Category Archives: COVID-19

Spring 2020*: The asterisk denotes community made all the difference.

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

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

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

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

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

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

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

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

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

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

Alice Villalobos, Ph.D., is an assistant professor in the Department of Medical Education at the Texas Tech Health Sciences Center in Lubbock, Texas.  She received her B.S.in biology from Loyola Marymount University and her Ph.D. in comparative physiology from the University of Arizona-College of Medicine.  Her research interests are the comparative aspects of the physiology and stress biology of organic solute transport by choroid plexus.  She has taught undergraduate and graduate courses in integrative systems physiology, nutrition and toxicology.  However, her most enjoyable teaching experience has been teaching first-graders about the heart and lungs!  Her educational interests focus on tools to enhance learning of challenging concepts in physiology for students at all levels.  She has been actively involved in social and educational programs to recruit and retain first-generation college students and underrepresented minorities in STEM. 
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.
  7. Matta MK, Florian J, Zusterzeel R, et al. Effect of sunscreen application on plasma concentration of sunscreen active ingredients: a randomized clinical trial. Jama. 2020;323(3):256-267.
  8. Schneider SL, Lim HW. Review of environmental effects of oxybenzone and other sunscreen active ingredients. Journal of the American Academy of Dermatology. 2019;80(1):266-271.
  9. DiNardo JC, Downs CA. Dermatological and environmental toxicological impact of the sunscreen ingredient oxybenzone/benzophenone‐3. Journal of cosmetic dermatology. 2018;17(1):15-19.

    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.

Keeping the Connection Alive During Remote Instruction
Candace Receno, PhD
Assistant Professor, Exercise Science & Athletic Training
Ithaca College

As a first year Assistant Professor, making the shift to remote learning during COVID-19 was certainly a gamechanger. As many previous blog posts have highlighted, the way we needed to look at instruction changed and forced both students and faculty to rapidly adapt. There were so many things that needed to be considered when making the transition. How flexible can our students be, now that some have become primary caretakers or have fallen ill or need to seek employment? How do instructors tackle making significant changes to their course, now that they are also dealing with similar issues? How do both groups create and participate in a high-quality course experience with fewer resources and a very short amount of time to adjust? Many of the insightful blogs posted have really highlighted how to keep these considerations in mind in order to create online courses that still meet course objectives and foster a high-quality learning experience. I have learned so much through reading these posts, in addition to numerous resources provided to our community. Through integration of these resources into my own courses, I found myself also trying to think of ways that I could keep the courses inherently “me”. Engaging and connecting with students on a personal level has always been something that I found helpful to my own teaching, but becomes hard when the mode of communication has shifted. This can also be difficult when some classes must be delivered asynchronously, in an effort to accommodate the changing lifestyles of our students. Perhaps just as important to a high-quality learning experience as shifting our instruction methods, is finding new ways to create the human connection that is much easier developed with on-campus learning. Here, I highlight some of the methods I found to be successful in making sure that I was able to keep my students engaged in the course while miles apart. While these may sound like really simple ideas, I’ll admit that I didn’t realize how important they were to the student experience until I had reflective conversations with many students after the Spring semester. With times of uncertainty still ahead, I plan to continue using these methods in the future.

1. Staying online after the class has ended.

This is probably the simplest of the suggestions to integrate, but really seemed to make a difference in getting the students more comfortable opening up over the computer screen. For my synchronous courses, I always ended class time by reminding the students I would stay in the virtual classroom to answer any questions or just to chat. I found that once students realized I would be sticking around for a few minutes regardless of if anyone else stayed, they were more willing to hang around and ask questions they might not have felt comfortable asking in front of other students or e-mailing me about. This also gave me another opportunity to reflect on how I was constructing my online course materials. Hearing what points students needed extra clarification on forced me to consider how topics that were ordinarily well understood in the physical classroom needed to be shifted with remote instruction.

