Category Archives: Teaching Strategies

Involving students in the teaching experience
Karen L. Sweazea, PhD, FAHA
Arizona State University

As faculty, we often find ourselves juggling multiple responsibilities at once. Although many of us are interested in adding hands-on or other activities to our classes, it can be difficult to find the time to develop them. This is where more advanced students who have already taken the class or graduate students can help.

A couple of summers ago I requested the help of an extra teaching assistant in my Animal Physiology course. The role of the position I was requesting was unique as I was not seeking a student to help with grading or proctoring exams. Rather, the role of this student was to help develop in-class activities that would enhance the learning experience of students taking the course.

For each lesson, the special graduate student TA was tasked with finding an existing (ex: https://www.lifescitrc.org/) or creating a new activity that could be implemented in the classroom during the last 10-20 minutes of each session, depending on the complexity of the activity. This enabled me to begin converting the course into a flipped classroom model as students enrolled in the course were responsible for reading the material ahead of time, completing a content comprehension quiz, and coming to class prepared to discuss the content and participate in an activity and/or case study. Special TAs can also assist with developing activities for online courses.

While the benefits of having such a TA for the faculty are clear, this type of experience is also beneficial to both the TA as well as the students enrolled in the course. For the TA, this experience provides an opportunity to develop their own teaching skills through learning to develop short lesson plans and activities as well as receiving feedback from the faculty and students. For the students, this is a great way to build cultural competence into the course as TAs are often closer in age to the students and may better reflect the demographics of the classroom. Cultural competence is defined by the National Education Association as “the ability to successfully teach students who come from a culture of cultures other than our own.” Increasing our cultural competency, therefore, is critical to student success and is something that we can learn to address. Having special TAs is just one way we can build this important skill.

Karen Sweazea is an Associate Professor in the College of Heath Solutions at Arizona State University. Her research specializes in diabetes and cardiovascular disease. She received her PhD in Physiological Sciences from the University of Arizona in 2005 where her research focused on understanding glucose homeostasis and natural insulin resistance in birds. Her postdoctoral research was designed to explore how poor dietary habits promote the development of cardiovascular diseases. 

Dr. Sweazea has over 40 publication and has chaired sessions and spoken on topics related to mentoring at a variety of national and local meetings. She has additionally given over 10 guest lectures and has developed 4 graduate courses on topics related to mentoring and professional development. She has mentored or served on the committees for undergraduate, master’s, and doctoral students and earned an Outstanding Faculty Mentor Award from the Faculty Women’s Association at Arizona State University for her dedication towards mentoring.   

Lighting the Spark: Engaging Medical Students in Renal Physiology
Jessica Dominguez Rieg, PhD
Department of Molecular Pharmacology and Physiology
University of South Florida Morsani College of Medicine

Recently, I spent some time reflecting on the way we teach physiology at my institution. One thing that kept coming to my mind- why does renal physiology get such a bad reputation? We often hear medical students commenting that renal physiology was the hardest topic of the first year, that there’s too much math involved, and concepts like acid-base and electrolyte disorders are too difficult to grasp. Does a negative attitude about renal physiology really matter in the long run? If the students can successfully pass USMLE Step 1, can I rest easy knowing they are competent in understanding how the kidneys function? Or can I, a basic science faculty, make a bigger impact on how these students view the renal system?

Chronic kidney disease is a growing public health concern in the United States, affecting roughly 40 million adults. Given the increasing burden of disease, an aging population, and modern medicine that is keeping patients with end-stage kidney disease alive longer, we need a robust workforce in nephrology. However, the field of nephrology is in the middle of a major crisis, and there is significant concern that there will not be an adequate workforce to meet the healthcare needs of patients afflicted with kidney disease. Only 62% of available nephrology fellowship positions were filled in the 2019 National Resident Matching Program match and less than 45% of positions were filled by U.S. MD graduates, making nephrology one of the least competitive subspecialties1. When does the waning interest in nephrology begin? Many think it starts early in a medical student’s academic journey.

I recently surveyed our medical students at the University of South Florida Morsani College of Medicine (250 respondents) and found that 60% of students agreed or strongly agreed that the topic of nephrology is interesting and yet close to one-third of them agreed or strongly agreed that renal pathophysiology is too complex and challenging for them. When asked what makes the biggest impact on their future career choice, 60% indicated that having role models and mentors in the specialty field was high impact; however, less than half of the students felt they had been exposed to encouraging role models or mentors in nephrology. Students ranked rotations during clerkships as having the highest impact in career choice; and yet our students are first exposed to nephrology during their Internal Medicine clerkship in their 3rd year, which only last 8 weeks. Not surprisingly, students ranked didactics in the preclinical years as having the lowest impact on career choice. What if we can change that? Perhaps there is too little done too late- and we just can’t get enough momentum going to gain a critical mass of students interested in nephrology. Is there anything that we, as medical physiology educators, can do to help? We can light the spark!

1. Make it matter. The complexity of renal physiology must be taught with meaningful clinical context. Students need to understand the clinical importance of what they are learning or there is a high chance they will get turned off from the very beginning. One of the best ways I have found to make it matter, is to work closely with my clinical colleagues. Not only can they provide (and co-teach) examples of how to

2. Make it digestible. Students often get overwhelmed by the level of detail that is expected in the renal block. We must ensure we are giving them the important content in bite-sized pieces so they have time to think about it, apply it, and understand it. I give our students a blank nephron map2 at the beginning of the renal block and ask that they work together to fill it out. On the last day of the renal block, we go through the maps together as a summary of renal function. Students like having all the transporters, hormones and key characteristics about each region of the nephron in one place. It helps them organize their knowledge and also gives them something to refer to in Year 2 and beyond.

3. Make it relatable. At our institution, students get renal physiology at the end of Year 1, so they’ve had all other organ systems besides reproductive physiology. I use many analogies throughout the renal system and always to try to highlight the similarities with the intestinal tract, which they are more familiar with at that point in time. After all, the nephron is like a “mini-intestine”, with similar histological features and transporter profiles. By relating the new renal content to something they’ve seen before, it can help make it a little easier to understand (and allows them to make systemic connections).

