Category Archives: engagement

The Great Student Disengagement

With excitement and anticipation for a “return to normal,” faculty, staff and administrators were especially excited to launch Spring semester 2022.  People were vaccinated, students would be attending class with their peers on campus, and extracurricular activities would return to campus. However, it was soon discovered that a return to campus would not mean a return to “normal.”

In addition to the period of “great resignation” and “great retirement,” we soon discovered that a return to campus could be described as the “great student disengagement.”  Faculty observed concerning student behaviors that impacted academic success. Students on our campus have been vocal about their desire to remain at home and on MS TEAMS/ZOOM©. Classroom sessions were required to shift and were often a mixed modality (high flex) as students and faculty underwent COVID protocols that required remote attendance. In a curriculum in which all sessions are mandatory (approximately 20 hours each week in a flipped environment), students requested far more absences in the spring semester than ever before. Even when students were physically present in class, blatant disengagement was observed by faculty.  Attempts to appeal to students’ sense of responsibility and professionalism had little impact in changing behavior.

In attending the Chairs of Physiology meeting at Experimental Biology (EB), student disengagement was an impactful topic of discussion. Somewhat surprisingly, it quickly became apparent that the environment on our campus was somewhat ubiquitous across all institutions of higher education represented in the room that day. Although we shared similar observations, few potential solutions were offered.

Serendipitously, on the final day of EB meetings, the Chronicle of Higher Education published an article by Beth McMurtrie titled “A Stunning Level of Student Disconnection.”  The article shared insight gained from faculty interviews representing a wide range of institutions:  community colleges, large public universities, small private colleges, and some highly selective institutions. Ms. McMurtrie shared stories of faculty who described how students’ brains are “shutting off” and limiting their ability to recall information. The article reports that far fewer students show up to class, those who do attend often avoid speaking, and many students openly admit that they do not prepare for class or complete assignments. Faculty commonly described students as defeated, exhausted, and overwhelmed.

Although specific causes of the “great student disengagement” have not been substantiated, many believe it is the after-math of the pandemic. It seems plausible that the learning environment became more individualized and flexible with fluid deadlines and greater accommodations during the pandemic. Thus, a return to normal expectations has been difficult.

It also seems reasonable that amid the more pressing issues of life (deaths within families, financial struggles, spread of disease), students are reporting high levels of stress, anxiety and general decline in mental health. Perhaps being absent or disengaging while in class (being on cell phones/computers, frequently leaving the room) are simply avoidance mechanisms that allow the student to cope.

Although post pandemic conditions have brought student disengagement to our awareness, some faculty have seen this coming for years.  In a 2020 Perspectives on Medical Education article by Sara Lamb et al. titled “Learning from failure: how eliminating required attendance sparked the beginning of a medical school transformation,” the authors reported low attendance rates, at times as low as 10%, which they attempted to fix with a mandatory attendance policy.  However, over the next six years, student dissatisfaction rose due to the inflexible and seemingly patronizing perception of the policy. This led students to strategize ways to subvert the policies while administration spent significant time attempting to enforce them.  To address the situation, the school transitioned away from required to “encouraged” and “expected” for learning activities.  This yielded both positive and negative results, including but not limited to: increased attendance to non-recorded activities which students deemed beneficial to their learning; reduced attendance to activities that were routinely recorded and posted leading to increased faculty discouragement; reduced administrative burden and tension; and increased student failure rate and feelings of isolation and loneliness.  The authors go on to describe efforts to mitigate the negative outcomes including empowering faculty with student engagement data, and training in active learning pedagogies to enhance student engagement.

As the definitions and root causes of student disengagement pre-date COVID and are somewhat ambiguous, finding effective solutions will be difficult. Perhaps the rapid evolution of teaching and learning brought about by COVID now dictates an evolution of the academic experience and the rise of scholarly projects to address both causes and solutions.

Suggestions on solving the disengagement crisis were published by Tobias Wilson-Bates and a host of contributing authors in the Chronicle of Higher Education dated May 11, 2022. Although we will leave it up to the reader to learn more by directly accessing the article, a list of topics is helpful to recognize the variety of approaches:

  1. Make Authentic Human Connections
  2. Respect Priorities
  3. Provide Hope
  4. Require Student Engagement
  5. Acknowledge that Students are Struggling
  6. Fight Against Burnout

Although we rely on faculty to address student disengagement, it is also useful to consider the stressful environment of faculty. In addition to experiencing the same COVID conditions that students experience, faculty are being asked to continue to provide up-to-date content, utilize engaging teaching modalities, become skillful small group facilitators, as well as advise, coach and provide career counseling.  It is perhaps not surprising that faculty may also feel stressed, isolated, and burned out, surmising that nothing they do makes much difference – opting instead to remain hopeful that students will bounce back.

Regardless of the learning environment on your campus, it is safe to say that now is the time to come together as faculty, students and administrators to discuss the best path forward. Collectively we can work together to set solutions into motion and gather evidence for our effectiveness. It is time to leverage our shared experiences and lessons learned over the past several years of transitioning away from and back into face-to-face classroom instruction. Such reflection and study will support teaching and learning as we all seek to find a “new normal” that meets the needs of students, faculty, and administration alike.

Lamb, Sara & Chow, Candace & Lindsley, Janet & Stevenson, Adam & Roussel, Danielle & Shaffer, Kerri & Samuelson, Wayne. (2020). Learning from failure: how eliminating required attendance sparked the beginning of a medical school transformation. Perspectives on Medical Education. 9. 10.1007/s40037-020-00615-y.

