2022 fifteen states have adopted such legislation (1). There have also been several well publicized instances of transwomen competing for championships in women’s sports (for example see 2, 3, 4). The International Olympic Committee, the NCAA, and other sports governing bodies have also recently revised their policies regarding the inclusion of transwomen in women’s sports (5, 6).  All of this has resulted in students in my exercise physiology classes commonly asking questions about sex-based differences in sports performance and the inclusion of transwomen in women’s sports.

In a previous PECOP Blog (7) I briefly summarized the sex-based advantages men have in athletic performance in adults, and the research evaluating the effects of testosterone suppression and cross sex hormone use on factors that influence athletic performance. In this PECOP Blog, I will briefly summarize the sex based prepubertal differences in athletic performance and touch on puberty blockers.

A 2012 report from the CDC indicated there were no differences between 6–11-year-old boys and girls in performance on physical fitness tests (8).  Many sports leagues for pre-pubertal children are not separated by sex since the focus is developing basic sports skills rather than competition (9). Furthermore, some scholars have stated that there are no differences in athletic performance between boys and girls prior to the onset of puberty, and that it is only the increased testosterone secretion during puberty that causes males to outperform females in athletic competition (10, 11).

On the other hand, evaluations of fitness testing in children as young as 3 years old shows that boys perform better than girls of the same age on tests of muscular strength, muscular endurance, and aerobic fitness (12-17).  For example, Tomkinson et al. (17) observed that at age 9 boys are running an average of 3.2% faster than girls of the same age during the last stage of a 20 m shuttle run (Figure 1).  In a separate evaluation Tomkinson et al. (16) reported that at age 9 boys have a bent arm hang time that is an average of 48.1% longer than girls of the same age (Figure 2).

Furthermore, youth records from USA Track & Field (18) in the 8-and-under age group and in the 9-10-years-old age group (who can reasonably be assumed to be pre-pubertal) show that boys outperform girls in all events (Table 1).  The smallest difference in track and field records between boys and girls is 0.94% in the 8-and-under 100 m run, with the largest difference being 38.42% in the 8-and-under javelin throw.  We recently analyzed top 10 data for national performance from Athletic.net in 100 m, 200 m, 400 m, 800 m, 1500 m, and 1600 m running events for children in the 7-8 and 9–10 year-old age groups for the years 2019-2021 and found that across all events 7-8-year-old boys were 4.4 ± 1.9% faster than girls, and 9-10-year-old boys were 5.4 ± 1.8% faster than girls (figure 3; not yet published data).  Youth records from USA swimming also show that in 19 out of 23 events the national records for 10 and under boys are faster than girls by an average of 1.72% (19).  It is important to note that in competition the difference between first and second place often comes down to as little as 0.02% difference in speed (Data to be presented at the 2022 ACSM Annual Meeting).

There is no question that the differences in running performance between prepubertal boys and girls is less than the 10-13% difference in running performance observed between post-pubertal boys and girls, and between adult men and women (10, 11, 20).  And there is no question that the large increases in circulating testosterone experienced by boys during puberty is responsible for most of the differences in athletic performance between post-pubertal boys and girls, and between adult men and women (21).  But the existence of differences in athletic performance between prepubertal boys and girls is well demonstrated (12-19).  Juxtaposing the statements of no pre-pubertal athletic differences between boys and girls (8, 10, 11) and the evidence demonstrating that there are pre-pubertal athletic differences between boys and girls (12-19) can facilitate an interesting discussion about data collection, sample size, data analysis, and other factors that may contribute to these contradictory findings.

When explaining the biological causes of the prepubertal athletic advantages in boys, a good starting point is to discuss the differences in growth and development between boys and girls and to explain the processes of sex determination and sex differentiation (22).  Sex determination occurs at conception with the conferral of sex chromosomes.  Six weeks later, sex differentiation begins to become apparent and during the remainder of development the gonads and genitalia acquire male or female characteristics.  During sexual differentiation, the presence of the SRY gene on the Y chromosome along with androgen exposure and anti-Müllerian hormone cause the internal and external genitalia to follow the male developmental pathway. In the absence of the SRY gene on the Y chromosome, lack of androgen exposure, and lack of anti-Müllerian hormone the female developmental pathway occurs. Of course these few brief sentences fail to cover the myriad of complex interactions of genes, primordial stem cells, and hormones that regulate sex development, and the possible differences and disorders that can occur. But it is remarkable that with all of the possible missteps that can happen during sexual differentiation and development, sex can be accurately and easily identified at birth 99.83% of the time (23).

Further substantiating the important role of sex in growth and development are the World Health Organization fetal growth charts (24), which indicate small but meaningful sex-based differences with male fetuses being consistently larger than female fetuses.  Similarly, substantiating the important role of sex in growth and development, the Centers for Disease Control and Prevention have different growth charts for boys and girls from birth through adolescence with boys having consistently higher values for body mass and body height (25).

With an eye towards physical fitness and athletic performance, starting at birth and continuing throughout youth girls have more body fat and less fat-free mass than boys. For example, Davis et al. (26) in an evaluation of 602 infants reported that at birth and age 5 months, infant boys have larger total body mass, body length, and fat-free mass while having lower percent body fat than infant girls. In an evaluation of 20 boys and 20 girls ages 3-8 years old, matched for age, height, and body weight Taylor et al. (27) reported that the boys had less body fat, lower percent body fat, and a higher bone free lean body mass than the girls, such that the girls’ fat mass was 52% higher than the boys, while the bone-free lean tissue mass was 9% lower. In an evaluation of 376 prepubertal [Tanner Stage 1] boys and girls, Taylor et al. (28) observed that the boys had ~22% more lean mass, and ~13% less body fat (when expressed as percent of total body mass) than did the girls. In a review of 22 peer reviewed publications on the topic, Staiano and Katzmarzyk (29) concluded that girls have more total body fat than boys throughout childhood and adolescence.  It is a tenet of exercise science that having more lean body mass provides athletic advantages, so it is reasonable to conclude that having more lean body mass contributes to the prepubertal sex-based male athletic advantages.

It is worth noting that serum testosterone concentrations in boys are higher for the first 5 months after birth than in girls (30). Testosterone concentrations are then similar between boys and girls until the onset of puberty, when testosterone concentrations increase 10-20-fold in boys.  Given the well know anabolic and androgenic effects of testosterone, the higher testosterone levels in newborn boys likely contributes to the sex related differences in body size and composition in newborns.  It is unknown how much the lingering sex-linked differences in body size, body composition, physical fitness, and athletic performance are due lasting effects of the higher testosterone levels in newborns, and how much the differences are due to Y chromosome or other sex-linked effects.

Strongly suggesting that sex linked differences in physical fitness and athletic performance in children before puberty are due to biological factors, Eiberg et al. (13) measured body composition, VO2max, and physical activity in 366 Danish boys and 332 Danish girls between the ages of 6 and 7 years old.  Their observations indicated that absolute VO2max was 11% higher in boys than girls, while relative to body mass the boys’ VO2max was still 8% higher than the girls.  Accelerometry based measurements of physical activity indicated that when boys and girls regularly participated in the same amount and intensity of physical activity, the boys had higher measured physical fitness than the girls.  When the findings of Eiberg (13) are taken collectively with the findings of large scale school based physical fitness testing in children that also shows pre-pubertal boys outperforming girls in measurements of aerobic fitness, muscular strength, and muscular endurance (12, 14-17), the youth records from USA Track & Field (18) showing that pre-pubertal boys outperform girls in all events, and the 10 and under records from USA Swimming showing that boys outperform girls in 19 out of 23 events (19), there exists strong evidence that there are differences in physical fitness and athletic performance between boys and girls before puberty.

