Category Archives: Teaching Strategies

Using Google Jamboard for Collaborative Online Learning in Human Physiology

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

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

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

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

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

 

 

 

 

 

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

 

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

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

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

 

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

 

 

 

 

 

 

 

References

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

Section 2: Can we move beyond cookbook style laboratories?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion

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

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

 

References

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

Pandemic

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

Physiology for Physical Therapy Students

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

Psychology and Purpose

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

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

Professor Fink

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

Practical Exams

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

Proficiency

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

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

Closing Remarks

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

REFERENCES:

  1. Williamson B, Eynon R, Potter J. Pandemic politics, pedagogies and practices: digital technologies and distance education during the coronavirus emergency. Learning, Media and Technology. 2020;45(2):107-14.
  2. Bozkurt A, Jung I, Xiao J, Vladimirschi V, Schuwer R, Egorov G, et al. A global outlook to the interruption of education due to COVID-19 pandemic: Navigating in a time of uncertainty and crisis. Asian Journal of Distance Education. 2020;15(1):1-126.
  3. Hodges C, Moore S, Lockee B, Trust T, Bond A. The difference between emergency remote teaching and online learning. Educause review. 2020;27:1-12.
  4. Begam M, Roche R, Hass JJ, Basel CA, Blackmer JM, Konja JT, et al. The effects of concentric and eccentric training in murine models of dysferlin-associated muscular dystrophy. Muscle Nerve. 2020.
  5. Roche JA, Roche R. A hypothesized role for dysregulated bradykinin signaling in COVID-19 respiratory complications. FASEB J. 2020;34(6):7265-9.
  6. Joseph R, Renuka R. AN OPEN LETTER TO THE SCIENTIFIC COMMUNITY ON THE POSSIBLE ROLE OF DYSREGULATED BRADYKININ SIGNALING IN COVID-19 RESPIRATORY COMPLICATIONS2020.
  7. Wikipedia contributors. Shaolin Kung Fu – Wikipedia, The Free Encyclopedia 2021 [Available from: https://en.wikipedia.org/w/index.php?title=Shaolin_Kung_Fu&oldid=1026594946.
  8. Wikipedia contributors. With great power comes great responsibility – Wikipedia, The Free Encyclopedia 2021 [Available from: https://en.wikipedia.org/w/index.php?title=With_great_power_comes_great_responsibility&oldid=1028753868.
  9. American Physical Therapy Association (APTA). Transforming Society – American Physical Therapy Association [Available from: https://www.apta.org/transforming-society.
  10. Yeager DS, Henderson MD, Paunesku D, Walton GM, D’Mello S, Spitzer BJ, et al. Boring but important: a self-transcendent purpose for learning fosters academic self-regulation. Journal of personality and social psychology. 2014;107(4):559.
  11. Fink S. ProfessorFink.com [Available from: https://professorfink.com/.
  12. Eby LT, Allen TD, Evans SC, Ng T, Dubois D. Does Mentoring Matter? A Multidisciplinary Meta-Analysis Comparing Mentored and Non-Mentored Individuals. J Vocat Behav. 2008;72(2):254-67.
  13. Winkelmes M. Transparency in Learning and Teaching: Faculty and students benefit directly from a shared focus on learning and teaching processes. NEA Higher Education Advocate. 2013;30(1):6-9.
  14. Alt D. Teachers’ practices in science learning environments and their use of formative and summative assessment tasks. Learning Environments Research. 2018;21(3):387-406.
Joseph A. Roche, BPT, PhD.  Associate Professor.  Physical Therapy Program.  Eugene Applebaum College of Pharmacy and Health Sciences.  

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

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

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


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

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

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

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

 

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

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

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

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

 

Person First Teaching in Physiology

Many of us are continuously trying to be as inclusive in our teaching as possible. One early concept I learned in this effort was to use person-first language, where one “puts the person before the disability, and describes what a person has, not who a person is”. This small change can lead to a more comfortable and inclusive classroom and also model behavior that future health professionals (the majority of my students) will need to employ in their careers.

 

Yet, there’s another ‘person first’ approach that I take in my classes and interactions with students that I think also builds inclusivity and perhaps more importantly, trust and understanding between my students and me. I try to be a person first, and a professor second. I try to see my students as people first, and students second. In the past year, during the unprecedented COVID-19 pandemic, this has been especially important as we all attempt to deal with additional life stresses, course modalities, and uncertainties.