A Stunning Level of Student Disconnection  https://www.chronicle.com/article/a-stunning-level-of-student-disconnection

How to Solve the Student Disengagement Crisis https://www.chronicle.com/article/how-to-solve-the-student-disengagement-crisis

 

Mari Hopper, PhD, is an Associate Dean for Pre-Clinical Education at Ohio University Heritage College of Osteopathic Medicine where she facilitates the collaboration of faculty curricular leadership and their engagement with staff in curricular operations.  Dr Hopper’s areas of professional interest include curricular development, delivery and management; continuous quality improvement including process efficiency and the development of positive learning environments and work culture; and mentorship of trainees in medical education.
Leah Sheridan, PhD, is a Professor of Physiology Instruction at Ohio University Heritage College of Osteopathic Medicine where she serves in curriculum innovation, development and leadership. Dr. Sheridan’s areas of professional interest include the scholarship of teaching and learning, physiology education, and curriculum development.
Don’t Panic!

I write this post at the end of my career in UK higher education (HE) and it was suggested that I reflect on how the sector (in the UK at least) has changed since the early 1990s? For weeks, nothing grabbed me. Completely unrelated to this brief, and for pleasure (much under-rated), I revisited the late Douglas Adams’ Hitch-hiker’s Guide to the Galaxy (H2G2) and to my surprise these two threads – my lived experience of UK HE and the imaginary world of H2G2 – have emerged from my subconscious as a couple of rather bizarre waking dreams. These dreams have provoked me to reflect broadly on education, particularly on HE.  Anyone familiar with H2G2 might comment that the eve of retirement is rather late in the day to start thinking about education. They would be right!

I’ve borrowed more than my title from the H2G2; ‘Don’t Panic’ being ‘written in large friendly letters’ at the start of eponymous guide. In H2G2, the Earth (and everything on it) was a computer tasked with finding the question to which the answer was 42.  My task here is to imagine the question to which the answer is education.  Ever since I revisited H2G2 I’m haunted by the thought that we are to the development of education as those who set out in the B Ark were to the development of the wheel (all thought of shape was subdued whilst they argued over what color it should be).  In my waking dreams, I was tasked with explaining what we were doing (in university education) to several key educational figures from my mind’s limited databank: Aristotle; John Ruskin; and John Dewey.  My surprise that Aristotle spoke flawless English aside, I was struck by their puzzled looks and their questions. My abiding impression was that my imaginary visitors believed that I had something in common with the B Ark architects of the wheel; we were both confidently and blissfully clueless. From that moment I’ve been wondering if we have become lost or confused and that we no longer serve society well.

I want you to stop reading for a second and reflect on what you understand by the suitcase term, ‘education’. What is the purpose of education; what is its role in society?

I think it’s necessary to point out that education changes over time; it evolves, not in a Darwinian sense, but by episodes of what we fervently hope turns out to be intelligent design.  So, what is ‘education’? What does it require or imply?  How was education regarded in the past?

In antiquity, education was not made available to all, but its value was clearly appreciated as shown by Aristotle’s assertion that

a man should be capable of engaging in business and war, but still more capable of living in peace and leisure; and he should do what is necessary and useful, but still more should he do what is noble. These then are the aims that ought to be kept in view in the education of the citizens both while still children and at the later ages that require education.’  (Rackham, 1944; book 7, sections 1333a and b).

The key point, for me, is that education should encourage citizens to ‘do what is noble’. In today’s parlance that means to have high moral principles (to include honesty, integrity and generosity).

By the early 20th century, education was becoming more technical but the capacity for critical analysis in the service of judgment was clearly valued, as illustrated by John Dewey, who suggested that education provided one with the tools for analysis and interpretation necessary for intelligent action (Dewey, 1938; pages 105-6). It was also Dewey who crystalised a view that, for me, comes closest to defining the value of education to any modern [democratic] society. In ‘Moral Principles in Education, Dewey argued that education should develop in all citizens what he termed ‘force of character’, elements of which he listed as ‘initiative, insistence, persistence, courage, and industry’. (Dewey, 1909, page 49)

Because I think it is justified, I’ll give a little more room to Dewey’s conception of education. In Democracy and Education, Dewey asserts that a society’s values and beliefs are communicated from generation to generation through education (Dewey, 1916, page 17).  Dewey is by no means alone in believing that education has a special role in any modern society; education, in a very real sense, is the means by which the knowledge, wisdom and values of a society are shared with successive generations (to be adopted, adapted or rejected). For this reason, I regard education as the most important responsibility of a society.

Dewey was nevertheless concerned by the relative neglect of wider societal concerns within the context of education, and this was voiced by non-other than President Franklin Roosevelt, who claimed that

There is not in all America a more dangerous trait than the deification of mere smartness unaccompanied by any sense of moral responsibility’.  (Roosevelt, 1903).

I confess that since reading Roosevelt’s assertion, I see little evidence that we still make a virtue of ‘moral responsibility’ in UK HE. There clearly are groups of people (often young) who are highly motivated by ethical and moral issues (e.g. climate activism) and too often they are not supported by the generation with the power and influence to effect change. In contrast to the student-led activism of the 1960s, Universities in recent years don’t seem to foster the same degree of critical thought and action.  Perhaps there are just too many issues?

As our society has become more complex, the interdependence on others felt by anyone with sufficient money to pay rent, buy food and stay warm has become less visible. Moreover, the huge financial incentives for those who increase profits (or influence public opinion) seems to erode the notion of societal value in favour of personal enrichment, as outlined in Mark Carney’s 2020 BBC Reith Lectures and in the 2016 Netflix documentary, The Great Hack. In consequence, it might be argued that focusing only on technical education goals and ignoring the development of societal values is reckless in the extreme. With luck, humanity will persist and so observe our present with the benefit of hindsight; with the perspective to judge the merits of this concern.

As I said at the outset, I write this at the end of my career in HE. What changes have I witnessed?