2. Integrating video/audio into online discussion boards.

I needed to teach asynchronously for a particular course where students had concerns about internet availability and meeting other personal obligations, which came with completely different issues from my synchronous course. Posting notes in addition to pre-recorded lectures allowed me to successfully get course material across, but it was still missing the personal component that is fostered via in class discussion. The use of discussion boards where both the students and I posed questions to one another helped with that. Importantly, I asked students to record their questions/answers for the discussion board via video or audio whenever possible. Students continually reported that it was nice to actually hear and see one another even though live sessions were not possible. Moreover, they described how it was nice to laugh and share with one another, as responses did not have to be rehearsed and could closely mimic what might have happened in the physical classroom. 

3. Holding several office hours, varying in day and time.

Disclaimer: This may be harder to implement for some individuals because with COVID-19 comes a host of additional responsibilities and stresses that need to be attended to. But, if possible even for one day, I highly recommend it. The traditional times for which we hold office hours may not be feasible when we take into account the added responsibilities of needing to stay at home. So, why not hold office hours at different times that lend themselves to our new schedules? I found that holding office hours much later than I normally would resulted in many more students coming to them. Moreover, similar to my first suggestion, I made sure that students knew I’d be in the meeting room for my virtual hours regardless of if students signed up or not. Previously, I had always had an “open door policy” where students knew they could stop by my office without prior notice as long as my door was physically open. The new virtual office hours I held helped to mimic that. By having drastically different hours on different days, I tried to make sure that students could stop in whenever suited them. An important memory that stuck with me about this particular method was an instance when I was available at 7 pm on a Tuesday night. I had a student who showed up just wanting to talk, and stated, “I figured I wasn’t bothering you since you were on here anyway.”  Prior to COVID-19, she often stopped in to talk about how things were going. Through our virtual conversation, I learned that this student wasn’t seeking any help related to the class, but just wanted to talk because it helped things feel “normal” again. Even if you can’t hold a large variety of office hours, I truly think that doing something that helps mimic the ways you previously interacted with your students is so helpful during this time.

4. Holding “unofficial” hours.

This was a tip that I originally learned from a colleague, and adapted to fit my own subject matter. This colleague would host “unofficial”  hours, where she would sporadically e-mail students to let them know she would be in an online meeting room partaking in some fun activity. For example, on a random weeknight, she e-mailed students and said they could join in on her quest to make enchiladas. Several students took her up on that offer, and she used it as a time for the class to come together without any defined learning expectations. This gave her students the opportunity to connect as they would have previously, in a class that was now asynchronous during remote learning. She began to take sessions one step further, and would ask her students to describe ingredients in her cooking sessions in the context of her speech language pathology lectures. In an effort to take her advice and put my own spin on it, I began asking students to join me when I would participate in online workouts. It became a great way to have students connect with their classmates using an activity that we all had some interest in. With students in my pathophysiology course, I’d sneak in questions about how students felt after participating in a particular exercise and how this might impact the clinical populations they work with, giving me a way to reiterate what they had learned in a real-world context. 

In my experience, a large part in keeping students engaged was understanding that the human component to a course has the potential to impact student learning irrespective of how well we can pivot our course formats to meet remote instruction needs. No matter how it’s done, showing the students that you are still on the other side of that WiFi signal is an important consideration for all of us. I hope that my experience helps to identify other ways you might do this, and I’d appreciate you sharing your own ways to cultivate the student-instructor relationships via online methods.

Candace Receno is an assistant professor in the Exercise Science & Athletic Training department at Ithaca College in Ithaca, NY. She earned her PhD in Science Education from Syracuse University and served as a Post-Doctoral Fellow in the Biological Sciences department at Le Moyne College for two years. Candace just completed her first year as an Assistant Professor at Ithaca College, where her undergraduate and graduate courses include Advanced Exercise Physiology, Cardiopulmonary Assessment for Exercise, Pathophysiology, and Foundations of Human Performance and Wellness. She also hopes to continue engaging undergraduates in research related to exercise performance in special populations.

