Category Archives: Teaching Strategies

Physiology as an Interpretive Lens for the Clinician’s Dilemma

Clinicians are faced with a dilemma – the need to make decisions based on a universal set of evidence and experience that usually does not explicitly include that individual. My understanding of the clinician’s dilemma germinated while working toward my professional Master’s in Physical Therapy and became clear during graduate course work in epidemiology. I didn’t have a chance to write about it and propose some vague abstract solutions until 2005,[i] and didn’t propose tangible solutions until 2014 which are embedded into a curriculum I developed for a new Doctor of Physical Therapy (DPT) program at Plymouth State University (2015-2017) and were then published in 2018.[ii] And to be clear, no one has solved this dilemma. At best we have some inkling of the types of reasoning that make it less poignant, or at least enable a clinician to have a rationale for decisions. There’s a gulf between a clinical researcher saying “Your practice is not evidence based”, and the clinician saying in response “Your research isn’t practice based”. A hardline stance of evidence-based practice not including mechanistic causal reasoning and only including (or giving strong priority to) randomized controlled trials that focus on outcomes as the primary determinant of the best treatment is not practice based.[iii]

The CauseHealth[iv] project considers the problem in their book Rethinking Causality, Complexity and Evidence for the Unique Patient[v]. Clinicians must be able to inquire and reason about unique situations and consider what, whether, how, when, and to what extent clinical practice guidelines and evidence from systematic reviews and randomized controlled trials apply in that particular situation. Clinicians consider mechanisms as causes underlying particular situations even when they are part of a unique arrangement of a complex system and when the observation of prior situations exist, or the ability to repeat the situation is limited.

In physical therapy this requires a depth and breadth of physiological understanding that starts with the core concepts and proceeds to integrated, complex, mechanistic causal relationships. Physical therapists “diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives” (APTA).[vi] A core component to the knowledge used in practice for this profession is physiological knowledge. Beyond understanding pathophysiology, physical therapists must be able to reason through the consequences of various situations – when is physiology as expected vs. not as expected and how does a set of expectations (or non expectations) influence our understanding of the current particular situation. In other words, clinicians are reasoning through causal models, either implicitly or explicitly. And often, much of what happens at the causal model level of knowledge for practice includes physiology.

My writing and teaching promote the use of causal models as representations of knowledge for clinical reasoning, and the use of graphical causal models for the clear articulation and sharing of such knowledge. This approach is helpful for the consideration of how universal concepts learned through an empirical process and thought to be true for a population can be applied in a particular situation. When teaching DPT students how to use physiology in clinical reasoning we approach causal models of physiological mechanisms as an interpretive lens for the clinician’s dilemma.

Clinical research utilizes statistical inference to estimate, from a sample, what a population characteristic or cause-effect relationship may be. The cause-effect relationship may be intervention-outcome, or it may be exposure-disease. The patient in front of a clinician was usually not in the original sample. The question then becomes, is this patient part of the population that this study (or these studies) represent via statistical inference? And is this patient part of that population in a manner that is important given the physiological mechanisms involved in the cause-effect relationship? This is a physiological question. We immediately can consider whether the inclusion and exclusion criteria of the research includes or excludes this particular patient. Those are obvious reasons to question whether the patient you are working with is part of the same population to which these studies inferred. We naturally look at age, sex, comorbidities and severity of the situation. All of these considerations imply variation in the underlying physiological state of the particular patient from the inferred population. But even if the particular patient is similar to the inferred population on all of these considerations, underlying physiological assumptions based on the mechanisms remain and should be considered.

For example, research demonstrates that electrical stimulation of the major skeletal muscles involved in walking is causally associated with positive outcomes in people with chronic heart failure such as maximum oxygen consumption (VO2max), six minute walk distance (6MWD) and even, to a lesser extent, health related quality of life (HRQOL).[vii]  Figure 1 depicts the simple graphical causal models that the clinical research (randomized controlled trials) has investigated as part of an evidence-based practice empirical approach to understanding the relationship between interventions and outcomes (made with DAGitty).[viii] Even when assuming a particular patient would be included (based on meeting inclusion criteria and not meeting exclusion criteria for these studies), there are several very poignant physiological mechanisms when considering the use of electrical stimulation in practice that impact the probability of the intended outcome.

No one assumes that electrical simulation directly improves health related quality of life, or six minute walk distance, or even oxygen consumption. There are physiological and even psycho-physiological, behavioral and cultural mechanisms involved in the connection between electrical stimulation and these three outcomes, and these three outcomes are very likely connected to one another.  Figure 2 is one possible graphical causal model that fills in some of the possible mechanisms.2

The clinician is working with many competing hypotheses, and is “faced with all sources of variation at the same time and must deal constantly with the full burden of the complex system.”Let’s take a closer look at the many causal assumptions of the model in Figure 2. As a graphical causal model, the first thing to realize is that all edges in the graph with an arrow encode the knowledge that one variable causes the other (and the lack of an arrow implies no causal connection). This does not have to be a definite causal connection; in fact, most of them are probabilistic and can be stated as conditional probabilities. For example, this graph encodes the knowledge that ES acts as a cause on muscle function. Which can be stated as a conditional probability: the probability of improved muscle function given ES is greater than the probability of improved muscle function given no ES. The model in Figure 2 also includes additional interventions since ES would rarely be considered the only intervention available. In fact, the patient in the condition where ES is the only intervention available probably would not be in the inferred population (for example, there are no studies on the use of electrical stimulation with patients with chronic heart failure that were not ambulatory or were unable to do other forms of exercise). This model includes aerobic training (AT), resistance training (RT), ES, adaptive equipment (AE), inspiratory muscle training (IMT), all as possible interventions for improving 6MWD, VO2max, and HRQOL in people with HF.

The characterization of the intervention (exposure, cause) in this model is discrete (yes/no), but it does not need to be discrete; it can be continuous and can include any of the considered important parameterizations of ES. Also, the effect muscle function is discrete but can be continuous and include any of the important parameterizations of muscle function. In other words, the causal model can encode as much of the ontological information about reality (its variables) as the user would have it encode. As attributed to George Box, “All models are wrong, some models are useful.”

The mathematical and logical implications of the causal model go on to include the multivariable considerations such as the chain rule of conditional probabilities (VO2max), identification of confounders (balance as a confounder), blocking variables (anaerobic threshold), and adjustment sets (6MWD).

My point here is to answer the question—“Isn’t this the same as concept map?” No. Causal models depicted as graphs are based on graph theory and adhere to a set of logical and mathematical rules that allow logical and mathematical implications to be proposed and tested. But they do share concepts. We could say that all causal models are concept maps, but not all concept maps are causal models; therefore, they are not equivalent since equivalence implies bidirectional implication.

Concept maps of physiological mechanisms are great teaching and learning tools. The next step, to use physiology as an interpretive lens for the clinician’s dilemma, is to consider encoding them as graphical causal models. In fact, this is the logical step from the core physiology concept of causation.

Another consideration for the clinician is that no single study has confirmed these causal connections all at the same time. But, a corpus of studies has tested these causal associations. The model in Figure 2 represents knowledge for practice; practicing based on this model is an example of using physiology to help in reasoning through whether to use an intervention with a particular patient. For example, if a particular patient has a problem with balance unrelated to muscle function then the probability of ES improving their 6MWD and even HRQOL is likely lower than in a particular patient without such a problem. And if a particular patient’s problem is mostly from the direct reduction in cardiac output associated with chronic heart failure, then a change in muscle function from ES may have less of an impact than in a particular patient with stronger contribution of muscle function in their reduction in oxygen consumption. And if the particular patient has low inspiratory muscle strength (IS), then IMT may be the best approach to start with – despite the fact that there are no clinical trials that investigate the intricacies of when to use ES vs. IMT. Thus, causal models of physiological mechanisms are an interpretive lens for applying clinical research in clinical practice. And this involves reasoning through causal models of complex physiological mechanisms.

The question is not whether this is already being done in practice (because it is, though usually implicitly not explicitly). The question is how are we teaching future clinicians and students? Is there a way to teach it that expedites the transition from classroom reasoning to clinic reasoning? Effective teaching often includes pulling back the curtain and explicitly revealing that which has been implicitly occurring. When a student asks me how their Clinical Instructor was able to come to some particular conclusion, the answer is usually that they were implicitly reasoning through some assumed causal model. Causal models can explicitly bridge the gap between learning physiology from a standard medical physiology textbook, doing a case study in a clinical course, and seeing a patient in a clinic.

The next step in my journey of using causal models for clinical pedagogy is the relationship between narratives, stories and causal models. If causal models are a more complex depiction of the reality underlying evidence-based causal claims; then narratives and stories are a more complex depiction of the reality underlying causal models. If you’re interested in discussing this further, please let me know.

Thank you to all of my colleagues (which includes all of the DPT students) at Plymouth State University for trusting this vision enough to take a chance on a new DPT program; and thank you to my closest dialogue partners in this and my upcoming work in the causal structure of narratives, Drs. Kelly Legacy and Stephanie Sprout (Clinical Assistant Professors of Physical Therapy); and Dr. Elliott Gruner (Professor of English/Director of Composition).

[i] Collins SM. Complex System Approaches: Could They Enhance the Relevance of Clinical Research? Physical Therapy. 2005;85(12):1393-1394. doi:10.1093/ptj/85.12.1393

[ii] Collins SM. Synthesis: Causal Models, Causal Knowledge. Cardiopulmonary Physical Therapy Journal. 2018;29(3):134-143.

[iii] Howick JH. The Philosophy of Evidence-Based Medicine. John Wiley & Sons; 2011.

[iv] CauseHealth Blog https://causehealthblog.org/ (Accessed 10/15/2021)

[v] Anjum RL, Copeland S, Rocca E. Rethinking Causality, Complexity and Evidence for the Unique Patient: A CauseHealth Resource for Healthcare Professionals and the Clinical Encounter. Springer Nature; 2020.

[vi] American Physical Therapy Association https://www.apta.org/your-career/careers-in-physical-therapy/becoming-a-pt (Accessed 10/15/2021)

[vii] Shoemaker MJ, Dias KJ, Lefebvre KM, Heick JD, Collins SM. Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure. Physical Therapy. 2020;100(1):14-43. doi:10.1093/ptj/pzz127

[viii] Textor J, van der Zander B, Gilthorpe MS, Liśkiewicz M, Ellison GT. Robust causal inference using directed acyclic graphs: The R package “dagitty.” International Journal of Epidemiology. 2016;45(6):1887-1894. doi:10.1093/ije/dyw341

Figure Legends

Figure 1: Simplified Causal Associations Tested in Clinical Trials (Abbreviations: ES, electrical stimulation; 6MWD, 6-minute walk distance; VO2_max, maximum oxygen consumption; HRQOL, health-related quality of life)

Figure 2: Complex Causal Associations Necessary for Clinical Practice (Abbreviations: AT, aerobic training; (a-v)O2, arteriovenous oxygen difference; IMT, inspiratory muscle training; IMS, inspiratory muscle strength; PaO2, partial pressure of oxygen in the arterial blood; RT, resistance training; Ve, minute ventilation; VQ matching, ventilation perfusion matching )

Sean Collins is a Professor of Physical Therapy at Plymouth State University and was the founding chair and director of the Doctor of Physical Therapy Program.  He earned an ScD in Ergonomics (work physiology focus) and epidemiology at the University of Massachusetts Lowell. He teaches a three-course series on Clinical Inquiry, as well as a course in Clinical Physiology and a course on physical therapy practice with patients that have complex medical and cardiopulmonary conditions. From 2015 through 2021 he served as the Editor of the Cardiopulmonary Physical Therapy Journal, was co-leader and co-author of the American Physical Therapy Association (APTA) Heart Failure Clinical Practice Guideline from 2014-2019, and in 2018 was honored with the Linda Crane Lecture Award by the Cardiovascular and Pulmonary Section of the APTA for his work on using causal models as tools to teach and to join clinical research and practice.