Despite believing with every fibre of my being that I’m right (see cognitive bias), I should acknowledge that the changes I describe might be more imaginary than real. The last two years of COVID-19 imposed change notwithstanding, not much has changed if one were to judge only on the movements of people from room to room, or the movements of the written word between students and educators. Lectures persist, as does laboratory work, small group teaching and a myriad of assessments.  What has changed in 35 years might appear more or less trivial; changes in the methods of presentation (chalk for computer graphics, with and without recordings) and notetaking (transcribed on paper or a tablet, or annotation of pre-circulated presentations). The point is that the activities appear to have undergone only a minor technical evolution, far short of a revolution. I would argue that appearances can be deceiving. In my opinion, several factors account for subtle but important changes in the process of education. My top three are 1) information overload, 2) marketisation of education and 3) intellectual isolation.

Information overload has at least two dimensions, first, we have more detailed knowledge of the cellular and molecular basis of biomedical science. Mastery of the additional detail imposes greater demands on the same educational window of opportunity. Second, there has been a proliferation of information sources that are readily available via a browser. Many of these information sources attempt to simplify the complex and some introduce substantial errors that are often not obvious to the learner. When simplifying the complex, we should make the effort to explain the unavoidable risks inherent in all simplification.

The marketisation of HE was intended to bring about the same sorts of improvements and efficiencies as seen in manufacturing and service industries (Molesworth, et al 2010). In the UK this has coincided with substantial expansion of student numbers, increasing the staff:student ratio. In practical terms, the competing needs for research outputs (in most HEIs) and student (customer) satisfaction is an equation that can only be balanced by extracting more from staff who teach and conduct research.  Despite the reports of higher workloads in HE, there is a reduced opportunity for dialogue between educators and students – there is finite supply of time and a larger number of calls on our time. Larger numbers of students is a relatively minor factor in the increased consumption of staff time – most staff report substantial increases in administration relating both to research and to teaching.

Intellectual isolation seems somewhat unlikely given the much-vaunted power of social media to ‘connect people’ and yet even those most closely aligned with social media are dubious of its merits. It is possible for students to have access to a million points of view without discussing them in any meaningful way. How does one properly evaluate the evidence for so many opinions without the combination of many minds and the probing power of discussion? It is relatively easy to find an information source that confirms our bias and which we, therefore, immediately recognise as right-thinking and entirely reasonable, regardless of what it might be that we believe. The emergence of a rainbow of myths and wisdom regarding effective treatment (or prevention) of COVID-19 infection over the last two years surely demonstrates this to be true.

Am I optimistic for the future?  Yes. Innovation in society is a lot like an experiment in nature, even if the innovation were the result of intelligent design. If it is seen to be beneficial, it will be retained and propagated.  If it is not beneficial it might persist but is unlikely to propagate.  If it is harmful, the harm will (eventually) be recognised and steps taken to discourage what the innovation initially encouraged. Child-labour and tobacco smoking are very conspicuous examples, but there many such examples in our collective histories. That said, the damage done can sometimes persist and things that cause harm in the long-term seem to be tolerated if short-term effects are positive (think alcohol and sugar).

So, what sort of steps could we take? Information overload could be reduced if what is expected of an undergraduate degree is re-imagined.  We might do better to focus on how to pare away unnecessary detail to find the key issues and to then frame good questions for further [curious and creative] thought or research. Marketisation within HE has been a creeping cancer (my view) and the solution will require surgery – all other treatment choices are palliative! Making the university system into an industry that has no aspiration beyond expansion has been a foolish experiment. The university system needs to be regarded by everyone as a social good, regardless of one’s personal interaction with it.  Intellectual isolation can be reduced in a host of ways. In the 1999 work, ‘Seven complex lessons in education for the future’, the French philosopher Edgar Morin (now 100 years old), argues that the development of separate scientific disciplines was closely linked to information overload – the human mind was too limited – and that despite advances, this isolation ultimately limits understanding and stifles innovation. The recent emergence of cross-disciplinary teaching and research is a move in the right direction.

More generally, I believe it would benefit society if we could make a virtue of exploring the choices we’ve made in the past and how well our current choices fit our society for the future. When economies were mainly local, interests could be local but as the developed countries now operate in a global market economy, our interests must be similarly global; we can’t pretend otherwise and to try is to gamble everyone’s future. A democracy can’t be led honestly if the population is ignorant of factors that make difficult change necessary (political parties would use public ignorance to manipulate opinion and voting habits). I’d like to see society (through education) champion wisdom and integrity rather more enthusiastically and perhaps we should all try to go to sleep behind Rawls’ veil of ignorance – not knowing the colour of our skin, our gender or our place in society when we wake the next day. Afterall, you never know whether the Earth will still exist tomorrow![1]

 

References (not included as in text hyperlinks)

Dewey, J. (1909). Moral Principles in Education. Riverside Press, Section V – The psychological aspect of moral education, page 49; https://www.gutenberg.org/files/25172/25172-h/25172-h.htm

Dewey, John. (1938). Experience and education. New York: Macmillan. Pages 105-106

Dewey, J. (1916). Democracy and education. Project Gutenberg. https://www.gutenberg.org/files/852/852-h/852-h.htm#link2HCH0002 – Chapter 2: Education as a Social Function, page 17

Molesworth, M., Scullion, R., & Nixon, E. (Eds.). (2011). The marketisation of higher education and the student as consumer. London: Routledge.

Rackham, H. (Harris), 1868-1944, trans.: Politics, by Aristotle (HTML at Perseus, Aristot. Pol. 7.1333a/b)

Roosevelt, T. (1903, May 2). Speech of President Roosevelt at Abilene, Kansas, May 2, 1903. Theodore Roosevelt Papers. Library of Congress Manuscript Division. Retrieved from https://www.theodorerooseveltcenter.org/Research/Digital-Library/Record?libID=o289769

[1] In H2G2 the Earth was demolished by aliens only minutes after humanity became aware that aliens existed.