Teaching an Integrated Human Anatomy and Physiology Course: Additional Lessons Learned and Online Course Adjustments
Jennifer Ann Stokes, PhD
Assistant Professor of Kinesiology
Southwestern University

In my previous blog post, I outlined the lessons learned in my first run teaching a year-long integrated upper-division human anatomy and physiology course. It has been about a year and a half since the original post and after having taught the course for a second time I will review and add to my list of initial lessons learned. Additionally, this spring semester brought new challenges with a very swift move to online coursework due to COVID-19, so I will also comment on the resulting course alterations. As a reminder, this course sequence (A&P I and II) is an upper-division junior and senior level course at my college and class sizes are very small (20-24 students) allowing for maximum time for interaction, questions, and instructor guidance both in lecture and lab.

First, I will review the previous lessons learned and add additional commentary based on what I learned in my second year. If you haven’t yet, I would check out the previous blog for the initial notes.

1) Use an integrative textbook.

My textbook of choice is still Physiology: An Integrated Approach by Dee U. Silverthorn. For anatomy, I continued to supplement the anatomy information, such as the specifics of the skeletal system and joints, muscles, histology, etc., through the use of models and other reference material in hands-on lab activities. One addition made in the second year was the use of AD Instrument’s Lt online learning platform.  I discuss the addition of Lt in more detail later in this post, but I think it is important to note here too since the Lt lessons directly complemented the textbook material and helped bridge the gap between lecture and lab for the students.

2) Start building and assessing students’ A&P knowledge from the ground up, and build incrementally.

Laying the foundation for the core concepts is critical to the student’s understanding, application, and mastery of the complex integrative content that this course builds. I took this foundation building more seriously the second time around and, in the end, I did not have to spend more time on the basic content but instead I provided more formative assessment opportunities. This helped the students who did not have as strong a background or understanding of the basic material to recognize that they needed additional assistance. In addition to the weekly homework assignments which were graded for completion only, I added weekly low-stake quizzes using our learning management system (LMS). At first I thought the students would dislike the extra work, but an end-of-the-year survey indicated that they appreciated the extra practice and that the quizzes helped them feel better prepared for the exams.

3) Create a detailed course outline, and then be prepared to change it.

This lesson holds true for just about any course, but I found it especially true for an integrated A&P course – even when teaching it a second time. And it is even more important when you have to switch to online delivery. In the second year, I learned to appreciate that no two cohorts of students are the same and what took the previous cohort a day to master took the next cohort up to two days in some cases. Having the “flex days” at the end of each section was crucial for concept review and content integration. These are days where no new content is introduced, but instead we review and practice together.

4) Constantly remind your students of the new course format.

I cannot emphasize this enough: students will want to revert back to what they are comfortable with and what has worked for them in the past. I constantly remind students that their “cram and forget” method will not serve them well in this course and provide them with ample opportunity to practice this both on the formative and summative assessments. In the second year I continued the individual meetings with each student after their first exam to discuss study strategies and new ways to approach this material, but I also implemented additional check-ins throughout the year particularly with those students who were struggling. I continued to remind the students that the course content not only builds throughout the entire semester but also the entire year! I hammered this point home a bit more with the addition of “retention” quizzes which were delivered unannounced throughout the year and tested major core concepts and application.

5) Solicit student feedback.

Students can be brutally honest, so use that to your advantage. A lot of the new things I added in my second year teaching this course came from the first year-student feedback. I send out my own surveys with specific questions throughout the year which the students fill out anonymously. I find that students are happy to help, especially when they can see a course alteration mid-semester which was based on their feedback.

6) Be prepared to spend a lot of time with students outside of the classroom.

Still very true, but that’s probably my favorite part of this job. Even when we switched to online course delivery the virtual office hours were busy and students took advantage of the extra review and time to ask questions. 

In this second section, I will add additional lessons learned in my second year of teaching this course and comment on the changes made when the course moved online mid-way through the second semester.  

7) Over-communication.

One of the things I am known for with my students is consistent and clear communication, probably to the point of over-communication. I also emphasize that communication is a two-way street, so just as I am constantly communicating information to them, I expect them to do the same to me, including any accommodations, sports travel, or general course questions. I model this behavior with regular use of our LMS announcement page and I use the start of each class to review important deadlines and open the floor for questions. The move to online instruction only made this over-communication even more important. Early on in the transition period I checked in often to let them know the new plan and opened discussion pages to allow them to ask questions and express any concerns. I checked in multiple times a day using the LMS announcement page, posted a “live” course schedule and tables of new homework and quiz due dates all in one central location, and I added silly memes to the discussion boards to up engagement. I also added resource pages on the basics of Zoom and how to be an online student since this was very new territory for them (and me). Looking back this was a lot of information that was constructed and disseminated very quickly, but an end-of-the-year survey indicated they appreciated the information and that it told them that I was prepared and willing to help them during the transition.