 

Course-based Research Experiences Help Transfer Students Transition

As transfer student numbers increase at 4-year institutions, we need to provide opportunities for the formation of learning communities and research experience. Course-based research experiences allows for both. Students receive course credit toward their degree, work on independent research, and engage with peers and faculty in a small setting.

Several studies have been conducted to show the advantages of undergraduate research as a value-added experience. (1,2,4,6,8). As an R1 university, we have a tremendous amount of resources devoted to STEM research – but we are unable to accommodate all of our undergraduates who are looking for lab experience. The development of course-based research experiences (CUREs) across colleges and universities has increased the availability of research opportunities for undergraduates. (1,3,5). In addition, they have provided an increased sense of community and interaction with faculty – two factors that were highly valued by all students. The question for us was how can we provide more of these courses given space and personnel constraints and are there student populations that might benefit more directly from these courses?

Several years ago, we increased the number of transfer students we accepted from community colleges and elsewhere. But there was no transfer-specific programming for those students and they had little sense of community. Transfer students tend to be a much more diverse student population in several ways. Their average age is higher than our incoming first-year class, they are more likely to be PELL Grant-eligible (40% of transfer vs 20% of first-year students), first-generation college students (30% of transfer vs 15% of first-year students) and are more likely to work and live off-campus. Although they recognize the value of community and research experience according to surveys, they often state they don’t have the time to invest as they are trying to graduate as quickly as possible.

We received a grant through HHMI (in part) to train faculty to develop CUREs specifically for transfer students. STEM courses that “counted toward graduation” was a way to get buy-in from the students and to be funded by grants and aid. All transfer students needed additional life science courses to complete their degree, and this was a course that wasn’t transferred in through the community colleges so there was space in their degree audits. These were small enrollment courses that lent themselves to forming cohorts of student learning communities as they proposed hypotheses, designed and implemented their experiments, and presented their findings to the class. This allowed transfer students to receive course credit toward graduation in a lower-stress way during that first transition semester.

Course-based Research Experiences Help Transfer Students Transition

Lisa Parks 9.30.2021

Figure 1

Cell Biology CURE Example:

Testing whether environmental compounds or other chemicals induce cell death

Protocols Provided:  Cell seeding and growth, Cell counting, Measuring cytotoxicity, Bradford Assay, Western Blot, Immunofluorescent Analysis

There are thousands of chemicals and compounds that either potentially affect cell growth, metabolism, and death.

This project has a lot of room for student individuality. Students could do endocrine disruptors, for example, or Parkinson’s disease related compounds (i.e., things that kill mitochondria), environmental toxicants, heavy metals, etc. They could test across cell types, concentrations, diseases, etc.  They could use the cancer cells and we could get a screen of compounds. Or they can pre-dose with a potential protectant (GSH?) and then expose the cells to something toxic to see if cell death can be attenuated.

This is particularly important because one issue we struggle with is that students with a 2-year associates degree automatically receive credit for all general education requirements through the NC Articulation Agreement. This means that transfer students are left with stacks of required difficult STEM courses with little opportunity to balance their course load for their remaining semesters. In addition, they are often trying to graduate “on time” so they are starting at a new, much larger, state university with little formal introductory programming and often, unfairly heavy STEM course loads. This isn’t the best way to set these students up for success. We found our transfer students falling behind in GPA and time to graduation. Tracking transfer students that take these first-semester CUREs will help us see if this approach increases student retention in the STEM majors, their graduation rates, and through surveys, their feelings of community at NCSU.

Teams of tenured or tenure-track research faculty and teaching-track faculty along with a handful of post-docs continue to develop these courses. As you can imagine, COVID interrupted this effort as we scrambled to go online and closed our lab spaces to undergraduates, but the CURE development continued.  Anecdotally, we noticed an increased collaboration and a sense of community among the faculty that extended beyond the workshop training. This has been seen in several studies at other institutions (7,9). As these labs have been developed, it has led to increased team teaching, research projects, and publications. Teaching faculty have had another mechanism for staying current and being engaged in research and literature while giving them another outlet for scholarly work. Research faculty have had another mechanism for exploring side projects that they may not have had the time or funds to pursue in their own labs and allowing them an opportunity to get into the classroom.

Faculty write up or discuss a proposal with each other – an idea that they wish they had time or space to devote to. It’s typically no more than a page. Students take it from there. They spend the first third of the semester learning techniques and protocols, and writing their experimental designs. The rest of the semester is devoted to implementing their experiments, presenting results and receiving feedback at weekly lab meetings, and re-working or replicating their experiments. Final findings are presented as a poster session in our main lobby where all faculty and students are encouraged to stop by. A sample CURE is provided in the box.

As this approach to teaching has increased in our department, it has begun to influence space allocation within the buildings. We are beginning to influence how future buildings are designed and how renovations to existing space can accommodate this approach. We have begun to question whether we need large amphitheaters for 300+ students in a classroom and we are starting to see how we can divide up that space into learning labs and rooms with moveable chairs and tables – facilities that will promote the formation of learning communities and critical thinking skills as opposed to memorization of content.

Thank you to Dana Thomas and Jill Anderson for collecting and providing data about our transfer students.

REFERENCES

  1. Auchincloss LS, Laursen SL, Branchaw JL, Eagan K, Graham M, Hanauer DI, Lawrie G, McLinn CM, Pelaez N, Rowland S, Towns M, Trautmann NM, Varma-Nelson P, Weston TJ, Dolan EL. Assessment of Course-Based Undergraduate Research Experiences: A Meeting Report. CBE Life Sci Educ 13(1):29-40, 2014.
  2. Banasik MD, Dean JL. Non-Tenure Track Faculty and Learning Communities: Bridging the Divide to Enhance Teaching Quality. Inn Higher Educ 41: 333-342, 2016.
  3. Bangera G, Brownell SE. Course-Based Undergraduate Research Experiences Can Make Scientific Research More Inclusive. CBE Life Sci Educ 13: 602-606, 2014.
  4. Beckham J, Metola P, Strong L. Year-long Research Experiences in Drug Discovery May lead to Positive Outcomes for Transfer Students. FASEB Journal 31:S1. 589.8, 2017.
  5. Eagan MK, Hurtado S, Chang MJ, Garcia GA, Herrera FA, Garibay JC. Making a Difference in Science Education: The Impact of Undergraduate Research Programs. Am Educ Res J 50:683-713, 2013.
  6. Griswold W. Launching Sustainability Leadership: Long-Term Impacts on Educational and Career Paths in Undergraduate Research Experiences. J Coll Sci Teach 49:19-23, 2019.
  7. Kezar A. Spanning the Great Divide Between Tenure-Track and Non-Tenure-Track Faculty, Change: The Magazine of Higher Learning, 44:6, 6-13, 2012. DOI: 10.1080/00091383.2012.728949
  8. Nagda BA, Gregerman SR, Jonides J, von Hippel W, Lerner JS. Undergraduate Student-Faculty Research Partnerships Affect Student Retention. Rev of Higher Educ 22:55-72, 1998.
  9. Ward HC, Selvester PM. Faculty Learning Communities: Improving Teaching in Higher Education, Educational Studies, 38:1, 111-121, DOI: 10.1080/03055698.2011.567029
Lisa Parks is a Professor of Teaching and Director of Undergraduate Programs in Biological Sciences at North Carolina State University. In addition to her regular teaching load of cell biology and advanced human physiology, she has helped develop several courses and is currently developing several course-based research opportunities for transfer students. She has been a participant, a mentor, and a current grant recipient with the Howard Hughes Medical Institute where she was bitten by the “research as pedagogy – inquiry-based learning – critical thinking” bug. She gladly drops what she is doing to talk about this. Lisa received her BS in Zoology from Duke University and her PhD in Biology with a concentration in cell physiology at Georgia State University.
Together or Apart? Lecture with Laboratory, or Taken Separately?

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

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

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

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

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

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

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

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

Laura Mackey Lorentzen is an associate professor of biology at Kean University in Union, NJ, where her teaching emphasis is general biology for majors as well as cell physiology, neuroscience and senior capstone. She earned a PhD in Biomedical Sciences/Molecular Physiology and Biophysics from Baylor College of Medicine in Houston TX, an MS in Cellular & Molecular Biology from Duquesne University in Pittsburgh PA, and a BS in biology from The University of Charleston, WV. She is a past president of the New Jersey Academy of Science (NJAS) and past editor-in-chief of AWIS Magazine, for the Association of Women in Science.
The Capstone Experience: Implementing lessons learned from a pandemic educational environment to create inspirational real-world educational experiences
Historically, physiology undergraduate students across the world have undertaken a laboratory-based, fieldwork or critical review research project, their educational purpose for students to gain research experience. However, decreasing numbers of physiology graduates are going onto careers in research, many are leaving science altogether. It is therefore imperative that we, as educators, better prepare the majority of our students, through their projects, for the diverse range of careers they go onto.

Pre-pandemic opportunities

Over the last twenty years, physiology and the broader global bioscience educator community, recognizing this diversity of graduate career destinations, have been expanding the range of projects available to their students, introducing for example, public engagement, educational development or enterprise projects.  However, the focus and purpose of these projects remained for students to gain research experience. They were traditional research projects but outside of the laboratory. The literature and Accrediting Bodies project criterion still talked about students undertaking “hypothesis-driven research” and “project/research-based assignments”.

Whilst these traditional research projects may have been relevant fifty years ago, they do not enable the majority of current Bioscience graduates to be “work-place ready”. The world is currently going through its fourth industrial revolution (4IR), a world and workplace governed by robotics, artificial intelligence, digitization and automation. Graduate recruiters require graduates with different skillsets, the so-called 4th Industrial Revolution (4IR) skills1.

I recognized that radical change was required, not only in my School of Biomedical Sciences, but across bioscience Higher Education globally. Collectively, bioscience educators needed to rethink the purpose, practices and outcomes of undergraduate research projects in order to better prepare our students for an increasingly challenging 21st Century global workplace.

My solution was to introduce project-based capstone experiences into my program. their purpose to provide students with opportunities for personal and professional development, and to gain real life work experience.

