Category Archives: Teaching Strategies

Still looking for an ethical way to assess “lifelong learning”

Medical school accreditation process requires that institutions document that medical students develop the skills for “lifelong learning”.  As other standards of the section require that you answer precisely the question that is asked, I found this topic particularly challenging.  “Lifelong” requires that the assessment occurs at the end of life.   Otherwise, you may have been a learner for three-quarters of your life, and this is not lifelong.  One option would be to assess learning capability and then immediately “dispatch” the individual, providing a data point that indeed reflects lifelong learning.  Even as my caffeine titers swing wildly from under- to over-caffeinated, this approach seems unlikely to pass the Institutional Review Board.  In fact, submission of the application may result in my developing a close relationship with individuals with behavioral clinical expertise.

When reaching an impasse, return to the original question. Revisiting the Liaison Committee on Medical Education (LCME) element # 6.3, the title is actually “Self-Directed and Lifelong Learning”.  So, there may be an opening – focus instead on Self-Directed Learning.  The accreditation documents helpfully provide an expanded description

“The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences that allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; appraisal of the credibility of information sources; and feedback on these skills from faculty and/or staff.”

Part of the quandary is rooted in the shift of professional education from information acquisition to the development of competencies.  Competencies are much better aligned with professional behaviors, and include aspects of knowledge, skills, and attitudes.  Among the competency domain buckets, self-directed learning is more appropriately identified as a skill and an attitude.

Conversation with a friend (pre-pandemic) indicated that a transposition of the phrase would be useful, and that “directed self-learning” is a more appropriate goal for professional school.  Each institution has a desired set of learning outcomes – the curriculum for the faculty must guide the students so that the skill of independent learning focuses on the knowledge content that must be learned.

The first component in the LCME expanded definition of the element is “…self-assessment of learning needs.”  Assessing this is a challenge – if a learner does identify a gap, you as the facilitator can check off that box.  More challenging is a situation when you recognize a learning need and the learner does not.  To get to check off that box, you have to use open-ended questions to probe the learner’s current state of awareness and lead them on a voyage of self-discovery.  It is indeed a challenge, but the ability to self-identify gaps is an essential characteristic of a professional.  While the journey is a challenge, the creation of the list of learning objectives as an outcome is nice, tangible, and easy to assess.

The second component is more straight-forward “…independent identification, analysis, and synthesis of relevant information.”  Finally, I get to return to my comfort zone – information.   Acquiring information as proof that you know how to acquire information is one logical outcome that is easy to assess.  Assessment of the ability to synthesize that information with other relevant information gets more obscure, and ultimately requires a value judgment.  Overall, still doable.

The third component is “appraisal of the credibility of information sources”.   After establishing a few boundaries (such as “Cite Wikipedia and I will hold you up for public shaming”), learners progressively master when to use texts, professional society position papers, clinical research studies and meta-analyses to obtain the appropriate type and depth of information.  That box is checked.

The concluding component “feedback on these skills”, returns the focus to assessment.   To document this, you have to do an assessment on assessment, or a meta-assessment.  And as evidence both that knowledge alone is not enough and that the ability to appraise the credibility of sources is needed, a Bing search produced over 1 billion web hits for the term “meta-assessment”.  Google Scholar was a little more selective returning only 1,290 results.  None of which I intend to read.

We now live in a world where knowledge gaps are no longer perceived as a problem.  For example, what if I wanted to go to Vermillion South Dakota and did not know how to get there?  The knowledge gap is unimportant as long as I know a successful strategy to remedy that gap.  Apple maps now becomes my new best friend.  Even in 2022, knowledge does still matter.  A keyboarding or spelling error can send (and has sent) travelers in interesting directions.  An individual needs to realize when they are headed in the wrong direction.

So, the “lifelong” adjective remains a non-starter in terms of assessment.  Directed self-learning, however, is a needed goal as we prepare professionals for the challenges that await them.

 

Robert G. Carroll earned his Ph.D. in 1981 from the Graduate School of Biomedical Sciences of the University of Medicine and Dentistry of New Jersey-Newark. Following a 3 year post-doc at University of Mississippi Medical Center in Jackson, he moved to East Carolina University in 1984 as an Assistant Professor of Physiology. He is currently Professor of Physiology at the Brody School of Medicine at East Carolina University and the Associate Dean for Medical Education.

Rob is the past chair the Education Committee for the American Physiological Society, and currently chairs the Education Committee of the International Union of Physiological Sciences. He was editor of the journal “Advances in Physiology Education” from 2008-2013.

Robert G. Carroll, PhD.

Professor of Physiology

Associate Dean for Medical Student Education

Brody School of Medicine at East Carolina University

Greenville NC USA

Do Animals & Aliens belong in a Human Physiology course?

As a human physiology instructor, one of the most frequent comments I get from students is about how hard the course is. In fact, I have started to bring this up right at the beginning of the semester and offer my students many ways to overcome the challenges, including keeping up with the reading and the homework, coming to office hours with questions, forming study groups, etc… There are several reasons why the students struggle with the physiology course. Physiology can be hard for students due to the amount of material and the nature of the subject which requires integrating knowledge from other fields such as anatomy, biochemistry, cell biology, physics, and chemistry. There is also a lot of heterogeneity among the students learning human physiology. They may be biology majors taking physiology as an elective, or those who are preparing for a career in a health profession, and they may be coming from different backgrounds with varying levels of preparation. Some students may start the course with basic biology knowledge and some pre-conceived notions that may even hinder their ability to learn the intricacies of human physiology.