And finally, this discussion arising from laws stating that only members of the female sex can participate in girl’s and women’s sports can lead to questions about the effects of puberty blockers on physical fitness and athletic performance in prepubertal children.  Puberty blockers are correctly known as gonadotropin-releasing hormone agonists (GnRHa), which disrupt the normal pattern of secretion of as gonadotropin-releasing hormone causing the pituitary gland to stop producing follicle-stimulating hormone and luteinizing hormone. Unfortunately, there is minimal research on the effects of puberty blockers on factors that influence physical fitness and athletic performance.

To the best of my knowledge, there is no research on the effects of puberty blockers on muscle strength, running speed, or other measures of athletic performance.  Indeed, Klaver et al. (31) is the only published research that I am aware of that has evaluated the use of puberty blockers on any athletic performance related factor, and this is only on body composition. Klaver et al. (31) demonstrated that the use of puberty blockers in Tanner stage 2-3 teenagers increased body fat and decreased lean body mass in transgirls, but the use of puberty blockers did not eliminate the differences in body composition between transgirls and comparable female teenagers. Roberts and Carswell (32), concluded that there is no published research that sufficiently characterizes the impact of puberty blockers on growth or final adult height.  Thus, the effect of prescribing puberty blockers to a male child before the onset of puberty on the physical components of athletic performance is almost entirely unknown. This becomes a great point in a discussion to remind students of the ever-evolving nature of science.  Any further discussion on this topic becomes speculation or can be removed from the realm of physiology and into metaphysical discussions of what is or is not fair.  Such metaphysical discussions can be fascinating, and also heated, so caution is advisable when proceeding outside of the realm of physiology in a physiology classroom.

In summary, there is strong evidence that even before puberty there are sex-based differences in physical fitness and athletic performance with boys running faster, jumping farther and higher, and demonstrating greater muscle strength than girls of the same age.  These pre-pubertal sex based differences are smaller than the differences in post pubertal teens and adults, but the differences are likely meaningful in terms of competition.  There is currently insufficient evidence to determine what effects puberty blockers have on physical fitness and athletic performance in children.

References

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  7. Brown G. (August 18, 2021). The Olympics, sex, and gender in the physiology classroom [online].  PECOP Blog. https://blog.lifescitrc.org/pecop/2021/08/18/the-olympics-sex-and-gender-in-the-physiology-classroom/ [Accessed April 20, 2022]
  8. Ervin RB,  Wang CY, Fryar CD, Miller IM, and Ogden CL. [online] Measures of Muscular Strength in U.S. Children and Adolescents, 2012.  NCHS Data Brief No. 139, December 2013. (https://www.cdc.gov/nchs/products/databriefs/db139.htm; accessed April 6, 2022)
  9. Wells MS, Arthur-Banning SG.  The Logic of Youth Development: Constructing a Logic Model of Youth Development through Sport. J Pakr & Rec Admin.  26: 189-202, 2008
  10. Handelsman DJ. Sex differences in athletic performance emerge coinciding with the onset of male puberty. Clin Endocrinol (Oxf). 87:68-72, 2017
  11. Handelsman DJ, Hirschberg AL, Bermon S. Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance. Endocr Rev. 39:803-829, 2018
  12. Catley MJ, and Tomkinson GR. Normative health-related fitness values for children: analysis of 85347 test results on 9-17-year-old Australians since 1985. Br J Sports Med 47: 98-108, 2013.
  13. Eiberg S, Hasselstrom H, Gronfeldt V, Froberg K, Svensson J, and Andersen LB. Maximum oxygen uptake and objectively measured physical activity in Danish children 6-7 years of age: the Copenhagen school child intervention study. Br J Sports Med 39: 725-730, 2005.
  14. Latorre Roman PA, Moreno Del Castillo R, Lucena Zurita M, Salas Sanchez J, Garcia-Pinillos F, and Mora Lopez D. Physical fitness in preschool children: association with sex, age and weight status. Child Care Health Dev 43: 267-273, 2017.
  15. Tambalis KD, Panagiotakos DB, Psarra G, Daskalakis S, Kavouras SA, Geladas N, Tokmakidis S, and Sidossis LS. Physical fitness normative values for 6-18-year-old Greek boys and girls, using the empirical distribution and the lambda, mu, and sigma statistical method. Eur J Sport Sci 16: 736-746, 2016.
  16. Tomkinson GR, Carver KD, Atkinson F, Daniell ND, Lewis LK, Fitzgerald JS, Lang JJ, and Ortega FB. European normative values for physical fitness in children and adolescents aged 9-17 years: results from 2 779 165 Eurofit performances representing 30 countries. Br J Sports Med 52: 1445-14563, 2018.
  17. Tomkinson GR, Lang JJ, Tremblay MS, Dale M, LeBlanc AG, Belanger K, Ortega FB, and Leger L. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. Br J Sports Med 51: 1545-1554, 2017.
  18. (December 19, 2018)  American Youth Outdoor Track & Field Records.  [online] USATF http://legacy.usatf.org/statistics/records/view.asp?division=american&location=outdoor%20track%20%26%20field&age=youth&sport=TF  (accessed April 20, 2022)
  19. (2022) National Age Group Records [online]. USA Swimming. https://www.usaswimming.org/times/popular-resources/national-age-group-records (accessed April 20, 2022)
  20. Millard-Stafford M, Swanson AE, Wittbrodt MT. Nature Versus Nurture: Have Performance Gaps Between Men and Women Reached an Asymptote? Int J Sports Physiol Perform. 13:530-535, 2018
  21. Levine BD, Joyner MJ, Keith NR,  Bagish AL, Pedersen BK, Schmidt W, Stachenfeld N, Girard O, Nagatomi R, Foster C, Okazaki K, Stellingwerf T, Jiexiu Z, Robson SJ, Bailey DM, Bosch A, Murphy RM, Qiu J, Lollgen H, Mitchell J, Kearney J, Scott JM, Lundby C, Steinacker J, Trappe S, La Gerche A, Masuki S, Roach R, Schneider S, Millet G, Kohrt WM, Roberts WO, Kraus WE, Benjamin HJ, Koning JJ, Gatterer H, Wehrlin JP, Charkoudian N, Lawley JS, Hopman MTE, Hawley J. The role of testosterone in athletic performance. [online] https://web.law.duke.edu/sites/default/files/centers/sportslaw/Experts_T_Statement_2019.pdf (accessed April 6, 2022).
  22. Rey R, Josso N, Racine C. Sexual Differentiation. 2020 May 27. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Online]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905232. (Accessed April 6, 2022)
  23. Sax L. How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 39:174-8, 2002
  24. Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, Giordano D, Cecatti JG, Abdel Aleem H, Talegawkar SA, Benachi A, Diemert A, Tshefu Kitoto A, Thinkhamrop J, Lumbiganon P, Tabor A, Kriplani A, Gonzalez Perez R, Hecher K, Hanson MA, Gülmezoglu AM, Platt LD. The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. PLoS Med. 14:e1002220, 2017
  25. Centers for Disease Control and Prevention.  Clinical Growth Charts  [online] https://www.cdc.gov/growthcharts/clinical_charts.htm; (Accessed April 6, 2022)
  26. Davis SM, Kaar JL, Ringham BM, Hockett CW, Glueck DH, and Dabelea D. Sex differences in infant body composition emerge in the first 5 months of life. J Pediatr Endocrinol Metab 32: 1235-1239, 2019.
  27. Taylor RW, Gold E, Manning P, and Goulding A. Gender differences in body fat content are present well before puberty. Int J Obes Relat Metab Disord 21: 1082-1084, 1997.
  28. Taylor RW, Grant AM, Williams SM, and Goulding A. Sex differences in regional body fat distribution from pre- to postpuberty. Obesity (Silver Spring) 18: 1410-1416, 2010.
  29. Staiano AE, Katzmarzyk PT. Ethnic and sex differences in body fat and visceral and subcutaneous adiposity in children and adolescents. Int J Obes (Lond). 36:1261-9. (2012).
  30. Senefeld JW, Lambelet Coleman D, Johnson PW, Carter RE, Clayburn AJ, Joyner MJ. Divergence in Timing and Magnitude of Testosterone Levels Between Male and Female Youths. JAMA. 324:99-101, 2020
  31. Klaver M, de Mutsert R, Wiepjes CM, Twisk JWR, den Heijer M, Rotteveel J, Klink DT. Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents. J Sex Med 15: 251-260, 2018.
  32. Roberts SA, Carswell JM. Growth, growth potential, and influences on adult height in the transgender and gender-diverse population. Andrology. 9:1679-1688, 2021.
Dr. Greg Brown is a Professor of Exercise Science in the Department of Kinesiology and Sport Sciences at the University of Nebraska at Kearney where he has been a faculty member since 2004. He is also the Director of the General Studies program at the University of Nebraska at Kearney. He earned a Bachelor of Science in Physical Education (pre-Physical Therapy emphasis) from Utah State University in 1997, a Master of Science in Exercise and Sport Science (Exercise Physiology Emphasis) from Iowa State University in 1999, and a Doctorate of Philosophy in Health and Human Performance (Biological Basis of Health & Human Performance emphasis) from Iowa State University in 2002. He is a Fellow of the American College of Sports Medicine and an American College of Sports Medicine Certified Exercise Physiologist.
Looking back and moving forward. The importance of reflective assessment in physiology education.