4. Make it stick. Students struggle with grasping acid-base disturbances. Consistent repetition and practice problems is key! Many times, students learn multiple ways to approach interpreting acid-base disturbances (different formulas, different values for expected compensatory responses, etc.) depending on who is teaching. This can be frustrating and confusing for students. We have found that having all faculty that teach some aspect of acid-base balance use a single resource, a step-by-step guide to interpreting acid-base disturbances3, has been very helpful in ensuring consistency in what we teach. Students also work through many practice problems in interpretation of arterial blood gases, starting in Year 1, again in Year 2, and again during the clerkships. The result is that students have gone from scoring less than 50% on NBME acid-base questions, to close to 90%- it’s sticking!

5. Make it fun! One of the notoriously challenging lectures in our preclinical years is integration of acid-base, volume, and electrolyte disorders. Traditionally, it was a lecture given by a nephrologist and was very technical and clinically oriented. However, students were lost and overwhelmed. So, I partnered with an internal medicine physician and we revamped the session into a fun, interactive series of cases where we co-facilitated discussion. Students were introduced to the 14th book of Lemony Snicket’s A Series of Unfortunate Events: The Hazardous Hospital, where they were asked to investigate the mysterious health issues of Sir Cornelius. The cases we presented were challenging and framed with very relevant basic science concepts, and students loved it! Not only did they have fun while learning, but they really appreciated having a basic scientist and clinician teaching together.

In conclusion, renal physiology is challenging and may be contributing to a lack of interest in a career in nephrology. As medical physiology educators, we have the ability to work with our clinical colleagues and revamp how we teach the renal system. We can get students engaged and excited about renal physiology by making the content clinically relevant, digestible, relatable and fun. After all, there needs to be a spark to light the fire!

References:

  1. National Resident Matching Program, Results and Data: Specialties Matching Service 2019 Appointment Year. National Resident Matching Program, Washington, DC. 2019
  2. Robinson PG, Newman D, Reitz CL, Vaynberg LZ, Bahga DK, Levitt MH. A large drawing of a nephron for teaching medical students renal physiology, histology, and pharmacology. Advances in Physiology Education. 42:2, 192-199, 2018.
  3. DeWaay D, Gordon J. The ABC’s of ABGs: teaching arterial blood gases to adult learners. MedEdPORTAL. 2011;7:9038.

Dr. Dominguez Rieg is a faculty member in the Department of Molecular Pharmacology & Physiology at the University of South Florida Morsani College of Medicine. She is the Course Director for the Gastrointestinal, Endocrine, Renal and Reproductive Systems block and the Physiology Integration Director that is responsible for mapping physiology content objectives across the entire curriculum. She teaches endocrine, renal and reproductive physiology and renal pathophysiology in multiple courses in the pre-clerkship years. She received her PhD in Physiological Sciences from the University of Arizona. Her research interests are kidney-intestine crosstalk and intestinal function in the context of systemic diseases such as obesity and diabetes. When she’s not at work, she is enjoying time with her young daughter and four German Shepherds.

Can the Flipped Classroom Method of Teaching Influence Students’ Self-Efficacy?
Chaya Gopalan, PhD, FAPS
Associate Professor
Departments of Applied Health, Primary Care & Health Systems
Southern Illinois University Edwardsville

Self-efficacy is the belief in one’s ability to succeed in a specific situation or accomplish a specific task (Bandura, 1977). Students with high self-efficacy have higher motivation to learn and, therefore, are able to reach higher academic goals (Honicke & Broadbent, 2016). Gender, age, and the field of study are some factors that are known to affect self-efficacy (Huang, 2013). Genetics plays a significant role (Waaktaar & Torgersen, 2013). Certain physiological factors such as perceptions of pain, fatigue, and fear may have a marked, deleterious effect on self-efficacy (Vieira, Salvetti, Damiani, & Pimenta, 2014). In fact, research has shown that self-efficacy can be strengthened by positive experiences, such as mastering a skill, observing others performing a specific task, or by constant encouragement (Vishnumolakala, Southam, Treagust, Mocerino, & Qureshi, 2017). Enhancement of self-efficacy may be achieved by the teachers who serve as role models as well as by the use of supportive teaching methods (Miller, Ramirez, & Murdock, 2017). Such boost in self-efficacy helps students achieve higher academic results.

The flipped classroom method of teaching shifts lectures out of class. These lectures are made available for students to access anytime and from anywhere. Students are given the autonomy to preview the content prior to class where they can spend as much time as it takes to learn the concepts. This approach helps students overcome cognitive overload by a lecture-heavy classroom.  It also enables them to take good notes by accessing lecture content as many times as necessary. Since the lecture is moved out of class, the class time becomes available for deep collaborative activities with support from the teacher as well as through interaction with their peers. Additionally, the flipped teaching method allows exposure to content multiple times such as in the form of lecture videos, practice questions, formative assessments, in-class review, and application of pre-class content. The flipped classroom therefore provides a supportive atmosphere for student learning such as repeated exposure to lecture content, total autonomy to use the constantly available lecture content, peer influence, and support from the decentered teacher. These listed benefits of flipped teaching are projected to strengthen self-efficacy which, in turn, is expected to increase students’ academic performance. However, a systematic approach measuring the effectiveness of flipped teaching on self-efficacy is lacking at present.

References:

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review84(2), 191.

de Moraes Vieira, É. B., de Góes Salvetti, M., Damiani, L. P., & de Mattos Pimenta, C. A. (2014). Self-efficacy and fear avoidance beliefs in chronic low back pain patients: coexistence and associated factors. Pain Management Nursing15(3), 593-602.

Honicke, T., & Broadbent, J. (2016). The influence of academic self-efficacy on academic performance: A systematic review. Educational Research Review17, 63-84.

Huang, C. (2013). Gender differences in academic self-efficacy: A meta-analysis. European journal of psychology of education28(1), 1-35.

Miller, A. D., Ramirez, E. M., & Murdock, T. B. (2017). The influence of teachers’ self-efficacy on perceptions: Perceived teacher competence and respect and student effort and achievement. Teaching and Teacher Education64, 260-269.

Vishnumolakala, V. R., Southam, D. C., Treagust, D. F., Mocerino, M., & Qureshi, S. (2017). Students’ attitudes, self-efficacy and experiences in a modified process-oriented guided inquiry learning undergraduate chemistry classroom. Chemistry Education Research and Practice18(2), 340-352.