8) More assessments. More practice. More activity.

In my second year, I assigned more practice problems from the textbook to help the students prepare for the exams and held problem sessions outside of class for review. This additional time and practice was well received even when it was a greater time commitment for the students. With the move to online instruction I was thankful that I had already established a fairly homework-heavy course as these assignments became even more important. The assigned “lecture” time was switched to virtual problem solving sessions and the course moved even more toward a flipped-classroom model. Since the switch to online occurred after I had already built a pretty solid reputation with this class (about a semester and a half) they were used to reading and problem solving before class, even if that class was now online. All homework and quizzes moved online which allowed for quicker feedback to the students on their progress and, thus, more time for questions before the exams. The switch to fully online homework and quizzes I plan to keep even when the course moves back to in-person as the quick feedback for the students and less time spent hand-grading by me is worth the extra time it takes to set-up the online modules.

9) Utilization of LMS Discussion Forums.

Honestly, the use of the LMS discussion forums did not start until the course moved online, but their quick success made me question why I had not taken advantage of this tool earlier. When the course moved online I added discussion pages with titles such as “What is going on?!? General course questions.” and “What I am most nervous about with the course moving online is…” The goal was to provide an outlet for students to ask questions and share their concerns. I always started the discussion myself, giving them a sort of “jumping off” point and an example. These discussion pages were utilized by almost all members of the course and were rated very highly in the end. Students could comment any time of day enhancing the accessibility of the discussion. I will modify these to be used in my courses moving forward for both in-person and online courses.

10) Online presence for both lecture and lab.

I actually increased my A&P online presence prior to the mandatory switch to online coursework with the implementation of AD Instruments Lt learning platform in the fall semester. My students received free access to both the anatomy and physiology modules thanks to an award from the American Physiological Society. The Teaching Career Enhancement Award supported a year-long study assessing the use of the ADInstruments Lt learning platform and its interactive and immersive lessons aimed at enhancing knowledge, retention, and practical application of the integrative course content. The Lt platform was fully customized to the course material and was used both in the lecture classroom and in the lab. In the lab, students were able to interact with a data acquisition system that is more “game-like” and familiar, while still collecting high-level human physiology data. Lt also allowed for the creation of new lessons that engaged students with the use of embedded questions in multiple formats, including drag-and-drop labeling, drawing, short answers, and completion of tables. These lessons were used in many ways: for pre-lab preparation, in-lab and post-lab assessment, and for active learning activities in the classroom. Lessons were completed individually or in small groups, and questions were set up with hints, immediate feedback, multiple tries, and/or automatic grading.

These modules were also incorporated in the active-learning lecture component of the course, providing additional exposure and practice with the content. The Lt lessons directly complemented the textbook material and helped bridge the gap between lecture and lab for the students. When the course moved fully online I was incredibly thankful that Lt was already in use in my course and that the students were already comfortable and familiar with the platform. I used Lt exclusively for the online labs and supplemental lecture content for the remainder of the spring semester. Just as before, the lessons and modules were customized by me to fit my course learning objectives and prepare the students for their new online assessments. Students could complete the online coursework at their leisure and stop by the virtual office hours for help or post questions on the discussion boards for feedback. Student feedback indicated that the addition of Lt to this course enhanced accessibility of the course content, provided extra practice and exposure to the material, and overall was rated highly by the students.  

And just as I did before, now I turn the conversation over to the MANY seasoned educators who read this blog. What did you learn in your quick move to online coursework? Did you implement any new pedagogical tools which you will continue to use even with in-person instruction? Please share!