At the end of the 1986 movie Platoon, the protagonist (Chris Taylor, played by Charlie Sheen) provides a very moving monologue that starts “I think now, looking back, we did not fight the enemy, we fought ourselves. The enemy was in us. The war is over for me now, but it will always be there, the rest of my days.”

When Platoon was first released in theaters I was in high school.  I was enthralled with Platoon, and it has held a very special place in my memories ever since.  The ending monologue has echoed through my mind at the end of almost every semester that I have been a faculty member (albeit with a few changes. No insult or mocking of the movie is intended, this is simply my effort to take a powerful cinematic scene and apply it to my personal situation).  My end of semester monologue goes something like this “I think now, looking, back, I did not teach the students but I taught myself. The student was within me.  The semester is over for me now, but it will always be there, the rest of my days.”  And with that, I begin reflective assessment of my teaching.

For many educators, assessment is a dirty word and a necessary evil.  Hall and Hord (1) reported that faulty experience anxiety about assessment because of a lack of understanding of the process or importance of assessment.  Faculty may also disdain participating in assessment due to concerns about accountability, or due to concerns about accreditation negatively impacting their careers (2). Often, faculty also view assessment reports as things that need to be prepared and submitted to meet requirements imposed on faculty from an administrative office within their institution, or some outside accrediting agency, but think that assessment reports are not really pertinent to the day-to-day work of education (3).  To help overcome hesitancy to fully engage in the assessment process Bahous and Nabhani (4) recommend that institutions hire a full-time assessment officer to work one-on-one with faculty.  All of these are relevant to the formal process of assessment and submitting data and reports to meet institutional or organizational requirements.  When done the right way, these assessment reports can be valuable tools in education.  But what I want to discuss in this blog post is a more informal form of assessment that I think all educators should do, and probably already do, which is reflective assessment.

Students and faculty alike perceive Physiology as a very challenging academic subject (5, 6).  The concepts are difficult, and there is a lot of terminology.  Our understanding of physiology is continually expanding, but yet students often still need to have a firm concept of the basic fundamentals before moving on to more complex and in-depth information.  Physiology is often taught in a system by system approach, yet the systems do not operate independently of one another so at times it may feel like the cart is put before the horse in regards to helping students to understand physiological processes. All of these issues with the difficulty of teaching physiology make reflective assessment an important part of teaching.

Quite simply, no matter how well we taught a class or a concept, as educators we may be able to teach better the next time (7, 8).  Perhaps we can tweak an assignment to make it better fit our needs.  Or perhaps we can provide a new resource to our students, like an appropriate instructional video or a scholarly article. Or maybe it’s time to select a new textbook.  Or maybe we have seen something in Advances in Physiology Education or on the PECOP Blog that we would like to incorporate into our teaching practice.  Whatever the reason, reflective assessment provides an opportunity for us to ask ourselves two very simple, but very important questions about our teaching:

  1. What went well in this class, and what didn’t go as well as planned?
  2. What improvements are we willing to make to this course to improve student learning?

The first question is important for identifying strengths and weaknesses in our courses.  We can ponder what went well, and ask why it went well.  Has it gone well each semester? Or did it go well because of changes we made in our teaching?  Or did it go well because of other changes, such as a change in prerequisite courses?

As we ponder what didn’t go as planned, we can also contemplate why things didn’t go as planned.  I think anyone who has taught through the COVID pandemic can identify lots of unforeseen and unusual disruptions to our courses.  But we can also use reflective assessment to identify ongoing problems that deserve some attention.  Or we can identify problems that have previously not been problems, and make a note to monitor these issues in future courses.

The second question, about what changes are we willing to make, is also extremely important.  Sometimes a problem may be outside of our control such as course scheduling, who teaches the prerequisite course, or other issues.  But if the identified problem is something we can control, such as the timing of the exams, or the exam format, or laboratory exercises, then we need to decide if the problem arises from something we are willing to change and then decide how and what to change.  Can the problem be addressed through the acquisition of new instrumentation?  Can the problem be addressed by changing textbooks?  Some of the problems may be easy to solve, while others might be more difficult.  Some problems might require funding, and so funding sources will need to be identified.  But this is where reflective assessment can really help us to prioritize changes to our teaching.

I ask myself these questions throughout the semester as I grade tests and assignments, but in the midst of a semester there is often not time to really ponder and make changes to my classes.  During the semester I keep a teaching diary to make note of the thoughts that come to me throughout the semester. Then, after final grades are submitted and before the next semester begins there is more time to read through the teaching diary and to reflect and ponder about my teaching.  Often, in this less pressured time between semesters, by reviewing my teaching diary I can take a step back to reflect on problems during the semester and determine if this has been an ongoing issue in my classes or an isolated issue limited to only this one semester.  I often find that what seemed like a problem in the middle of the semester has resolved itself by the end of the semester.

Of course there are many other questions that can be asked as part of reflective assessment (7, 8), and any question can lead to numerous follow up questions.  But I think these two questions (1. What went well in this class, and what didn’t go as well as planned? 2.  What improvements are we willing to make to this course to improve student learning?) form the cornerstone of reflective assessment.  And reflective assessment can then lead to a career long endeavor to engage in action research to improve our teaching skills.