A highly experienced science communicator, I facilitated ethical debates in High Schools.  I realized that this would make an ideal opportunity for my undergraduates – something different as their research project. Starting small, I collaborated with one of my project mentees to co-create and co-deliver an ethics-focused workshop for High School students at the 2005 Leeds Festival of Science2. The capstone experience, as an alternative to traditional research projects, was born.

Over the last sixteen years, I have progressively expanded the range of capstone opportunities in my course. Colleagues within my School of Biomedical Sciences at the University of Leeds (UK), recognizing the benefits of capstones to students, joined me. In partnership with our students, we have created a sector-leading portfolio of traditional research projects offered alongside science or industry-focused capstones, and those with a civic or societal focus in the same course (Figure 1)3. Students select the project that best addresses their individual developmental needs and/or future career intentions. By offering this broad portfolio of sixteen opportunities, it is inclusive, there is something for each and every student to realize their full academic potential and personal goals.

 

Figure 1: Research and capstone project opportunities available to students

My students have wholeheartedly grasped this opportunity, excelling academically.  Their course marks are significantly higher than students undertaking traditional research projects (2020: mean ± SD = 71.4±4.4% vs 68.4±5.8%, p<0.05).  In 2020-21, 27% selected capstones as their first choice of project, a massive cultural shift given we are a research-intensive (R1) Institution where laboratory projects have traditionally been viewed by both students and Faculty as the “gold-standard”.

Our work as a team has resulted in the award of a prestigious national (UK) higher education prize, an Advance HE Collaborative Award for Teaching Excellence.

My work came to the attention of other Bioscience educators. I was invited to run workshops at Institutions across the UK seeking to introduce capstones into their program. I re-wrote one of the two UK Bioscience Accrediting Bodies project accreditation criteria, incorporating my capstone ideas.

And then Covid struck!

With restricted or no access to research facilities, Bioscience educators globally struggled to provide alternatives to traditional research projects.  To support colleagues across the world, in partnership with Sue Jones (York St John University, UK) and Michelle Payne (University of Sunderland, UK), I ran virtual workshops, sharing my capstone ideas and resources.  I created and shared globally, guides for students4 and educators5, and resource repositories6,7. The workshops were attended by over 1000 educators from as far afield as Australia, Africa and America. The resources viewed 12,000 times from over 50 countries.

A year on, we surveyed both students and Faculty globally. All responding institutions had introduced capstone projects into their programs in 2020-21. More importantly, they are here to stay. Recognizing the benefits to their future employability and careers, a massive 94% of students wanted capstones to be provided alongside traditional research projects. Faculty thought the same. All are not only keeping capstones, but more importantly, are broadening their portfolios going forward. Each new format developing different skill sets and attributes, and therefore preparing students for additional career destinations. We have inspired sector-wide curriculum change!

Going forward, we cannot return to our old ways!

As the world opens up and returns to a new “normal”, we cannot go back to our old ways of just offering traditional research projects. We would be massively letting our students and wider Society down. We need to take the best from what we have learnt and achieved, both before and during the pandemic, and continue to develop and evolve our collective capstone provision going forward.

We are at the start of an exciting Global journey.  Capstones across the world are predominantly conservative in nature, for example taught courses, senior seminar series or extended essays. Educators globally have yet to fully realize the transformative (massive uplift in skills and attributes) and translational (preparation for the workplace) potential of capstones.

We need to create capstones that are more representative of the work place for example, multi-disciplinary teams and sub-teams working on the same capstone, and capstones that run over multiple years, with current students taking the previous year’s project outputs and outcomes to the next stage.  The events of the past two years have made Universities realize they need to better address their local and global civic and societal responsibilities and missions, so capstones that facilitate societal engagement. We need to move away from traditional dissertations or reports to more authentic real-world assessments.

Within my School of Biomedical Sciences and the broader University of Leeds, we have started down this journey. Ninety percent of the capstones in my course are now team-based. Students choose their primary assessment method (e.g. academic paper, commercial report, e-portfolio) – the one most suited to their particular capstone format and which best showcases their knowledge, skills and attributes. I have introduced Grand Challenges capstones where students work as to teams to create evidence-driven solutions to global Grand Challenges or UN Sustainable Development Goals (SDG). The intention to develop these into trans-national educational opportunities, where students from the Global North and South work collaboratively on the same SDG or Grand Challenge capstone. We have an Institutional requirement that all undergraduate students, regardless of discipline, must undertake a major research-based assignment in their final year of study. I have been awarded a Leeds Institute of Teaching Excellence to work with Faculty across the University to introduce capstones into their programs and to create pan-university multi-disciplinary capstone opportunities for our students.

I do not do things by halves. My vision is not just limited to Leeds, the UK or the Biosciences, but Global!

I have created a global Community of Practice for stakeholders across the world to work collaboratively together, sharing ideas, expertise and resources, to co-create and introduce inspirational multi-disciplinary, multi-national team-based capstone projects that address globally relevant issues into undergraduate and taught postgraduate degree programs across the world.  I want to make it a truly global and inclusive community, to include all stakeholders- students, alumni, educators, employers, NGOs, social enterprise, Global North or South, all disciplines or sectors….The list is endless.

If you would like to join this Community of Practice and be part of this exciting journey, please email me (d.i.lewis@leeds.ac.uk). Please share this opportunity amongst your colleagues, networks and across your Institution. The broader the membership, the greater the collective benefits for all.

If we pull this off, the benefits for students, other stakeholders and Society will be phenomenal. Our graduates would be truly global graduates, equipped with the skills and attributes to become leaders in whatever field they enter. As Faculty, we would be providing an exceptional educational experience for our students, properly preparing them for the workplace. Universities, through student capstones, would be better able to address their civic and societal responsibilities and missions. Employers would have graduates able to take their businesses forward and to thrive in an increasingly competitive global marketplace. We would be creating solutions to some of the complex problems facing mankind.

Figure 1: Research and capstone project opportunities available to students

1.    Gray, A. (2016). The 10 skills you need to thrive in the Fourth Industrial Revolution. World Economic Forum. https://www.weforum.org/agenda/2016/01/the-10-skills-you-need-to-thrive-in-the-fourth-industrial-revolution/

2.    Lewis DI (2011) Enhancing student employability through ethics-based outreach activities and OERs. Bioscience Education 18, 7SE https://www.tandfonline.com/doi/full/10.3108/beej.18.7SE

3.    Lewis DI (2020a). Final year or Honours projects: Time for a total re-think? Physiology News 119: 10-11.

4.    Lewis DI (2020b). Choosing the right final year research, honours or capstone project for you. Skills career pathways & what’s involved. https://bit.ly/ChoosingBioCapstone

5.    Lewis DI (2020c). Final year research, honours or capstone projects in the Biosciences. How to Do it Guides. https://bit.ly/BiosciCapstones

6.    Lewis DI (2020d) E-Biopracticals (Collection of simulations & e-learning resources for use in Bioscience practical education. Available at: https://bit.ly/e-BioPracticals

7.    Lewis DI (2020e) Open access data repositories (Collection of large datasets, data analysis & visualization tools).  Available at: https://bit.ly/OADataRep.

 

Dr. Dave Lewis is currently a Senior Lecturer (Associate Prof) in Pharmacology and Bioethics in the School of Biomedical Sciences, University of Leeds, UK. A student education focused colleague, he creates inspirational educational and professional educational interventions designed to promote learner personal and professional development, and prepare them for the workplace.  He is the architect of the introduction of capstone projects into Bioscience programs across the UK and beyond.  He also Chairs the International Union of Basic & Clinical Pharmacology’s Integrative & Organ Systems Pharmacology Initiative, working with Professional and Regulatory Bodies, and NGOs in India, China and across Africa to co-create and co-deliver professional education in research animal sciences and ethics.

In recognition of his exceptional contribution to Bioscience Higher Education globally, he has received multiple prestigious education awards including a UK Advance HE National Teaching Fellowship and its Collaborative Teaching Excellence Award, the (UK) Biochemical Society’s Teaching Excellence Award, the (UK) Physiological Society’s Otto Hutter Teaching Prize, and Fellowship of the British Pharmacological Society & its Zaimis Prize.

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.
The COVID-19 Pandemic: An Opportunity for Change in my Teaching

As the 2020-21 academic year ended, I sighed with relief. I had survived the switch to an online teaching format, wearing a mask while teaching when I had to have a class in-person, and the loss of my father. But as quickly as my sighs of relief subsided, I began to wonder, “What will happen next academic year?” Will I be teaching all my classes in-person, will my classes be online, or will I have some classes or labs online and others in-person? As these questions swirled in my head, I began to reflect on this past year. Teaching online was tough. There were activities that bombed. But there were activities that rocked. And there were activities that could be improved. And believe it or not, there were some great things that came from teaching online. Some had to do with content, some had to do with skills, and some had to do with community. Now comes the challenge of choosing what I should take with me, and what I should leave behind? And as I reflected, I realized there are two experiences from this past year I want to use this year, whether I am teaching in-person or online. One had to do with the idea of community and the other had to do with skills. While others came up, I decided to be kind to myself and focus on two.

1. Forming an Inclusive Scientific Community
Prior to the COVID-19 pandemic, I had never taught a course online nor had I taken a class online. I had attended webinars but had never presented an online seminar either. Now I was being asked to teach courses online to students I had never met, and these students had never met each other in-person either. When I reflected on my teaching in-person, I realized I had never worried about whether I knew the students immediately or whether they knew each other. I assumed their presence in class with me and with the other students would allow relationships to form and a learning community to be built. But now they were just images on a screen and often, just names since cameras were not always on.
Now that I was teaching online, I had to be more intentional about building a learning community. This was to help not only me but also my students. Research has shown that students do not just want to be faces in a crowd (1, 2). They want to be recognized by the professor and by their peers. And as the pandemic progressed, they needed this more personal interaction. Creating a community would foster interaction and make students comfortable to share in an online environment (1, 2). To begin, I included icebreaker activities to allow me and the students to learn more about each other. And these icebreakers were not a one and done activity. They continued throughout the first several weeks of class. As the semester continued, polls or questions replaced the icebreakers. These were questions anyone could answer. They could be content questions, well-being checks, or simple questions about plans for the weekend or favorite ice cream. All meant to foster community. When in the classroom, peer interactions can be observed by the instructor. In the online classroom, it was more difficult to monitor interactions and those who were uncomfortable with group work could disappear when the breakout rooms opened.
Including these activities online allowed me and the students to feel like we were in this class together. While I was not a student, I was no longer “The Sage on the Stage.” We, the professor and the students, were in this online learning community together. When an online activity was successful, we celebrated together. If something did not work, what discussed the activity and what we could change. This community was most evident when my father fell ill and then passed away. These students I had been working with stepped up and helped me during this emotionally challenging time. While I still guided their learning, they took more on themselves, and they helped each other and me. The entire year we had spoken about grace and that we all needed to give and receive it. They gave me grace when I needed it most. Who would not want to take this community into the in-person classroom?


