Category Archives: Curriculum

The Teaching of Basic Science as a Necessity in the Doctor in Physical Therapy Clinical Curriculum

There is an ever increasing need to train evidenced-based clinicians among all the health disciplines. This is particularly true in the relatively young profession of physical therapy, where the educational standards have shifted from entry level bachelor’s degree requirements to clinical doctorate training. The increase in educational standards reflect the growth of the discipline, with an effort to increase the depth of knowledge and level of skill required to be a physical therapist while moving from technician to an independent direct access practitioner. This evolution also marks a shift in standards of evidenced-based practice from clinical observation to an ability to provide mechanistic understanding which includes fundamental scientific insights and transforms clinical practice. The profession also recognizes the need to advance the profession through research that provides a scientific basis validating physical therapy treatment approaches. As a result, there is an expanding, yet underappreciated role, for the basic science researcher / educator in Doctor of Physical Therapy (DPT) programs.

Strategies to integrate and infuse the basic science into practice:

1. Faculty training:

Big Four Bridge in Louisville, KY

How to bridge the gap between basic science and clinical education?  As dual credentialed physical therapist and basic scientist these influence Sonja’s teaching approach, to serve as a “bridge” between foundational science content and clinical application.  Teaching across broad content areas in a DPT curriculum provides opportunities to “make the connection” from what students learn in the sciences, clinical courses, and relate these to patient diagnosis and therapeutic approaches.

While dual training is one approach, these credentials combined with years of ongoing contemporary clinical practice, are rare and impractical to implement in an academic setting. Most often DPT programs rely on PhD trained anatomists, neuroanatomists, and physiologists to teach foundational courses, often borrowed from other departments to fulfill these foundational teaching needs. Thus, Chris’s approach is through crosstalk between scientist/physiologist and clinician to serve as a role model and teach the application of discoveries for identifying best evidence in clinical decision making. By either approach, we have become that key bridge teaching and demonstrating how foundational science, both basic and applied impact clinical decision making.

2. Placement of foundational science courses (physiology, neuroscience, anatomy):

Traditional curricular approaches introduce foundational sciences in anatomy, neuroscience, and physiology in the first year of the DPT curriculum, followed by clinical content with either integrated or end loaded clinical experiences over the course of remaining 2.5-3 years. Our current program established an alternative approach of introducing foundational sciences after the introduction of clinical content and subsequently followed by a full time clinical clerkship/ education. Having taught in both models, early or late introduction of foundational sciences, we recognized either partitioned approaches lead to educational gaps and makes bridging the knowledge to application gap challenging for students.

Regardless, the overall message is clear and suggestive of the need for better integration of foundational/scientific content throughout the curriculum. These challenges are not unique to physical therapy, as this knowledge to clinical translation gap is well documented in medicine and nursing and has been the impetus for ongoing curriculum transformations in these programs. These professions are exploring a variety of approaches on how to best deliver /package courses / and curriculum that foster rapid translation into clinical practice. Arena, R., et al., 2017; Fall, L.H. 2015; Newhouse, R.P. and Spring, B., 2010; Fincher et al., 2009.

Recently, new curricular models have emerged within the doctoral of physical therapy curriculum that complement the academic mission to train competent evidenced based clinicians Bliss et al., 2018, Arena R. et al. 2017. These models leverage the faculty expertise of physiologist/scientist, research, and clinical faculty to create integrative learning experiences for students. These models include integrated models of clinical laboratory learning and/ or classroom-based discussion of case scenarios, that pair the basic scientist and the clinical expert. It is our belief, that teaching our clinical students through these models will lead to enhanced educational experience, application of didactic course work, and the appreciation for high quality research both basic and applied.

3. Appreciation and value of foundational sciences through participation in faculty led research:

Capstone experiences are common curricular elements for the physical therapy profession. This model is believed to 1) prepare future physical therapy generations to provide high-quality clinical care and, 2) provide research needed to guide evidence-based care, and 3) foster the appreciation for evidence and advances in the field. We believe these pipeline experiences could allow for advanced training incorporating strong foundational (science) knowledge that is relevant to the field, which can be applied broadly and adapted to integrate the rapidly growing knowledge base. Such models may assist in integrating the importance of scientific findings (basic and applied) while facilitating the breakdown of barriers (perceived and real) that silo clinical and foundational content (Haramati, A., 2011).

Contributing to the barriers are that relatively few of the basic sciences and translational studies are being conducted by rehabilitation experts. Furthermore, like medicine disciplines, it is unlikely that DPT faculty will be experts as both a clinician and scientist. Rather these emerging models promote teams of scientists and clinical faculty who work together to promote scientific, evidence-based education (Polancich S. et al., 2018; Read and Ward 2017; Fincher et al., 2009). Implementation of these education models requires “buy in” from administration and faculty who must recognize and value a core of outstanding clinician-educators, clinician-scientists, and basic scientists, and reward effective collaboration in education (Fincher 2009).