Waaktaar, T., & Torgersen, S. (2013). Self-efficacy is mainly genetic, not learned: a multiple-rater twin study on the causal structure of general self-efficacy in young people. Twin Research and Human Genetics16(3), 651-660.

Dr. Chaya Gopalan received her PhD in Physiology from the University of Glasgow, Scotland. Upon completing two years of postdoctoral training at Michigan State University, she started her teaching career at St. Louis Community College. She is currently teaching at Southern Illinois University Edwardsville. Her teaching is in the areas of anatomy, physiology, and pathophysiology at both undergraduate and graduate levels for health science career programs. Dr. Gopalan has been practicing evidence-based teaching where she has tested team-based learning and case-based learning methodologies and most recently, the flipped classroom. She has received several grants to support her research interest.

Backward planning of lab course to enhance students’ critical thinking
Zhiyong Cheng, PhD
Food Science and Human Nutrition Department
The University of Florida

Development of critical thinking and problem-solving skills hallmarks effective teaching and learning [1-2]. Physiology serves as a fundamental subject for students in various majors, particularly for bioscience and pre-professional students [1-8]. Whether they plan on careers in science or healthcare, critical thinking and problem-solving skills will be keys to their success [1-8].

Backwards course design is increasingly employed in higher education. To effectively accomplish specific learning goals, instructions are to begin course development with setting learning objectives, then backwardly create assessment methods, and lastly design and deliver teaching and learning activities pertaining to the learning objectives and assessment methods. In terms of development of critical thinking and problem-solving skills, a lab course constitutes an excellent option to provide opportunities for instructors and students to explore innovative paths to their desired destinations, i.e., to accomplish specific learning goals.

In a traditional “cookbook” lab setting, detailed procedures are provided for the students to follow like cooking with a recipe. Students are usually told what to do step-by-step and what to expect at the end of the experiment. As such, finishing a procedure might become the expected goal of a lab course to the students who passively followed the “cookbook”, and the opportunity for developing critical thinking skills is limited. In a backwards design of a lab course; however, the instructor may engage the students in a series of active learning/critical thinking activities, including literature research, hypothesis formulation, study design, experimental planning, hands-on skill training, and project execution. Practically, the instructor may provide a well-defined context and questions to address. Students are asked to delve into the literature, map existing connections and identify missing links for their project to bridge. With the instructor’s guidance, students work together in groups on hypothesis development and study design. In this scenario, students’ focus is no longer on finishing a procedure but on a whole picture with intensive synthesis of information and critical thinking (i.e., projecting from generic context to literature search and evaluation, development of hypothesis and research strategy, and testing the hypothesis by doing experiments).

An example is this lab on the physiology of fasting-feeding transitions. The transition from fasting to feeding state is associated with increased blood glucose concentration. Students are informed of the potential contributors to elevated blood glucose, i.e., dietary carbohydrates, glycogen breakdown (glycogenolysis), and de novo glucose production (gluconeogenesis) in the liver. Based on the context information, students are asked to formulate a hypothesis on whether and how hepatic gluconeogenesis contributes to postprandial blood glucose levels. The hypothesis must be supported by evidence-based rationales and will be tested by experiments proposed by students with the instructor’s guidance. Development of the hypothesis and rationales as well as study design requires students to do intensive information extraction and processing, thereby building critical thinking and problem-solving skills. Students also need to make sound judgments and right decisions for their research plans to be feasible. For instance, most students tend to propose to employ the hyper-insulinemic-euglycemic clamp because the literature ranks it as a “gold standard” method to directly measure hepatic gluconeogenesis. However, the equipment is expensive and not readily accessible, and students have to find alternative approaches to address these questions. With the instructor’s guidance, students adjust their approaches and adopt more accessible techniques like qPCR (quantitative polymerase chain reaction) and Western blotting to analyze key gluconeogenic regulators or enzymes. Engaging students in the evaluation of research methods and selection helps them navigate the problem-solving procedure, increasing their motivation (or eagerness) and dedication to learning new techniques and testing their hypotheses. Whether their hypotheses are validated or disproved by the results they acquire in the end, they become skillful in thinking critically and problem solving in addition to hands-on experience in qPCR and Western blotting.

Evidently, students can benefit from backwards planning in different ways because it engages them in problem-based, inquiry-based, and collaborative learning — all targeted to build student problem solving skills [1-8]. For a typical lab course with pre-lab lectures; however, there is only 3-6 hours to plan activities. As such, time and resources could be the top challenges to implement backwards planning in a lab course. To address this, the following strategies will be of great value: (i) implementing a flipped classroom model to promote students’ pre- and after-class learning activities, (ii) delivering lectures in the lab setting (other than in a traditional classroom), where, with all the lab resources accessible, the instructor and students have more flexibility to plan activities, and (iii) offering “boot camp” sessions in the summer, when students have less pressure from other classes and more time to concentrate on the lab training of critical thinking and problem solving skills. However, I believe that this is a worthwhile investment for training and developing next-generation professionals and leaders.

References and further reading

[1] Abraham RR, Upadhya S, Torke S, Ramnarayan K. Clinically oriented physiology teaching: strategy for developing critical-thinking skills in undergraduate medical students. Adv Physiol Educ. 2004 Dec;28(1-4):102-4.

[2] Brahler CJ, Quitadamo IJ, Johnson EC. Student critical thinking is enhanced by developing exercise prescriptions using online learning modules. Adv Physiol Educ. 2002 Dec;26(1-4):210-21.

[3] McNeal AP, Mierson S. Teaching critical thinking skills in physiology. Am J Physiol. 1999 Dec;277(6 Pt 2):S268-9.

[4] Hayes MM, Chatterjee S, Schwartzstein RM. Critical Thinking in Critical Care: Five Strategies to Improve Teaching and Learning in the Intensive Care Unit. Ann Am Thorac Soc. 2017 Apr;14(4):569-575.

[5] Nguyen K, Ben Khallouq B, Schuster A, Beevers C, Dil N, Kay D, Kibble JD, Harris DM. Developing a tool for observing group critical thinking skills in first-year medical students: a pilot study using physiology-based, high-fidelity patient simulations. Adv Physiol Educ. 2017 Dec 1;41(4):604-611.

[6] Bruce RM. The control of ventilation during exercise: a lesson in critical thinking. Adv Physiol Educ. 2017 Dec 1;41(4):539-547.