2. Promoting Scientific Soft Skills
With the initial move to online teaching, one of the challenges faced was laboratory experiments. Many laboratory exercises require specialized equipment (3). In my case, this was the Biopac Student Lab System®. One of the benefits of this system is that students get to record physiologic data on each other. The cost of and logistical issues regarding supervision and liability for the Biopac® home system prevented me from using this as an option. However, one of the benefits of the Biopac Student Lab System® is the free access to sample data and the free analysis software for downloading offered by the company (Figure 1). Additionally, as I had been using these systems for over 10 years, I had previously recorded student data at my fingertips (Figure 2). Students could download the software to their personal computers and open any shared data for analysis. While the students were not actually recording the data themselves, this provided an alternative for learning about physiological processes with data from subjects. This also allowed me to have the students focus more on how they presented the results and how they discussed the science behind the results. We could focus on the writing of the results and the understanding of the science because the students were no longer focusing on the possibility of user error as to why they did not get the results expected.
As I was reflecting, I realized that with lab exercises moving online that the reduction in focus on learning how to use equipment and collect data was a positive (3). This allowed students to focus on writing and understanding what they were writing. This made me think that I could expand the use of pre-recorded data to include other skills such as inter-rater reliability and statistical analysis. As stated earlier, in my physiology courses, students consistently would state user error was the reason they did not get the results they expected. While this may have been the case for some experiments it was not always the case. This is where sample raw data, whether the raw data was from the equipment company or recordings from prior years’ labs, is useful. Students can be provided with the same raw data to be analyzed. Students could then compare results with each other and determine if they were following the same directions for analyzing the data. The closer the values to their peers suggested they were analyzing the data in a comparable manner.
Another interesting opportunity that pre-recorded data provides is the ability to discuss statistical significance in a more detailed fashion. Often when students are collecting and analyzing their own raw data, there is not enough time to aggregate the data for statistical analysis. Now students could all be given multiple sets of raw data to analyze, these results could be aggregated, and statistical analysis performed. In upper-level courses, students can then learn when to use t-tests versus ANOVA, learn about post hoc tests, and p-values. As journals and professional societies recommend more in-depth presentation of statistical analysis, this can be added as well. In more introductory courses, this could be modified to focus on mean and standard deviation. Finally, by focusing on inter-rater reliability and statistics, students can further improve their writing of the results and discussion sections.
One of the reasons labs are often popular is because students get to be the scientist. I do not want this to disappear when in-person labs return. I still want students to learn how to use the Biopac® systems and record data from each other when we return to class; seeing the excitement in the students’ eyes when they see the ECG or EMG recording of their own bodies is one of the joys of teaching. But I want to find ways to keep the positive aspects of using pre-recorded data. Could this be a pre-lab activity? Could I take one or two of the experiments we do and provide the data rather than record the data? Could I have students record their own data and exchange the raw data with each other? I am still trying to decide how this might look in my class. Maybe that is my next blog?
In conclusion, the COVID-19 pandemic created a flurry of change in a short period of time. In higher education, we are not used to this quick a change. And as humans, we are typically resistant to change. However, I suggest that instead of being anxious to return to the way we used to be that we look back at this time as a needed push for some change. We should use this opportunity to see what we changed that made our teaching better.

1. Faulkner SL, Watson WK, Pollino MA, Shetterly JR. “Treat me like a person, rather than another number”: university student perceptions of inclusive classroom practices. Communication Education. 2021;70(1):92-111. doi: 10.1080/03634523.2020.1812680.
2. Kirn-Safran CB, Reid AC, Chatman MM. Peer Mentors Prove to be Strong Assets in Virtual Anatomy & Physiology Labs. Imprint. 2021:16-8.
3. Xinnian Chen CBK-S, Talitha van der Meulen, Karen L. Myhr, Alan H. Savitzky, Melissa A. Fleegal-DeMotta. Physiology Labs During a Pandemic: What did we learn? Advances in Physiology Education. 2021;In Press.

Figure 1: Image of free download Biopac Student Analysis Software®. Note you can review a saved lesson, analyze sample data from the company, or analyze data collected in the lab.

Figure 2:  Image of pre-recorded spirogram with vital capacity indicated. Values are indicated in the boxes on the top of the spirogram.

Opening image Creator: Victoria Bar; Credit: Getty Images

Melissa DeMotta, PhD is currently an Associate Professor of Biology at Clarke University in Dubuque, IA. Melissa received her BS in biology from Lebanon Valley College. After working for three years at Penn State’s College of Medicine in Hershey, PA, she received her PhD in Physiology and Pharmacology from the University of Florida in Gainesville. Following postdoctoral fellowships at the University of Arizona and Saint Louis University, Melissa joined the Biology Department at Clarke University. Melissa currently teaches Human Physiology and Exercise Physiology to physical therapy graduate students and undergraduates. She also enjoys teaching non-majors life science courses as well.
Using Google Jamboard for Collaborative Online Learning in Human Physiology

Active and cooperative learning strategies are useful tools for engaging students in the classroom and improving learning (Allen & Tanner, 2005; García-Almeida & Cabrera-Nuez, 2020; Montrezor, 2021). These learning strategies require students to engage with course content by “seeking new information, organizing it in a way that is meaningful, and having the chance to explain it to others” (Allen & Tanner, 2005, p. 262). Both active and cooperative learning emphasize peer interactions and give students opportunities to demonstrate understanding.

The COVID-19 pandemic provided an opportunity for instructors to practice new pedagogies in face to face, hybrid, and remote learning environments. Prior to the pandemic, I often asked students to use the classroom white boards collaboratively to draw diagrams, processes, and outline concepts. Given limitations on face to face interactions in hybrid and remote classes, I used Google’s Jamboard to recreate this in-class experience for a virtual Human Anatomy & Physiology course. Students were Exercise and Health Science majors and minors. The course was offered in 15, three-hour class periods over a four-week course block in spring 2021. The three-hour class periods necessitated a variety of pedagogies to maintain student engagement.

Jamboard is a virtual white board space that can be used collaboratively by sharing a link with others. Before sharing, the link settings must be adjusted to allow any user with the link to edit the Jamboard. Each board can hold up to 20 different frames, or white board spaces, which can be modified by adding figures, text, drawings, and sticky notes. I began the first day of class demonstrating to students how to use Jamboard. We started with a blank frame and I asked students to add “sticky notes” to the board with thoughts about how they would stay engaged with the course during our three-hour meeting time. Students also practiced using various editing tools such as the pen, textbox, and creating shapes. The students and I both found Jamboard very user friendly and easy to navigate.

In subsequent classes, I created specific Jamboard frames prior to class with the outline of an activity or figures. Some frames were created for the class to contribute to collaboratively, similar to a jigsaw format. For example, a picture of a neuron was added to one frame (Figure 1).

Preassigned student groups worked in Zoom breakout rooms to identify one anatomical location and describe its primary function on the neuron. Each group was assigned a different neuron structure and reported back to the class after their group work. During the cardiovascular physiology unit, student groups were each assigned one component of the cardiac cycle on a Wigger’s diagram. Groups worked in Zoom breakout rooms to identify their component of the cycle and write an explanation on the diagram. Groups also collaboratively completed a chart with each group completing one row or column in the chart (Figure 2). Jamboard was also useful for students to order and label steps in a physiological process. In the skeletal muscle unit, students worked in groups to correctly order the steps of muscle contraction. Each group was assigned one picture on the Jamboard frame, groups placed their picture in the correct order and used a textbox or sticky note to describe the picture.

 

 

 

 

 

For other activities, frames were created once and duplicated for each group with the group number noted at the top of the frame. Frames containing concept map instructions or feedback loop skeletons were duplicated for each group. For example, groups worked in Zoom breakout rooms to design a concept map demonstrating the relationships between cell membrane components (Figure 3) or outline a control system for different responses to deviations for homeostasis. During the homeostatic control system activity, each group was assigned a different control system. Groups reported back to the class as a whole and described their work to the class (Figure 4).

 

At the end of the course, students were surveyed about our Jamboard use. Of 17 students, 11 completed the survey. Overall, students indicated that Jamboard was an effective learning (100%, n=11) and group engagement tool (100%, n=11). In open-ended responses, students indicated that Jamboard was most effective for engaging in collaboration and checks for understanding during class. They especially liked that Jamboard helped create an in class feeling and kept them engaged with their class and their group in an interactive way. Even though groups were often labeled on Jamboard (e.g.- one frame labeled “Group 1 Concept Map” or a diagram with a “1” and arrow pointing to a specific area for identification for Group 1), several students remarked that they liked the anonymity provided by Jamboard and the lower perceived pressure to answer correctly. Students listed labeling diagrams (n=10), creating concept maps (n=7), and drawing physiological processes (n=6) as their favorite Jamboard activities. The students also appreciated that the boards were available after class for review. I posted the Jamboard link to our learning management system (Canvas) and students could return to the boards to review after class. 100% (n=11) of student respondents indicated they went back to the Jamboards two or more times after class to review.

From the instructor perspective, Jamboard provided an easy online collaborative tool for teaching physiology. Jamboard was user-friendly, flexible, and easy to set up before or during class. I found that my students were able to sustain engagement during three hours of remote class. The Jamboard group assignments were not graded, but asking student groups to report back to the class was effective motivation for producing quality group work. Challenges associated with Jamboard were consistent with most online activities including student access to a computer and reliable internet. Students occasionally had issues accessing the board anonymously if they were logged into their personal google accounts.

In moving back to face to learning, the Jamboard activities could be easily done on a whiteboard; however, collaborative drawing and annotating diagrams and charts might still be difficult without appropriate projectors or smartboard technology. Additionally, extra steps involved in taking a picture of the white board and uploading the picture to a course webpage may be barriers to making the collaborative work available after class for review. Jamboard could also be used for out of class individual or group assignments such a pre- or post- class assignments or for brainstorming activities. While the class size in the present example is quite small (17 students), use of Jamboard in these ways would be easily adaptable to larger classes and may improve student engagement in large classes (Essop & Beselaar, 2020)

 

Overall, Jamboard was an effective online collaborative tool for teaching and learning human physiology. Jamboard was user-friendly, easy to prepare before class, and kept students engaged with the class and their groups.