There is a belief among many physiology students that since there is a lot of factual detail then memorization is the way to go. This inevitably leads to memorization fatigue, and confusion when seemingly contradictory material is encountered. Instead of focusing on the overwhelming number of details, a better strategy would be to focus on common themes or core concepts that once learned will allow the formation of a strong foundation. When the students learn core concepts, they do not need to learn all the details of all the systems, just the common themes and this reduces the cognitive load. By having to remember fewer items, the students can work on learning as opposed to memorizing. Focusing on core concepts allows the students to transfer their learning from one body system to another with an understanding of the basics. Core concepts provide a way to raise the level of knowledge of the students, so that long after they have completed the course, they can continue to learn physiology even if they do not remember all the details.

Michael & McFarland (2011) have compiled a list of 15 physiology core concepts based on physiology faculty surveys that describe the most important parts of teaching physiology. It is clear from Michael et al. (2017) that these core concepts are ‘general models’ as they are widely applicable in most areas of physiology. Some of these core concepts include homeostasis, cell membrane, cell-cell communication, flow-down gradients, and interdependence and provide an excellent framework for the teaching of physiology.

The wide applicability of core concepts allows the instructor to generate models involving animals as well as hypothetical aliens. It may be reasonable to assume that learning core concepts will then enable the students to answer questions and solve problems involving animals and aliens. There are some really good reasons for the use of animal and alien models for teaching core concepts as well as for assessment. The use of animals & aliens in teaching and assessment removes any preconceived notions about how the human body works and can hone in on the most important facets of the concepts that we want the students to learn. Animal & alien models in assessment can be an excellent way to test for comprehension of concepts and the ability to transfer the learning from the known system to a novel scenario.

Problem sets with animals & aliens can be used in teaching as well as assessment. Courses on animal physiology or comparative physiology can shine a spotlight on the common themes between animals and humans. Animal models are routinely used in research to study human diseases as well as to test interventions. Teaching modules that incorporate animal physiology like the one from HHMI Biointeractive on dinosaurs’ ability to maintain their body temperature can engage the students to apply principles of physiology to understanding how dinosaurs were able to regulate their body temperature. Tools like the Fictional Animal project (Batch et al. 2017) help students in their systems thinking to identify the most important physiological models to integrate the various body systems and in addition to understanding the interactions between an animal and its environment.

With the increased interest in space exploration and human travel to moon and Mars, physiology questions on aliens can help us learn more about human physiology and how we might adapt to space. Research on extraordinary life forms at the bottom of the oceans and hydrothermal vents that provide us with more ways to imagine life in space while emphasizing similarities with human physiology. Most importantly, bringing animals, fictional or real, and aliens into the classroom can increase student engagement and impact learning and transfer of knowledge.

One way to use non-human examples is by using the framework of Test Question Templates (TQTs; Crowther et al. 2020), in which clearly articulated Learning Objectives (LO) are used to generate questions. Every TQTs based on an LO can be used to create multiple questions, thus reducing the possibility of memorizing answers. The use of TQTs can result in questions that assess student understanding and application of core concepts, expecting students to use higher levels of Bloom’s taxonomy. (Casagrand & Semsar, 2017). The consistent use of TQTs can build an appreciation of physiology concepts leading to better preparation for patient care and real-life medical scenarios.

The appeal of TQTs for students, in addition to learning concepts as opposed to facts, is also that they can envision what questions can be asked based on an LO. TQTs can be used in class as models for generating questions in which the students can also participate. As instructors, we like it when our students answer questions, but it is even better when they ask the questions. So, does it matter to a pre-health student whether a dinosaur was endothermic or ectothermic? And the answer to that is if it helps the student understand how temperature regulation works, it certainly does.

References:

Batch, S.A., et al. 2017 Adv Physiol Educ. 41:2 https://doi.org/10.1152/advan.00159.2016

Casagrand, K. and Semsar, J. (2017). Adv in Physiol Educ. 41: 170-177. 10.1152/advan.00102.2016

Crowther, G. J. et al. (2020). HAPS Educator 24(1):74-81. https://doi.org/10.21692/haps.2020.006

Michael, J. and J. McFarland (2020). Advances in Physiology Education 44: 752-762. https://doi.org/10.1152/advan.00114.2020.

Michael, J. & McFarland, J. (2011) https://doi.org/10.1152/advan.00004.2011

Usha Sankar Ph.D. is a Sr. Lecturer at Fordham University, Bronx, NY and has been teaching human physiology for over 10 years. Usha is very interested in bridging the gap between teaching and learning and is looking to improve her own physiology teaching as she believes learning about the inner workings of the human body is the most fun thing anyone can do. Usha is also involved in conducting air quality research and collaborating with young scholars from middle and high schools about air quality, health impacts, and climate change research. This research combines all her interests including human health, education, and climate change.

Usha Sankar Ph.D.

Senior Lecturer

Dept. of Biological Sciences

Fordham University

441 E Fordham Rd

Bronx, NY 10458

Impactful activities to create a framework to support team-based activities

While the recent pandemic has forced a number of rapid reforms in learning and teaching, the need to rethink how we learn and teach at the tertiary level began well before that. This has been exemplified by increasing interest in topics such as flipped classrooms, authentic assessments, and students as co-contributors. Although one might argue that the idea of flipped classroom is not new, there has been a growing push to create authentic learning experiences and authentic assessments to better prepare our graduates for the next stage of their careers – be it further professional education or employment. To work towards this goal our department recently restructured our final-year physiology courses to create an environment that empowers students to be agents of their own learning. We believe that over their lifetimes of their degrees, the students should transition from learning through knowledge transfer to self-guided agents in their own learning to promote lifelong learning. To achieve this aim, our assessments were restructured to shift the focus and emphasis from tests and exams, to more authentic assessment tasks. Here we will share an example of one such assessment and the guides we provide to help the students succeed.