[7] Greenwald RR, Quitadamo IJ. A Mind of Their Own: Using Inquiry-based Teaching to Build Critical Thinking Skills and Intellectual Engagement in an Undergraduate Neuroanatomy Course. J Undergrad Neurosci Educ. 2014 Mar 15;12(2):A100-6.

[8] Peters MW, Smith MF, Smith GW. Use of critical interactive thinking exercises in teaching reproductive physiology to undergraduate students. J Anim Sci. 2002 Mar;80(3):862-5.

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

Which Level of Students are Best Suited for Flipped Learning?
Chaya Gopalan, PhD, FAPS
Associate Professor, Departments of Applied Health, Primary Care and Health Systems
Southern Illinois University Edwardsville

The flipped classroom (FC) is a student-centered teaching method that is embraced by educators in recent years for several reasons. According to Bergmann and Sams (2012), FC accommodates students’ busy schedules, helps struggling students, and allows self-pacing. In this teaching method, students are exposed to content prior to class in the form of assignments and the class time is structured to include mini-lectures so that students have opportunities to ask questions and engage with teachers. Additionally, the instructors can also administer learning activities, such as quizzes and group work so that students can gain a much deeper understanding of the content when compared to lectures alone. Khan Academy is an example of a FC that can be utilized by students ranging from elementary to high school.

A similar situation is true in the higher education arena where FC is introduced in courses ranging from community college all the way up to the graduate level courses in a wide variety of programs and professions. However, it is unclear as to which level, in particular, would benefit from the FC model the most. Ideally, college freshmen are open-minded and are able to adapt quickly to the FC approach thus being better prepared for the rest of their college years. Nevertheless, in a study conducted in China, for example, Li (2018) found that many freshmen do not utilize pre-class assignments and therefore are not prepared for in-class activities. For some freshmen, FC is not a new teaching method because they experienced it in their high schools. Introducing FC in the third and fourth years of undergraduate education, once again, could be argued as either “too late” because they have not been exposed to FC thus far, or “most ideal” because these students are more mature and do their pre-class work more reliably.   

Students’ experiences of the FC model can vary greatly. As part of an NSF-funded project, data collected from freshmen and sophomore STEM classrooms at a community college suggested that students’ perceptions, such as “learned more in the FC classroom” and “more engaged” were far less common when compared to the same level of students in a four-year institution. At the same time, when doctoral students entering a Nurse Anesthesia program were given a similar experience with FC, the response was overwhelmingly positive. On the other hand, for senior students in the Exercise Science program, their perception of FC was stronger than the freshmen-sophomore group but not as strong as that of the graduate students. Since the age of the freshmen-sophomore students at the community college varies considerably, assessing the most critical determinant can be challenging.

In summary, the students that achieve higher levels of educational experience seem to be able to utilize the FC method to the fullest extent. It must be noted that the majority of our students are experiencing FC for the very first time. Since this instructional approach demands regular study habits and time commitment while minimizing procrastination, students may take time to develop new learning strategies to be able to value their experience. Whether students respond similarly, provided they are exposed to FC classes more frequently across the curriculum, is yet to be seen.

Acknowledgements: Part of the data shared in this blog is funded by NSF-IUSE grant DUE – 1821664 “Examining Faculty Attitudes and Strategies that Support Successful Flipped Teaching”.

References

Bergmann, J., & Sams, A. (2012). Flip your classroom: Reach every student in every class every day. Eugene, Or: International Society for Technology in Education.
Li, Yi. (2018). Current problems with the prerequisites for flipped classroom teaching—a case study in a university in Northwest China. Smart Learning Environments, 5:2

Dr. Chaya Gopalan received her PhD in Physiology from the University of Glasgow, Scotland. Upon completing two years of postdoctoral training at Michigan State University, she began her teaching career at St. Louis Community College. After a short tenure at St. Louis College of Pharmacy, Dr. Gopalan joined the departments of Applied Health, Primary Care and Health Systems at Southern Illinois University Edwardsville. Her teaching is in the areas of anatomy, physiology, and pathophysiology at both undergraduate and graduate levels. Dr. Gopalan has been practicing evidence-based teaching where she has tested team-based learning methodology, case-based learning methodology and most recently, the flipped classroom. She has received several research grants in pursuing her research interests.

Using Quests to Engage and Elevate Laboratory Learning
Sarah Knight Marvar, PhD
American University

My students, like me, enjoy a challenge. Occasionally this challenge comes in the form of staying on track, using our lab time efficiently to achieve the learning outcomes and staying engaged with the material. There are specific topics that we cover in our undergraduate human anatomy and physiology course, such as the skeletal system, that had become a little dry over time. Classes occasionally included students sitting at desks looking disinterestedly at disarticulated bones glancing at their lab manual and then checking their phones. I felt that the students were not getting enough out of our laboratory time and weren’t nearly as excited as I was to be there!

With other faculty members I recently devised some new laboratory activities that include a series of quests that closely resemble a mental obstacle course, to try to encourage engagement with the material and make our learning more playful and memorable. There may also be some healthy competition along the way.

I teach an undergraduate two semester combined anatomy and physiology course, in which I lead both the lecture and laboratory portions. Students who are enrolled in this course are majoring in Biology, Neuroscience, Public Health and Health Promotions. Many of the enrolled students are destined for graduate school programs such as Medicine, Nursing, Physical Therapy, Physicians Assistant and PhD Programs. An example of the quest format we used recently in a bone laboratory is described here.

The Quests

The laboratory is set up with multiple quest stations that each represent a multi-step task on areas within the overarching laboratory topic. All of the tasks are designed to enable students to achieve the learning outcomes of the laboratory in an engaging way. The quest stations are designed to encourage the students to physically move around the laboratory in order to interact with other students, touch the exhibits, explore case studies, complete illustrations and build models. Each student begins with a quest guide which provides instructions and upon which they take notes, answer questions and complete drawings. Students move at their own pace and work in self-selected pairs or groups of three. They are able to ask for assistance at any stage of a quest from either of two faculty members present.   

Clinical case studies

Because of the students’ interest in patient care, we use clinical case studies as a major component of the obstacle course. X-ray images of a variety of pathological conditions as well as healthy individuals challenged students’ ability to identify anomalies in bone structure and surgery outcomes. The images that we used included a skull of a newborn showing clearly the fontanelles, an example of osteoporosis and joint replacement surgery. Students are required to identify anatomical location of the image as well as any anomalies, pathology or points of interest. Because of the student demographic of this class, many of them are destined to enter healthcare professions, they are particularly interested in this quest and are invested in solving the mystery diagnoses.