Jennifer Ann Stokes is a soon-to-be Assistant Professor of Kinesiology at Southwestern University in Georgetown, TX, after spending the last three years at Centenary College of Louisiana. Jennifer received her PhD in Biomedical Sciences from the University of California, San Diego (UCSD) and following a Postdoctoral Fellowship in respiratory physiology at UCSD, Jennifer spent a year at Beloit College (Beloit, WI) as a Visiting Assistant Professor of Biology to expand her teaching background and pursue a teaching career at a primarily undergraduate institution. Jennifer’s courses include Human Anatomy and Physiology (using an integrative approach), Nutritional Physiology, Exercise Physiology, Medical Terminology, and Psychopharmacology. Jennifer is also actively engaged with undergraduates in basic science research (www.stokeslab.com) and in her free time enjoys cycling, hiking, and yoga.

Shifting course expectations as well as the mode of delivery during the spring 2020 COVID-19 pandemic
Kristen L.W. Walton, PhD
Biology Department
Missouri Western State University

COVID-19 (Coronavirus Disease 2019) is caused by infection with SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2).  Current evidence suggests that this zoonotic coronavirus originated in China in late 20191, and it subsequently spread rapidly across the globe, causing significant morbidity and mortality.  To help contain the spread of this virus, many countries have implemented policies and orders aimed at reducing contact between people.  The terms “social distancing” and “flatten the curve” have been rapidly imbued in our culture. Indeed, a Google Trends search shows a significant surge in searches for “social distancing” between the week of March 1-7, 2020 and the week of March 29-April 4, 20202.  In the United States, to help mitigate the rapid spread of SARS-CoV-2, a few colleges and universities began to announce in early March that they would be suspending face-to-face classes and shifting to all-online instruction, and soon most postgraduate institutions in the USA followed suit, including my institution.

In early March, as the situation became recognized as increasingly urgent by the higher education institutions in our region, the administration at my institution, Missouri Western State University (MWSU), made a decision to extend spring break by one week, through March 22.  Then, in the middle of that second week of spring break, the university administration announced that MWSU would cancel all face-to-face classes for the rest of the semester, and students would have several options regarding their grades for the spring 2020 semester3.  Higher education institutions across the USA have grappled with how to handle grades in this unprecedented time.  Students who did not sign up for online classes are finishing their face-to-face courses, in many if not most cases, as hastily-constructed online versions.  Many institutions have chosen to make all classes pass/fail, others have opted to keep letter grades as the only option, and still others, including MWSU, have given students flexible options to choose a pass/fail option or a letter grade.  The MWSU administration also gave faculty flexibility in determining whether to create a “culminating experience” for students who elected to complete their courses. This could mean anything from reducing the amount of content and/or assessments, changing the format of assessments (for example, a final paper in lieu of a final exam), or essentially continuing as originally planned but with online course delivery and assessments.  This flexibility for faculty was intended to recognize that some types of classes are more amenable than others to a shift to online delivery.  Students whose midterm grade was a C or higher could elect to choose the “credit” (pass) grade option for the course if they chose not to complete the culminating experience; students who chose to complete the culminating experience earned a letter grade based on their course grade at the end of the semester.  To increase flexibility for students, this option was available to students up until the last day of classes, April 24.  The deadline for a withdrawal from the class was also extended to April 24.

For me, as a biology faculty member, the flexibility allowed by our administration in how to structure the last five weeks of my classes led to a lot of thought about my courses and how to best achieve the course objectives for each of them.  I spent many hours considering this, discussing options with my colleagues in a socially distant manner, through emails and our first Zoom department meeting, a somewhat difficult transition for our close-knit group of faculty used to frequent in-person conversations.  I also spent time reading a flurry of articles and blog posts about the importance of being understanding of the major disruption to our students’ lives and college experience4; the importance of recognizing the difficulty in creating a high-quality online course experience with a few days’ notice5; and, not to be overlooked, the importance of tending to one’s own needs, both professional and personal, in this high-stress time.  