In one subject Physiology: Adapting to Challenges, the students are required to work in a team on a project to be presented in a mini-student conference at the end of the semester, to mimic a scientific conference. While a team presentation might not be a truly novel idea, a few factors that we have included in the project design make it distinctive from other similar assessments.

In the early years we were concerned that students would shy away from the team project aspect of the subject. We, like many of our colleagues, thought that the students would detest the prospect of group work and thus be put off by a group project as was observed in a study at another Australian University (White et al. 2007). However, when we surveyed our second- and third-year Physiology students, it was interesting to find that approximately 75% of respondents in both second- and third-year preferred working in groups rather than individually, and the majority of the students understand the importance of acquiring teamwork skills. Many raised concerns about working in a group from prior negative experiences, similar to concerns raised in a previous blog post here. This led us to come up with ways to support the students’ success in this team project. Here we will share some of the lessons we have learned along the way.

1) Broad topics with multiple possible directions

The students were presented with a number of broad research topics or questions of physiology, examples of topics include “Tips and tricks to aging well.” Or “Stress: is it always bad?”. While at first these topics might seem like ‘bad’ topics as they do not appear to provide any research direction, this apparent flaw is also the beauty of this design, as the ‘vagueness’ of the topic gives the student groups flexibility and scope to develop and identify their own common interests within the broad field of physiology and is one of the unique aspects of this assessment. As the starting point covers a broad range of potential directions, the team must arrive at a consensus on the ultimate and final direction of the project. This freedom was an intentional design to give students agency and choice in their project. While some teams do find this lack of direction challenging, the majority of the feedback from the students was positive, with 85% of the respondents in an end of semester survey enjoying the flexibility this provides. In fact, some students stated that they have never experienced this type of freedom in taking their learning into their own hands in their university degree and felt empowered by this option. The feedback from academics who help review these presentations was overwhelmingly positive and we have been consistently impressed by the quality and depth of work produced by our undergraduate students.

2) Create groups based on common interest

The groups were created based on the student nominated projects and not randomly assigned. The students are asked to nominate and rank their top three picks of the projects, together with a short description of their reason for picking that project. The student groups are created from their nominations and the rationale for their interest in the project. This creates groups with a common goal and facilitates the group formation process. While diversity in groups is a well-recognized factor in strong groups, it is also important that groups have common goals. A fine balance must be struck between diverse groups and the common goal. Student feedback on this aspect of the assessment was positive as it gave them a choice on what to research on a topic of their choice. Something that they don’t often get a chance to do in other subjects.

3) Nominate a team mate – if you want

Our previous experience in group formation has shown us that being introduced to a group of unfamiliar people can be a stressful experience for some students, especially with the added stress of an associated assessment. We found that many students appreciated the option and opportunity to nominate a team mate. This reduced their social anxiety in the formation phase of the team. While some students did try to ‘cheat’ the system by either nominating multiple people, or in some cases nominating people in a chain, it is up to the academic to decide whether to allow or disallow these cases. It is important to keep in mind a number of other factors such as making sure that no single student in any group is the solo person without a nominated ‘buddy’ to minimize social exclusion, and still maintaining diversity in the group. The observation from the tutors and teaching staff was that this nominated ‘buddy’ system reduced the social anxiety in early group formation and allowed the groups to move forward to the next stage to discuss their direction sooner.

4) Effective ice breaker activities

Most of us would have experienced ice-breaker activities in a workshop or other types of settings and may have cringed at the idea of these activities. However, finding effective ice breaker activities can help overcome the initial social anxiety and allow the students to get to know each other. The key to effective ice breakers is to choose ones that require and assist their communication, whether it is discussing an idea that is not associated with the assessment (e.g. team name) to reduce the stress, or activities where the team members get to learn something about each other, or work towards a common goal that is not assessment associated. The ultimate aim is to get them to start conversing and help ease the more in depth and intense discussions that will follow. Indeed, in a survey of our students following the ice-breaker activity, the students noted that the ice-breaker activities were cliche but did benefit by increasing comfort with team members by the end of the activity and thus could see the benefit of the activity.

5) Team contract

Following the ice breaker activity, the student teams are asked to discuss and sign a team contract. The team contract provides a framework for the students to discuss and outline their expectations within the team. It includes basic information such as contact information. There are also general procedural discussions such as location for sharing documents, the best means of communication within the team, the preferred method for everyone. The students are advised to set up a team chat that everyone can access. This was an extra layer of challenge in the online learning space as some messaging tools may not be available in some geographical locations.

As the team progresses through the contract, the discussion topics get progressively deeper. The team is asked to discuss their goals and expectations of the project and of each other. They are encouraged to discuss the frequency and duration of meetings outside of scheduled class times; to include discussion of people work responsibilities so they can be considerate of others in setting alternative meeting times; preparation for meetings; note taking in meetings. Finally, the team is asked to discuss how they will deal with conflicts in their group, including topics such as assigning specific tasks, or unmet expectations. The students are provided with scenarios on potential conflicts that they might face and given the time to work through the scenarios as a team. Thus, the team contract guides the teams in a structured and scaffolded discussion about some of the challenging situations they may face.

For the majority of students, this is the first time they have encountered this type of document and it was a daunting task to begin with. However, many students also found the structure of the document with the guided discussion points helpful in navigating some of the more tricky questions.

6) Peer-review and feedback

The student teams undergo two rounds of peer review over the course of 8 weeks. The first peer-review is a required (hurdle) task but is not included in the assessment. This peer review takes place 3 weeks after the groups are formed. The first peer-review is entirely a formative feedback for each member so they have the opportunity for self-reflection and to receive anonymous feedback from their team. This feedback provides the students with an opportunity to adjust any problem behaviors before the final peer review at the end of the project. It also provides the academics with an opportunity to identify any group dynamic issues before it gets too late!