 

As a person, the past year has not only been marked by the pandemic, but rather a significant medical challenge. In March 2020, amidst emergency planning to send students home permanently for the semester and move to remote teaching, I was diagnosed with Stage IV metastatic breast cancer. In 2014, in my second year as a faculty member, I had gone through chemo, surgery, radiation, and continued therapy for what was at that time stage III breast cancer. Remission lasted nearly five years. Since the original diagnosis, while I never felt like cancer defined me, it became an essential part of me, as a person, and as a professor.

 

The hormonal treatment regimen I followed from 2015-2019 provided a real-life example of many of the principles of the endocrine system that I taught my mid-level Human Physiology students. Along with an example of my grandmother stubbornly tapering off high-dose IV steroids after a kidney infection, I began to teach “my story” as our application of the endocrine system chapter in my flipped-classroom course.

 

I present a case study on “Patient X”, only revealing that I am in fact patient X after the relevant physiology is covered. As I explain to students, it’s not just an example to allow them to apply what they are learning to a clinical situation. Rather, it’s my attempt to demonstrate that the knowledge they are (hopefully) gaining, the vocabulary and critical thinking skills are not meant to just serve their future professional goals, but their personal life as well. They may be the one in the future helping a loved one navigate a challenging health situation. I’ve been forever grateful for my own physiological knowledge helping me to deal with my diagnosis, treatment, and prognosis.

 

This year, with the progression of my disease, the lesson takes a slightly different tone (although better this semester since my current infusion treatment has led to some regression of lung metastases). I also take the time to have a “soapbox moment” (and yes, I call it that…) to also inform students about metastatic breast cancer in general, some statistics, and the importance of early detection. I remind the students about the importance of drug discovery and clinical trials in changing people’s lives, mine included.

 

This year, in anticipation of writing this post, as part of the pre- and post- reflection students complete about “why is important to understand hormones?” I asked them for feedback on my person-first approach of sharing my own story. In addition to many students reflecting that they did in fact “see the bigger picture” of why we learn basic physiology, many provided comments that support my approach. A selection of some of their responses:

 

I really liked that you incorporated your own personal story into class because it made me feel like I genuinely knew you better as a person rather than just my professor – students really don’t get to see their teacher’s lives outside of class, but I think it’s really special when they do and when they are vulnerable with us and can share things like you did. It also gave us some insight as to why you do the things you do and why you are interested in what you teach. Thank you for sharing!”

You sharing your story today and being vulnerable with us gave real-life application to what we are learning. We are able to now better understand that learning this information is not just about memorizing facts to get a good grade. Rather, it shows us the importance of what we are studying and how we can use it to help others throughout our lifetime. So, thank you very much for sharing and inspiring other teachers to share as well.”

I am really happy that you shared your personal story. I think case studies are a great way to learn in general, but actually knowing the person in the case makes is so much more powerful. I will never forget today’s class and I genuinely have a much better understanding and appreciation for the material that we covered.”

Obviously, not everyone has their own story to tell, but my guess is that we all have ways that we can be vulnerable and connect the material to our own lives, encouraging our students to do the same. Storytelling and narrative medicine have received recent attention as ways to promote empathy and build trust. Why not then share our own stories? Why not put the person first in our teaching?

To summarize, I am a person with cancer. I am a person who teaches physiology. I am a person who utilizes my cancer to help me teach physiology.


Anne Crecelius 
(@DaytonDrC) is an Associate Professor in the Department of Health and Sport Science at the University of Dayton..  She teaches Human Physiology, Introduction to Health Professions, and Research in Sport and Health Science. She returned to her undergraduate alma mater to join the faculty after completing her M.S. and Ph.D. studying Cardiovascular Physiology at Colorado State University.  Her research interest is in the integrative control of muscle blood flow.  She is a member of the American Physiological Society (APS) and on the leadership team for the Physiology Majors Interest Group (P-MIG).
Flipped Teaching to Remote Flipped Teaching

Although flipped teaching design has been around for years, the term ‘flipped teaching’ was only coined slightly over a decade ago, mainly when Salman Khan used this teaching method to his cousins over the internet that subsequently gained attention. Advancements in educational technology must be given credit for the origin of this new term as well.