Although these models are flowering in research intensive universities, the challenges of integrating the basic sciences are greater in programs embedded within smaller liberal arts institutions that lack the infrastructure and administrative support for creating teaching-science-clinical synergies. Often these programs are heavily weighted towards clinical education faculty who emphasize clinical teaching and development of clinical skills, with a less integrated emphasis on the fundamental science in clinical decision making. Our own experience, having taught foundational (physiology and neuroscience) sciences, are that faculty in these programs are more reluctant to embrace and value foundational sciences. A possible explanation may be the limited exposure to and unrecognized value of contributions to the field from such basic and translational approaches. It is frequently implied if it works, it may not be necessary to understand mechanistically how it works. While this might suffice for today’s practice approach, this will not be enough for future clinicians in a rapidly evolving clinical environment. Programs that may not foster scientific curiosity, may be missing the opportunity to instill lifelong learning. We agree with other educators that the integration of basic science is critical for the student progress toward independence and essential competence, and that health science educators should support the teaching of basic science as it aids in the teaching of how to solve complex clinical scenarios even if clinicians may not emphasize the basic science that underlies their reasoning (Pangaro, 2011).

Concluding Thoughts:

Physical therapy departments particularly those within major academic centers housing a mix of research, education, and clinically focused faculty can successfully operate a curriculum able to synergize education, research, and clinical initiatives. Creating synergies early in a curriculum by pairing clinical specialists with science trained faculty will facilitate connections between clinical practice and science (Bliss, et al., 2018). While curricular change can be challenging, programs that implement a collaborative model where faculty with a shared area of expertise (e.g., orthopedics, neurology, cardiopulmonary, pediatrics and geriatrics) and unique complementary skill sets (i.e., research, education, and clinical practice) come together to transform student educational experiences – completing that bridge between basic science and clinical practice.

Stacked Stone Arch

 

References:

Arena, R., Girolami, G., Aruin, A., Keil, A., Sainsbury, J. and Phillips, S.A.,

Integrated approaches to physical Therapy education: a new comprehensive model from the University of Illinois Chicago, Physiotherapy Theory and Practice, 2017, 33:5, 353-360, doi: 10.1080/09593985.2017.1305471.

Bliss, R., Brueilly, K. E., Swiggum, M. S., Morris, G. S., Williamson, E.M., Importance of Terminal Academic Degreed Core Faculty in Physical Therapist Education, Journal of Physical Therapy Education. 2018, 32(2):123-127, doi: 10.1097/JTE.0000000000000054.

Fall, L.H., The Collaborative Construction of the Clinical Mind: Excellence in Patient Care through Cognitive Integration of Basic Sciences Concepts into Routine Clinical Practice, Med.Sci.Educ. 2015, 25(Suppl 1): 5, doi: 10.1007/s40670-015-0192-9.

Fincher, M., Wallach P., and Richardson, W.S.,  Basic Science Right, Not Basic Science Lite: Medical Education at a Crossroad, J Gen Intern Med. 2009, Nov; 24(11): 1255–1258, doi: 10.1007/s11606-009-1109-3

Haramati, A., Fostering Scientific Curiosity and Professional Behaviors in a Basic Science Curriculum, Med.Sci.Educ. 2011, 21(Suppl 3): 254, doi: 10.1007/BF03341720.

Newhouse, R.P. and Spring, B., Interdisciplinary Evidence-based Practice: Moving from Silos to Synergy, Nurs Outlook. 2010, Nov–Dec; 58(6): 309–317, doi: 10.1016/j.outlook.2010.09.001.

Pangaro, L., The Role and Value of the Basic Sciences in Medical Education: The Perspective of Clinical Education -Students’ Progress from Understanding to Action. Medical Science Educator. 2010, Volume 20: No. 3. 307-313.

Polancich, S., Roussel, L., Graves, B.A., O’Neal, P.V., A regional consortium for doctor of nursing practice education: Integrating improvement science into the curriculum. J Prof Nurs. 2017, Nov – Dec;33(6):417-421, doi: 10.1016/j.profnurs.2017.07.013.

Read C.Y., Ward L.D., Misconceptions About Genomics Among Nursing Faculty and Students. Nurse Educ. 2018, Jul/Aug;43(4):196-200, doi: 10.1097/NNE.0000000000000444.

 

 

Chris Wingard completed his BA in Biology form Hiram College a MS from University of Akron and PhD from Wayne State University. He has served in physiology departments at University of Virginia, Medical College of Georgia and East Carolina University during his career and has most recently joined the Bellarmine University College of Health Professions as Professor teaching in the Physical Therapy, Accelerated Nursing and Biology Programs.  His interests are in the impacts of environmental exposures on the function of the cardiovascular pulmonary systems.
Sonja Bareiss received a BS in Biology and Master’s in Physical Therapy from Rockhurst University. She completed her PhD in Anatomy and Cell Biology at East Carolina University. Dr. Bareiss was a faculty member at East Carolina University Department of Physical Therapy and Department of Anatomy and Cell Biology before joining the DPT program at Bellarmine University. Her areas of teaching span foundational sciences (neuroscience and anatomy) to clinical content (electrical modalities). Her most recent efforts have been to develop and implement a pain mechanisms and management course into physical therapy curriculum with emphasis on interdisciplinary learning. In addition to her academic experience, Dr. Bareiss has over 8 years of full-time clinical experience where she specialized in treating patients with chronic pain syndromes. Her research and clinical interests have been dedicated to understanding mechanisms of neural plasticity related to the development and treatment of pain and neurodegenerative disease and injury and integrating undergraduate Biology Honors and DPT students into the work.
Medical Physiology for Undergraduate Students: A Galaxy No Longer Far, Far Away