The second peer-review occurs after the final presentation and is counted towards the student grade. The average of the grade they receive from their team mates is used for the grade. In each peer review, the students are asked to assess their team members in a number of criteria:

  • Initiative / self – motivation / motivates others
  • Communication
  • Accountability & sense of responsibility
  • Timeliness and preparation
  • Contribution to the team work & Commitment to the team success
  • Respect & Adaptability

Another key factor is that the peer-review score may be used to adjust the team presentation grade if the student receives a low grade from their team. This increases the student accountability to their team. This also provides the team members a means to hold their team mates to account and minimizes the impact of ‘freeloading’ in the team project. Student feedback on this aspect confirms that peer review is a good way to encourage individual accountability and contribution to the team project with 83% of the respondents in our end of semester survey agreeing to that statement.

We used the tool Feedback Fruit for the peer-review process and it has been a smooth process as this is integrated into our learning management system (Canvas) and the groups synch and import automatically. This reduces the workload tremendously! Before Feedback Fruit become available we tried the same process with Qualtrics. However, this required much more background work to set up the groups for the peer-review process.

We have now run this assessment or similar variations of it, for 5 years, over this time we have made a number of tweaks and adjustments to improve the student learning experiences. Here we have shared some of the lessons we have learned along our journey that we hope readers will find useful. We believe that with some careful sign posts and guard rails we have created a positive and enjoyable learning experience for the students. Not only has this made for an enjoyable learning experience and environment for the students, the workshops have become a highlight of our weeks as we watch the student projects develop and grow. This is reflected in the overall feedback from students, tutors, and assessing academics. Most pleasing is perhaps the student feedback that many found this to be an enjoyable and highly memorable experience and was a highlight of their university journey and they may have learned some interesting facts about physiology that they will take with them as they continue their life journeys.

Angelina is a senior lecturer and the Physiology discipline coordinator in the Department of Anatomy and Physiology in the Faculty of Medicine, Dentistry and Health Sciences, at the University of Melbourne. Her current learning and teaching focus is on practical-based in practical classes, using technology to engage learners in large cohorts in Physiology, and in integrating employability skills within the science and biomedicine curriculum.

Dr Angelina Y Fong PhD GCUT | Senior Lecturer

Physiology Discipline Coordinator

Department of Anatomy and Physiology

School of Biomedical Sciences

Faculty of Medicine, Dentistry and Health Sciences
The University of Melbourne, Victoria, Australia

White, F., Lloyd, H., & Goldfried, G. (2007). Evaluating student perceptions of group work and group assessment. Sydney University Press

 

Designing asynchronous learning material: the Pomodoro way

This post shares my reflection on making asynchronous learning materials during COVID19. I taught physiology to years 1 and 2 medical students at Newcastle University Medicine Malaysia. My usual approach in the classroom is: passive – active – passive i.e. I would first clarify the concepts in which students listen passively, ask questions to push students to think actively, back to passive again, and so forth.

 

When the pandemic hit Malaysia and the country went into complete lockdown, teachers were asked to decide if they wanted to make their teaching session synchronous or asynchronous. It was a stressful time as it was just my third year of teaching, and I still had a lot to learn about teaching. Fortunately, this happened during the semester break, and I had time to ponder these potential issues. Synchronous online sessions happen in real time, just like an in-person teaching session but online. Asynchronous sessions, on the other hand, allow students to go through the learning materials at their convenience.

 

I chose to make all my teaching sessions asynchronous after reflecting on several issues which the students and I might encounter if they were synchronous sessions. The student demography in the university consists of both local (Malaysian) and international students (ranging from Australia, to South Asia, and all the way to Canada). Considering where the students were from, the first problem with conducting synchronous sessions would be the time difference. After making adjustments, we had only a couple of hours a day where the schedule was appropriate for everyone.

 

Using Zoom for teaching was my first time, I needed to take into consideration student engagement, internet connectivity (both students’ and mine), glitches etc. Taken together, I realized that there were more things that were not within my control for a synchronous session, so asynchronous session was the better choice: the students could just go through the materials at their convenience. They could learn at their own pace without the need to stress themselves (and myself) about internet connectivity during a synchronous session or waking up at 5 in the morning; And I could avoid real-time technical issues in the middle of a teaching session. What’s left is student engagement. How do I engage students during asynchronous teaching? What can I do to motivate the students to complete the seemingly ‘boring’ hour-long lectures when they were on their own? Once I decided to make asynchronous materials, I actually felt relief in a way as I just needed to focus on making the materials rather than worried about other issues.

 

When I started working from home during the semester break, I had productivity anxiety which I had not experienced before. I began watching videos and reading articles which people shared on how to be more productive. This was when I discovered the Pomodoro technique. In general, this time management technique improves productivity by breaking down the work day into 25-minute blocks (also called Pomodoro’s) with 5-minute breaks in between the blocks. This actually gave me the idea on how I could help the students to go through the asynchronous learning materials with ‘less suffering’, as well as to achieve more when they were on their own.

 

I divided an hour-long lecture into three parts: Part 1, Part 2 and Summary which mimicked the block mentioned above. Parts 1 and 2 were recorded lectures that were 20-25 minutes long, and the Summary was a short, 5-minute roundup of what had been mentioned. Within the recorded lectures, I also prepared activities for students to assess their own understanding (active learning). For instance, after describing the structure of the skeletal muscle, I inserted another diagram of muscle fibers and asked students to pause the video to try and label the diagram. After explaining the two-neuron model, receptors and the neurotransmitters in the autonomic nervous system lecture, I prepared another diagram and students were asked to pause the video to fill in the blanks. When students resumed the video, I explained the answers. The videos were uploaded into Microsoft Stream and the links to the videos were shared on the university learning management system. I could easily track the number of views of the videos.