Phil Langton is a senior lecturer in the School of Physiology, Pharmacology and Neuroscience, University of Bristol, UK.  A biologist turned physiologist, he worked with Kent Sanders in Reno (NV) and then with the late Nick Standen in Leicester (UK) before moving to Bristol in 1995.  Phil has been teaching respiratory and GI physiology for vets, nerve and muscle physiology for medics and cardiovascular and respiratory physiology for physiologists. He also runs a series of units in the second and third (final) years that are focused on the development of soft (but not easy) skills.  He has been interested for years in the development of new approaches to old problems in education.
The Olympics, sex, and gender in the physiology classroom

Are there sex based difference in athletic performance before puberty?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

  1. Lavietes M. (April 13, 2022) Kentucky Legislature overrides governor’s veto of transgender sports ban [online]. NBCNews.com  https://www.nbcnews.com/nbc-out/out-politics-and-policy/kentucky-legislature-overrides-governors-veto-transgender-sports-ban-rcna24303 [Accessed April 20, 2022]
  2. Barnes K.  (March 17, 2022)  Amid protests, Penn swimmer Lia Thomas becomes first known transgender athlete to win Division I national championship. [online]. espnW.com. https://www.espn.com/college-sports/story/_/id/33529775/amid-protests-pennsylvania-swimmer-lia-thomas-becomes-first-known-transgender-athlete-win-division-national-championship [Accessed April 20, 2022]
  3. Ellingworth J, Ho S.  (August 2, 2021) Transgender weightlifter Hubbard makes history at Olympics. [online]. APNews.com https://apnews.com/article/2020-tokyo-olympics-sports-weightlifting-laurel-hubbard-e721827cdaf7299f47a9115a09c2a162 [Accessed April 20, 2022]
  4. Morton V.  (June 3, 2019)  CeCe Telfer, Franklin Pierce transgender hurdler, wins NCAA women’s national championship [online]. Washingtontimes.com  https://www.washingtontimes.com/news/2019/jun/3/cece-telfer-franklin-pierce-transgender-hurdler-wi/ [Accessed April 20, 2022]
  5. Yurcaba C.  (January 22, 2022) NCAA’s new trans athlete guidelines sow confusion amid Lia Thomas debate [online]. NBCnews.com https://www.nbcnews.com/nbc-out/out-news/ncaas-new-trans-athlete-guidelines-sow-confusion-lia-thomas-debate-rcna13073 [Accessed April 20, 2022]
  6. Nair A, Nair R, Davis T.  (April 8, 2022) Transgender women unable to compete in British Cycling events as policy suspended [online]. Reuters.com https://www.reuters.com/lifestyle/sports/british-cycling-suspend-transgender-participation-policy-2022-04-08/[Accessed April 20, 2022]
  7. Brown G. (August 18, 2021). The Olympics, sex, and gender in the physiology classroom [online].  PECOP Blog. https://blog.lifescitrc.org/pecop/2021/08/18/the-olympics-sex-and-gender-in-the-physiology-classroom/ [Accessed April 20, 2022]
  8. Ervin RB,  Wang CY, Fryar CD, Miller IM, and Ogden CL. [online] Measures of Muscular Strength in U.S. Children and Adolescents, 2012.  NCHS Data Brief No. 139, December 2013. (https://www.cdc.gov/nchs/products/databriefs/db139.htm; accessed April 6, 2022)
  9. Wells MS, Arthur-Banning SG.  The Logic of Youth Development: Constructing a Logic Model of Youth Development through Sport. J Pakr & Rec Admin.  26: 189-202, 2008
  10. Handelsman DJ. Sex differences in athletic performance emerge coinciding with the onset of male puberty. Clin Endocrinol (Oxf). 87:68-72, 2017
  11. Handelsman DJ, Hirschberg AL, Bermon S. Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance. Endocr Rev. 39:803-829, 2018
  12. Catley MJ, and Tomkinson GR. Normative health-related fitness values for children: analysis of 85347 test results on 9-17-year-old Australians since 1985. Br J Sports Med 47: 98-108, 2013.
  13. Eiberg S, Hasselstrom H, Gronfeldt V, Froberg K, Svensson J, and Andersen LB. Maximum oxygen uptake and objectively measured physical activity in Danish children 6-7 years of age: the Copenhagen school child intervention study. Br J Sports Med 39: 725-730, 2005.
  14. Latorre Roman PA, Moreno Del Castillo R, Lucena Zurita M, Salas Sanchez J, Garcia-Pinillos F, and Mora Lopez D. Physical fitness in preschool children: association with sex, age and weight status. Child Care Health Dev 43: 267-273, 2017.
  15. Tambalis KD, Panagiotakos DB, Psarra G, Daskalakis S, Kavouras SA, Geladas N, Tokmakidis S, and Sidossis LS. Physical fitness normative values for 6-18-year-old Greek boys and girls, using the empirical distribution and the lambda, mu, and sigma statistical method. Eur J Sport Sci 16: 736-746, 2016.
  16. Tomkinson GR, Carver KD, Atkinson F, Daniell ND, Lewis LK, Fitzgerald JS, Lang JJ, and Ortega FB. European normative values for physical fitness in children and adolescents aged 9-17 years: results from 2 779 165 Eurofit performances representing 30 countries. Br J Sports Med 52: 1445-14563, 2018.
  17. Tomkinson GR, Lang JJ, Tremblay MS, Dale M, LeBlanc AG, Belanger K, Ortega FB, and Leger L. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. Br J Sports Med 51: 1545-1554, 2017.
  18. (December 19, 2018)  American Youth Outdoor Track & Field Records.  [online] USATF http://legacy.usatf.org/statistics/records/view.asp?division=american&location=outdoor%20track%20%26%20field&age=youth&sport=TF  (accessed April 20, 2022)
  19. (2022) National Age Group Records [online]. USA Swimming. https://www.usaswimming.org/times/popular-resources/national-age-group-records (accessed April 20, 2022)
  20. Millard-Stafford M, Swanson AE, Wittbrodt MT. Nature Versus Nurture: Have Performance Gaps Between Men and Women Reached an Asymptote? Int J Sports Physiol Perform. 13:530-535, 2018
  21. Levine BD, Joyner MJ, Keith NR,  Bagish AL, Pedersen BK, Schmidt W, Stachenfeld N, Girard O, Nagatomi R, Foster C, Okazaki K, Stellingwerf T, Jiexiu Z, Robson SJ, Bailey DM, Bosch A, Murphy RM, Qiu J, Lollgen H, Mitchell J, Kearney J, Scott JM, Lundby C, Steinacker J, Trappe S, La Gerche A, Masuki S, Roach R, Schneider S, Millet G, Kohrt WM, Roberts WO, Kraus WE, Benjamin HJ, Koning JJ, Gatterer H, Wehrlin JP, Charkoudian N, Lawley JS, Hopman MTE, Hawley J. The role of testosterone in athletic performance. [online] https://web.law.duke.edu/sites/default/files/centers/sportslaw/Experts_T_Statement_2019.pdf (accessed April 6, 2022).
  22. Rey R, Josso N, Racine C. Sexual Differentiation. 2020 May 27. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Online]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905232. (Accessed April 6, 2022)
  23. Sax L. How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 39:174-8, 2002
  24. Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, Giordano D, Cecatti JG, Abdel Aleem H, Talegawkar SA, Benachi A, Diemert A, Tshefu Kitoto A, Thinkhamrop J, Lumbiganon P, Tabor A, Kriplani A, Gonzalez Perez R, Hecher K, Hanson MA, Gülmezoglu AM, Platt LD. The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. PLoS Med. 14:e1002220, 2017
  25. Centers for Disease Control and Prevention.  Clinical Growth Charts  [online] https://www.cdc.gov/growthcharts/clinical_charts.htm; (Accessed April 6, 2022)
  26. Davis SM, Kaar JL, Ringham BM, Hockett CW, Glueck DH, and Dabelea D. Sex differences in infant body composition emerge in the first 5 months of life. J Pediatr Endocrinol Metab 32: 1235-1239, 2019.
  27. Taylor RW, Gold E, Manning P, and Goulding A. Gender differences in body fat content are present well before puberty. Int J Obes Relat Metab Disord 21: 1082-1084, 1997.
  28. Taylor RW, Grant AM, Williams SM, and Goulding A. Sex differences in regional body fat distribution from pre- to postpuberty. Obesity (Silver Spring) 18: 1410-1416, 2010.
  29. Staiano AE, Katzmarzyk PT. Ethnic and sex differences in body fat and visceral and subcutaneous adiposity in children and adolescents. Int J Obes (Lond). 36:1261-9. (2012).
  30. Senefeld JW, Lambelet Coleman D, Johnson PW, Carter RE, Clayburn AJ, Joyner MJ. Divergence in Timing and Magnitude of Testosterone Levels Between Male and Female Youths. JAMA. 324:99-101, 2020
  31. Klaver M, de Mutsert R, Wiepjes CM, Twisk JWR, den Heijer M, Rotteveel J, Klink DT. Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents. J Sex Med 15: 251-260, 2018.
  32. Roberts SA, Carswell JM. Growth, growth potential, and influences on adult height in the transgender and gender-diverse population. Andrology. 9:1679-1688, 2021.
Dr. Greg Brown is a Professor of Exercise Science in the Department of Kinesiology and Sport Sciences at the University of Nebraska at Kearney where he has been a faculty member since 2004. He is also the Director of the General Studies program at the University of Nebraska at Kearney. He earned a Bachelor of Science in Physical Education (pre-Physical Therapy emphasis) from Utah State University in 1997, a Master of Science in Exercise and Sport Science (Exercise Physiology Emphasis) from Iowa State University in 1999, and a Doctorate of Philosophy in Health and Human Performance (Biological Basis of Health & Human Performance emphasis) from Iowa State University in 2002. He is a Fellow of the American College of Sports Medicine and an American College of Sports Medicine Certified Exercise Physiologist.
Developing a Community of Practice in an A&P Course