The landscape of medical school basic science education has undergone a significant transformation in the past 15 years.  This transformation continues to grow as medical school basic science faculty are faced with the task of providing “systems based” learning of the fundamental concepts of the Big 3 P’s: Physiology, Pathology & Pharmacology, within the context of clinical medicine and case studies.  Student understanding of conceptual basic science is combined with the growing knowledge base of science that has been doubling exponentially for the past century.  Add macro and microanatomy to the mix and students entering their clinical years of medical education are now being deemed only “moderately prepared” to tackle the complexities of clinical diagnosis and treatment.  This has placed a new and daunting premium on the preparation of students for entry into medical school.  Perhaps medical education is no longer a straightforward task of 4 consecutive years of learning.  I portend that our highest quality students today, are significantly more prepared and in many ways more focused in the fundamentals of mathematics, science and logic than those of even 30 years ago.  However, we are presenting them with a near impossible task of deeply learning and integrating a volume of information that is simply far too vast for a mere 4 semesters of early medical education.

 

To deal with this academic conundrum, I recommend here that the academic community quickly begin to address this complex set of problems in a number of new and different ways.  Our educators have addressed the learning of STEM in recent times by implementing a number of “student centered” pedagogical philosophies and practices that have been proven to be far more effective in the retention of knowledge and the overall understanding of problem solving.  The K-12 revolution of problem-based and student-centered education continues to grow and now these classroom structures have become well placed on many of our college and university campuses.  There is still much to be done in expanding and perfecting student-centered learning, but we are all keenly aware that these kinds of classroom teaching methods also come with a significant price in terms of basic science courses.

 

It is my contention that we must now expand our time frame and begin preparing our future scientists and physicians with robust undergraduate preprofessional education.  Many of our universities have already embarked upon this mission by developing undergraduate physiology majors that have placed them at the forefront of this movement.  Michigan State University, the University of Arizona and the University of Oregon have well established and long standing physiology majors.  Smaller liberal arts focused colleges and universities may not invest in a full majors program, but rather offer robust curricular courses in the basic medical sciences that appropriately prepare their students for professional medical and/or veterinary education.  Other research 1 universities with strong basic medical science programs housed in biology departments of their Colleges of Arts and Sciences may be encouraged to develop discipline focused “tracks” in the basic medical sciences.  These tracks may be focused on disciplines such as physiology, pharmacology, neuroscience, medical genetics & bioinformatics and microbiology & immunology.  These latter programs will allow students to continue learning with more broad degrees of undergraduate education in the arts, humanities and social sciences while gaining an early start on advanced in depth knowledge and understanding of the fundamentals of medical bioscience.  Thus, a true undergraduate “major” in these disciplines would not be a requirement, but rather a basic offering of focused, core biomedical science courses that better prepare the future professional for the rigors of integrated organ-based medical education.

 

In the long term, it is important for leaders in undergraduate biomedical education to develop a common set of curriculum standards that provide a framework from which all institutions can determine how and when they choose to prepare their own students for their post-undergraduate education.  National guidelines for physiology programs should become the standard through which institutions can begin to prepare their students.  Core concepts in physiology are currently being developed.  We must carefully identify how student learning and understanding of basic science transcends future career development, and teach professional skills that improve future employability.  Lastly, we must develop clear and effective mechanisms to assess and evaluate programs to assure that what we believe is successful is supported by data which demonstrates specific program strengths and challenges for the future.  These kinds of challenges in biomedical education are currently being addressed in open forum discussions and meetings fostered by the newly developed Physiology Majors Interest Group (P-MIG) of the APS.  This growing group of interested physiology educators are now meeting each year to discuss, compare and share their thoughts on these and other issues related to the future success of our undergraduate physiology students.  The current year will meet June 28-29 at the University of Arizona, Tucson, AZ.  It is through these forums and discussions that we, as a discipline, will continue to grow and meet the needs and challenges of teaching physiology and other basic science disciplines of the future.

Jeffrey L. Osborn, PhD is a professor of biology at the University of Kentucky where he teaches undergraduate and graduate physiology. He currently serves as APS Education Committee chair and is a former medical physiology educator and K12 magnet school director. His research focuses on hypertension and renal function and scholarship of teaching and learning. This is his first blog.
Thoughts from the Future

 

 

April 23, 2028

 

Dear Dave Harris of 2018,

It has been a long time my friend, in fact 10 years.  I have plenty of good news to share with you, which may be shocking or expected!

First, I am happy to inform you that the past decade has been extremely good for your Philadelphia Eagles!  After winning Super Bowl LII in 2018, they have gone on to win 3 more with Carson Wentz running new “Philly Specials” year after year!  Tom Brady finally retired after he dropped another wide-open pass in Super Bowl LV.  However, the biggest surprise for you may be that the Cleveland Browns won Super Bowl LV!

I am also happy to tell you that the educators survived the Great Medical Education Transformation of the 2020s! I knew that you saw this coming around 2015, but the speed at which the Transformation occurred was mind-blowing for many faculty!  We lost a few good “soldiers” in the process when they failed to adapt their educational views and styles, but as of now, medical education has never been better and there have been substantial improvements in patient safety and outcomes!  I am sharing some of the changes with you to prepare the faculty of the future!