  1. Hall G, Hord S. Implementing change: Patterns, principles, and potholes (5th ed). New York: Pearson, 2019.
  2. Haviland D, Turley S, Shin SH. Changes over time in faculty attitudes, confidence, and understanding as related to program assessment. Iss Teacher Educ. 2: 69-84, 2011.
  3. Welsh JF, Metcalf J. Faculty and administrative support for institutional effectiveness activities. J Higher Educ. 74: 445-68, 2003.
  4. Bahous R, Nabhani M. Faculty Views on Developing and Assessing Learning Outcomes at the Tertiary Level. J General Educ. 64: 294-309, 2015.
  5. Slominski T, Grindberg S, Momsen J. Physiology is hard: a replication study of students’ perceived learning difficulties. Adv Physiol Educ. 43:121-127, 2019.
  6. Colthorpe KL, Abe H, Ainscough L. How do students deal with difficult physiological knowledge? Adv Physiol Educ. 42:555-564, 2018.
  7. Pennington SE. Inquiry into Teaching: Using Reflective Teaching to Improve My Practice. Networks, An Online Journal for Teacher Research 17, 2015. https://doi.org/10.4148/2470-6353.1036
  8. Reflective Teaching Practices. Int J Instruc. 10: 165-184, 2017. NM, Artini LP, Padmadewi NN. Incorporating Self and Peer Assessment in Reflective Teaching Practices. Int J Instruc. 10: 165-184, 2017.
    Dr. Greg Brown is a Professor of Exercise Science in the Department of Kinesiology and Sport Sciences at the University of Nebraska at Kearney where he has been a faculty member since 2004. He is also the Director of the General Studies program at the University of Nebraska at Kearney. He earned a Bachelor of Science in Physical Education (pre-Physical Therapy emphasis) from Utah State University in 1997, a Master of Science in Exercise and Sport Science (Exercise Physiology Emphasis) from Iowa State University in 1999, and a Doctorate of Philosophy in Health and Human Performance (Biological Basis of Health & Human Performance emphasis) from Iowa State University in 2002. He is a Fellow of the American College of Sports Medicine and

     

Together or Apart? Lecture with Laboratory, or Taken Separately?

Think back to your days as a college student majoring in science. Was your college on the smaller scale such that your professor met with you weekly for both your lecture and laboratory in chemistry, biology and physics? Or was your university on the large size, and while you sat among dozens or even hundreds of your peers in an auditorium where your professor lectured, you then met weekly in a smaller laboratory session conducted by teaching assistants? Our past experiences as students may or may not bear similarities to our professional career teaching environment at present.

As college professors in biology, or related science disciplines, our student enrollment in the major and the headcount of part-time versus full-time faculty have likely dictated the course schedule each semester. Such quantitative data, meshed with the physical resources of chairs in a classroom and square footage of laboratory space for teaching purposes, may be the major drivers of curricular practices. Pedagogical tradition perhaps accounts for science course scheduling practices as well. Budgetary matters too weigh heavily on decisions to maintain the status quo, or to experiment with test piloting the implementation of emerging course designs.

I teach at a mid-sized public university that offers graduate degrees alongside our more populous undergraduate majors. Our biology majors number approximately 1,000. Our faculty include part-time adjuncts, full-time lecturers and tenured/tenure-track professors. We do not have graduate teaching assistants in the classroom. Most often the assigned faculty teach both their lecture and laboratory sessions for a given course. A recent trend in our college has been to identify traditional lecture/laboratory courses that could be split such that students enroll in completely separate courses for the lecture versus the laboratory. For example, our microbiology course that used to be one combined course meeting twice weekly for lecture and once weekly for laboratory is now two distinct courses, laboratory versus lecture, although both are taken in the same semester, each course posts an individual grade on the transcript.

When asked to consider if any of the courses I teach would or would not be appropriate for separation of lecture from laboratory, I went to the pedagogical literature to see what I could find on the topic. Where science courses are combined into a single course (one grade) with lecture and laboratory, the lecture may be to a large scale audience, while the labs are disseminated into smaller break out groups led by either the lecture faculty or else another faculty member or teaching assistant. On the other hand, a science “course” may have a completely separate course number where students enroll and earn a grade for lecture, and a distinctly different course number where they enroll and earn a separate grade for the laboratory. Knowing these two variations exist, the literature reveals other alternatives as well.

A paper in the Journal of Scholarship of Teaching and Learning evaluated college introductory biology courses where either the same instructor teaches both the lecture and laboratory sessions versus those where there are different instructors for the lecture versus the lab. The author reports “no general trend indicating that students had a better experience when they had the same instructor for both lecture and laboratory than when the lecture and laboratory instructor differed (Wise 2017).” In fact, he states that students may even benefit from having different lecture and laboratory instructors for the same course as such would afford students exposure to instructors with different backgrounds and teaching styles (this paper’s doi: 10.14434/josotl.v17i1.19583).

When I was a teaching assistant during my graduate school days, I developed my teaching style by trial and error as the TA for the laboratory session break outs from the professor-led large auditorium style lectures for the undergraduate first year students majoring in biology. That was the early 1990s, and it was a mid-sized private university where at the same time they were “experimenting” with upper level undergraduate laboratory classes that were lab only. They called them “super labs” and they were not attached to a concurrent lecture course. Indeed, a 2005 paper in Biochemistry and Molecular Biology Education by D.R. Caprette, S. Armstrong and K. Beth Beason entitled “Modular Laboratory Courses” details such a concept whereby the laboratory course is not linked to a lecture (doi/epdf/10.1002/bmb.2005.49403305351). These modular laboratory-only courses are shorter in duration, ranging from a quarter to a half of semester, for 1 or 2 academic credits. Their intent is to apply the learning of specific skills, methods and instrumentation in their undergraduate biology and biochemistry curriculum. Of note, they recognized that their transition to such modular short-term laboratory courses was eased by their academic program already having their traditional curriculum with individual laboratory courses separate from the lecture courses.

Studio courses had in my mind been those taken by the art majors and other fine arts students. In the literature, however, there is an integrated “studio” model for science courses. A paper in Journal of College Science Teaching details how a small private college converted their Anatomy & Physiology I course, among others, from traditional lecture/laboratory courses to the integrated studio model. Their traditional twice weekly 75 minute lectures with 60 students and 150 minute breakout laboratories with 16 students per section, was reconfigured to 30 students meeting with the same instructor and teaching assistant twice weekly, each for 2 hours. These longer duration class sessions each consisted of, for example, 20 minutes lecture followed by 30 minutes of a context-linked laboratory, and then 20 minutes lecture followed again by 40 minutes of a linked laboratory They report fewer course withdrawals and unsatisfactory grades and cite that students felt “engaged and active” as did instructors who spoke of “immediate application and hands on” activity in the interactive classroom (Finn, Fitzpatrick, Yan 2017; https://eric.ed.gov/?id=EJ1155409).

Based on my experience with comprehension by students with the content delivery, I have decided to redesign my upper level undergraduate Cell Physiology course such that the cell physiology lecture will be a standalone 3 credit course, and students will be encouraged to take either during the same semester or the following semester, the 1 credit cell physiology laboratory course. When viewed thru the course scheduling and facilities lenses, this “split” will afford more students to enroll in a single lecture course section, while then having multiple smaller capacity laboratory course sections. As this is an upper level elective, students may find that a 3 + 1 credit option as well as a 3 credit only option suits their needs accordingly. And they can decide for themselves, together or apart, lecture with laboratory, or taken separately.

Laura Mackey Lorentzen is an associate professor of biology at Kean University in Union, NJ, where her teaching emphasis is general biology for majors as well as cell physiology, neuroscience and senior capstone. She earned a PhD in Biomedical Sciences/Molecular Physiology and Biophysics from Baylor College of Medicine in Houston TX, an MS in Cellular & Molecular Biology from Duquesne University in Pittsburgh PA, and a BS in biology from The University of Charleston, WV. She is a past president of the New Jersey Academy of Science (NJAS) and past editor-in-chief of AWIS Magazine, for the Association of Women in Science.
The Olympics, sex, and gender in the physiology classroom
The recent Tokyo Olympic Games present an opportunity for a number of intriguing discussions in a physiology classroom.  Typical discussion topics around the Olympic Games involve muscle strength, muscle power, aerobic fitness, bioenergetics, and a number of other physiological factors that determine athletic performance.  Coronavirus, immunity, disease transmission, and similar topics may be unique areas of discussion related to the Tokyo Olympic Games.  Another topic that has been prevalent in the news for the Tokyo Olympic Games is the role of sex and gender in athletic competition.