 

In between the two parts, there was a 5-minute-long interlude that mimicked the break in Pomodoro technique. A variety of activities was used in the interlude, including a short reading or fun fact related to the previous part. For instance, a question that required students to apply what they learned from the previous part; or games such as crossword puzzles, drag-and-drop for students to match the meanings with the terminology; or in the muscle physiology lecture, a short reading on rigor mortis were given in the interlude. Students could skip this if they wanted to but I encouraged them to follow the activities in the interlude to take a break from the passive listening, and do something active.

 

Other small things I did with this ‘Pomodoro arrangement’ of the learning materials included a clear instruction and the estimated time required to complete it. These are common if one is familiar with taking online courses. Clear instructions and estimated time of completion helped setting goals and expectations for the students the moment they opened the asynchronous learning materials. This might seem trivial, but it’s one of the keys of getting things done.

 

I included captions to all my videos to improve accessibility. Particularly for the new students, they might need time to get used to my accent and certain terminology. On top of that, captions could also be useful to English speakers to improve comprehension (1). PLYmedia found that videos with captions are more engaging and the viewers tend to watch until the end (1). These are something that I wanted for my videos as well. In fact, the sound quality, the accent of the teachers, the internet connection, and whether English is the student’s first language, could all affect the quality of synchronous teaching without proper captions. I would acknowledge that adding captions could be troublesome. When I first tried to edit the caption generated automatically by Microsoft Stream, I was amused by how bizarre it was, full of errors. However, I was actually glad as it reminded me to put efforts into my speaking and pronunciation (especially if you do not have a good microphone). One thing that I learned was that YouTube actually has a better AI system in terms of generating captions, the accuracy rate was high. After getting used to recording videos and adjusting how I speak, I didn’t have to do much editing in my subsequent videos. I also took caption-editing as an additional step to assess the contents of my videos.

 

The completion rate of the videos was 100% based on the number of views recorded in Microsoft Stream and students showed great appreciation about the captions in their feedback. When I asked them privately how they felt about the ‘Pomodoro arrangement’, some students said that they felt accomplished whenever they finished the 20-plus-minutes long videos and were motivated to continue. I believe this is the effect of the original Pomodoro method. Although COVID19 is pretty much ‘over’ in most countries and in-person teaching has resumed, I think this ‘Pomodoro arrangement’ could still be beneficial in blended learning. One might argue that there is no need to deliberately include the ‘breaks’ for the students since the students can just pause an hour-long video on their own. But I see no reason why we can’t actively make this happen by breaking up the lectures into smaller chunks and inserting fun active learning in between.

References:

[1] Albright, Dann. “7 Reasons Your Videos Need Subtitles [Infographic].” Uscreen, 18 Nov. 2020, www.uscreen.tv/blog/7-reasons-videos-need-subtitles-infographic/.

Dr. Tan received his BSc and MMedSc from the University of Malaya, Malaysia, and his Ph.D. from the National University of Singapore. He then worked at Newcastle University Medicine Malaysia (2018-2021) as lecturer, teaching physiology to years 1 and 2 medical students. Currently, he is a lecturer at the Chinese University of Hong Kong (Shenzhen), teaching physiology and histology to years 1 & 2 medical students.
The Great Student Disengagement

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

References (not included as in text hyperlinks)

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

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

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

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

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

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

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

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

Are there sex based difference in athletic performance before puberty?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

As of March 2020, when the SARS-COV-2 pandemic sent teachers and students home to figure out online instruction and learning, I had been teaching high school biology/AP biology for 27 years and anatomy & physiology at the two local community colleges for 7 years. Since I had been practicing flipped coursework for years, I knew that my biggest challenge would be how to fairly assess my students and their learning. This challenge would be compounded by an at-home virtual testing environment without any proctoring.

As I pondered the best approach to my assessment challenge, I was naturally drawn to the College Board’s 2012-13 redesign of the AP (Advanced Placement) Biology curriculum and examination. In the redesign, the AP curriculum focuses on four “Big Ideas” or broad themes covering a number of subtopics/concepts that are further broken down into learning objectives for students. The examination focuses on measuring student learning and skills using what the College Board (AP Higher Education, 2012-2013) calls an “evidence-centered-design approach that parallels the curriculum’s understanding-by-design approach.” The examination consists of a mix of multiple-choice and short-answer/free-response questions. I know from my many years of grading student AP essays/short answers that, when students turn to Google for their answers, they often fail. Students will frequently regurgitate the rubrics for grading the prompts rather than dissecting and answering the question. Subsequently, the students fail to demonstrate their own learning or understanding of the material. This is unfortunate as it is also a missed opportunity for feedback, correction and/or remediation.

In designing a new accelerated online physiology course, I really wanted the course assessments to mimic the AP Biology style of assessments. I wanted them not only to be aligned with course objectives, but to require students to think about and demonstrate the skills and concepts they were learning. I was skeptical, but hopeful I could also find an approach in which I would not have to rewrite the entire examination from scratch each term. In my search for related pedagogies, I ran across an article in the May 2020 HAPS Educator, “Testing in the Age of Active Learning: Test Question Templates Help to Align Activities and Assessments,” and recognized the name of one of the authors, Dr. Greg Crowther (Everett Community College, Everett, WA) from a previous association. I reached out to Greg and requested some more details about Test Question Templates (TQTs). What I found was a pedagogical gold mine!