The Creative Part

Illustrations

An example of a student’s histological drawing.

The coloring pencils and electric pencil sharpener have come into their own in the laboratory and like Grey’s Anatomy illustrator Henry Vandyke Carter created before them, amazing anatomically accurate drawings are appearing on the page. Histology has been a particularly challenging aspect of our course for students with little previous exposure to sectioned specimens. In an attempt to allow students to really process what they are looking at and reflect on the tissue function I have asked students to draw detailed images of the histological specimens, label cell types and reflect on specific cell functions. This exercise aims to elevate the student’s ability to look closely at histological specimens and gain a better understanding of what they are observing and contemplate specific cell function.

Another quest involves categorizing bones and making illustrations of them, making note of unique identifying features and their functions.

3-D Modeling

Student synovial joint models with notes on function

Reminiscent of scenes from my three year old’s birthday party, I brought out the modeling clay and tried to stifle the reflex instruction to “don’t mix the colors”! Students were tasked with creating a 3-dimensional model of structures such as synovial joints. This is a particularly successful exercise in which students work with colored modeling clay to construct models of joints and label parts of the joint and describe the function of each part. This allows students to consider the relationship between the structure and function and move beyond looking at two-dimensional images from their textbooks and lecture slides. Students submit images of their completed models to the faculty for successful completion of the quest.

Other quest stations that were part of this particular laboratory session included Vertebrae Organizing, Mystery Bone Identification and Bone Growth Mechanisms.

One of the primary things that I learned from this exercise was that designing game-like scenarios in the classroom is far more enjoyable and entertaining for me as well as for the students, a win-win scenario. Overall from the perspective of the teaching faculty, the level of engagement was significantly increased compared with previous iterations of the class. The quality of the work submitted was high and in addition, this quest-based laboratory design is suitable for a wide range of topics and activities. I am currently designing a muscle physiology laboratory in a similar format that will include an electromyogram strength and cheering station as well as a sliding filament muscle contraction student demonstration station. In reflection I feel that my personal quest to find a novel and interesting way for the students to learn about bones was successful. Now onto the next quest……

Sarah Knight Marvar received her BSc in Medical Science and PhD in Renal Physiology from the University of Birmingham, UK. Sarah is currently a Senior Professorial Lecturer and Assistant Laboratory Director in the Biology Department at American University in Washington DC. Sarah teaches undergraduate Anatomy and Physiology, general biology classes as well as a Complex Problems class on genetic modification to non-majors as part of the AU Core program. Sarah’s research interests include using primary research literature as a teaching tool in the classroom, open educational resources and outreach activities.

Physiology Bumper Stickers for Teaching and Learning
Alice R. Villalobos, BS, PhD
Texas Tech University

As teachers we hope students remember and apply all the physiology they learned in our class.  However, many undergraduate students hope simply to get through this semester of physiology and their other courses.  They dread the amount of material and that ‘so many things go on in the body at one time.’  I asked myself what could be integrated into lecture or lab to help students better learn material in class, study more effectively on their own and ideally, improve recall when taking exams.  Around this time, I attended a teaching workshop focused on short activities and simple tools that could be incorporated into lectures to facilitate learning and recall.  One tool was the ‘bumper sticker’. 

Similar to an actual bumper sticker, the teaching bumper sticker is a short memorable phrase or slogan that encapsulates a thought, principle, or concept.  In this case, a bumper sticker helps students learn and remember a concept or principle.  In all areas of life, we use short sayings or one-liners often of unknown derivation that convey a profound or funny, classic or clever, instructional or encouraging thought.  ‘Righty tighty, lefty loosey.’ means turn the screw to right to tighten and left to loosen.  “I before E except after C.” with the addendum, “… and in words, such as protein or weight.”  Could bumper stickers work in a physiology course?  I already borrowed “Water follows sodium; sodium doesn’t follow water.” from my undergraduate professor.  We all develop short phrases while working on lectures, reading physiology papers and books, or on the fly during lecture.  

Recently, I began using bumper stickers in a more organized manner.  I took a sheet of lined paper, wrote ‘Bumper Stickers for A&P-II’ on the top, and made plenty of copies.  On the first day of class I discussed tips to improve learning and study habits.  I explained the bumper sticker was a teaching/learning tool and gave each student a sheet.  I admitted it was an experiment, but my intention was to give them short phrases to refer to and contemplate when studying on their own or spark a memory on an exam.  That very day we started glycolysis.  The first bumper sticker was “You must spend an ATP to make ATP.”  I explained the first step in glycolysis is phosphorylation, using a phosphate from ATP.  Despite some initial skepticism, bumper stickers caught on and helped many students. 

Rather than repeating your explanation verbatim, students must accurately explain concepts to themselves and others in their own words.  When students study with a partner or in groups, they can refer back to the bumper sticker along with lecture notes, diagrams and textbook to explain the respective concept to each other in their own words and peer-correct.  When students are teaching each other, they are truly ‘getting it’.  Granted, it is essential that students use more exact and scientific vocabulary to describe a mechanism or concept, as is true for any discipline.  For most students this won’t happen the very first time they explain the concept.  Learning physiology or any subject is a process; developing the vocabulary is part of that process.  A memorable bumper sticker is a prompt for stimulating discussion – verbal communication in the context of learning a given physiological mechanism and developing the vocabulary of physiology. 

There is no established technique for the initial delivery of a bumper sticker phrase.  However, its two-fold purpose as a teaching/learning tool is to help students understand and remember a concept; thus, the phrase and initial proclamation must be memorable.  Based on my hits and misses, here are several tips.  First, keep it short, ideally 10 words or less.  Second, timing is key.  Similar to a joke, timing is important but varies with topic and teaching style.  Some use the phrase as a teaser to introduce a topic; others use it to summarize key points.  Third, be as direct as possible and capture students’ full attention.  Some write the phrase on the board or slide and make an announcement, “Listen up.  Write this down.”  Fourth, look directly at your students and state the phrase clearly with meaning, effective voice inflection, dramatic tone, appropriate pause, facial expression, hand gesturing, and/or a little physical comedy.  Fifth, use accurate and scientific terms to explain the meaning of the phrase as it applies to the physiological concept.  This is absolutely critical.  Left to interpretation, students might misunderstand the actual physiological concept.