Before and during the Tokyo Olympic Games several athletes were featured in news headlines due to either gender identity or differences of sexual development (DSD, also sometimes called disorders of sexual development).  Male-to-female transgender athletes competing in women’s sports in the Tokyo Olympic Games include weightlifter Laurel Hubbard, archer Stephanie Barrett, cyclist Chelsea Wolfe, soccer player Quinn, and volleyball player Tifanny Abreu, (1, 2).  There have also been news stories about Caster Semenya, Christine Mboma, and Beatrice Masilingi being ineligible to participate in the Olympics due to their DSD causing their serum testosterone concentrations to be above the allowed limits for female athletes (3, 4).  In addition to physiology sex and gender are interwoven with culture, religion, and politics, so how to discuss sex and gender in the physiology classroom needs to be carefully considered by each instructor depending on the campus climate, policies, and individual comfort level with walking into these potential minefields.  However, sex and gender in sports are very appropriate topics to discuss from a physiological perspective.

Although sex and gender have been used interchangeably in common conversation and in the scientific literature, the American Psychological Association defines sex as “physical and biological traits that distinguish between males and females” (5) whereas gender “implies the psychological, behavioral, social, and cultural aspects of being male or female (i.e., masculinity or femininity)” (6).  Using these definitions can be helpful to draw a clear distinction between gender (and/or gender identity) as a social construct and sex as a biological variable, which can help focus the discussion on physiology.

As reviewed by Mazure and Jones (7) since 1993 the NIH puts a priority on funding research that includes women as well as men in clinical studies and includes an analysis of the results by sex or gender.  Mazure and Jones (7) also summarized a comprehensive 2001 Institute of Medicine sponsored evaluation that concluded that every cell has a sex.  A 2021 Endocrine Society scientific statement provides considerable information on the biological basis of human sexual dimorphism, disorders of sexual development, and lack of a known biological underpinning for gender identity (8).  On August 12, 2021 a PubMed search using the term “Sex Matters” (in quotation marks) returned 179 results, with many of the linked papers demonstrating the importance of sex for health, disease, and overall biological function (without quotation marks there were 10,979 results).  Given that there have been various discussions in the news media and across social media blurring the distinction between sex and gender, it is very important that students in physiology understand that sex in humans is an important biologically dimorphic trait of male or female.

Relevant to a discussion of the Olympic Games, the differences in performance between male and female running has been analyzed for world’s best and world’s 100th best (9), annual world’s best performance (10), world record performance (11-13), Olympic and elite performance (13-16), High School performance in CA, FL, MN, NY, and WA (17), and 100 all-time best Norwegian youth performance (18).  Hilton and Lundberg (19) also provided an excellent review of the large differences in athletic performance between men and women in numerous sports.  Overall, by mid-puberty males outperform comparably aged and trained females by 10-60%, depending on the sport (see figure 1 of Hilton and Lundberg, reproduced here with no changes under the Creative Commons license https://creativecommons.org/licenses/by/4.0/).

 

Hilton and Lundberg (19) also reviewed the present state of research regarding the effects of male-to-female hormone treatment on muscle strength and body composition and concluded that men typically have 45% more muscle mass than women, and male-to-female hormone treatment reduces muscle mass by ~5%.  These authors also concluded that men typically have 30-60% higher muscle strength than women, and male-to-female hormone treatment reduces muscle strength by 0-9%.  Overall, Hilton and Lundberg (19) conclude that transwomen retain considerable advantages over cisgender women even after 1-3 years of male-to-female hormone treatment.  Harper at al. (20) also reviewed the research regarding the effects of male-to-female hormone treatment on muscle strength and body composition and came to the same conclusions as Hilton and Lundberg.  Harper et al. (20) further concluded that male-to-female hormone treatment eliminates the difference in hemoglobin concentrations between cisgender men and women.  In a single research project, Roberts et al. (21) observed that before transition male-to-female members in the US Air Force completed a 1.5 mile running fitness test 21% faster than comparably aged cisgender women.  After 2.5 years of male-to-female hormone treatment the transwomen completed the 1.5 mile running fitness test 12% faster than comparably aged cisgender women. (Figure 1 Hilton and Lundberg)

All of the previously mentioned information is important to consider when asking if transwomen can be fairly and safely included in women’s sports.  It is also important to note that the effects of male-to-female hormone treatment on important determinants of athletic performance remain largely unknown.  Measurements of VO2max in transwomen using direct or indirect calorimetry are not available.  Measurements of muscle strength in standard lifts (e.g. bench press, leg press, squat, deadlift, etc.) in transwomen are not available.  Nor have there been evaluations of the effects of male-to-female hormone therapy on agility, flexibility, or reaction time.  There has been no controlled research evaluating how male-to-female hormone treatment influences the adaptations to aerobic or resistance training.  And there are only anecdotal reports of the competitive athletic performance of transwomen before and after using male-to-female hormone treatment.

The safe and fair inclusion of transgender athletes and athletes with DSD in women’s sports is a topic being debated in many states and countries, and by many sporting organizations including the International Olympic Committee.  In the end, whether it is safe and fair to include transgender athletes and athletes with DSD in women’s sports comes down a few facts that can be extrapolated, lots of opinions, and an interesting but complicated discussion.  This is a worthwhile discussion in a physiology classroom because it allows a good review of the biologically dimorphic nature of human sex.  However, the safe and fair inclusion of transgender athletes and athletes with DSD in women’s sports is also a discussion that should be approached with caution due to the many opinions this topic entails that reside outside of physiology.

 

 

1.    The Economist explains: Why are transgender Olympians proving so controversial? The Economist. https://www.economist.com/the-economist-explains/2021/07/16/why-are-transgender-olympians-proving-so-controversial. [Accessed: August 12, 2021, 2021].

2.    Pruitt-Young S. Live Updates: The Tokyo Olympics Canadian Soccer Player Quinn Becomes The First Out Trans And Nonbinary Gold Medalist NPR. https://www.npr.org/2021/08/06/1025442511/canadian-soccer-player-quinn-becomes-first-trans-and-nonbinary-olympic-gold-meda. [Accessed: August 12, 2021, 2021].

3.    The Clock Ticks on Caster Semenya’s Olympic Career https://www.nytimes.com/2021/06/28/sports/olympics/caster-semenya-olympics-gender.html. [Accessed: August 12, 2021, 2021].

4.    Tokyo 2020: Two Namibian Olympic medal contenders ruled ineligible for women’s 400m due to naturally high testosterone levels CNN. https://www.cbs58.com/news/tokyo-2020-two-namibian-olympic-medal-contenders-ruled-ineligible-for-womens-400m-due-to-naturally-high-testosterone-levels. [Accessed: August 21, 2021, 2021].

5.    APA Dictionary of Psychology: sex. American Psychological Association. https://dictionary.apa.org/sex. [Accessed: August 12, 2021, 2021].

6.    APA Dictionary of Psychology: gender. American Psychological Association. https://dictionary.apa.org/sex. [Accessed: August 12, 2021, 2021].

7.    Mazure CM, and Jones DP. Twenty years and still counting: including women as participants and studying sex and gender in biomedical research. BMC Womens Health 15: 94, 2015.

8.    Bhargava A, Arnold AP, Bangasser DA, Denton KM, Gupta A, Hilliard Krause LM, Mayer EA, McCarthy M, Miller WL, Raznahan A, and Verma R. Considering Sex as a Biological Variable in Basic and Clinical Studies: An Endocrine Society Scientific Statement. Endocr Rev 2021.

9.    Sparling PB, O’Donnell EM, and Snow TK. The gender difference in distance running performance has plateaued: an analysis of world rankings from 1980 to 1996. Med Sci Sports Exerc 30: 1725-1729, 1998.