Depending on one’s personal situation, a faculty member could also be dealing with changes in family schedules and responsibilities due to children who were suddenly not attending school or day care.  Illness could strike any of us or our friends and family members, certainly adding to the stress and anxiety experiences.  Partners could be furloughed as businesses shuttered their doors due to the pandemic.  While some academics touted their ability to be highly productive during the quarantine and even cited the invention of calculus by Sir Isaac Newton during the black plague as inspiration, others pointed out that quarantine is not universally a time when one can focus solely on work and scientific discovery.  This is true for me, on a personal level.  I have two elementary school-aged children whose school closed a week after my university suspended face-to-face classes.  I have had sole responsibility for child care and helping them with their school work at home, while also moving my classes online and maintaining other work responsibilities.  Many of the students in my classes are non-traditional and have similar child care and “home school” responsibilities.  Others have financial stress due to job layoffs, or, conversely, increased work stress and time demands for those working in the health care field.  Another concern is that many of our students have poor access to broadband internet and technology to access class materials online.  Several of my students emailed me during the transition stating that they were using only a smartphone to access course materials and had no access to a laptop or desktop computer, printer, or other technology, and no high-speed internet.

Consideration of my students’ access to technology, stress, and other burdens, as well as the other factors described above led me to make different choices for each of my three classes this spring.  For my honors colloquium, titled, ironically enough, Plagues That Changed the World, my co-instructor and I decided not to try to coordinate the student-led presentations that were scheduled for the last 6 weeks of the semester and instead only required a final paper.  Seven of 13 undergraduates in this course chose the credit grade based on their midterm grade, and did not complete this rather minimal culminating experience. For my upper-division biology majors course, Molecular Basis of Disease, which is a capstone-type elective course that is not a prerequisite for any other classes, I chose to culminate the lab portion by keeping a scheduled lab quiz, but not attempt to recreate the planned five-week group research project.  For the lecture portion of that class, students who elected to complete the culminating experience wrote a literature review article as originally planned and were given one online exam instead of two in-class exams.  Even with this reduced workload, 6 of the 15 undergraduates enrolled in the course chose to take a credit grade and did not complete the course.  My third course this spring, Pathophysiology, is primarily populated by pre-nursing majors and population health majors, with a few pre-health-professions biology majors.  It would not have been appropriate to drop content or assessments of content knowledge from this course, because the overwhelming majority of students in the course needed to learn that content for success in later coursework.  As it happens, I have taught this lecture-only course in an online format in the summer for several years, so transitioning it to an online delivery mode was relatively easy, with a few exceptions: increased modes of accessing the material, and exams.  I have structured the all-online previous version of that class to be asynchronous, based on knowledge of my student population, many of whom work full time while also taking classes.  I felt that was still the best choice in these uncertain times.  However, in addition to posting video lectures, I downloaded the audio-only podcasts and posted them separately for students who did not have regular high-speed internet access or were working solely from a smartphone with a small screen.  I also made additional course notes available.  

As for the exams, I have always required proctored exams in the online version of this course, and structured them similarly to the written exams taken by students in the traditional, face-to-face version of the course.  Proctored online exams would not have been feasible in the COVID-19-induced chaos that ensued in late March and early April, as some of my students were moving home many states away, finding themselves under self-quarantine, caring for family members, etc., and I myself had schedule considerations to juggle with children and their school work and Zoom meetings which competed for our limited bandwidth home internet.  I tried to strike a balance between several considerations:  best practices for online unproctored exams, such as making them open-book and not easily Google-able; the format and level of rigor students were used to from the first two written, face-to-face exams; and being mindful of unequal access to technology among my students.  In this class, 81 of 86 undergraduates completed the culminating experience, a high proportion driven largely by the requirement of their specific majors for a letter grade in this required course.