One of the first recognizable changes was the manner in which students approached medical school curricula.  Even during your time, schools saw drastic reductions in class attendance and student engagement with the formal curriculum.  The millennial students were used to obtaining information how they wanted and immediately when they wanted.  Recording of lectures led to students remaining at home so that they could double speed your voice to sound (you have no idea how they describe you!), allowed them to view these lectures at midnight in their pajamas, and gave them the ability to stop and take notes.  Many faculty mistook this as student disengagement and tried to “force” them into class by making mandatory sessions or increasing the frequency of assessments. However, students responded by stating that some sessions were a “waste of time” and “took time away from studying for Step 1”.  They continued to vote with their feet and migrate away from the classroom!

However, what caught most faculty of your time off guard was the use of external resources outside of your own curricular items.  The emergence of the “hidden curriculum”!  Students were presented with alternative options such as Anki, Sketchy Medical, Osmosis, First Aid, Khan Academy and Pathoma to name a few!  At first faculty were unaware and put up a staunch resistance.  It was even postulated by some that the core curriculum of basic science could be delivered as a shared Medical Curricular Ecosystem (Le and Prober) that would help reduce redundancy in medical schools.  This caused an imbalance in the galaxy and many of the upset faculty tried to prevent this from coming. However, many astute faculty quickly realized that it was already there!!  At that point the faculty rebel forces decided to become proactive instead of reactive!

Town hall meetings, focus groups, and interviewing revealed many weaknesses in the medical school schema to date.  Faculty struggled to realize that the millennial students grew up with the internet and basically a cell phone attached to their hand.  Finding content was not an issue for them and what faculty discovered was that much of the content delivered in lectures was identical to what could be viewed in a video in 8 minutes.  They also discovered that students grew up in a world where everyone was connected through social media and available almost 24 hours a day!  They expected responses from their friends on a chat within seconds!  After all, how many people sleep with their cell phone next to them?  Faculty also discovered in these town halls that the generation valued work/life balance and anything that was deemed inefficient cut into this time that they could be doing something else.  Through these important meetings, faculty also discovered that students were excellent at recalling facts and regurgitating knowledge. However, when asked to apply that knowledge to a problem, the students went back to recalling the facts. Students had mistaken memorizing for learning!  And many faculty had mistaken learning for telling!  Some faculty reflected back and actually admitted that we may have enabled the behaviors with our constant barrage of standardized tests of knowledge!

At least, the good news is that this led to some drastic changes in medical education!  Gross anatomy has been severely trimmed down in an effort to focus on clinically relevant anatomy for undifferentiated medical students. Gross anatomy dissection is reserved for students interested in a surgical career as an elective.  Much of that experience of cutting through muscle layers and isolating each artery, nerve and vein, and picking through layers of fat to get there has been replaced by complex computer programs that help students visualize the anatomy in 3D!  Since ultrasound is currently available to any physician through their phone, more emphasis of anatomy related to ultrasound aspects has been a focus of instruction.  For many of the pathological or anatomical variations, 3D printing has allowed for much cheaper and better alternatives for learning.  Everything is currently related to clinical medicine and focuses on key concepts that are necessary to master as opposed to “knowing” everything!  However, the changes did not stop there!

Much of the basic physiology content knowledge is now presented to the students in alternative ways using directed, short videos or providing references.  The class time has been reserved for higher level threshold concepts where students are placed in situations in which misconceptions and dangerous reasoning can be identified and corrected.  Simulations and standardized patients (robots) have become common place where students have to integrate what they were learning in Doctoring courses with real life physiology.  Students enjoy the safe environment and as faculty discovered the role of affect in cognition, they quickly realized that this was a time efficient pedagogy.  Faculty have discovered that 1 hour of intense, clinically oriented, and high yield threshold concept learning is much more beneficial and time efficient than 4 hours of didactic lecture. And faculty discovered it was fun!

Another aspect under appreciated by faculty of your time is that students enjoy being able to learn in their own environment as opposed to in the classroom.  In your day coffee shops were filled with students studying away, but technology has allowed for large communities of learners to “get together” from their own homes.  Time spent traveling from various hospital sites during the clerkships was saved by developing online communities for learning and using technology to facilitate discussion.  Students felt more at ease critiquing another’s differential with this new design and appreciated the time saved from travel.

As I said my friend, medical education has been transformed in exciting and very positive ways!  Successful faculty have worked with the students to enhance the learning experience as opposed to trying to teach the way we were taught!  Faculty focused more on the learning process as opposed to trying to relay knowledge to the students.  It was discovered that technology could not substitute for poor teaching. Faculty learned to develop activities to get students out of their comfort zones so that true learning could occur.  And lastly, faculty realized that their roles were not eliminated. Rather the role of faculty had to change from the expert sage on the stage to the facilitator of student learning!

Well, I can’t wait to see what the next ten years will bring!  You will be happy to know that your two daughters have grown up to be beautiful, caring people!

 

See you in 10 years and Fly Eagles Fly!!

Dave Harris of 2028

 

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I realize that this letter may be viewed as provocative, crazy, and aspiring!  However, I hope that the conversations in medical education can begin to REALLY improve patient safety and outcomes in the future.  What changes do you think will occur in medical education in the next 10 years?