10.  Tang L, Ding W, and Liu C. Scaling Invariance of Sports Sex Gap. Front Physiol 11: 606769, 2020.

11.  Cheuvront SN, Carter R, Deruisseau KC, and Moffatt RJ. Running performance differences between men and women:an update. Sports Med 35: 1017-1024, 2005.

12.  Thibault V, Guillaume M, Berthelot G, Helou NE, Schaal K, Quinquis L, Nassif H, Tafflet M, Escolano S, Hermine O, and Toussaint JF. Women and Men in Sport Performance: The Gender Gap has not Evolved since 1983. J Sports Sci Med 9: 214-223, 2010.

13.  Sandbakk O, Solli GS, and Holmberg HC. Sex Differences in World-Record Performance: The Influence of Sport Discipline and Competition Duration. Int J Sports Physiol Perform 13: 2-8, 2018.

14.  Millard-Stafford M, Swanson AE, and Wittbrodt MT. Nature Versus Nurture: Have Performance Gaps Between Men and Women Reached an Asymptote? Int J Sports Physiol Perform 13: 530-535, 2018.

15.  Seiler S, De Koning JJ, and Foster C. The fall and rise of the gender difference in elite anaerobic performance 1952-2006. Med Sci Sports Exerc 39: 534-540, 2007.

16.  Nuell S, Illera-Dominguez V, Carmona G, Alomar X, Padulles JM, Lloret M, and Cadefau JA. Sex differences in thigh muscle volumes, sprint performance and mechanical properties in national-level sprinters. PLoS One 14: e0224862, 2019.

17.  Higerd GA. Assessing the Potential Transgender Impact on Girl Champions in American High School Track and Field. In: Sports Management. PQDT Open: United States Sports Academy, 2020, p. 168.

18.  Tonnessen E, Svendsen IS, Olsen IC, Guttormsen A, and Haugen T. Performance development in adolescent track and field athletes according to age, sex and sport discipline. PLoS One 10: e0129014, 2015.

19.  Hilton EN, and Lundberg TR. Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage. Sports Med 2020.

20.  Harper J, O’Donnell E, Sorouri Khorashad B, McDermott H, and Witcomb GL. How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation. Br J Sports Med 2021.

21.  Roberts TA, Smalley J, and Ahrendt D. Effect of gender affirming hormones on athletic performance in transwomen and transmen: implications for sporting organisations and legislators. Br J Sports Med 2020.

Dr. Greg Brown is a Professor of Exercise Science in the Department of Kinesiology and Sport Sciences at the University of Nebraska at Kearney where he has been a faculty member since 2004. He is also the Director of the General Studies program at the University of Nebraska at Kearney. He earned a Bachelor of Science in Physical Education (pre-Physical Therapy emphasis) from Utah State University in 1997, a Master of Science in Exercise and Sport Science (Exercise Physiology Emphasis) from Iowa State University in 1999, and a Doctorate of Philosophy in Health and Human Performance (Biological Basis of Health & Human Performance emphasis) from Iowa State University in 2002. He is a Fellow of the American College of Sports Medicine and an American College of Sports Medicine Certified Exercise Physiologist.
Why demonstrating and embracing uncertainty should be a learning objective, especially in uncertain times?

Uncertainty.  We have all heard that word quite frequently lately.  It tends to carry negative connotations and feelings of uneasiness.  It seems the answer to every question these days is, “well, it depends”.  As physiology educators, this is not new to us.  How many times have we answered a student’s broad question with this same phrase?    Regardless of how much active learning is accomplished in the classroom, students at all levels are tasked with preparing for and taking standardized tests.  My children started taking assessments in preschool, multiple choice tests for grading purposes in kindergarten, and state assessment tests in 3rd grade.  Then there will be standardized tests for admissions to college, graduate admissions, and licensing.  It’s no wonder that some students are conditioned to study ‘to the test’ instead of having the goal of truly learning the material, and are hesitant to express when they don’t know something.   I spent the first decade of my career teaching science at the undergraduate level and have spent the last five years teaching in the professional school setting, including medical, dental, and podiatry students.  I have found that these health professions students in particular become especially aware of uncertainty when they start gaining experience with clinical cases and with patients.  I also notice that they are uneasy with uncertainty even from the interactions in the classroom – they are high achieving students and don’t want to be wrong, to be perceived as not knowing an answer or a concept, of maybe feeling like they don’t belong.  In truth, many students have the same questions, and the same feelings, but are hesitant to express them.   It is known that dealing with uncertainty and ambiguity, especially in professions where people are serving patients whose health is at stake, can result in the experience of stress, anxiety, depression, and burnout (1).  Wellness is an important consideration, especially in a climate where things seem to be changing day-to-day and we are provided limited information and answers.  How one deals with uncertainty can lead to life and professional decisions including which career or specialty to pursue.  While this concept is not novel, actually teaching students how to tolerate or even embrace uncertainty is a relatively new concept, one which I think should be made a more purposeful objective in our courses.   What if instead of shying away from admitting we don’t know something, we learn how to accept it, and how to approach the problem to find the most effective answer?  How do we best learn to tolerate uncertainty, and train our students how to cope with and learn from uncertainty?  What are the benefits of embracing uncertainty?   

Bring uncertainty into the classroom Thoughtfully and purposely embedding uncertainty into activities in the classroom does several things.  First, it allows students to learn that not every question has an absolute answer.  Students need help shifting their mindset.  This also encourages students to work with material at higher levels of Bloom’s taxonomy, like evaluation and application.   Additionally, this helps create a culture in the classroom where asking questions and admitting to what we don’t know is a good thing, and brings value to classroom discussions.  This allows students to bring in their own experiences in an attempt to work through a problem and arrive at an answer, enhancing students’ learning.  Students can build their confidence as they find value in embracing the unknown as they learn to navigate the process to find the answers to their questions.   The learning theory constructivism suggests that students build their own learning, that knowledge is built upon knowledge, and that it works best in context (2). This encourages students to bring their own experiences to the learning process, and the result is that each student may bring a different perspective and answer (3).  These principles match well with the intention of teaching how to manage uncertainty.  A goal is for students to be engaged and motivated in an active learning environment, allowing them to share ideas and build their knowledge based on their prior knowledge and experiences.  

Leading to deeper learning To further expand the idea of students building their mental models, activities designed to allow for more open-ended thinking or answers, which build upon each other, can be utilized.  For example, in the cardiovascular physiology component of our medical course, we build on the basic concepts in a series of small group sessions which encourage students to work in their teams to answer questions pertaining to these concepts.  We may start with the principles of hemodynamics but eventually work our way to the integration of cardiac function and vascular function.  These sessions require students to not only recall knowledge, but also apply information in a manner which may lead to uncertainty.  They learn to question the severity of perturbations, the balance of factors which interact, and the cause and effect.  We find students may become frustrated with the “it depends” answer, but they learn how to view the nuance and ask the appropriate questions.  This type of exploration and learning transitions well to more clinical sessions, where students need to know which questions to ask, which tests to order, and which colleagues to consult.    