This blog is about striving to create a Community of Practice (CoP) to engage students in Situated/Social Learning by using Team-based activities and assessments along with the web-based social learning annotation platform, Perusall.

We have all experienced those “Aha” moments when something we were struggling with suddenly becomes clear.  Think back to a time when you experienced real/durable learning.  When I did that, three things popped into my mind:  a hallway discussion in graduate school with classmates in my neurophysiology class about the Goldman-Hodgkin-Katz equation; American Physiological Society – Institute of Teaching and Learning (APS-ITL) conferences/interaction with Physiology Educators Community of Practice (PECOP); and the Community of Practice at HCC via the Instructional Development Center (IDC) which organizes and facilitates Best Practices and Faculty Academy.  And what this made me realize was that I learned best in a social setting with peers rather than isolated in my room/office tackling a topic by myself.  Although this was new to me, Lave and Wenger realized this long ago.

Lave and Wenger put forth the social learning theory of situated learning and communities of practice (CoP) in the early 90s.  Core ideas of their theory are that learning is identity formation through social participation and that communities of practice are groups of people (communities), brought together by a need for shared learning (domain) for something they do together (practice) and learn how to do it better as they interact regularly (Lave and Wenger, 1991; Wenger, 1998). And I believe, in a classroom setting, this should be framed within a significant learning environment. See Fink (2003) for explicit steps that can be taken to create an environment conducive to learning.

While a CoP is often discussed relative to professional societies, I believe that a CoP can develop within an A&P course and bring about durable learning through social interaction.  In this case, then, the domain includes the students who are in the course to learn A&P – shared learning needs; the community includes the class as well as the community within student groups/teams; and the practice includes interactions and participation in evidence-based teaching best practices from the resources those produce.