The TQTs are based on somewhat general learning objectives, much like the four Big Ideas of the AP Biology exam. Students often ignore these learning objectives because they don’t know what they mean or how they will be assessed, but TQTs are formatted as input-output statements that tell the student exactly what they will be assessed on. Two examples (“Example A” and “Example B”) are provided for the students, followed by a prompt encouraging students to create their own test question following the template format.

The timing of my find was perfect for incorporating TQTs into the design of the new course. Since I am totally online, I took the time to video each TQT. On video, I present the input-output statement for each TQT and present Example A, along with approaches to answering the question or solving the problem. My TQT videos are attached to a weekly discussion board in the course management system, where students are then encouraged to work on solving Example B and creating a third example. I frequently visit the discussion board and provide feedback and guidance as needed throughout the week.

Below is an example of a TQT input-output statement and examples given to students ahead of the examination in the discussion board and used to model the examination question:

TQT 3.1. Given the chemical structure or chemical formula of an ion or molecule (chemical structure or text description), list the most likely mechanism(s) by which it crosses cell membranes.

  • Example A: See structure below left. By which process(es) is this molecule most likely to cross cell membranes? Explain your reasoning. [add chemical structure of a molecule like urea]
  • Example B: See structure below right. By which process(es) is this molecule most likely to cross cell membranes? Explain your reasoning. [add image of a peptide like insulin]
  • Example C: Make up an example (think of an ion or molecule that you’ve heard of) and ask your classmates!

In the previous unit, students had been instructed on chemical structures/formulas and bonding properties. In this unit, students are asked to extend and apply their understanding of chemical structures, bonding properties (polar, nonpolar, ionic) with their new knowledge of cell membrane structure (phospholipid) and cell transport mechanisms (passive or active).

Examinations are carefully aligned with the objectives, formative assessments and exact input-output statements given to students in the TQTs. The examination contains 10-11 short answer questions and approximately 25-30 multiple choice questions. I have added a statement on the examination for students to sign, reminding them not to use any outside resources (people, notes, internet….) along with the consequences for doing so. Students are reminded to use what they are learning in the course to answer and solve exam problems/questions. I explain to students how I will know if they don’t follow the rules.

I will admit that the new course has gotten off to a rough start. For reasons I can only guess at, more than half my students are procrastinating until the last minute to start assignments (lecture, reading, lab, formative assessments, TQTs…). This approach is not consistent with my suggestions to space out their learning, practice, or repetition of concepts that we know is so important to learning and applying the information to new situations.

Not surprisingly, students who participated during the week and spaced-out lecture segments, formative assessments and TQTs did much better on the examination than those who did not. Those who chose alternative approaches to the course material often googled their way through the examination and failed miserably. Using Google, they could identify a molecule, how it is made, and where it is found, but they couldn’t answer the questions asked.

It has taken several examinations to convince many of the students that physiology is not simply about googling or memorizing facts, but about developing critical thinking skills and a higher-order understanding of the material that will persist beyond the course. More students are now actively preparing, studying and asking more complex questions throughout the week than previously (as evidenced by the course management system analytics and student contact). Many have shown improvement not only on their overall exam scores, but in their demonstrations of reasoning on assignments and exams.

After the initial rough weeks of getting students on board, students are now reaching out via email to report progress in their learning, growth, and ability to connect the material to their work as CNAs and Medical Assistants.  For example, one young man in the course writes, “As we’ve progressed onward to future chapters I feel like my knowledge is increasing gradually and I personally feel that like I CAN do this, it has been a struggle I’m not going to lie and say it was a breeze but, I feel like I’m truly getting a ton of knowledge from these chapters, I’ve found much interest on the systems we’ve been studying especially with the TQT examples and formative questions that you help me with your feedback.” Another young lady states, “I am sorry I am not doing well. I have never been forced to study before and though the TQTs are hard I am finding that I am learning a lot and am really interested in learning more. I am glad I didn’t give up.”

In summary, both the AP Biology redesign assessment questions and the TQTs have allowed me to better assess my students’ knowledge and skills. These approaches have also given me insight into student misconceptions and helped me provide feedback, remediation, and other support as needed. I can easily write (or rewrite) questions based on the TQT input/output statements without having to rewrite entire examinations each term. Students are learning that simply googling will not let them ace the exams; instead, they are learning to more carefully read the questions and answer the questions based on their own understanding.

“ACKNOWLEDGMENTS: The author thanks Greg Crowther for help implementing TQTs and for feedback on this blog post.”

References:

  1. AP Higher Education (2012-2013). AP Course and Exam Redesign. https://aphighered.collegeboard.org/courses-exams/course-exam-redesign
  2. Crowther, G., Wiggins, B., Jenkins, L. HAPS Educator (May 2020). “Testing in the Age of Active Learning: Test Question Templates Help to Align Activities and Assessments.”
    Julie Gallagher, professor of anatomy and physiology, has been teaching at Barstow Community College (Barstow, CA) since 2014 and was a high school AP Biology teacher for 27 years at Serrano HS (Phelan, Ca).  Believing in equity and inclusion, Professor Gallagher has built state-of-the-art online anatomy and physiology courses, focused on helping all students succeed.
From a Group to a Team: Medical Education Orientation Curriculum for Building Effective Teams

I am part of a small team of Core Educators in the pre-clerkship undergraduate medical education program at the Lewis Katz School of Medicine at Temple University (LKSOM).  Last year we introduced a new curriculum to our medical students.  Part of this restructuring involved changing the format of the week-long orientation for first year students.  Operating under the new title of Transition to Medical School (TTMS), we introduced education programming amongst traditional orientation activities in which we specifically address the importance of teamwork, while providing a three-part series of 1.5- to 2-hour sessions given over three days to allow the students to get to know each other, learn about team dynamics in education and medicine, and develop their small teams; practice with patient cases to get experience with a type of active learning activities which form part of the backbone of their pre-clerkship education; reflect on the previous two sessions as part of their team’s norming process.  The focus of this blog is to describe the first session of this series, which was designed to dismantle preconceived notions of team learning, highlight the potential impact of high functioning teams, and participate in asset mapping to aid in forming of teams.