 

 

 

 

 

 

 

References

Allen, D., & Tanner, K. (2005). Infusing Active Learning into the Large-enrollment Biology Class: Seven Strategies, from the Simple to Complex. Cell Biology Education, 4(4), 262–268. https://doi.org/10.1187/cbe.05-08-0113

Essop, M. F., & Beselaar, L. (2020). Student response to a cooperative learning element within a large physiology class setting: Lessons learned. Advances in Physiology Education, 44(3), 269–275. https://doi.org/10.1152/advan.00165.2019

García-Almeida, D. J., & Cabrera-Nuez, M. T. (2020). The influence of knowledge recipients’ proactivity on knowledge construction in cooperative learning experiences. Active Learning in Higher Education, 21(1), 79–92. https://doi.org/10.1177/1469787418754569

Montrezor, L. H. (2021). Lectures and collaborative working improves the performance of medical students. Advances in Physiology Education, 45(1), 18–23. https://doi.org/10.1152/advan.00121.2020

Dr. Mary Stenson earned her B.S. in Biology from Niagara University and her M.S. and Ph.D. in Exercise Physiology from Springfield College. She is an Associate Professor of Exercise Science and Sport Studies at the College of Saint Benedict/Saint John’s University in Saint Joseph, Minnesota. Dr. Stenson teaches exercise physiology, research methods, anatomy & physiology, and health & fitness. Her research focuses on recovery from exercises and improving health of college students. Dr. Stenson mentors several undergraduate research students each year and considers teaching and mentoring the most important and fulfilling parts of her work.
Reworking the recipe: Adding experimentation and reflection to exercise physiology laboratories

What do you get when you follow a recipe? We suppose it depends on how carefully you follow the instructions, but assuming you stay true to the steps and have the requisite skills, you get something that approximates the taste described on the food blog (it never looks as good). While following a recipe can get you an expected result in the kitchen, it does not make you a chef—you probably will not learn to create new dishes, improve tired ones, or reverse-engineer your favorite take-out order. What do you do if you run out of vanilla!? We think the same is true in a science laboratory: You don’t develop the skills of a scientist by just following instructions. Sure, scientists follow instructions, but they also need to choose, create, and improve instructions. How do scientists become nimble with their craft? They experiment, make mistakes, troubleshoot, and iterate (or “Take chances, make mistakes, and get messy” for those who grew up with Miss Frizzle). If we asked you where undergraduate students learn to become scientists, we expect “laboratories” would be the most common answer, but unless laboratory activities are intentionally designed to develop the curiosity, creativity, and skills to pose and answer questions, they won’t produce adept scientists. In contrast to traditional laboratory activities, inquiry-based laboratory activities allow learners to develop important scientific skills.

Two years ago, we began a project aimed at improving student learning by replacing recipes with authentic science in exercise physiology laboratories. With one year remaining in our project, this blog post will explore our rationale, progress, and future plans.

Section 1: Put the scientist cookie-cutter back in the drawer

In undergraduate exercise physiology courses, laboratory-based learning is common, but it focuses more on students learning techniques than experimenting (9). In our experience, a typical undergraduate laboratory activity requires students to follow step-by-step procedures to measure one or more variables in a limited number of participants, most commonly their lab mates. Students administer exercise protocols on bikes, treadmills, and dynamometers to collect a variety of data, including oxygen uptake, heart rate, and muscle strength. These labs are largely descriptive. For example, a quintessential undergraduate exercise physiology laboratory involves performing a graded exercise test to measure the maximal rate of oxygen uptake (V̇O2max). Students assume the role of physiologist, repeatedly increasing the speed of a treadmill (or power output of a cycle ergometer) while sampling expired gases until the participant is unable to continue due to exhaustion. Students are discouraged (actually, prohibited) from altering the protocol and rarely given the chance to fix mistakes in a future laboratory (don’t forget the nose clips!). While the specific results may not be known in advance—they depend on characteristics of the participant—this activity is not an experiment. This traditional approach to laboratory teaching is standard (8, 11, 13). In contrast, an inquiry-based approach allows students to act like scientists and experiment.

There is a terrific description of levels of student inquiry in science for interested readers outlined in Bell et al. (4) and summarized in Table 1 below. The authors describe four levels of inquiry, and in our early stages of reforming labs, we found these levels very helpful for grappling with and revising laboratory learning activities and assessments. In our experience, only level 1 inquiry-based activities are regularly included in undergraduate laboratories: For example, our students compare post-exercise blood lactate concentration responses to passive and active recovery. Even though the results are known in advance and students are following the instructor’s procedures for level 1 inquiry, learners are frequently assessed on their ability to create laboratory reports where they find themselves toiling over uninspired post hoc hypotheses and rewriting a common set of methods in their own words. This process is disingenuous. Furthermore, knowing that they are attempting to verify a known result may lead some students to engage in questionable research practices to obtain that result (14).

Table 1. The four levels of inquiry, as described by Bell et al. (4).

Level Type Description of student activities
1 Confirmation Students verify or confirm known results
2 Structured inquiry Students investigate instructor-determined question using instructor-determined procedures (results not known in advance)
3 Guided inquiry Students investigate instructor-determined question using student-determined procedures
4 Open inquiry Students develop questions and procedures for rigorously answering them

 

We think traditional laboratory teaching goes against the spirit of what science actually is: The application of rigorous methods in the pursuit of answers to questions. Although students may develop technical skills by completing descriptive activities and low-level inquiry activities (e.g., data acquisition, data analysis, technical writing), there is a missed opportunity to develop the habits of mind and skills of a scientist in traditional laboratories. More than that, there is a misrepresentation, or at least obfuscation, of science. If we pretend these laboratories represent the scientific process, how do we expect students to become curious about, inspired by, and ultimately capable of doing science on their own? Students need to progress to higher levels of inquiry-based learning, but implementing these types of laboratories can be challenging in exercise physiology.

It is understandable that exercise physiology laboratories tend to exclude inquiry-based learning, as all tests are performed on human participants. First, there are legitimate safety concerns in exercise physiology laboratories, as participants are asked to exert themselves, often maximally; manipulations have physiological consequences; and some techniques are invasive. It would be irresponsible to let students change data collection protocols on the fly and jeopardize the health and safety of their peers. Second, as multiple testing sessions may be required to collect experimental data, manipulating independent variables may also be impractical for an undergraduate course aiming to cover a broad curriculum. For example, with sessions spread over multiple weeks, standardizing for diet is difficult. Third, the types of interventions that would have large enough effect sizes to be observable with small sample sizes (with a reasonable amount of “noise”) may be impractical or inappropriate in an undergraduate laboratory. For example, learners may not want to exercise for prolonged durations in the heat or deplete their muscle glycogen in advance of an exercise test. And finally, laboratory instructors may be uncomfortable or inexperienced with facilitating inquiry-based laboratories that go beyond level 1 (to say nothing of the confidence and ability of the learners themselves).

In addition to the practical concerns of adding more inquiry to undergraduate labs, we know students must learn the technical skills associated with fitness assessment, as exercise physiology is a health profession. If students pursue exercise physiology as a career path, they will apply advanced technical skills to accurately measure variables that impact exercise prescription, health assessments, and disease prognosis. Technical rigor is paramount in this profession, and imparting these skills is a major reason to offer exercise physiology laboratories. Unless specializing in research, exercise physiologists may not perform scientific experiments in their occupation. It is also challenging to collect most physiological data, and certainly learners cannot become scientists without acquiring data collection skills. Students need to practice and develop confidence using laboratory equipment before they can answer their own questions.

We understand that performing true experiments (especially student-led experiments) is difficult in undergraduate exercise physiology laboratories and we also appreciate why technical skills are essential. Yet, we do not believe that an exclusive focus on technical skills is the best strategy for students to learn scientific reasoning, critical thinking, and problem-solving skills. Regardless of a students’ career path, these are transferrable skills, and a laboratory is the ideal venue to nurture scientific thinking.

Section 2: Can we move beyond cookbook style laboratories?

What makes a good scientist? This answer probably varies across disciplines: Some scientists may be skilled in animal surgery, some may interrogate enormous data sets, and others may focus on theoretical concepts and proofs. There is probably no single skill set that is common among all scientists. But, if we put the specific technical skills aside, students need to ask questions, create hypotheses, solve problems, and think critically in order to conduct experiments. The mechanism for developing any skill is practice: Learners need opportunities to develop and refine their skills, whether they are technical or cognitive. Some students may be able to walk into a first-year laboratory and create an experiment, but many more will need additional support to reach this level of competency. In short, students need to practice being scientists. To be effective, this practice must be authentic: As scientists do not just follow instructions, a recipe-based approach to laboratory learning will not develop a good scientist. The higher levels of inquiry, (see Table 1), are where students get to practice being scientists.

Including higher level inquiry-based learning in exercise physiology isn’t entirely novel. For example, Kolkhorst et al. (11) described the implementation of an inquiry-based learning model in an undergraduate exercise physiology course. The structure of this course was (i) an introductory laboratory session; (ii) five laboratory sessions focused on key concepts in exercise physiology; and (iii) nine laboratory sessions to complete two separate research projects (4-5 sessions each). In the latter portion of the course–an example of level 4 inquiry (Table 1)–students proposed research questions and hypotheses and worked with instructors to devise an experiment, collected and analyzed data, and presented their results to the class. After addressing one research question, students repeated this process with a new research question focused on a different physiological system. Following the initial iteration—from which Kolkhorst et al. (11) noted students were not sufficiently prepared for undertaking the research projects—the authors devised a more structured transition, providing students with more opportunities to practice answering research questions and developing technical skills (i.e., level 2-3 inquiry). The results of this shift in laboratory learning were largely positive: The authors reported that students were more enthusiastic about the inquiry-based labs and better able to describe and discuss physiological principles. A separate study (8) indicated that students reported preferring high-level as opposed to low-level inquiry in exercise physiology laboratories, crediting the independence, responsibility, freedom, and personal relevance as key influences on their satisfaction. These qualitative results are further supported by quantitative data from Nybo and May (13), which demonstrated greater test scores for students who completed an inquiry-based laboratory session related to cardiopulmonary exercise physiology compared to a traditional laboratory on the same topic. Collectively, these studies demonstrate that enabling students to experiment in undergraduate exercise physiology is possible and beneficial.

Although writing specifically about physics education, Drs. Emily Smith and Natasha Holmes (14) advise us to eliminate confirmation (level 1) work and attempts at learning theory in laboratories. Based on extensive research, they suggest increasing the amount of laboratory time students spend (i) making predictions about what they think might happen; (ii) doing activities that involve trial-and-error; (iii) practicing decision making; and (iv) processing how things went. By allowing students to devise questions, design experiments, and collect data (with the opportunity to fix mistakes), students are practicing being scientists. By design, inquiry-based laboratory activities facilitate the first three suggestions; however, whether Smith and Holmes’ fourth recommendation occurs in inquiry-based laboratory activities is hard to determine, but this recommendation is important. This processing phase of laboratory learning improves students’ capacities to make good decisions over time. Including this reflective step in laboratories is something we have taken to heart and into all of our reformed labs.

Section 3: Adding inquiry and mixing reflection into exercise physiology laboratories

In our project, we are focused on two specific exercise physiology courses, an introductory undergraduate course (n = 80-200 students, depending on the semester) and an advanced graduate course (n = 10), both of which have a weekly 3-hour laboratory session. Prior to intervening, we surveyed the nature of laboratory teaching in each course, finding that students indeed followed step-by-step instructions without the opportunity to make decisions or investigate new questions. The only form of inquiry-based learning was level 1 (Table 1). We planned to make two broad types of changes: (i) provide students with more autonomy in the laboratory, and (ii) encourage students to reflect on the activities they were completing. As the graduate course was much smaller, this was deemed the easier place to start, and because of its size, this course was also allowed to remain in-person during the COVID-19 pandemic. Accordingly, most of our progress to date has been in revising this graduate exercise physiology course.