The following infographic is a summary of best practices in evidence-based teaching (Petty, 2006) which Michaelson and Sweet (2011) suggest can be met by and are a part of Team-based Learning (TBL). These include Visual presentation and graphic organizers which are met in my classes by team projects; feedback and assessment for learning; cooperative learning; reciprocal teaching e.g., peer instruction; whole-class interactive teaching; requiring concept-driven decisions e.g., concept questions and higher-order thinking levels for summative assessments.  This provides a very strong rationale for using TBL.  And TBL, by its very nature, promotes social learning.

Michaelsen and Richards (2005) identified the four key components of TBL: group formation; meaningful team assignments; routine feedback; and accountability.  The following infographic includes the components of TBL and summarizes some of the ways they are addressed in my courses.  I will go into more detail on some of these throughout the blog.

Formation of diverse teams is very important for the successful use of team-based learning.  In the physical classroom, I used a ‘show of hands’ to questions asked on the first day of class and had the students line up, then I counted them off into the appropriate number of groups. Questions used were: “How many have ……had me as an instructor before?; had medical terminology?; a college degree or certificate?; been born outside of IL?” etc.  This provides transparency in how the teams are formed and lets students know what things the instructor thinks are important to include in each team.

For the virtual, online-synchronous classroom, I use the web-based platform, CATME Smarter Teamwork, Team-maker tool.  Team-maker tool page can be found at this link.  The Team-maker tool simplifies the team-assignment process, for the virtual classroom, and creates diverse teams.  Instructors decide which criteria will be used to form teams/student groups.  For example, it is helpful for team members to have similar work schedules to facilitate group work.  It is also helpful for team members to have dissimilar GPAs.  Instructors can also write custom questions and criteria to add to the Team Maker Tool survey.  CATME Smarter Teamwork platform is a product of and administered by Purdue University.  General information about the CATME Smarter Teamwork platform can be found at this link.

In addition to properly forming teams, teams must be properly managed. Team members should receive feedback regarding their effectiveness in the team early and often.  I use Peer Evaluation (PE) Surveys administered by the CATME Smarter Teamwork platform to help teams and team members become more effective.  The TBL community uses the phrase “forming, storming, and norming,” to describe phases teams go through during the semester.  PE surveys helps teams to progress to the norming phase more quickly.  Team members are evaluated in 5 areas: contributing to the team’s work, interacting with teammates, keeping the team on track, expecting quality, and having relevant knowledge, skills, and abilities.

Three PE surveys are administered over the course of the semester.  The first two PE surveys (week 5 and week 10) were formative and the third one (week 15) was summative.  Students’ PE score is based on how well they evaluate their teammates and how well their teammates evaluate them.  I used the ‘additional questions’ option for each PE survey.  They provide information on team dynamics and effectiveness which is very helpful to identify teams that are struggling which might require instructor intervention. Survey results can be viewed and then released to the students.  Students receive anonymous information on how their teammates evaluated them compared with how students evaluated themselves and this provides encouragement when they have rated themselves lower than their peers and praises students whose teammates have rated them highly. It is important to emphasize that students are evaluating, not judging, their teammates.  The CATME Smarter Teamwork website has a plethora of resources for instructors and students to help improve team effectiveness.

In addition to the CATME Smarter Teamwork PE surveys the Peer Evaluation form obtained from the University of Buffalo Case Study Workshop I attended is used to evaluate teammate participation in the team projects.  This evaluation produces a score that is used as a multiplier to the grade on the team project which helps to improve student accountability.

To promote learning, team development, and provide timely and frequent feedback, I use Just-in-time-teaching, combined with Peer Instruction (PI) and Concept Questions that are assessed using a classroom response system (Learning Catalytics) in a manner described by Mazur (1991).  Students are to complete pre-class reading assignments followed by a pre-quiz in the Learning Management System (LMS).  The pre-quizzes check for knowledge comprehension as well as identify confusing topics which are the focus of the concept questions used in the ensuing class meeting.  Each concept question has an individual round followed by a team round.  Students answer the individual questions on their own from memory.  Once students have answered the individual questions, they are instructed to discuss it with their teammates, using all available resources before the question is asked again.  These activities provide formative feedback to students and the instructor alike and provides practice for team-based summative assessments which focus on the conceptual application of material and strive for more authentic assessments with questions situated in a clinical scenario.  Learning Catalytics, the classroom response system used in my classes, has a variety of question types that can be used to write questions that require lower-order or higher-order thinking skills.

Additionally, the PI and team interaction help students negotiate their identity in the group and facilitates new learning, which are earmarks of social learning in a community of practice.  Of course, all of this is dependent upon students coming to class prepared.

Much to my dismay, even though pre-quizzes are given to hold students accountable, rather than read the assignment, they tend to ‘hunt and peck’ in the textbook or search Google for answers which are out of context and don’t really answer the question.  Funnily enough, pre-class reading assignments and pre-quizzes didn’t even hold Harvard physics students accountable to complete the reading assignments.  So, Eric Mazur and his team developed the social annotation platform Perusall.  Information about the platform can be found at this link.

Perusall allows for/encourages social interaction ‘outside’ of class and uses programs like those used in social media. Students annotate pre-class reading assignments and can comment on classmates’ annotations, “like” comments, and ask and answer questions; they are not reading/processing material alone. Students can interact with classmates in the entire class, rather than only with their teammates, which expands the community for social learning.  By clicking on an annotation in a pre-reading assignment a current conversation window opens, and the thread of conversation shows who made comments and when they were made.  This shows the asynchronous social interaction taking place in Perusall, and documents social learning taking place outside of class.  It lets the students know they are not alone in their struggle to understand a topic and offers opportunities for students to offer explanations and suggestions to help classmates learn.