A problem which we identified as we transitioned to more case-based learning leading up to the curricular change, and that was particularly highlighted during the transition to virtual and then hybrid teaching and learning during the Covid-19 pandemic, was that medical students often struggle to learn in dysfunctional small groups if they do not first gain the skills to create and sustain high functioning, collaborative teams. Ineffective group dynamics led to limitations in students learning the material and resulted in less buy-in of the value of the case-based activities.  In addition, the downstream effects of dysfunctional team dynamics are well documented and include poor patient outcomes1. This is important as our competencies include preparing students for working in patient care teams.

We began the first education session with a word cloud activity to allow students and faculty to learn about the students’ pre-conceived ideas regarding group work.  Students were asked to submit using software (we used mentimeter.com) a word or phrase that came to mind when we said “group work”; the app then collated and displayed their responses in a figure composed of words.  Words which were submitted by multiple participants appeared larger in the word cloud (see figure for an example of a word cloud).  In our word cloud (not shown) the most frequently submitted words included “collaboration”, “communication”, “stressful”, “teamwork”, “frustrating”, and “compromise”.  Other words and phrases which appeared included “painful”, “judgment”, “overwhelming”, “open minded”, “unequal effort”, “hearing every voice”, “more work”, “understanding”, “innovative”, “constructive”, “helpful” “divide and conquer”, and “mixed bag”.  It was evident and probably not surprising that there was a range of responses from the more skeptical or negative to the more positive and enthusiastic.

Next, we shared information gathered from the literature with regards to the importance of small group, active learning in medical education.  The literature indicates that students who participate in small group learning activities demonstrate improved levels of critical thinking as compared with their peers who participate in lecture-based activities only2-4.  It has also been shown that small group work promotes communication skills5, active learning, cooperation, engagement, and retention of material6.

We then spent a few minutes reviewing the importance of diverse, effective teams in medicine.  The literature indicates that vulnerable patients with multiple chronic conditions have many doctors on their care team.  The number of people involved in a patient’s care is also increased by the nature of interprofessional roles in medicine.  Care teams include physicians (attendings, fellows, residents), medical students, nurses, physician assistants, nurse practitioners, medical assistants, pharmacists, case managers, social workers, physical and occupational therapists, technicians, pathologists, lab specialists, front desk personnel, billing specialists, and many more.  Therefore, it is imperative that students practice their communication and teamwork skills to provide their patients with the best possible care.

We also described to the students the difference between a “group” and a “team”.  A “group” can be defined as a number of people who are associated together in work or activity and has a set leader.  The group members may not work with each other but report directly to that leader, only hold themselves accountable, and rarely assess progress or celebrate successes7.  Revisiting the list above from our students’ word cloud activity, “unequal effort”, “divide and conquer”, and “more work” may be used to describe this kind of group.  In contrast, a “team” includes a small number of people with complimentary skills, who are committed to a common goal and purpose, who set performance goals and hold themselves mutually accountable.  They may share leadership and value open-ended discussion and active problem-solving7.  The terms “open minded”, “hear every voice”, “collaboration”, and “communication” from our students’ word cloud are aspects of a team.

Next, we asked the students to move into their assigned teams of 6-7 students for an asset mapping activity.  The goal of asset mapping is to create more equitable team dynamics by having students identify their own assets and share them with their team.  Each team was assigned to stay together for their first semester courses, so this experience not only allowed the students to think about their contributions to the team, but also served as an icebreaker in a classroom setting for the students before they began their first course.  We used an asset map (see figure) we adapted from George Pfeifer and Elisabeth Stoddard from Worcester Polytechnic Institute, who authored “Equitable and Effective Teams: Creating and Managing Team Dynamics for Equitable Learning Outcomes”8 and from Cliff Rouder of Temple University’s Center for the Advancement of Teaching, who authored “Asset Mapping: An Equity-Based Approach to Improving Student Team Dynamics”9.  Students were given time individually to complete their asset map, and then were instructed to share parts of their maps with their teammates.  Anecdotally, we were impressed with the depth of conversations, the degree of engagement and participation with each team, and the enthusiasm the students shared with each other.  An anonymous RedCap survey was given to the students after TTMS ended, and 87% of responding students indicated they found the asset mapping session useful (response rate was 97% of the class).

The Association of American Medical Colleges (AAMC) reports 11% of students in medical schools identify as historically underrepresented in medicine.  At LKSOM, our current M1 and M2 classes are both comprised of ~30% students who are historically underrepresented in medicine.  Our students come from a diversity of backgrounds and lived experiences, and have varying interests, skills, passions, and responsibilities.  Asset mapping provided a mechanism by which our students could initially learn about and from each other, and later led to conversations which allowed the teams to set their goals and expectations, and hopefully work towards providing a more equitable experience.  Asset mapping can be used to reassess team dynamics and for forming new teams as students progress through the curriculum.  This tool can also be used to help students optimize team dynamics for those who are struggling or underperforming.

This is an example of how sharing the literature with respect to the value of small group learning, team dynamics, and the role of asset mapping was useful in the building of teams in the first semester of medical school.  However, these tools could be adapted and used for learners at any level, or for team building within our departments.