Bumper stickers for better study and testing strategies

*Use common sense at all times, especially on test day.* At times, students forget obvious and intuitive things.  For example, when applying Boyle’s Law to respiration, don’t forget to breathe.  I remind students that lung volume and intrapulmonary pressure will change such that when we inhale air flows in, and when we exhale air flows out.  Physical laws applied to physiological mechanisms explain relationships among different components of a mechanism, e.g., the pressure of a quantity of gas to its volume.  I assure them, they can and will learn the fundamental physics on which Boyle’s law is based, but keep it simple and remember – when you inhale air flows in, when you exhale air flows out. 

            *Understand the question, before you answer it.* My PhD advisor shared this pearl of wisdom before my qualifying exam.  I encourage students to calmly, slowly and deliberately read the entire question.  On any multiple choice or essay exam, they must be certain of what is being asked, before answering a question.  Do not stop reading the question until you come to a period, question mark or exclamation point.  Students are concerned about wasting precious time.  Slowing down just a bit to answer correctly is worth the time and decreases the odds of second guessing or having to go back to the question.  I make another pitch for reading the text book.  It is a way to practice reading calmly and deliberately and catching differences in font or formatting, e.g., print style, italics, bold, underline, that may indicate key terms for an exam question. 

Bumper stickers for general principles in physiology

*Enough, but not too much.* Many students think every physiological end point is maintained at a constant value.  I explain that various parameters are regulated such that they gently fluctuate within a narrow range.  Plasma sodium must be ‘enough’; if it drops too low osmolarity decreases.  If sodium is ‘too much’, osmolarity increases; plasma volume increases; blood pressure increases.  If an endpoint falls below range, regulatory mechanisms bring it back up into range; should it increase above normal range, regulatory mechanisms bring it back down into range.  

*It’s not a mathematical equation; it’s a relationship.* Many students confess they are ‘really bad at math’ or ‘hate math’.  CO, MAP, renal clearance, alveolar ventilation rate – all math.  Understanding and passing physiology requires math.  I tell students math describes physiological relationships between different factors that regulate or dictate a given endpoint, similar to interactions and relationships among friends or a team.  Actual equations represent precise relationships, e.g., CO = HR x SV.  In that case, cardiac output will increase and decrease in direct proportion to heart rate and stroke volume.  Then there is Poiseuille’s Equation.  Students are not required to memorize that equation, but they must learn and apply the principles of the equation: F α DP, F α 1/R and F α r4.  I clarify the α symbol means ‘in proportion to’, not equals.  I repeat, ‘It’s not a mathematical equation; it’s a relationship.”  I suggest they view a as a hug, and embrace the dependence of blood flow on the pressure gradient, vascular resistance, and the luminal radius.  The 4 means when radius changes even just a little, flow changes a lot!  I provide a more technical explanation of how blood flow can decrease significantly with gentle vasoconstriction and increase with gentle vasodilation; this showcases the essential regulatory role of vascular smooth muscle.  This particular bumper sticker serves to remind them math is critical to our understanding of physiology and hopefully, ease their anxiety.  More math awaits in respiratory physiology, and they revisit and apply F α DP, F α 1/R and F α r4 to air flow.

*Know what abbreviations mean, and don’t make up abbreviations.* I explain the names of hormones, especially, are rich in information.  These names indicate source, stimulus for release, and mechanism of action.  For example, atrial natriuretic peptide, ANP, is a peptide hormone secreted from atrial tissue when plasma volume increases that increases urine output (-uretic) and sodium (natri-) excretion.  Not too creative, but self-explanatory.  Couple it with “Water follows sodium …”; problem solved.  

Bumper stickers for chronological order or sequence

For many cellular and organ mechanisms, there is a strict chronological order of events.  During the cardiac cycle, there is a distinct chronological order for each of several different phenomena that occur simultaneously and interdependently.  I use bumper stickers to teach a basic concept of cardiac physiology that help students learn the cardiac cycle – the electrical~mechanical relationship.  First, I show the entire Wiggers diagram and explain it tracks the series of interrelated electrical and mechanical events as they occur in the same timeline of one heartbeat.  I assure them we will take one panel at a time and pull it altogether at the end.  I start with the relationship of the ECG to the 4 ventricular phases, using a set of bumper sticker phrases that I write on the board.  We review the electrical events of P (atrial depolarization), QRS (ventricular depolarization) and T (ventricular repolarization) deflections.  Then, I say, “Pay attention.  Write down each phrase.”

*Electrical then mechanical.* I explain emphatically that first an electrical signal is transmitted and received, then the atrial or ventricular muscle responds.  In the cardiac cycle, electrical events P, QRS, and T each precede atrial or ventricular responses.  

*Depolarizeàcontract.  Repolarizeàrelax.* I explain depolarization triggers contraction; repolarization leads to relaxation.  P wave signals atrial contraction; QRS complex signals ventricular contraction; T wave signals ventricular relaxation.

*Depolarizeàcontractàincrease pressure.  Repolarizeàrelaxàdecrease pressure.*  I remind them changes in pressure gradients across the atrioventricular and semilunar valves determine whether valves open or close and consequently, whether blood flows into or out of the ventricle.  Depolarization leads to ventricular contraction and in turn, an increase in pressure; repolarization leads to ventricular relaxation and in turn, a decrease in pressure. 

*The AV valve is the fill valve; the semilunar valve is the ejection valve.*  A student thought of this phrase!  She explained, “When the AV valve – tricuspid or mitral – is open during diastole, the ventricle fills with blood from the atrium.  When the semilunar valve – pulmonary or aortic – is open during systole, blood is ejected.”  In that moment I thought my work as a teacher was done; my student is teaching herself and others.  I give her full credit, but use her bumper sticker.  I further explain when the ventricle relaxes and pressure drops below the atrial pressure, the AV valve will open, and blood enters the ventricle; when it contracts ventricular pressure exceeds atrial pressure and the AV valve closes; as it continues to contract, eventually ventricular pressure exceeds aortic pressure, the aortic valves opens, and blood is ejected into the aorta. 