Using Perusall helps students to become better prepared for in-class activities.  Following the adoption of Perusall, 88% of students annotated 80-100% of the pre-class reading assignments throughout a semester. Whereas only 69% of students completed 80-100% of the pre-quizzes associated with the pre-class reading assignment before using Perusall.  Completing the pre-quiz, as mentioned above does not necessarily indicate that students read the assignment.  They may have just Googled the answers.

So far, I have talked about Perusall as a social annotation platform that encourages students to thoughtfully annotate reading assignments as a way to promote social learning and a sense of community which is one of the main reasons I use Perusall and why I believe Perusall helps to build a CoP in my courses.  However, I think it is important to point out that the adoption implementation of Perusall is very easy and offers valuable features without adding to the instructional load.  Once the course is set up, which does not take long, there is little to no extra work for the instructor.  The quality of the annotations is graded automatically using a machine algorithm to assess intellectual content.  Also, with a click of a tab, instructors receive a ‘confusion report’ listing the top three points of confusion with the top three annotations articulating the confusion and other analytic reports. Perusall also automatically sends emails to students who have missed reading assignments.  For anyone interested in viewing a course in Perusall a demo course has been set up – course code = CHAPMAN-GJZQV.  To access the course, follow this link and click the ‘register’ link provided on the page.  Once the registration is complete there will be an option to enroll in a course, click on that tab and enter the course code listed above.  Or just jump into the deep end of the pool and register as an instructor just to see how easy and intuitive the platform is to use.

By putting students into diverse, permanent/fixed student groups the sense of community can grow. During group work and the social annotation of reading assignments throughout the semester, students negotiate their identity in the group, negotiate new learning, and work together to learn anatomy and physiology. The following photo is of a team on the last day of the semester.  The “CEO” of the team made the t-shirts using team members’ identities negotiated throughout the semester and gave them to all teammates near the end of the semester.

When it works properly a Community of Practice can develop.  I have witnessed tremendous learning in my classroom which is the result of helping my students create a community of practice within the framework of efforts to create a significant learning environment and allowing students to socially interact via team-based activities/assessments and social interaction while annotating pre-class reading assignments.

References:

Fink, L.D. (2003) Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses, Jossey-Bass, San Francisco, CA.

Lave, J. Wenger, E. (1991) Situated Learning: Legitimate Peripheral Participation. Cambridge UK: Cambridge University Press.

Michaelsen, L. K., Knight, A. B., and Fink, L. D. (2004) Team-Based Learning: A Transformative Use of Small Groups in College Teaching. Sterling, Va.: Stylus.

Michaelsen, L. K., Parmelee, D. X., McMahon, K. K., and Levine, R. E. (eds.). (2008) Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning. Sterling, Va.: Stylus.

Michaelsen, L., & Richards, B. (2005). Commentary: drawing conclusions from the team-learning literature in health sciences education: a commentary. Teaching and learning in medicine, 17(1), 85-88.

Michaelson, L.K., and Sweet, M.  Team-based Learning.  (2011) New Directions for Teaching and Learning.  no. 128. Wiley Periodicals, Inc. Published online in Wiley Online Library. DOI:10.1002/tl.467.

Petty, G. (2006) Evidence-Based Teaching. Gloucestershire, U.K.: Nelson-Thornes, 2006.

Wenger, E. (1998) Communities of Practice Learning, Meaning and Identity. Cambridge, UK: Ca

After a post-doctoral fellowship at Washington University School of Medicine, Jane began her academic teaching career at Benedictine University in the graduate programs in exercise physiology.  After that Jane taught in the Physician Assistant Programs at Rosalind Franklin University and the University of Kentucky. For the past 18 years Jane taught Anatomy and Physiology at Heartland Community College in Normal, IL, where innovative, student-centered instruction is encouraged. For the last decade, Jane employed Just-in-Time Teaching with Peer Instruction and concept questions assessed with a classroom response system.  Recently, permanent, fixed teams were used in her classes, along with team-based summative assessments, as well as with in-class and post-class forced retrieval activities. Jane is a Professor Emerita of Biology and had served as the Anatomy and Physiology course coordinator.

Jane received her B.S. from Eastern Illinois University, her M.S. from Illinois State University, and her Ph.D. from Marquette University.

mbridge University Press.

The Olympics, sex, and gender in the physiology classroom
The recent Tokyo Olympic Games present an opportunity for a number of intriguing discussions in a physiology classroom.  Typical discussion topics around the Olympic Games involve muscle strength, muscle power, aerobic fitness, bioenergetics, and a number of other physiological factors that determine athletic performance.  Coronavirus, immunity, disease transmission, and similar topics may be unique areas of discussion related to the Tokyo Olympic Games.  Another topic that has been prevalent in the news for the Tokyo Olympic Games is the role of sex and gender in athletic competition.

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

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

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

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

 

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

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

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

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Greg Brown is a Professor of Exercise Science in the Department of Kinesiology and Sport Sciences at the University of Nebraska at Kearney where he has been a faculty member since 2004. He is also the Director of the General Studies program at the University of Nebraska at Kearney. He earned a Bachelor of Science in Physical Education (pre-Physical Therapy emphasis) from Utah State University in 1997, a Master of Science in Exercise and Sport Science (Exercise Physiology Emphasis) from Iowa State University in 1999, and a Doctorate of Philosophy in Health and Human Performance (Biological Basis of Health & Human Performance emphasis) from Iowa State University in 2002. He is a Fellow of the American College of Sports Medicine and an American College of Sports Medicine Certified Exercise Physiologist.
Less is more – focusing on the core concepts

When it comes to teaching a subject in depth and breadth, an instructor may face the challenges of limited time versus unlimited contents. To this end, the instructor may focus on covering as much as possible material in a lecture, or on the key concepts that help prioritize contents and overarch a myriad of information. The former strategy is highly content-centered and can be overwhelming to both the instructor and students, and in fact, studies have shown that instruction time is not necessarily proportional to learning outcome [1]. By contrast, the latter strategy makes time for the instructor and student to interact, discuss, and apply the key concepts to problem solving activities, which fosters an active and interactive learning environment. In line with the evidence showing that students benefit more from an active and interactive learning experience [2], educators have called for less coverage and more inquiry aiming high beyond just the facts so that student’s learning can be enhanced by talking, writing, and collaborating [3-4].