As I write this, I still have several papers to grade and final course grades to enter.  I can say with certainty, however, that the choices for assessments and content coverage that I made for my Pathophysiology course did not appear to substantially disadvantage the majority of students, and the course grade distribution will be noticeably higher than usual, aside from the small number of students who did not complete the course.  Several of my colleagues have observed similar increases in their course grades this semester.  In that course, I erred on the side of leniency with the exams, but since I could not in good conscience drop content from that course – pre-nursing students still need to have learned about diseases of the digestive tract, even if COVID-19 interrupted their semester! – I am comfortable that they will at least have a reasonable degree of preparation for their subsequent courses.  For my other two courses, grades will not be higher and in some cases students submitted work that was of lower quality than I expected from their work earlier in the semester.  I strongly suspect that many students who chose to complete those courses did not have the focus or the ability to do so as well as they would have in the face-to-face courses.  I do not have survey data to help clarify what the students were thinking, but I suspect the students who needed the letter grade for subsequent coursework approached this altered, online part of the semester differently from those who were only taking an elective where a credit grade would suffice or a GPA issue was not anticipated.  Informal feedback from all three of my classes included several students commenting about how they did not sign up for online classes because they prefer traditional-format classes, comments about family issues (helping children with school work, moving back home because of job loss, stressful quarantine situations), and comments about missing deadlines because of work or other outside responsibilities.

Although I still need to submit my final course grades for the spring 2020 semester, the summer session is already looming.  My institution chose a few weeks ago to offer only 100% online summer classes, so my usual summer online Pathophysiology class will need to have exam structure revamped away from the written, proctored format that I have previously used.  In addition, many institutions including my own are having discussions about the fall semester.  At this time, we just don’t know what the COVID-19 situation will be in late August.  We have been told to prepare for something unusual, whether it will be a fully online semester, a restructured semester with two or three shorter block sessions, or some other plan.  In preparing for that, I will be considering these questions for each of my classes:

1. How can the course learning objectives best be accomplished in an altered course format?

2. What are the best ways to transition a heavily hands-on lab course to an online or shortened course format?

3. What are the needs of the student population in this course?

4. What is the appropriate balance between flexibility versus maintaining appropriate expectations in the course?

Considering the course goals and learning objectives is a critical component of any course design or transition to a different format, and the course may need to change if the different format is not amenable to the original goals and learning objectives.  In this time of forced transitions to altered course structures and the impacts of COVID-19 mitigation strategies on us and our students, choices might be different from the choices we would otherwise make. It’s also important for faculty, administrators, and students to recognize that different types of courses may be more or less easy to convert to an all-online format.  And while online instruction can be excellent and perhaps this experience will encourage broader use of certain online course components in future face-to-face classes for many faculty, it is not the “college experience” that many students expect and there is speculation among higher education administrators that enrollments will be down this fall, adding to the financial distress that many universities and colleges are already experiencing. Although I have read some opinion pieces that higher education should use this spring as a springboard to shift to more online courses permanently, I would argue that it’s also important to recognize that a large proportion of our students and faculty, myself included, strongly prefer those face-to-face classes and hope to return to them as soon as we can.  I am certain that as a global community of physiology educators we will continue to interact and support each other as we navigate all of the upcoming transitions.

References:

Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5:536–44.

Google Trends, search term “social distancing”. URL  https://trends.google.com/trends/explore?geo=US&q=social%20distancing  , accessed April 30, 2020.

Missouri Western State University COVID-19 information. URL https://www.missouriwestern.edu/covid-19/keep-learning/ , accessed April 30, 2020.

Barrett-Fox, Rebecca. “Please do a bad job of putting your classes online” URL https://anygoodthing.com/2020/03/12/please-do-a-bad-job-of-putting-your-courses-online/ , accessed April 30, 2020. 

Darby, F.  5 Low-tech, time-saving ways to teach online during COVID-19.  The Chronicle of Higher Education  URL  https://www.chronicle.com/article/5-Low-Tech-Time-Saving-Ways/248519  accessed April 30, 2020.

Kristen Walton is a Professor in the Biology Department at Missouri Western State University.  She earned her PhD in Physiology from the University of North Carolina-Chapel Hill in 2001 and was a SPIRE (Seeding Postdoctoral Innovators in Research and Education) Postdoctoral Fellow at UNC-Chapel Hill from 2001-2006.   In 2006, she began her current position at Missouri Western State University, a primarily undergraduate institution.  She has taught a variety of undergraduate courses including animal physiology, pathophysiology, immunology, molecular basis of disease, introductory cell biology, public health microbiology, and human anatomy & physiology.  Her research interests are in intestinal inflammation and inflammatory bowel disease, and in discipline-based education research.