Initially, our changes to the graduate course’s laboratory focused on asking students to make and validate predictions while using a standard set of protocols (i.e., level 1 inquiry). In our first iteration, we modified four laboratory sessions to focus on the “unexpected” breakdown in the linear relationship between oxygen uptake and cycling power output that occurs during exercise with constant-load efforts and the difficulty in identifying the boundary between the heavy and severe exercise intensity domains (10). We (and students in the course) felt these activities were successful, so we modified the laboratory again the following year to allow students to focus on answering novel questions rather than verifying results. Using a gradual implementation approach similar to Kolkhorst et al. (11), students were first asked to create and test unique hypotheses for a set of data they collected over four laboratory sessions, combining aspects of level 2 and 4 inquiry (i.e., instructor-led procedures and student-led questions). Next, based on an article read earlier in the course (1), students worked as a group to determine whether fatiguing one limb influenced measures of exercise performance and fatigue in the contralateral limb when contractions were isometric (level 2). Finally, with a focus on inquiry-based learning and professional development, students were challenged to develop their own laboratory activity for a hypothetical course, which required devising an experiment to teach an important concept in exercise physiology and collecting pilot data to demonstrate feasibility (nearing level 4). To fully understand the impacts of these changes, we have collected survey and semi-structured interview data from students in reformed laboratories, which we hope to formally report at the end of the project.

Despite teaching our undergraduate exercise physiology course online this year, we attempted to create a virtual exercise physiology laboratory that focused on developing the skills needed to answer research questions. Learning activities focused on hypothesis creation, research design, data analysis, and statistical analysis. For one activity, we asked students to design a hypothetical study comparing mechanical aspects of sprinting for two groups of athletes (e.g., bobsleigh vs. fencing). Although new to research design, students were given the freedom to choose the sample size, the variable of interest, and the two types of athletes (selected from normative data published by Haugen et al. (7)). Martin used the students’ choices to simulate datasets, and students performed statistical analysis to test their hypotheses. While students couldn’t collect their own data, this activity allowed them to pose and answer a question, while learning about sprinting and research design. When this lab returns to in-person learning, plans are being formulated to include inquiry-based learning, similar to the structure that Kolkhorst et al. (11) and Henige (8) reported.

After two years of tinkering with our graduate course and beginning to reform our undergraduate course (despite its online format), we have realized that we simply need to give students more time in the laboratory to work on their own questions. Note that Kolkhorst et al. (11) and Henige (8) each provided 4-5 sessions for their level 4 inquiry laboratory activities. This can be a tough sell for instructors (ourselves included): It means we need to cover fewer topics. But, sometimes the best addition to a recipe is a subtraction (e.g., prohibiting pineapple on pizza). The battle over which absolutely essential topic has to be removed has already begun!

While we think increasing autonomy and inquiry in the lab is an important part of enhancing student learning, we also think students need to be able to debrief learning activities and process their experiences to enrich their learning. For both courses described above, students were asked to engage in reflective activities each week. We know reflection can move learning from surface to deep and even transformative levels (12). Reflection is a form of cognitive housekeeping and processing that enables students to develop their understanding of complex or unstructured ideas (12). When students actively engage in a constructive sense-making process, they understand complex systems and concepts better (6). Metacognitive practices are shown to improve self-regulation and commitment to lifelong learning; however, instructional strategies often neglect or assume students are engaging in metacognition (2). Evidence suggests metacognition at the end of STEM learning activities enriches learning (17). Based on this evidence and our experiences with reflection as a catalyst for curiosity and connection-making, we integrated a small amount of reflection with learning activities and added a low-stakes assessment in both courses. Students were asked to thoughtfully reflect on and respond to a specific prompt in approximately 100 words at the end of each lab. Questions like those listed below acted as a call to metacognition:

What did you find most challenging (or surprising, or interesting) in this lab and why?

What did you learn in this lab? What would you still like to know?

What do you think is the major obstacle to performing high-intensity interval training?

How would you explain the importance of fat oxidation to a lay person interested in exercise?

By asking students to connect their experience, knowledge, ideas, and sometimes uncertainty to their lab learning activities, we hoped to support them in deepening, extending, and amplifying their learning.

As we reformed student learning activities and move away from recipe-only laboratories, our teaching practices needed to change too. Recognizing that the laboratory instructors had mostly been trained through traditional style laboratories, we identified a need for some targeted professional development for our group of educators. To meet this need, Cari developed an asynchronous learning module called “Teaching to Enable Learning in Exercise Physiology,” for the instructional team to complete prior to the start of term, and we debriefed this 6-8 hour module together at our first meeting. This meeting set the tone and expectation in many ways for the teaching practices we were expecting teaching assistants to try in labs. We took a community of practice (CoP) approach to supporting laboratory teaching and learning throughout the semester. A CoP is a group of practitioners who meet regularly, reflect and problem solve collaboratively to learn to do their practice (for us, teaching) better (16). CoPs have been used to facilitate teaching and learning change in many higher education projects (5, 15). Each week, we (Martin and Cari) invited the lab technician, the teaching assistants (i.e., laboratory instructors), and a graduate student researcher (Joy Camarao) to reflect on and share both positive and negative teaching experiences from the week that was.

Conclusion

Years after completing an undergraduate degree in biology, the laboratory activities that stuck with me (Martin) the most are those that let me experiment. My favorite laboratory activity involved transplanting barnacles from the exposed side of a breakwater to the inner harbor on the coast of Nova Scotia to examine phenotypic plasticity in leg morphology. My lab mates and I chose the topic and designed the experiment, basing our question on a relationship observed in a related species of barnacle (3). We drove to the coast to find and transplant the barnacles, and we returned weeks later to collect the barnacles for analysis, hypothesizing that they would increase their leg length to optimize feeding in the calmer waters. Unlike most of my other laboratory experiences, we were performing a real experiment with real hypothesis and a (somewhat) novel question. Our study had flaws, and our results weren’t perfect, but the laboratory report was authentic, and so was my excitement. This type of lab is a challenge in exercise physiology, but it’s possible and worthwhile. As we enter the final year of our project, we hope to give students more opportunities to experiment.

Image Credits: Image 1- Nicole Michalou, Image 2- Maarten VanDenHeuvel, Image 3 William Choquette, Image 4- Frans VanHeerden.

 

References

  1. Amann M, Venturelli M, Ives SJ, McDaniel J, Layec G, Rossman MJ, Richardson RS. Peripheral fatigue limits endurance exercise via a sensory feedback-mediated reduction in spinal motoneuronal output. J Appl Physiol 115: 355–364, 2013.
  2. Ambrose SA, Bridges MW, DiPietro M, Lovett MC, Norman MK. How learning works: Seven research-based principles for smart teaching. John Wiley & Sons., 2010.
  3. Arsenault DJ, Marchinko KB, Palmer AR. Precise tuning of barnacle leg length to coastal wave action. Proceedings Biol Sci 268: 2149–2154, 2001.
  4. Bell RL, Smetana L, Binns I. Simplifying inquiry instruction. Sci Teach 72: 30–33, 2005.
  5. Elliott ER, Reason RD, Coffman CR, Gangloff EJ, Raker JR, Powell-Coffman JA, Ogilvie CA. Improved student learning through a faculty learning community: How faculty collaboration transformed a large-enrollment course from lecture to student centered. CBE—Life Sci Educ 15: 1–14, 2016.
  6. Eyler JR. How humans learn: The science and stories behind effective college teaching. West Virginia University Press, 2018.
  7. Haugen TA, Breitschädel F, Seiler S. Sprint mechanical variables in elite athletes: Are force-velocity profiles sport specific or individual? PLoS One 14: e0215551, 2019.
  8. Henige K. Undergraduate student attitudes and perceptions toward low- and high-level inquiry exercise physiology teaching laboratory experiences. Adv Physiol Educ 35: 197–205, 2011.
  9. Ivy JL. Exercise Physiology: A Brief History and Recommendations Regarding Content Requirements for the Kinesiology Major. Quest 59: 34–41, 2007.
  10. Keir DA, Paterson DH, Kowalchuk JM, Murias JM. Using ramp-incremental VO2 responses for constant-intensity exercise selection. Appl Physiol Nutr Metab (2018). doi: 10.1139/apnm-2017-0826.
  11. Kolkhorst FW, Mason CL, DiPasquale DM, Patterson P, Buono MJ. An inquiry-based learning model for an exercise physiology laboratory course. Adv Physiol Educ 25: 117–122, 2001.
  12. Moon JA. A handbook of reflective and experiential learning: Theory and practice. Routledge, 2013.
  13. Nybo L, May M. Effectiveness of inquiry-based learning in an undergraduate exercise physiology course. Adv Physiol Educ 39: 76–80, 2015.
  14. Smith EM, Holmes NG. Best practice for instructional labs. Nature 17: 662–663, 2021.
  15. Tinnell TL, Ralston PA, Tretter TR, Mills ME. Sustaining pedagogical change via faculty learning community. Int J STEM Educ 6: 1–16, 2019.
  16. Wenger-Trayner B, Wenger-Trayner E. What is a community of practice? [Online]. 2011. https://wenger-trayner.com/resources/what-is-a-community-of-practice/ [25 Jun. 2021].
  17. Wieman C, Gilbert S. The teaching practices inventory: A new tool for characterizing college and university teaching in mathematics and science. CBE—Life Sci Educ 13: 552-569., 2014.
Dr. Martin MacInnis is an assistant professor who studies exercise and environmental physiology from an integrative perspective, focusing on the skeletal muscle mitochondrial content, red blood cell volume, interval training, and applications of wearable technology. Martin teaches courses in exercise physiology at the undergraduate and graduate levels, and his SoTL research, in collaboration with Dr. Cari Din, focuses on using labs to develop scientific thinking.
Dr. Cari Din, PhD,  is an instructor, leadership fellow, and teaching scholar at the University of Calgary in the Faculty of Kinesiology. She works closely with Dr. Martin MacInnis, to support continuous improvement in teaching and learning experiences for students and graduate teaching assistants in the courses Martin leads. Cari works to enable agency, curiosity, and connection between learners in all of her work. She lives near the Rocky Mountains and appreciates hiking in them.
Pandemic, Physiology, Physical Therapy, Psychology, Purpose, Professor Fink, Practical Exams, and Proficiency!

Pandemic

To say that the COVID-19 pandemic has affected education would be an understatement.  Physical distancing measures that were introduced across the world to reduce community spread of SARS-CoV-2 (the COVID-19 pathogen), necessitated a cessation or reduction of in-person instruction, and the introduction of what has come to be known as “emergency remote education”(1, 2).  Emergency remote education or teaching (ERE or ERT) is different from remote or online education in that, it is not planned and optional, but rather, a response to an educational emergency (3).