How can one effectively prioritize contents by focusing on the key concepts pertaining to the latter strategy? One of the possible ways is to use learning objectives or anticipated learning outcomes to navigate content prioritization. It is overwhelming to start with materials for teaching planning due to fast growing research and knowledge explosion. However, using a backward design may change the game. Backward design of a course starts with developing clear learning objectives, which aligns selection of lecture contents with anticipated learning outcomes [5-6]. For instance, to accomplish the objective of building students’ critical thinking skills, an instructor will strategically plan time for not only covering materials but also information processing and application. Other than concentrating student learning on facts only, the class will be fueled by problem-based collaborative learning. To this end, it is critical for the instructor to elaborate the key principles or concepts, the very guides students need to address complex problems that demand more than simple factual answers. The collection of facts relevant to the class can be provided as supplemental information or resources for students to look up for problem solving, while it can limit student learning as a major commitment of memorization.

Mastery of basic principles plus being detail-oriented is required for success in experimentation and authentic research in a lab course [7]. To this end, students are expected to pay attention to experimental details in addition to core concepts, raising the question as to how course contents can be prioritized. First, the strategy of backward design still applies. Secondly, the learning objectives or anticipated learning outcomes can be defined such that they focus on core principles and transferrable or interchangeable skills. For instance, the course Laboratory Techniques in Molecular Nutrition covers several sets of lab techniques, one of which is immunoassays. Immunoassays represent a set of methods based on antigen-antibody binding reactions, including Western blotting (WB), immunoprecipitation (IP), co-immunoprecipitation (co-IP), chromatin immunoprecipitation (ChIP), ChIP sequencing (ChIPsec), immunohistochemistry (IHC), immunocytochemistry (ICC), and enzyme-linked immunosorbent assay (ELISA). Each method may take 1-2 weeks (5 hours/week) to cover the principles and operational procedures, and the set of immunoassays alone may occupy a semester. Obviously, it is very challenging to elaborate on each of the immunoassays within a semester given the limited time and resources, plus the needs to cover non-immunoassay techniques. However, it is practical for students to learn about the techniques within 4-5 weeks (5 hours/week) with a prioritized focus by elaborating on the core concepts shared by the eight immunoassays and contrasting the major differences among them. The core principles are shared by all the immunoassays regarding immobilization, blocking, immunobinding, washing, and detection processes. Yet, they are different in assay microenvironments including the solid phases, blocking solutions, antibodies, targets of interest, washing solutions, and detection reagents and instruments. Priority can be given to elaborating the core concepts and major differences (1-2 weeks) and to practicing the most used and accessible immunoassays such as WB, IP, and ELISA (3 weeks).

Practically, use of flipped classrooms can further enhance students’ mastery of key concepts and their ability to apply the concepts to solving problems. In a flipped classroom, the instructor lectures less in class but the course materials and recorded lectures are uploaded to the course management site (e.g., Canvas) for students to study in advance. Students tend to learn more through problem-solving activities with the instructor and peers in class that build critical thinking skills. As such, the learning outcomes can be increased and go beyond the contents by enhancing students’ critical thinking skills, which will benefit their lifelong learning after college.

Taken together, focusing on facts less in class but targeting core concepts and knowledge application more may serve as an effective strategy to build students’ critical thinking skills. The “less” by no means refers to an easy class. Instead, both the instructor and students spend more time outside the class preparing and studying course materials. This is to prepare everyone for more higher-order-thinking activities (e.g., analysis, evaluation, and application) in class. The “less” for “more” pedagogy may benefit student’s lifelong learning experience.

 

References and further reading

[1] Andersen SC, Humlum MK, Nandrup AB. Increasing instruction time in school does increase learning.

Proc Natl Acad Sci USA. 2016 Jul 5;113(27):7481-4.

[2] Dolan EL, Collins JP. We must teach more effectively: here are four ways to get started. Mol Biol Cell. 2015 Jun 15;26(12):2151-5.

[3] Luckie DB, Aubry JR, Marengo BJ, Rivkin AM, Foos LA, Maleszewski JJ. Less teaching, more learning: 10-yr study supports increasing student learning through less coverage and more inquiry. Adv Physiol Educ. 2012 Dec;36(4):325-35.

[4] DiCarlo SE. Too much content, not enough thinking, and too little fun! Adv Physiol Educ. 2009 Dec;33(4):257-64.

[5] Allen D, Tanner K. Putting the horse back in front of the cart: using visions and decisions about high-quality learning experiences to drive course design. CBE Life Sci Educ. 2007, 6(2): 85–89

[6] Hills M, Harcombe K, Bernstein N. Using anticipated learning outcomes for backward design of a molecular cell biology Course-based Undergraduate Research Experience. Biochem Mol Biol Educ. 2020 Jul;48(4):311-319.

[7] DiCarlo SE. Cell biology should be taught as science is practiced. Nat Rev Mol Cell Biol. 2006 Apr;7(4):290-6.

Dr. Zhiyong Cheng received his PhD in Analytical Biochemistry from Peking University, after which he conducted postdoctoral research at the University of Michigan (Ann Arbor) and Harvard Medical School. Dr. Cheng is now an Assistant Professor of Nutritional Science at the University of Florida. He has taught several undergraduate- and graduate-level courses (lectures and lab) in human nutrition and metabolism (including metabolic physiology). As the principal investigator in a research lab studying metabolic diseases (obesity and type 2 diabetes), Dr. Cheng has been actively developing and implementing new pedagogical approaches to build students’ critical thinking and problem-solving skills.