Demonstrate uncertainty as educators and professionals In addition to our basic science session, I spend a lot of time teaching with clinical colleagues in the pre-clerkship medical classroom.  We have a small cohort of core educators who participate in a special type of small group learning we call Clinical Reasoning Conferences.  The core educators are either basic scientists or clinicians and come from different disciplines, bringing different experiences and expertise to each session. We are always joined by content experts in our sessions with the students as well.  This means that we are likely to be in a session where we are not the content expert, but have immediate access to one. This gives us an opportunity to demonstrate uncertainty in the classroom, to students who feel constant pressure to know everything and to perform at the highest level.  To be honest, it took a while for us to get comfortable with telling the students, “I don’t know”, but that “I don’t know” was, in reality, “I don’t know but let’s get the answer”, which gave us the opportunity to demonstrate how we get the answer.  It could be a reference from the literature, a clinical resource, or a colleague.  Students not only benefit from getting perhaps a more comprehensive answer to their questions, but also knowledge that no one can know everything or even how much is still unknown.  It is imperative in medicine that they learn and practice how to find appropriate information in order to make the most informed decision when it comes to patient care.  These practices have also been shared by other medical educators (1).  Clinical Reasoning Sessions also include students teaching the material to their colleagues, and we make it clear in our expectations that we much rather they describe their process and maybe come up with an incorrect conclusion than have short, although correct, answers which do not demonstrate process and reasoning.  Another goal is to allow the students plenty of chances to practice answering questions of a clinical nature posed by faculty, and allow them to become comfortable asking faculty questions, well before they start their clerkships.    

Manage expectations In my experience, students appreciate the ability to give feedback and share their expectations of their courses and programs.  They also align these with their own expectations of themselves.  Faculty and course directors work to resolve the students’ expectations with their own, and to assist students in forming and revising their expectations of and their role and responsibilities within the course.  Educating during a pandemic has shined a light on and challenged the way we manage these expectations. A word I have heard my colleagues use lately is grace; we should extend grace to our students, to ourselves, and ask for grace from others.  This is another way we can demonstrate how we deal with uncertainty, which can hopefully serve as a soft teaching point for our students.    

Outside of the science classroom Developing skills to help us manage uncertainty extends to outside of our classroom.  We hope that students will take the lessons and continue to use them in other classes, or outside of school altogether.  Medical schools often offer electives, some of which are tied to wellness or extracurricular subjects.  For example, some of our electives include Artful Thinking, in which students hone their skills of observation, application, and context, and Fundamentals of Improv, so that students can work on skills of listening, support, creativity, and quick thinking and response.  Other schools and programs offer similar experiences for students (4,5).  The narrative medicine program emphasizes skills of reflective writing to focus on the human side of medicine, reminding why we’re here in the first place (6).  

Challenging ourselves and encouraging our creativity One of the most important lessons I learned in the transition to remote and hybrid education over the past six months was to face the uncertainty with planning, reflection, and flexibility.  I am the type to have a backup plan to my backup plan, which I realized gave me the flexibility to be more creative in my course design and preparation.  I feel that my courses benefitted from my ability to challenge myself, because of uncertainty, and I intend to continue to reflect and employ what I consider my ‘best practices’ even when we move back into the in-person classroom in the future.   We are exposed to uncertainty every day.  How we choose to frame our mindset, to help our students and ourselves tolerate or even embrace uncertainty can bring benefits both in and outside of the classroom.  

References and further reading Twelve tips for thriving in the face of clinical uncertainty, accessed 8/28/20  https://www.tandfonline.com/doi/pdf/10.1080/0142159X.2019.1579308 What is Constructivism?, accessed 8/28/20 https://www.wgu.edu/blog/what-constructivism2005.html Inviting Uncertainty into the Classroom, accessed 8/28/20 http://www.ascd.org/publications/educational-leadership/oct17/vol75/num02/Inviting-Uncertainty-into-the-Classroom.aspx Teaching Medical Students the Art of Uncertainty, accessed 8/28/20 https://www.cuimc.columbia.edu/news/teaching-medical-students-art-uncertainty The Alda Method, Alda Center for Communicating Science, accessed 9/4/20 https://www.aldacenter.org/alda-method Narrative Medicine Program, Accessed 9/4/20 https://medicine.temple.edu/education/narrative-medicine-program The Diagnosis, Prognosis, and Treatment of Medical Uncertainty https://www.jgme.org/doi/pdf/10.4300/JGME-D-14-00638.1 The Ethics of Ambiguity: Rethinking the Role and Importance of Uncertainty in Medical Education and Practice https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5497921&blobtype=pdf Helping Students Deal with Uncertainty in the classroom https://www.edutopia.org/blog/dealing-with-uncertainty-classroom-students-ben-johnson Learning: Theory and Research http://gsi.berkeley.edu/media/Learning.pdf          


Rebecca Petre Sullivan, Ph.D.
Associate Professor of Physiology
Lewis Katz School of Medicine at Temple University		Dr. Rebecca Petre Sullivan earned her Ph.D. in Physiology from the Lewis Katz School of Medicine at Temple University and completed a Post-Doctoral Fellowship in the Interdisciplinary Training Program in Muscle Biology at the University of Maryland School of Medicine.  She taught undergraduate biology courses at Ursinus College and Neumann University.  As an Associate Professor of Physiology and a Core Basic Science Educator, she is currently course director in the Pre-Clerkship curriculum at LKSOM and at the Kornberg School of Dentistry; in addition to teaching medical and dental students, she also teaches physiology in Temple’s podiatry school and in the physician assistant program.  She is a member of Temple University’s Provost’s Teaching Academy.  She was the recipient of the Mary DeLeo Prize for Excellence in Basic Science Teaching in 2020 and a Golden Apple Award in 2017 from LKSOM, and the Excellence in Undergraduate Teaching Award from Neumann University in 2012.
Protecting yourself means more than a mask; should classes be moved outside?
Mari K. Hopper, PhD
Associate Dean for Biomedical Science
Sam Houston State University College of Osteopathic Medicine

Disruption sparks creativity and innovation. For example, in hopes of curbing viral spread by moving classroom instruction outdoors, one Texas University recently purchased “circus tents” to use as temporary outdoor classrooms.

Although circus tents may be a creative solution… solving one problem may inadvertently create another. Moving events outdoors may be effective in reducing viral spread, but it also increases the skin’s exposure to harmful ultraviolet (UV) radiation from the sun. The skin, our body’s largest organ by weight, is vulnerable to injury. For the skin to remain effective in its role of protecting us from pollutants, microbes, and excessive fluid loss – we must protect it.

It is well known that UV radiation, including UVA and UVB, has deleterious effects including sunburn, premature wrinkling and age spots, and most importantly an increased risk of developing skin cancer.

Although most of the solar radiation passing through the earth’s atmosphere is UVA, both UVA and UVB cause damage. This damage includes disruption of DNA resulting in the formation of dimers and generation of a DNA repair response. This response may include apoptosis of cells and the release of a number of inflammatory markers such as prostaglandins, histamine, reactive oxygen species, and bradykinin. This classic inflammatory response promotes vasodilation, edema, and the red, hot, and painful condition we refer to as “sun burn.”1,2

Prevention of sunburn is relatively easy and inexpensive. Best practice is to apply broad spectrum sunscreen (blocks both UVA and UVB) 30 minutes before exposure, and reapply every 90 minutes. Most dermatologists recommend using SPF (sun protection factor) of at least 30. Generally speaking, an SPF of 30 will prevent redness for approximately 30 times longer than without the sunscreen. An important point is that the sunscreen must be reapplied to maintain its protection.

There are two basic formulations for sunscreen:  chemical and physical. Chemical formulations are designed to be easier to rub into the skin. Chemical sunscreens act similar to a sponge as they “absorb” UV radiation and initiate a chemical reaction which transforms energy from UV rays into heat. Heat generated is then released from the skin.3  This type of sunscreen product typically contains one or more of the following active ingredient organic compounds: oxybenzone, avobenzone, octisalate, octocrylene, homosalate, and octinoxate. Physical sunscreens work by acting as a shield. This type of sunscreen sits on the surface of the skin and deflects the UV rays. Active ingredients zinc oxide and/or titanium dioxide act in this way.4  It’s interesting to note that some sunscreens include an expiration date – and others do not. It is reassuring that the FDA requires sunscreen to retain their original “strength” for three or more years.