Physiology for Physical Therapy Students

Against the backdrop of the COVID-19 pandemic, as I was trying to keep my primary research program on regenerative and rehabilitative muscle biology moving forward (4), engaging with the scientific community on repurposing FDA-approved drugs for COVID-19 (5, 6), and working on the Biomaterials, Pharmacology, and Muscle Biology courses that I teach each year; I was requested to take on a new responsibility.  The new responsibility was to serve as the course master and sole instructor for a 3-credit, 15-week course on Physiology and Pathophysiology for Professional Year One (PY1) Doctor of Physical Therapy (DPT) students.  I had foreseen taking on this responsibility a couple of years down the road, but COVID-19 contingencies required that I start teaching the course in January 2021.  I had always believed that within the Physical Therapy curriculum, Anatomy, Physiology and Neuroscience, were courses that could only be taught by people who were specialists – i.e. you had to be born for it and should have received a level of training needed to become a master of Shaolin Kung Fu (7).  With less than a year to prepare for my Physiology and Pathophysiology course, and with the acknowledgment that I was not trained in the martial art of Physiology instruction, I looked for inspiration.  The Peter Parker Principle from Spider-Man came to mind – “With great power comes great responsibility” (8).  Unfortunately, I realized that there was no corollary that said “With great responsibility comes great power”.  Self-doubt, anxious thoughts, and frank fear of failure abounded.

Psychology and Purpose

Call it coincidence, grace, or anything in between; at the time when I started preparing to teach Physiology and Pathophysiology, I had been working with a psychological counselor who was helping me process my grief following my father’s passing a couple of months before COVID-19 was declared a pandemic.  In addition to processing my grief, through counseling, I had also started learning more about myself and how to process anxious thoughts, such as the fear of failing in my new superhero role of teaching Physiology and Pathophysiology to Physical Therapy students.  Learning how to effectively use my “wise mind” (an optimal intersection of the “emotional mind” and “reasonable mind”), writing out the possible “worst outcomes” and “likely outcomes”, practicing “self-compassion”, increasing distress tolerance, working on emotional regulation, and most importantly embracing “radical acceptance” of the things I cannot change, helped me work through the anxiety induced by my new teaching responsibility.  This does not mean that my anxiety vanished, it just means that I was more aware of it, acknowledged it, and worked my way through it to get to what I was supposed to do.  I also learned through counseling that purpose drives motivation.  I realized that my anxiety over teaching Physiology was related to the value I placed on the teaching and learning of Physiology in Physical Therapy and other health professions.  Being a Physical Therapist and Physiologist who is committed to promoting movement-centered healthcare, I found motivation in the prospect of training Physical Therapists to serve as health educators with the ultimate goal of improving human movement.  Therefore, the idea of developing a course that would give my students a solid foundation in the Physiology and Pathophysiology of Human Movement began to excite me more than intimidate me.  The aspects of my personality that inspired me to publish a paper on the possible pathophysiological mechanisms underlying COVID-19 complications (5), stirred in me the passion to train the next generation of Physical Therapists, who through their sound knowledge of Physiology would likely go on to transform healthcare and promote healthier societies through movement (9).

The point about purpose being a positive driver of motivation, mentioned above, has been known to educational psychologists for a while.  When students see that the purpose of learning something is bigger than themselves, they are more motivated to learn (10).  So, rather than setting up my course as a generic medical physiology course, I decided to set it up as a Physiology and Pathophysiology of Human Movement course that is customized for human movement experts in training – i.e. Student Physical Therapists.  I set my course up in four modules – Moving the Body (focused on muscle and nerve), Moving Materials Around the Body (focused on the cardiovascular and pulmonary systems), Fueling Movement (focused on cellular respiration and the ATP story), and Decoding the Genetics of Human Movement (focused on how genetic information is transcribed and translated into proteins that make movement possible).

Professor Fink

For those of you who have not heard of Professor Steven Fink, you should look him up (11).  A Ph.D.-trained Physiologist and former member of the American Physiological Society (APS), Professor Fink has posted over 200 original educational videos on YouTube, covering Anatomy, Physiology, Pharmacology, and other subjects.  I had found his YouTube videos several years ago, while looking for good resources for my Pharmacology course, and never stopped watching them ever since then.  I would watch his videos while exercising, and listen to them during my commute (and sometimes even during my ablutions!).  There were two topics in Physiology that scared me the most – cellular respiration and genetics.  I had learned these topics just well enough to get me through high school, four years of Physical Therapy School, one year of Post-Professional Physical Therapy training, six years of Ph.D. training in a Physiology laboratory, six years as a Postdoctoral Fellow (also in a Physiology laboratory), and several years as an Assistant Professor in Physical Therapy.  However, despite the “few years” I had spent in academia and my 10+ years being a member of the APS, I never felt that I had gained mastery over the basic physiology of cellular respiration and genetics.  So, when I started preparing to teach Physiology, I decided to up my number of views on Professor Fink’s videos on cellular respiration and genetics.  Furthermore, I reached out to Professor Fink and asked him if he would serve as a teaching mentor for my new course and he very kindly agreed.  I am fortunate to be a teacher-scholar in a department and university, which places a high priority on teaching, and supports training in pedagogy and the scholarship of teaching and learning through consultation with experts within and outside the university.  As part of our mentoring relationship, Professor Fink gave feedback on my syllabus, course content, testing materials and pedagogical strategies.  He also introduced me to “Principles of Anatomy and Physiology, 16th Edition, by Gerard J. Tortora, Bryan H. Derrickson, which proved to be a useful resource (ISBN: 978-1-119-66268-6).  Through all these interactions, Professor Fink demonstrated that a person can be a “celebrity professor” and still be a kind and gentle human being.  Having him as my teaching mentor played a significant role in building my confidence as a physiology teacher.  Research shows that academic mentoring is related to favorable outcomes in various domains, which include behavior, attitudes, health, interpersonal relations, motivation, and career (12).

Practical Exams

As the COVID-19 pandemic rolled on through the Winter, Spring/Summer, and Fall semesters of 2020, it became certain that I would have to teach my Physiology and Pathophysiology course in a virtual environment come January 2021.  I had to figure out a way to make sure that the learning objectives of my course would be met despite the challenges posed by teaching and testing in a virtual environment.  Therefore, I came up with the idea of virtual practical exams for each of the four modules in my course.  These practical exams would be set up as a mock discussion between a Physical Therapist and a referring health professional regarding a patient who had been referred for Physical Therapy.  Students would take the exam individually.  On entering the virtual exam room, the student would introduce themselves as a Student Physical Therapist and then request me (the referring healthcare professional) to provide relevant details regarding the patient, in order to customize assessment, goal setting and treatment for the patient.  With the patient’s condition as the backdrop, I would ask the student questions from the course content that was relevant to the patient’s condition.  A clear and precise rubric for the exam would be provided to the students in keeping with the principles of transparency in learning and teaching (13).

Proficiency

As we went through the course, the virtual practical exams proved to be an opportunity to provide individualized attention and both summative and formative feedback to students (14).  As a teacher, it was rewarding to see my Physical Therapy students talk about cellular respiration and gene expression with more confidence and clarity than I could do during my prior 12+ years as a Ph.D.-trained Physiologist.  It was clear to me that my students had found a sense of purpose in the course content that was bigger than themselves – they believed that what they were learning would translate to better care for their patients and would ultimately help create healthier societies through movement.

In the qualitative feedback received through a formal student evaluation of teaching (SET) survey, one student wrote “Absolutely exceptional professor.  Please continue to do what you are doing for future cohorts.  You must keep the verbal practical examinations for this class.  Testing one’s ability to verbally explain how the body functions and how it is dysfunctional is the perfect way to assess if true learning has occurred.”  Sharing similar sentiments, another student wrote “I really enjoyed the format of this class. The virtual exams in this class forced us to really understand the content in a way that we can talk about it, rather than learning to answer a MC question. I hope future students are able to learn as much as I did from this class.”

Closing Remarks

When I meet students for the first time during a course, I tell them that even though I am their teacher, I am first a student.  I let them know that in order to teach, I first need to learn the content well myself.  Pandemic pedagogy in the time of COVID-19-related emergency remote education has reinforced my belief that, the best way to learn something is to teach it.  Thanks to my Physiology and Pathophysiology of Human Movement course, I learned more about myself, about teaching and learning, and of course about cellular respiration and genetics.  Do I now consider myself a master of Physiology instruction?  No!  Am I a more confident physiology teacher?  Yes!  Has writing this article made me reflect more on what worked well and what needs to be fine-tuned for the next iteration of my Physiology and Pathophysiology course?  Yes!

REFERENCES:

  1. Williamson B, Eynon R, Potter J. Pandemic politics, pedagogies and practices: digital technologies and distance education during the coronavirus emergency. Learning, Media and Technology. 2020;45(2):107-14.
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  3. Hodges C, Moore S, Lockee B, Trust T, Bond A. The difference between emergency remote teaching and online learning. Educause review. 2020;27:1-12.
  4. Begam M, Roche R, Hass JJ, Basel CA, Blackmer JM, Konja JT, et al. The effects of concentric and eccentric training in murine models of dysferlin-associated muscular dystrophy. Muscle Nerve. 2020.
  5. Roche JA, Roche R. A hypothesized role for dysregulated bradykinin signaling in COVID-19 respiratory complications. FASEB J. 2020;34(6):7265-9.
  6. Joseph R, Renuka R. AN OPEN LETTER TO THE SCIENTIFIC COMMUNITY ON THE POSSIBLE ROLE OF DYSREGULATED BRADYKININ SIGNALING IN COVID-19 RESPIRATORY COMPLICATIONS2020.
  7. Wikipedia contributors. Shaolin Kung Fu – Wikipedia, The Free Encyclopedia 2021 [Available from: https://en.wikipedia.org/w/index.php?title=Shaolin_Kung_Fu&oldid=1026594946.
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  9. American Physical Therapy Association (APTA). Transforming Society – American Physical Therapy Association [Available from: https://www.apta.org/transforming-society.
  10. Yeager DS, Henderson MD, Paunesku D, Walton GM, D’Mello S, Spitzer BJ, et al. Boring but important: a self-transcendent purpose for learning fosters academic self-regulation. Journal of personality and social psychology. 2014;107(4):559.
  11. Fink S. ProfessorFink.com [Available from: https://professorfink.com/.
  12. Eby LT, Allen TD, Evans SC, Ng T, Dubois D. Does Mentoring Matter? A Multidisciplinary Meta-Analysis Comparing Mentored and Non-Mentored Individuals. J Vocat Behav. 2008;72(2):254-67.
  13. Winkelmes M. Transparency in Learning and Teaching: Faculty and students benefit directly from a shared focus on learning and teaching processes. NEA Higher Education Advocate. 2013;30(1):6-9.
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Joseph A. Roche, BPT, PhD.  Associate Professor.  Physical Therapy Program.  Eugene Applebaum College of Pharmacy and Health Sciences.  