 

David M. Harris, PhD, is currently an Associate Professor of Physiology at the University of Central Florida College of Medicine in Orlando, Florida.  He received his PhD from Temple University School of Medicine, completed his post-doctoral research at Thomas Jefferson University, and was offered his first faculty position at Drexel University College of Medicine. He moved away from Philly to Orlando in 2011.  He has written several educational research manuscripts, mostly about the use of high fidelity mannequin simulators in medical physiology and currently serves as an Associate Editor for Advances in Physiology Education.  He is also on the Aquifer Sciences (formerly MedU Science) leadership team developing a curriculum that provides tools or how to integrate basic science knowledge with clinical decision making  to prevent harm.

Reference:  Le TT, Prober CG. A Proposal for a Shared Medical School Curricular Ecosystem. Acad Med, March 6, 2018

Stress and adaptation to curricular changes

 

 

 

…there was a teacher interested in enhancing the learning process of his students. He wanted to see them develop skills beyond routine memorization. With the support of colleagues and the education team at his university, he succeeded and chose a semi-flipped classroom approach that allowed him to introduce novel curricular changes that did not generate much resistance on the part of the students.

The change was made. The students apparently benefited from the course. They worked in groups and learned cooperatively and collaboratively. Students evaluated peers and learned to improve their own work in the process. They not only learned the topics of the class, but also improved their communication skills.

At some point the institution asked the teacher to teach another course. He happily did so, and based on his experience introduced some of the changes of his semi-flipped classroom into the new course. The students in this course were slightly younger and had not been exposed to education in biomedical sciences. To the teacher’s surprise, the students showed a lot of resistance to change. The sessions moved slowly, the test scores were not all that good, and students did not reach the expected outcomes. It was clear that the teacher and the students were going through a period of considerable stress, while adapting to the new model. Students and teachers worked hard but the results did not improve at the expected rate.

Some time ago this was my experience and as I wandered looking for solutions, I started to question the benefits of active learning and the role of stress in educational practice.

Advantages and challenges of active learning

Evidence says that active learning significantly improves student outcomes (higher grades and lower failure rates) and may also promote critical thinking and high level cognitive skills (1, 2). These are essential components of a curriculum that attempts to promote professionalism. However, it may be quite problematic to introduce active learning in settings in which professors and students are used to traditional/passive learning (2).

Some of the biggest challenges for teachers are the following:

  • To learn about backward design of educational activities
  • To think carefully about the expected accomplishments of students
  • To find an efficient way to evaluate student learning
  • To spend the time finding the best strategies for teaching, guiding, and evaluating students.
  • To recognize their limitations. For example, it is possible that despite their expertise, some teachers cannot answer the students’ questions. This is not necessarily bad; in fact, these circumstances should motivate teachers to seek alternatives to clarify the doubts of students. At this point, teachers become role models of professionals who seek to learn continuously.
  • To learn about innovations and disruptive technologies that can improve the teacher role.

Some of the challenges for students include:

  • Understanding their leading role in the learning process
  • Working hard but efficiently to acquire complex skills
  • Reflecting on the effectiveness of their learning methods (metacognition). Usually reading is not enough to learn, and students should look for ways to actively process the information.
  • Trusting (critically) on the methods made available by the teachers to guide their learning. For example, some tasks may seem simple or too complex, but teachers have the experience to choose the right methodology. A work from our team showed that strategies that seem very simple for the student (clay modeling) have a favorable impact on learning outcomes (3).
  • Seeking timely advice and support from teachers, tutors and mentors.

Working to overcome these challenges may generate a high level of stress on students and teachers. Without emphasizing that stress is a desirable trait, I do find that some disturbance in the traditional learning process and risk taking motivate teachers and students to improve their methods.

Intermediate disturbance hypothesis and stress in education

In the twentieth century, the work of Joseph H. Connell became famous for describing factors associated with the diversity of species in an ecosystem (4). Some of his observations were presented in Charles Duhigg’s book “Smarter Faster Better” which discusses circumstances related to effective teamwork (5). Duhigg reports that Connell, a biologist, found that in corals and forests there might be patches where species diversity increases markedly. Curiously, these patches appear after a disturbance in the ecosystem. For example, trees falling in a forest can facilitate the access of light to surface plants and allow the growth of species that otherwise could not survive (5). Connell’s work suggests that species diversity increases under circumstances that cause intermediate stress in the ecosystem. In situations of low stress, one species can become dominant and eradicate other species, whereas in situations of high stress, even the strongest species may not survive. But if, an intermediate stress where to appear, not very strong and not very weak, the diversity of species in an ecosystem could flourish.

I propose that the hypothesis of the intermediate disturbance can also be applied in education. In traditional learning, an individual (ecosystem) learns to react to the challenges presented and develops a method for passing a course. In situations of low stress, memorization (evaluated at the lower levels of Miller´s pyramid) may be enough to pass a course. In high stress level situations, students may drop out or feel inadequate. However, courses that involve active learning may include moderate challenges (intermediate disturbance). These well-managed challenges can motivate the student to develop more complex skills (diversity of species) that lead to effective learning and a broader professional development.