Bumper stickers might not be the right tool for every teacher, student, or topic, or be appropriate for undergraduate versus graduate course.  If you decide to implement this tool, you might not have a bumper sticker for every basic or general physiology concept or mechanism or a set of bumper stickers for every organ system.  You might only use a bumper sticker phrase once or twice in a whole semester.  When used appropriately, they truly can make a difference.  On the other hand – if how you teach is working just fine and your students are getting it – then all I have to say is, “If it ain’t broke, don’t fix it!”

Alice Villalobos received her Bachelors of Science in biology from Loyola Marymount University and her PhD in comparative physiology from the University of Arizona-College of Medicine.  For the past several years, she has taught Anatomy & Physiology-II and Introduction to Human Nutrition in the Department of Biology at Blinn College and guest lectured at Texas A&M University on the topics of brain barrier physiology and heavy metal toxicology.  She recently relocated to Texas Tech University to join the Department of Kinesiology & Sport Management where she teaches Physiological Nutrition for Exercise.

Teaching Physiology with Educational Games
Fernanda Klein Marcondes
Associate Professor of Physiology
Biosciences Department
Piracicaba Dental School (FOP), University of Campinas (UNICAMP)

Educational games may help students to understand Physiology concepts and solve misconceptions. Considering the topics that have been difficult to me during my undergraduate and graduate courses, I’ve developed some educational games, as simulations and noncompetitive activities. The first one was the cardiac cycle puzzle. The puzzle presents figures of phases of the cardiac cycle and a table with five columns: phases of cardiac cycle, atrial state, ventricular state, state of atrioventricular valves, and state of pulmonary and aortic valves. Chips are provided for use to complete the table. Students are requested to discuss which is the correct sequence of figures indicating the phases of cardiac cycle, complete the table with the chips and answer questions in groups. This activity is performed after a short lecture on the characteristics of cardiac cells, pacemaker and plato action potentials and reading in the textbook. It replaces the oral explanation from the professor to teach the physiology of the cardiac cycle.

I also developed an educational game to help students to understand the mechanisms of action potentials in cell membranes. This game is composed of pieces representing the intracellular and extracellular environments, ions, ion channels, and the Na+-K+-ATPase pumps. After a short lecture about resting membrane potential, and textbook reading, there is the game activity. The students must arrange the pieces to demonstrate how the ions move through the membrane in a resting state and during an action potential, linking the ion movements with a graph of the action potential.  In these activities the students learn by doing.

According to their opinions, the educational games make the concepts more concrete, facilitate their understanding, and make the environment in class more relaxed and enjoyable. Our first studies also showed that the educational games increased the scores and reduced the number of wrong answers in learning assessments. We continue to develop and apply new educational games that we can share with interested professors, with pleasure.

Contact: ferklein@unicamp.br

Luchi KCG, Montrezor LH, Marcondes FK. Effect of an educational game on university students´ learning about action potentials. Adv Physiol Educ., 41 (2): 222-230, 2017.

Cardozo LT, Miranda AS, Moura MJCS, Marcondes FK. Effect of a puzzle on the process of students’ learning about cardiac physiology. Adv Physiol Educ., 40(3): 425-431, 2016.

Marcondes FK, Moura MJCS, Sanches A, Costa R, Lima PO, Groppo FC, Amaral MEC, Zeni P, Gaviao KC, Montrezor LH. A puzzle used to teach the cardiac cycle. Adv Physiol Educ., 39(1):27-31, 2015.

Fernanda Klein Marcondes received her Bachelor’s Degree in Biological Sciences at University of Campinas (UNICAMP), Campinas – SP, Brazil in 1992. She received her Master in Biological Sciences (1993) and PhD in Sciences (1998). In 1995 she began a position at Piracicaba Dental School, UNICAMP, where she is an Associate Professor of Physiology and coordinates studies of the Laboratory of Stress. She coordinates the subjects Biosciences I and II, with integration of Biochemistry, Anatomy, Histology, Physiology and Pharmacology content in the Dentistry course. In order to increase the interest, engagement and learning of students in Physiology classes, she combines lectures with educational games, quizzes, dramatization, discussion of scientific articles and group activities. Recently she started to investigate the perception of students considering the different teaching methodologies and the effects of these methodologies on student learning.

My Summer Reading: Discussion as a Way of Teaching: Tools and Techniques for Democratic Classrooms 2nd Edition by Stephen D. Brookfield and Stephen Preskill

Jessica L. Fry, PhD
Associate Professor of Biology
Curry College, Milton, MA

Ah Summer – the three months of the year when my To Do list is an aspirational and idealistic mix of research progress, pedagogical reading, curriculum planning, and getting ahead.  Here we are in July, and between hiring, new building construction, uncooperative experiments and familial obligations, I am predictably behind, but my strategic scheduling of this blog as a book review– meaning I have a deadline for both reading and digesting this book handed out at our annual faculty retreat — means that I am guaranteed to get at least one item crossed off my list!

My acceptance of (and planning for) my tendency to procrastinate is an example of the self-awareness Stephen D. Brookfield and Stephen Preskill advocate for teachers in their book “Discussion as a Way of Teaching”.  By planning for the major pitfalls of discussion, as well as the reasons behind why both teachers and students manage discussions poorly, they catalog numerous strategies to increase the odds of realizing the major benefits of discussion in the classroom.  At fifteen years old, this book is hardly dated; some of the discussion formats will be familiar to practitioners of active learning such as snowballing and jigsaw, but the real value in this book for me was the frank discussion of the benefits, drawbacks, and misconceptions about discussion in the classroom that are directly relevant to my current teaching practice.  

My lowest moments as a professor seem to come when my students are more focused on “finding the right answer” than on exploring a topic and fitting it into their conceptual understanding.  Paper discussions can fall flat, with students hastily reciting sentences from the discussion or results sections and any reading questions I may have assigned.  This book firmly makes the case that with proper groundwork and incentive, students can and will develop deliberative conversational skills.  Chapter 3 describes how the principles for discussion can be modeled during lecture, small group work, and formats designed for students to practice the processes of reflection and analysis before engaging in discussions themselves. Chapters 4 and 5 present the nuts and bolts of keeping a discussion going by describing active listening techniques, teacher responses, and group formats that promote rather than suppress discourse, and chapters 9 and 10 illustrate the ways students and teachers talk too much… and too little.  One of the most emphasized concepts in these chapters and threaded throughout the book is allowing silence.  Silence allows for reflection and should not be feared – 26 pages in this book cover silence and importantly, how and why professors and students are compelled to fill it, which can act as a barrier to all students participating in the discussion.   