In addition to sunscreen, clothing is effective in blocking UV skin exposure. Darker fabrics with denser weaves are effective, and so too are today’s specially designed fabrics. These special fabrics are tested in the laboratory to determine the ultraviolet protection factor (UPF) which is similar to SPF for sunscreen.  A fabric must carry a UPF rating of at least 30 to qualify for the Skin Cancer Foundation’s Seal of Recommendation. A UPF of 50 allows just 1/50th of the UV rays to penetrate (effectively blocking 98%). Some articles of clothing are produced with a finish that will wash out over time. Other fabrics have inherent properties that block UV rays and remain relatively unchanged due to washing (some loss of protection over time is unavoidable) – be careful to read the clothing label.

Some individuals prefer relying on protective clothing instead of sunscreen due to concerns about vitamin D synthesis. Vitamin D activation in the body includes an important chemical conversion stimulated by UV exposure in the skin – and there is concern that sunscreen interferes with this conversion. However, several studies, including a recent review by Neale, et al., concluded that use of sunscreen in natural conditions is NOT associated with vitamin D deficiency.5,6 The authors did go on to note that at the time of publication, they could not find trials testing the high SPF sunscreens that are widely available today (current products available for purchase include SPFs over 100).

Additional concern about use of sunscreens includes systemic absorption of potentially toxic chemicals found in sunscreen. A recent randomized clinical trial conducted by Matta and colleagues investigated the systemic absorption and pharmacokinetics of six active sunscreen ingredients under single and maximal use conditions. Seven Product formulations included lotion, aerosol spray, non-aerosol spray, and pump spray. Their study found that in response to repeat application over 75% of the body surface area, all 6 of the tested active ingredients were absorbed systemically. In this study, plasma concentrations surpassed the current FDA threshold for potentially waiving some of the additional safety studies for sunscreen. The authors went on to note that the data is difficult to translate to common use and further studies are needed. It is important to note that the authors also conclude that due to associated risk for development of skin cancer, we should continue to use sunscreen.

Yet another concern for using sunscreen is the potential for harmful environmental and human health impact. Sunscreen products that include organic UV filters have been implicated in adverse reactions in coral and fish, allergic reactions, and possible endocrine disruption.8,9 In some areas, specific sunscreen products are now being banned (for example, beginning January of 2021, Hawaii will ban products that include oxybenzone and octinoxate). As there are alternatives to the use of various organic compounds, there is a need to continue to monitor and weigh the benefit verses the potential negative effects.

Although the use of sunscreen is being questioned, there is the potential for a decline in use to be associated with an increase in skin cancer. Skin cancer, although on the decline in recent years, is the most common type of cancer in the U.S. It is estimated that more than 3 million people in the United States are diagnosed with skin cancers each year (cancer.net). Although this is fewer than the current number of Americans diagnosed with COVID-19 (Centers for Disease Control and Prevention, July 20, 2020) – changes in human behavior during the pandemic (spending more time outdoors) may inadvertently result in an increase in the number of skin cancer cases in future years.  

While we responsibly counter the impact of COVID-19 by wearing masks, socially distancing, and congregating outdoors – we must also continue to protect ourselves from damaging effects of the sun. As physiologists, we are called upon to continue to investigate the physiological impacts of various sunscreen delivery modes (lotion, aerosol, non-aerosol spray, and pumps) and SPF formulations. We are also challenged to investigate inadvertent and potentially negative impacts of sunscreen including altered Vitamin D metabolism, systemic absorption of organic chemicals, and potentially adverse environmental and health outcomes.

Again, solving one problem may create another challenge – the work of a physiologist is never done!

Stay safe friends!

Mari

References:

  1. Lopes DM, McMahon SB. Ultraviolet radiation on the skin: a painful experience? CNS neuroscience & therapeutics. 2016;22(2):118-126.
  2. Dawes JM, Calvo M, Perkins JR, et al. CXCL5 mediates UVB irradiation–induced pain. Science translational medicine. 2011;3(90):90ra60-90ra60.
  3. Kimbrough DR. The photochemistry of sunscreens. Journal of chemical education. 1997;74(1):51.
  4. Tsuzuki T, Nearn M, Trotter G. Substantially visibly transparent topical physical sunscreen formulation. In: Google Patents; 2003.
  5. Passeron T, Bouillon R, Callender V, et al. Sunscreen photoprotection and vitamin D status. British Journal of Dermatology. 2019;181(5):916-931.
  6. Neale RE, Khan SR, Lucas RM, Waterhouse M, Whiteman DC, Olsen CM. The effect of sunscreen on vitamin D: a review. British Journal of Dermatology. 2019;181(5):907-915.
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    All images from:
    Royalty Free Stock Pictures – Public Domain Images
    www.dreamstime.com/

Prior to accepting the Dean’s positon at Sam Houston State University, Dr Hopper taught physiology and served as the Director of Student Research and Scholarly Work at Indiana University School of Medicine (IUSM). Dr Hopper earned tenure at IUSM and was twice awarded the Trustees Teaching Award. Based on her experience in developing curriculum, addressing accreditation and teaching and mentoring of medical students, she was selected to help build a new program of Osteopathic Medicine at SHSU. Active in a number of professional organizations, Dr. Hopper is past chair of the Chapter Advisory Council Chair for the American Physiological Society, the HAPS Conference Site Selection Committee, and Past-President of the Indiana Physiological Society.

Physiology Educators Community of Practice (PECOP) Webinar Series

The American Physiological Society (APS) is pleased to announce a new webinar series focused on our educator community. The monthly series includes live webinars focused on education best practices, synchronous and/or asynchronous teaching, establishing inclusive classrooms and publishing. Educator town halls will also be featured as we strive to support and engage the educator community throughout the year.

Starting this month, take advantage of the educator webinar series by visiting the events webpage on the APS website. Register for each webinar, learn about speakers and their talks today!

What to do on the First Day of Class: Insights From Physiology Educators?
July 23, 2020
12 p.m. EDT

Join in the discussion about how to greet students on the first day of class and set the tone for the rest of the course.

Speakers:

  • Barbara E. Goodman, PhD from the Sandford School of Medicine, University of South Dakota (Vermillion)
  • Dee Silverthorn, PhD from the University of Texas at Austin
Register Now!

A successful semester: Applying resilient and inclusive pedagogy to mitigate faculty and student stress
August 20, 2020
2 p.m. EDT

As we head into an uncertain academic year, spend an hour with us to consider strategies which will help you and your students navigate our changing academic, professional, and personal lives. Participants will work through pragmatic and concrete strategies they can transition into their own work to promote student learning and minimize stress.

Speakers:

  • Josef Brandauer, PhD from Gettysburg College (Penn.)
  • Katie Johnson, PhD from Trail Build, LLC (East Troy, Wisc.)
Register Now!

Writing & Reviewing for Advances
September 17, 2020
12 p.m. EDT

This session will be a chance to encourage all who have adapted their teaching during the COVID-19 pandemic to share their work. This topic also ties in to the Teaching Section featured topic for EB 2021.

Speaker:

  • Doug Everett, PhD from National Jewish Health (Denver, Colo.)
Register Now!

A Framework of College Student Buy-in to Evidence-Based Teaching Practices in STEM: The Roles of Trust and Growth Mindset
October 22, 2020
12 p.m. EST

This topic is relevant to building trust, which goes hand-in-hand with inclusion and diversity. Trust is essential for the different modalities of teaching which educators and students will experience in the fall.

 

Educators Town Hall
November 19, 2020
12 p.m. EST

A chance to talk about what happened during the fall semester and also plan for the upcoming year