 

 

 

 

 

 

 

 

 

Figure 1. Intermediate disturbance hypothesis in education.

 

In the book “Problem-based learning, how to gain the most from PBL”, Donald Woods describes the challenges and stresses associated with the incorporation of active learning (PBL) in a curriculum (6). He describes the stages of grief that a student (and I add, a teacher) must go through while adapting to the new system. This adaptation can take months and generally is characterized by the following phases:

  • Shock
  • Denial
  • Strong emotion (including depression, panic and anger)
  • Resistance to change
  • Acceptance and resignation to change
  • Struggle to advance in the process
  • Perception of improvement in the expected performance
  • Incorporation of new habits and skills to professional practice

 

 

 

 

 

 

 

 

 

Figure 2. Performance adjustment after curricular changes. Adapted and modified from (6).

 

Properly managing stress and finding strategies to advance in the process are rewarded by achieving better performance once the students become familiar with the new method of active learning. However, to better adapt to curricular or pedagogical changes, it is important for all the education actors to recognize the importance of deliberate work and to have clear goals. In addition, students and teachers should have access to institutional strategies to promote effective time, and anger and frustration management.

Stress is not ideal, but some stress may motivate students and teachers to reevaluate their methods and ultimately work together for a classroom focused on professional excellence. The critical question is how big is the intermediate disturbance needed to improve learning outcomes. As is commonly concluded in papers, more research is needed to answer this question, and we can learn a lot from the theories and methods from our colleagues in Biology.

References

  1. Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, et al. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A. 2014;111(23):8410-5.
  2. Michael J. Where’s the evidence that active learning works? Adv Physiol Educ. 2006;30(4):159-67.
  3. Akle V, Pena-Silva RA, Valencia DM, Rincon-Perez CW. Validation of clay modeling as a learning tool for the periventricular structures of the human brain. Anat Sci Educ. 2017.
  4. Connell JH. Diversity in Tropical Rain Forests and Coral Reefs. Science. 1978;199(4335):1302-10.
  5. Duhigg C. Smarter Faster Better: Random House; 2016.
  6. Woods DR. Problem Based Learning: How to gain the most from PBL. 2nd. ed1997.
Ricardo A. Peña-Silva M.D., PhD is an associate professor at the Universidad de los Andes, School of Medicine in Bogota, Colombia, where he is the coordinator of the physiology and pharmacology courses for second-year medical students. He received his doctorate in Pharmacology from The University of Iowa in Iowa City. His research interests are in aging, hypertension, cerebrovascular disease and medical education. He works in incorporation and evaluation of educational technology in biomedical education.

He enjoys spending time with his kids. Outside the office he likes running and riding his bicycle in the Colombian mountains.

Teaching Physiology in an Integrated Curriculum

Culmination of the 2016-17 academic year allows time for reflection and planning for the next year.   This past academic year, I was involved in the delivery of a new medical curriculum to an inaugural class of osteopathic medical students.   In keeping with current medical education trends, physiology and all other basic sciences were integrated throughout the year in individual systems based courses.  It is against this backdrop that I have decided to share a few observations and offer a few suggestions on delivering physiology content in a completely integrated teaching environment.

 

  • Delivery of an integrated curriculum is very time intensive for faculty. The idea of incorporating the teaching of anatomy, biochemistry, cell biology, physiology and microbiology/immunology of an organ system in a single course is conceptually attractive and to many medical practitioners the best way to educate the next generation of physicians.   Curricular challenges center on time limitations and the blurring of boundaries between the basic science disciplines.  Successful courses result when faculty are able to connect relevant information.   For example, my preparation for classroom discussions involved gaining an awareness of what was being taught in other disciplines and to incorporate appropriate synergies with the teaching materials developed by my colleagues in other disciplines.   The challenge was not to re-teach material.
  • Learning for the majority of students is not integrative. The development and delivery of an interdisciplinary integrated curriculum does not instantly result in students who are higher order problem solvers.   Learning is sequential, iterative, and cumulative.   Integration of concepts takes time and a firm foundation.   Guiding students along towards higher learning dimensions requires careful planning on behalf of the educator and can be accomplished through various pedagogical approaches.  Central to any approach should be basic questions for the educator to consider such as: 1) What is/are the basic fact(s) that the student should know? 2) Why does the student need to know this particular material?  and 3) How will the particular material be used in the problem solving process?   The answers to these and similar questions should then be used to introduce material in the classroom environment that keeps study groups discussing content after the session ends.
  • The true effectiveness of an integrated systems based curriculum should be measured by assessments that include questions designed specifically to high levels of integration. Data from both multidisciplinary and comprehensive formative as well as summative assessment instruments will provide a basis for future curricular decisions.

In the preceding discourse I have attempted to share a few views based on a year long teaching experience in a systems based medical curriculum.   My overall impression is that an integrated curriculum is a great way to teach physiology.   I also have learned that I am at the beginning of a new teaching journey that is sequential, iterative, and cumulative.   Sound familiar?  In preparation for next year, I know what I will be doing this summer to refine my previous year’s work in ways that facilitate student learning next year.    I am sure that I am not alone and wish you the best for a productive summer.