Preskill and Brookfield emphasize the need for all students to be active listeners and participants in a discussion, even if they never speak a word, because discussion develops the capacity for the clear communication of ideas and meaning.  “Through conversation, students can learn to think and speak metaphorically and to use analogical reasoning…. They can get better at knowing when using specialized terminology is justified and when it is just intellectual posturing” (pg. 32).  What follows is an incredibly powerful discussion on not only honoring and respecting diversity, but a concise well-written explanation of how perceptions of social class and race affect both non-white and non-middle-class students in American college classrooms.  Their explanation of how academia privileges certain patterns of discourse and speech that are not common to all students leading to feelings of impostership should be read by everyone who has ever tone-policed a student or a colleague.  The authors advocate for a democratic approach to speech, allowing students to anonymously report if, for example, another student banging their hand on their desk to emphasize a point seemed too violent, which then allows the group to discuss and if necessary, change the group rules in response to that incident.  The authors note that “A discussion of what constitutes appropriate academic speech is not lightweight or idle.  It cuts to several core issues: how we privilege certain ways of speaking and conveying knowledge and ideas, who has the power to define appropriate forms and patterns of communication, and whose interests these forms and patterns serve” (pg 146).  The idea that academic language can be gatekeeping and alienating to many students is especially important in discussions surrounding retention and persistence in the sciences, where students seeing themselves as scientists is critical (Perez et al. 2014).  Brookfield and Preskill argue that through consistent participation in discussion, students will see themselves as co-creators of knowledge and bring their authentic selves to the community.   

All in all, this book left me inspired and I recommend it for those who imagine the kinds of invigorating discussions we have with colleagues taking place with our students and want to increase the chances it will happen in the classroom.  I want to cut out quotes from my favorite paper’s discussion section and have my students justify or refute the statements made using information from the rest of the paper (pg. 72-73 Getting Discussion Started).  I want my students to reflect on their journey to science and use social media to see themselves reflected in the scientific community (pg. 159-160 Discussing Across Gender Differences), and I want to lay the groundwork for the first discussion I have planned for the class of 2023; Is Water Wet?  All this and the rest of that pesky To Do list with my remaining month of summer. Wish me luck!  

Brookfield, S. D., & Preskill, S. (2005). Discussion as a Way of Teaching: Tools and Techniques for Democratic Classrooms (2nd ed.). San Francisco: Jossey-Bass.

Perez, T., Cromley, J. G., & Kaplan, A. (2014). The role of identity development, values, and costs in college STEM retention. Journal of Educational Psychology. http://doi.org/10.1037/a0034027

Jessica L. Fry Ph.D. is an Associate Professor of Biology at Curry College, a liberal-arts based primarily undergraduate institution in Milton, Massachusetts.  She currently teaches Advanced Physiology, Cell Biology, and Introduction to Molecules and Cells for majors, and How to Get Away with Murder which is a Junior Year Interdisciplinary Course in the General Education Program.  She procrastinates by training her dog, having great discussions with her colleagues, and reading copious amounts of science fiction. 

The Benefits of Learner-Centered Teaching

Jaclyn E. Welles
Cell & Molecular Physiology PhD Candidate
Pennsylvania State University – College of Medicine

In the US, Students at Still Facing Struggles in the STEMs

Literacy in the World Today:
According to the United Nations Educational, Scientific, and Cultural Organization (UNESCO), there are approximately 250 million individuals worldwide, who cannot read, write, or do basic math, despite having been in school for a number of years (5, 8). In fact, UNESCO, is calling this unfortunate situation a “Global Learning Crisis” (7). The fact that a significant number of people are lacking in these fundamental life skills regardless of attending school, shows that part of the problem lies within how students are being taught.

Two Main Styles of Teaching – Learner or Teacher-Centered

Learning and Teaching Styles:
It was due to an early exposure to various education systems that I was able to learn of that there were two main styles of teaching – Learner-centered teaching, and Teacher-centered teaching (2). Even more fascinating, with the different styles of teaching, it has become very clear that there are also various types of learners in any given classroom or lecture setting (2, 6, 10). Surprisingly however, despite the fact that many learners had their own learning “modularity” or learning-style, instructors oftentimes taught their students in a fixed-manner, unwilling or unable to adapt or implement changes to their curriculum. In fact, learner-centered teaching models such as the “VARK/VAK – Visual Learners, Auditory Learners and Kinesthetic Learners”, model by Fleming and Mills created in 1992 (6), was primarily established due to the emerging evidence that learners were versatile in nature.

VARK Model of Learners Consists of Four Main Types of Learners: Visual, Auditory, Reading and Writing, and Tactile/Kinesthetic (touch)

What We Can Do to Improve Learning:
The fundamental truth is that when a student is unable to get what they need to learn efficiently, factors such as “learning curves” – which may actually be skewing the evidence that students are struggling to learn the content, need to be implemented (1, 3). Instead of masking student learning difficulties with curves and extra-credit, we can take a few simple steps during lesson-planning, or prior to teaching new content, to gauge what methods will result in the best natural overall retention and comprehension by students (4, 9). Some of methods with evidence include (2, 9):

  • Concept Maps – Students Breakdown the Structure or Organization of a Concept
  • Concept Inventories – Short Answer Questions Specific to a Concept
  • Self-Assessments – Short Answer/Multiple Choice Questions
  • Inquiry-Based Projects – Students Investigate Concept in a Hands-On Project

All in all, by combining both previously established teaching methodologies with some of these newer, simple methods of gauging your students’ baseline knowledge and making the necessary adjustments to teaching methods to fit the needs of a given student population or class, you may find that a significant portion of the difficulties that can occur with students and learning such as – poor comprehension, retention, and engagement, can be eliminated (4, 9) .

Jaclyn Welles is a PhD student in Cellular and Molecular Physiology at the Pennsylvania State University – College of Medicine. She has received many awards and accolades on her work so far promoting outreach in science and education, including the 2019 Student Educator Award from PSCoM.

Her thesis work in the lab of Scot Kimball, focuses on liver physiology and nutrition; mainly how nutrients in our diet, can play a role in influencing mRNA translation in the liver.