The LKSOM Core Educator Team includes: Jill Allenbaugh MD, Bettina Buttaro PhD, Linda Console-Bram PhD, Anahita Deboo MD, Jamie Garfield MD, Lawrence Kaplan MD, David Karras MD, Karen Lin MD, Judith Litvin PhD, Bill Robinson PhD DPT, Rebecca Petre Sullivan PhD

 

References:

  1. Mitchell R, Parker V, Giles M, Boyle B. The ABC of health care team dynamics: understanding complex affective, behavioral, and cognitive dynamics in interprofessional teams. Health Care Manage Rev. 2014 Jan-Mar;39(1):1-9. doi: 10.1097/HCM.0b013e3182766504. PMID: 24304597.
  2. Tiwari, Agnes & Lai, Patrick & So, Mike & Yuen, Kwan. (2006). A Comparison of the Effects of Problem-Based Learning and Lecturing on the Development of Students’ Critical Thinking. Medical education. 40. 547-54. 10.1111/j.1365-2929.2006.02481.x.
  3. Charles Engel (2009) An Internet Guide to Key Variables for a Coherent Educational System Based on Principles of Problem-Based Learning, Teaching and Learning in Medicine, 21:1, 59-63, DOI: 10.1080/10401330802384888
  4. Kamin, Carol & O’Sullivan, Patricia & Younger, Monica & Deterding, Robin. (2001). Measuring Critical Thinking in Problem-Based Learning Discourse. Teaching and learning in medicine. 13. 27-35. 10.1207/S15328015TLM1301_6.
  5. Walton H. Small group methods in medical teaching. Med Educ. 1997 Nov;31(6):459-64. doi: 10.1046/j.1365-2923.1997.00703.x. PMID: 9463650.
  6. Van Amburgh JA, Devlin JW, Kirwin JL, Qualters DM. A tool for measuring active learning in the classroom. Am J Pharm Educ. 2007 Oct 15;71(5):85. doi: 10.5688/aj710585. PMID: 17998982; PMCID: PMC2064883.
  7. Katzenbach, JR & Smith, DK. (2005). The discipline of teams. Harvard business review. 83. 162-+.
  8. Pfeifer, Geoffrey and Elisabeth A. Stoddard (2019). “Equitable and Effective Teams: Creating and Managing Team Dynamics for Equitable Learning Outcomes” in Kristin Wobbe and Elisabeth A. Stoddard, eds. Beyond All Expectations: Project-Based Learning in the First Year.
  9. Rouder, C (2021). Asset Mapping: An Equity-Based Approach to Improving Student Team Dynamics.  Temple University Center for the Advancement of Teaching.  https://teaching.temple.edu/edvice-exchange/2021/03/asset-mapping-equity-based-approach-improving-student-team-dynamics.
Dr. Rebecca Petre Sullivan earned her Ph.D. in Physiology from the Lewis Katz School of Medicine at Temple University and completed a Post-Doctoral Fellowship in the Interdisciplinary Training Program in Muscle Biology at the University of Maryland School of Medicine.  She taught undergraduate biology courses at Ursinus College and Neumann University.  As an Associate Professor of Physiology in the Department of Biomedical Education and Data Science and the Department of Cardiovascular Sciences, and as a Core Basic Science Educator, she is currently course director in the Pre-Clerkship curriculum at LKSOM and at the Kornberg School of Dentistry; in addition to teaching medical and dental students, she also teaches physiology in Temple’s podiatry school, in the biomedical sciences graduate program, and in the physician assistant program.  She is a member of Temple University’s Provost’s Teaching Academy.  She was the recipient of the Mary DeLeo Prize for Excellence in Basic Science Teaching in 2020, the Golden Apple Award in 2017 and 2021, and the Excellence in Education Award, Year 2 in 2020 from LKSOM, and the Excellence in Undergraduate Teaching Award from Neumann University in 2012.
Pandemic Adaptations for PECOP and the 2022 ITL!

The American Physiological Society (APS) Physiology Educators Community of Practice (PECOP) and Institute on Teaching and Learning (ITL) were created to build connections among physiology educators and to promote the sharing of evidence-based teaching practices in physiology education. Due to the COVID-19 pandemic, the 2020 ITL and other PECOP activities were shifted to a virtual format. Virtual ITL Week included daily two-hour interactive sessions. Session topics and speakers were selected from the original conference schedule, with emphasis on topics that would assist educators during the pandemic. Registration was free, attracting nearly 500 registrants, a five-fold increase over normal ITL attendance. International educator participation was more than double that of previous ITL meetings. Long-term impacts of this unplanned “experiment” include plans for virtual components at some future ITL meetings, a PECOP webinar series open to the public, and an online professional skills training course for new physiology educators. An editorial describing these outcomes has recently been published in Advances in Physiology Education (https://journals.physiology.org/doi/full/10.1152/advan.00245.2020).  Please join PECOP for free by registering your email at the LifeSciTRC (https://www.lifescitrc.org) and select “PECOP Member” in your user profile.  The 2022 APS Institute on Teaching and Learning will be June 21-24 in Madison, WI (https://www.physiology.org/professional-development/meetings-events/itl-2022?SSO=Y).  The institute will engage educators in interactive sessions on best practices in teaching, learning and assessment.  Whether you are an experienced educator or new to teaching, ITL will challenge you to gain the skills needed to design and implement educational research in your classroom and learn how to share your findings with colleagues.  The institute includes plenary talks, concurrent workshops, poster sessions and time to network and connect with your colleagues.  Please keep checking the website to see when registration is ready!

Barbara E. Goodman, Ph.D., Professor of Physiology

Fellow of the American Physiological Society

Editor-in-Chief, Advances in Physiology Education

Division of Basic Biomedical Sciences

Room 224 Lee Medicine

Sanford School of Medicine of the University of South Dakota