Joseph N. Benoit, PhD is Professor of Physiology and Director of Research & Sponsored Programs at the Burrell College of Osteopathic Medicine.   He has served in various higher education positions over the past 30 years including faculty, graduate school dean, college president and most recently founding faculty at a new medical school.   His current scholarly interests center on student learning, curriculum development, and regulatory compliance.  He lives and works in Las Cruces, NM.
Boredom, the Evil Destroyer of Motivation vs. Inquiry, the Motivation Maker

Students have an innate desire to learn and more learning takes place when doing rather than when listening. (4)  This begins in pre-school and kindergarten when children have fun while learning by playing with blocks, coloring, drawing, etc.  This is their first experience with active learning.  But then as education progresses through grade school, high school and college, something bad happens.  That is, fun learning activities are slowly replaced with often very boring listening activities filled with inane factoids, and consequently, students often become disinterested.  The disinterest is seen in the form of poor class attendance, and the lack of motivation is palpable through continual yawns, bobbing heads, and walking to the back of the classroom and looking at student laptops to see how many are streaming Netflix or shopping for shoes.  As educators that take part in this process, we actively destroy their innate desire to learn.  We do not do this intentionally, as all of us want our students to learn as much as possible.  However, with the ever increasing and endless mountain of information, we cannot teach them everything, and often feel that we should be actively teaching, rather than letting them actively learn. (3)  Thus, after hours, days and years of sitting in class “listening”, the traditional “sage on the stage” can slowly chip away at the inner desire to learn.  But, if this internal motivation can be decreased by boring activities, can it also be increased by fun or intriguing activities?

 

As educators, we hold an awesome power that has the potential to inspire and increase student motivation.  Student-centered learning activities that include but are not limited to collaborative group testing, inquiry-based learning, team-based learning and laboratory exercises (5) provide students with the opportunity to apply their minds, to have fruitful discussions with their peers (2) and to see and appreciate the complex beauty that science and medicine are.  If we can provide our students with learning activities that open their imaginations and make them feel excitement, we can actively increase their innate desire to learn, and improve their chances of success. (1)  In doing so, the awesome potential power that we hold can become fully realized in the form of life-long learners.

 

References

  1. Augustyniak RA, Ables AZ, Guilford P, Lujan HL, Cortright RN, and DiCarlo SE. Intrinsic motivation: an overlooked component for student success. Adv Physiol Educ 40: 465-466, 2016.
  2. Cortright RN, Collins HL, and DiCarlo SE. Peer instruction enhanced meaningful learning: ability to solve novel problems. Adv Physiol Educ 29: 107-111, 2005.
  3. DiCarlo SE. Too much content, not enough thinking, and too little fun! Adv Physiol Educ 33: 257-264, 2009.
  4. Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, and Wenderoth MP. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A 111: 8410-8415, 2014.
  5. Goodman BE. An evolution in student-centered teaching. Adv Physiol Educ 40: 278-282, 2016.

 

 

Robert A. Augustyniak is an Associate Professor and Physiology Discipline Chair at Edward Via college of Osteopathic Medicine- Carolinas Campus, Spartanburg, SC. Rob received his Ph.D. in Physiology at Wayne State University School of Medicine, Detroit, MI, and subsequently completed a post-doctoral fellowship at the University of Texas Southwestern Medical Center, Dallas, TX. A cardiovascular physiologist by training, his studies have focused on the blood pressure regulation during exercise and in heart failure and hypertensive states. In 2009, Rob became a founding faculty member at Oakland University William Beaumont School of Medicine where he began to focus on the scholarship of medical education. These research interests continued to grow when he moved to Spartanburg, SC in 2013. He is profoundly interested in how medical student motivation impacts learning and in finding best practices in teaching and assessment that can increase motivation. For the past several years, he has been and continues to be active within the leadership of the APS Teaching Section.

Putting More Physiology into A & P

thinker-28741_640It’s tough being an undergrad student nowadays.  It’s expensive. State funding has cut into the budgets that used to go to offset tuition, and buildings for new classrooms have been on hold forever. Still they keep coming, paying higher and higher fees and tuition, crowded into larger and larger classroom sizes, getting shut out of labs: these are just the surface to larger problems in general. What kind of education are students getting now?  I ponder this as I teach A & P again after teaching physiology at a medical school for the last six years and A & P in smaller class sizes four years before that at universities and community colleges. Things have changed, and not for the better.  I’ll toss around some ideas that may or may not resonate with you, but these are things I feel we need to improve upon.

 

  1. How can we get class sizes smaller so we can teach and communicate? The depth of what students know goes not far beyond binge and purge. We can have small group discussion, more TBL and other models for active learning (if they read the pre-class material) and we’ll always have the good students, but for many lectures have become something to avoid. I get students who ask for my PPTs beforehand and use them as note templates, yet many rely on those as a sole source. The chances to integrate material become less frequent as we teach to the room and decrease the amount of material students can absorb. The long term rewards to learning are not being reinforced. I have students submit corrections for points in paragraph form, making them compose answers.

 

  1. Students need learning skills. Something I learned the hard way, but even in the prehistoric 1970’s note taking was essential. I implore students to do this as a way to create schemas even providing handouts with study skills that I have collected over the last thirty years. Of course the good students use this info, while the middle of the packers might but only after the first exam. We have more students who are being advised that health professions are good careers but not telling them how steep the competition is and how much is expected. Do I want an ED nurse who might forget that NaCl is not the same as KCl? Maybe I don’t have to weed them out, but I want their expectations to be parallel to the challenge and this should be considered the beginning of their career.