I am an Associate Professor in the Physical Therapy Program at Wayne State University, located in the heart of “Motor City”, Detroit, Michigan.  My research program is focused on developing regenerative and rehabilitative interventions for muscle loss arising from neuromuscular diseases, trauma and aging.  I have a clinical background in Physical Therapy and have received intensive doctoral and postdoctoral research training in muscle physiology/biology.

https://www.researchgate.net/profile/Joseph-Roche-2

https://scholar.google.com/citations?user=-RCFS6oAAAAJ&hl=en


Repurposing the notecard to create a concept map for blood pressure regulation

One amazing aspect of physiology is the coordinated, almost choreographed function of millions of moving parts.  The body has mastered multitasking, maintaining hundreds of parameters within narrow and optimal ranges at the same time.  This very aspect of physiology fuels our passion and enthusiasm for teaching physiology and piques the interests of students.  The networks of numerous overt and subtle interdependent mechanisms and signaling pathways between multiple organs and tissues that regulate plasma calcium or energy intake, for example, also represent major challenges to understanding and learning physiology for students.  We ask our students to combine the wisdom of two old sayings: “You can’t see the forest for the trees’, and “The devil is in the details.”  They need to understand both the bigger picture of the whole animal and the nuanced interlinking of mechanisms, and even molecules, that seamlessly and dynamically maintain different parameters within narrow ranges.  It can be frustrating and discouraging for students.  Furthermore, passing with high marks in systems physiology or anatomy-physiology II is a criterion for eligibility to apply to various health profession programs.  As educators we must acknowledge the complexity of physiology and find ways to help our students literally see and master smaller sections of the larger regulatory network so they can recreate and master the larger network.

For even the best prepared student, as well as the student who cannot take all recommended prerequisite courses for A&P-II or basic physiology, the collection of numerous parts, mechanisms, equations and connections, principles, and laws can represent an obstacle to learning.  Student comments such as, “There is so much to know.”, “It’s so complicated.”, and “Physiology is hard.” are accurate and fair, but also warrant validation.  A little bit of validation and communicating the challenges we encountered as students goes a long way in helping our students’ willingness to endure and continue to strive.  Physiology courses are not impossible, but they are difficult and might well be the most difficult courses a student takes.  I will not pretend or lie to my students.  If I were to dismiss physiology as a whole or a given concept as easy and simple, I risk my student thinking they should be learning principles effortlessly or instinctively and begin to doubt themselves and give up.  It helps to confess apprehensions you yourself felt when first learning various physiological concepts or phenomena.  As a novice physiology student, I had many moments at which I wanted to tap out.  ne major example was my introduction to the beautiful, albeit daunting display of all the electrical and mechanical events that occur in only the heart during a single cardiac cycle in just 0.8 seconds, i.e., the Wiggers diagram.  Every time I project this diagram on the screen, I give students a moment to take it in and listen for the gasps or moans.  I admit to my students that upon seeing that diagram for the first time I looked for the nearest exit and thought to myself, ‘Are you kiddin’ me?”  Students laugh nervously.  They sigh in relief when I tell them that my professor broke down the diagram one panel at a time before putting all together; his approached worked, and that is what I will do for them.  Dr. Carl Wiggers was committed to teaching physiology and developed the diagram over 100 years ago as a teaching tool for medical students (1).  The diagram is instrumental in teaching normal cardiac physiology, as well as pathophysiology of congenital valve abnormalities and septal defects.  Nevertheless, students still need help to understand the diagram.  Again, here an example of the function of just one organ, the heart, being a central element to a larger network that regulates a major parameter – blood pressure.  Learning regulation of blood pressure can be an uphill battle for many students.

Cardiovascular physiology is typically a single unit in an undergraduate physiology course, and it is often the most challenging and difficult exam of the semester.  Several years ago, when preparing to teach this section in an AP-II course I felt compelled to find ways to help students break-down and reconstruct pieces of complex regulation of blood pressure.  I considered the many high-tech digital learning resources and online videos available to our students but wondered whether those resources help or hinder students.  I was also looking for tools that would facilitate multisensory learning, which is shown to yield better memory and recall (2).  Despite all these high-tech resources, I noticed students were still avid users of notecards and were convinced they held the secret to success in AP-I and thus, must also be the key to success in AP-II or systems physiology.  I found this quite amusing, because we used notecards back when I was in college in the 80s – when there were no digital learning platforms and highlighters only came in yellow.  Students tote around stacks of hand-written, color coded notecards that grow taller as the semester progresses, but often their comprehension and ability to connect one concept or mechanism to the next does not increase with the height of the stack.  Students often memorize terms on note cards but cannot readily connect the mechanism listed on one card to that on the next card or explain the consequence of that mechanism failing.  Around this time a non-science colleague was talking to me about her successful use of concept maps with her students.  To me, concept maps look a lot like biochemical pathways or physiological network diagrams.  It dawned on me.  I did not need to reinvent the wheel or make a newer better teaching tool.  I simply needed to help my students connect The Notecards and practice arranging them to better pattern regulatory networks.  Students were already writing a term on one side of the card and a definition and other notes on the back.  Why not build on that activity and more deliberately guide students to use cards to build a concept map of the network for regulation of blood pressure which is central to cardiovascular physiology?

 

Blood pressure is a physiological endpoint regulated by a nexus of autoregulatory, neural and hormonal mechanisms and multiple organs and tissues.  Blood pressure is directly dependent on cardiac output, vascular peripheral resistance, and blood volume, but can be altered by a tiered network of numerous neural, hormonal and cellular mechanisms that directly or indirectly modulate any one of the three primary determinants.  The expansive network, e.g., numerous organs and tissues, and multiple and intersecting effects of different mechanisms within the network, e.g., the renin-angiotensin-aldosterone system modulates both vascular resistance and blood volume) make it difficult to see the network in its entirety.  Nevertheless, students must understand and master the entire network, the individual mechanisms, and the nuances.  Thus, in preparing for the cardiovascular section and planning how to implement the concept map, I made a list of all components that comprised the regulatory network for blood pressure with the first terms being blood pressure, cardiac output, vascular peripheral resistance, and blood volume.  At this point in the semester, the students had learned the basics of cellular respiration and metabolism.  I began the very first cardiovascular lecture with an illustration of the human circulatory system projected on the screen as I worked at the white board.  In the center of the board, I drew a cell with a single mitochondrion and three simple arrows to indicate the use of glucose and oxygen to convert ADP to ATP.  Guided through a series of questions and answers, students collectively explained that the heart must pump blood through arteries and veins to deliver oxygen and glucose and fat needed to generate ATP, as well as to remove carbon dioxide and other wastes.  Using the illustration of the human circulatory system, I then carefully explained the human circulatory system is a closed system comprised of the blood (the medium carrying oxygen, nutrients, CO2 and other wastes), the heart (the pump), and the arterial and venous vessels (the conduits in which blood flows from the heart to the tissues where oxygen and nutrients are delivered and CO2 and other wastes are removed).  If adequate pressure is sustained, blood continues to flow through veins back through the heart and to the lungs to unload CO2 and reoxygenate blood and then back to the heart to make another round.  I further explained blood pressure must be regulated to ensure blood flow to tissues optimally matches both metabolic need for oxygen and nutrients and production of CO2.  On the board, I then wrote “Blood Pressure (BP)” and stated that because this is a closed circulatory system, blood pressure changes in direct response and proportion to cardiac output or volume of blood pumped out of heart into systemic vessels in one minute, the total volume of blood in the system, and the vascular resistance that opposes flow and will be predominantly dependent vasoconstriction and vasodilation.  I wrote the terms “Cardiac Output (CO), Blood Volume (BV), and Vascular or Total Peripheral Resistance (VPR) one at a time underneath BP, each with an arrow pointing directly to BP.  I stated that any factor that changes cardiac output, blood volume, or vascular resistance can indirectly alter blood pressure.  For example, a change in heart rate can change cardiac output and thus, alter blood pressure.  I then distributed the series of hand drawn diagrams shown below.  As I pass out the sheets and display on slides, I tell them they will be learning about all these various factors and mechanisms and will be able to recreate the network and use it as a study aid.

To get students started, I handed out the list of cardiovascular terms, hormones, equations, etc. and several small pieces of paper, e.g., 2”x2” plain paper squares, to each student.  [I found free clean scratch paper in various colors in the computer lab and copy room recycling bins.]  Students can also take their trusty 3”x5” cards and cut each in half or even quarters or use standard-size Post-It® notes.  I explained that as I introduce a term or mechanism they will write the term or conventional abbreviation on one side of the paper and the definition and pertinent information on the other in pencil for easier editing.  [I emphasized the importance of using conventional abbreviations.]  For example, Blood Pressure would be written on one side of the paper and ‘pressure exerted against vessel wall’ on other, along with ‘mm Hg’, and later the equation for mean arterial pressure (MAP) can be added.  I had my own set of terms written on Post-It® notes and arranged BP, CO, BV, VPR and other terms on a white board so they could see the mapping of functional relationships take shape.  As new concepts were taught and learned, e.g., CO = Stroke Volume (SV) x Heart Rate (HR), the respective terms were added to the concept map to reflect the physiological relationships between and among the new mechanism to the existing mechanisms or phenomena already in the concept map.  In that case, on the back of the CO paper or card one might write “volume of blood ejected from ventricle in one minute into aorta”, “CO = HR x SV“, “If HR is too fast, CO will decrease!”, “Right CO must equal Left CO!”  I explained students can lay out their terms on a table, floor, their bed, etc.  I reminded students how important it was to say the terms out loud as they wrote the terms in their best penmanship.  This helps students slow down and deliberately think about what they are writing and refer to their lecture notes or textbook (be it an actual book or e-book).  I had given students copies of the complete concept map of all terms but did not dictate exactly what they should write on the back of the cards.  The small size of the paper or card, almost forces students to annotate explanations; this helped them better encapsulate their ideas.  I was open to checking their annotation and reflecting back to students the apparent meaning of their word choice.  While studying alone or with study partners, students were encouraged to audibly define terms and relationships among mechanisms as they arranged their maps in the correct configuration.  They were encouraged to ‘shuffle the deck’ and recreate subsections of the network to understand mechanistic connections at different points in the network.  Because I had given them the diagrams or concept maps for cardiac output, blood volume, and vascular resistance, students were able to check their work and conduct formative assessments alone or in groups in an accurate and supportive manner.

Students expressed that manually arranging components allowed them to literally see functional and consequential relationships among different mechanisms.  The activity complemented and re-enforced quizzes and formative assessments already in use.  It’s not a perfect tool and certainly has room for improvement.  There are quite a few pieces of paper, but students found ways to keep the pieces together, e.g., binder clips, Zip-lock bags, rubber bands.  Nonetheless, it is simple, portable, and expandable concept map students can use to learn cardiovascular physiology and represents a tool that can be applied to teach and learn other regulatory networks, such as those of the digestion-reabsorption-secretion in the GI tract and calcium homeostasis.

  1. Wiggers C. Circulation in Health and Disease. Philadelphia, PA: Lea & Febiger, 1915.
  2. http://learnthroughexperience.org/blog/power-of-context-learning-through-senses/
Alice Villalobos, Ph.D., is an assistant professor in the Department of Medical Education at the Texas Tech Health Sciences Center in Lubbock, Texas.  She received her B.S.in biology from Loyola Marymount University and her Ph.D. in comparative physiology from the University of Arizona-College of Medicine.  Her research interests are the comparative aspects of the physiology and stress biology of organic solute transport by choroid plexus.  She has taught undergraduate and graduate courses in integrative systems physiology, nutrition and toxicology.  However, her most enjoyable teaching experience has been teaching first-graders about the heart and lungs!  Her educational interests focus on tools to enhance learning of challenging concepts in physiology for students at all levels.  She has been actively involved in social and educational programs to recruit and retain first-generation college students and underrepresented minorities in STEM.