 

  1. Lastly, I propose perhaps a new approach to A & P; let’s separate the classes. Some institutions do this having advanced anatomy and general physiology classes for exercise science, why not do these for pre-health majors as well? The texts nowadays for A & P are humongous, with tons of information that skims the surface without enough integration. Let’s teach physiology with a chance to do more hands-on experiments and not have lab just being anatomy. I poll my students about whether they have seen frog muscle or heart experiments or any Mr. Wizard styled presentations. Few have, maybe from the more affluent secondary schools, therefore descriptions of diffusion or tetanus become an abstraction without the physical connection. They do ECGs and FEV1s in the second half of A & P, why not have that be the whole year?

 

Personally my career in physiology began when I walked into a behavioral neuroscience lab and ran my own independent study experiments for undergrad credit, all the while learning about the other research going on. I was happy that one of my biology students worked over the summer on an Integrative and Organismal NSF summer fellowship (that I know from my APS Porter Committee membership go underutilized) because statistics show that these students will go on in science.  I’d like to see our future caregivers have that depth as well.

 

johnson
 

 

 

William Johnson received his Master degree in Education from Johns Hopkins University in 1990. After teaching high school on the Dine reservation, he then pursued and obtained his PhD in Biology from Northern Arizonan University, studying angiotensin in desert anurans. After teaching physiology at University of South Florida Colleges of Public Health and Medicine, William has returned to his alma mater to teach anatomy and physiology and human physiology, as well as being involved in the summer program for Journey for Underrepresented in Medical Professions HRSA grant at NAU.

 

Description of an Innovative Undergraduate Human Biology Program

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The series of PECOP blogs has provided many examples of the positive changes that biology educators are making in what we teach and how we facilitate student learning. I would like to share a new program that was developed by a faculty team at Bastyr University.

We responded to the call for changes in biology education by developing an undergraduate program in integrated human biology that was launched in 2012. We used backwards design and competencies recommended in Scientific Foundations for Future Physicians: Report of the AAMC-HHMI Committee as a foundation to develop a progressive, premedical curriculum. The program competencies also align well with the AAAS/NSF Vision and Change core concepts and competencies. The IHB program competencies are listed in Table 1. We are continuing to use the program competencies and PULSE Vision and Change rubrics in our work to improve assessment at both the course and program level.

Table 1. Integrated Human Biology Program Competencies
Use mathematics and quantitative reasoning appropriately to describe or analyze natural phenomena.
Demonstrate understanding of the scientific process and describe how scientific knowledge is developed and validated.
Demonstrate understanding of basic physical principles and apply these principles to living systems.
Demonstrate understanding of basic principles of chemistry and apply these principles to living systems.
Demonstrate knowledge of how the 4 categories of biological molecules contribute to the structure and function of cells.
Demonstrate an understanding of the link between structure and function at all levels within a living organism: molecular, microscopic, and macroscopic.
Explain how internal environments are maintained in the face of changing external environments.
Demonstrate an understanding of the theory of evolution by natural selection.
Demonstrate an understanding of the biological basis for human behavior.
Demonstrate an understanding of the connection between the human organism and the biosphere as a whole.
Communicate effectively within and between scientific disciplines and with nonscientists.

Integrated Human Biology Program Highlights

  • The program includes a series of integrated human biology courses that require that students apply core concepts at multiple levels of complexity from cell and molecular to organismal in the context of organ systems.
  • Students are also required to apply physical principles from physics courses to biological systems in the integrated human biology series and through a parallel biophysics series.
  • The curriculum includes a required bioethics course and elective courses that require students to examine the applications of science to world problems.
  • Courses are team-taught by a group of faculty from different sub-disciplines who collaborate to create course materials and exams.
  • Classes are organized so that students are active participants.
  • Competencies are assessed in courses in a variety of ways including projects, presentations, papers, and exams.
  • All laboratories require students to participate in inquiry-based activities.
  • A majority of IHB students have completed a research project and presented their work at a University Research Symposium.
  • Student surveys have demonstrated that students appreciate the integrated approach to learning.
  • The first class graduated from the program in 2014, and a majority of those students have entered medical school or are working in research.

Have you developed or revised a program or curriculum in response to initiatives aimed at improving life sciences education?  Please share your experiences and recommendations.

Lynelle Golden is Goldena broadly trained physiologist who currently serves as Professor and Dean of the School of Natural Health Arts and Sciences at Bastyr University near Seattle Washington. She has more than 20 years of experience teaching junior/senior level physiology for biology majors and anatomy and physiology for allied health, nutrition and exercise science students. Her experience at Bastyr also includes teaching integrated case studies and physiology courses for medical students. While at Bastyr, Lynelle has been actively involved in curriculum development and revision. She has been a member of the teaching section of the American Physiological Society since 1986, and she currently serves as Chair of the Programming Committee for the APS Teaching Section. Lynelle earned an M.S. and a PhD in Life Sciences/Physiology from the University of Tennessee, Knoxville, and she completed postdoctoral research in Cardiovascular Diseases at the University of Alabama at Birmingham.