 

About a decade ago, I started using flipped teaching, but the terms ‘synchronous’ and ‘asynchronous’ were not associated with it at that time. About four years ago, in one of the conferences, I was introduced to synchronous online teaching for the first time. Since I also teach an online class without flipped instruction, I tried to modify my asynchronous online course to a synchronous one but had difficulty doing so. The students in my online class worked full time, and there was not a single common time convenient for the entire class.

 

My flipped teaching design has been steadily evolving since I first started using it (Figure 1). Briefly, there are two significant components of this teaching method- the pre-class and the in-class. The flipped teaching’s pre-class portion is where students first explore new course content in their personal space and time. In-class time is deliberately designed around student engagement and inquiry, allowing students to apply and elaborate on course concepts (DeLozier & Rhodes, 2017; Jensen, Kummer, & Godoy, 2015). In-class sessions typically entail collaborative active learning strategies. My fascination for the retrieval exercise in facilitating learning (Dobson, Linderholm, & Stroud, 2019) led to its blending in conjunction with flipped teaching (Figure 1). There are challenges with this contemporary teaching method. One of them is student buy-in. Yet another one is student motivation. However, I have developed strategies that have helped overcome these challenges.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1. Flipped Teaching to Remote Flipped Teaching

COVID-19 was the unexpected challenge every instructor had to face in 2020. Since COVID 19, the original flipped teaching design had to be revised to shift to remote teaching. One advantage for those using flipped teaching was the use of the pre-class portion that was already available. The term ‘pre-class’ suddenly became synonymous with the ‘asynchronous’ part of online instruction. The in-class activities would now be referred to as the ‘synchronous’ sessions. Although some modifications had to be made for the in-class or synchronous portion of the flipped teaching, such as the Zoom’s breakout rooms for group work and a clicker activity for the in-class individual assessments, the in-class content that was already prepared was reusable. Thus, evolved a new form of flipped teaching called remote flipped teaching (Figure 1). It must be noted that flipped teaching must have some form of synchronous time with the students. Otherwise, it would simply be referred to as an online course. The remote flipped classroom is where students engage with course content in an online platform prior to attending a virtual face-to-face course session. Pairing flipped classroom pedagogy, in which students engage with content independently before a synchronous class, with online learning objects intentionally designed to promote independent learning, helps build a strong foundation (Humrickhouse, 2021).

References

DeLozier, S. J., & Rhodes, M. G. (2017). Flipped classrooms: a review of key ideas and recommendations for practice. Educational Psychology Review29(1), 141-151.

Dobson, J. L., Linderholm, T., & Stroud, L. (2019). Retrieval practice and judgements of learning enhance transfer of physiology information. Advances in Health Sciences Education24(3), 525-537.


Humrickhouse, E. (2021). Flipped classroom pedagogy in an online learning environment: A self-regulated introduction to information literacy threshold concepts. The Journal of Academic Librarianship47(2), 102327.

Jensen, J. L., Kummer, T. A., & Godoy, P. D. D. M. (2015). Improvements from a flipped classroom may simply be the fruits of active learning. CBE—Life Sciences Education14(1), ar5.

Dr. Chaya Gopalan received her bachelor’s and master’s degrees from Bangalore University, India, and Ph.D. from the University of Glasgow, Scotland. Dr. Gopalan wanted to follow her passion for teaching. She started as an adjunct faculty position at Maryville University in St. Louis, which led to tenure-track positions at St. Louis Community College and St. Louis College of Pharmacy, and now at Southern Illinois University Edwardsville (SIUE). She has been teaching anatomy, physiology, and pathophysiology at graduate and undergraduate levels for health professional programs. Dr. Gopalan has been practicing evidence-based teaching using team-based learning, case-based learning, and flipped classroom methods. Besides her passion for teaching, Dr. Gopalan has kept up with lab research in neuroendocrine physiology. She is currently working on two research projects: gonadal steroid hormones in the sexual dimorphism of the brain and the other study on obesity, intermittent fasting, and physical and mental exhaustion.

 

Dr. Gopalan has received many teaching awards, including the Arthur C. Guyton Educator of the Year award from the American Physiological Society (APS), the Outstanding Two-Year College Teaching award by the National Association of Biology Teachers, and the Excellence in Undergraduate Education award by SIUE. She has also received several grants, including an NSF-IUSE, an NSF-STEM Talent Expansion Program, and the APS Teaching Career Enhancement awards.

 

Besides teaching and research, Dr. Gopalan enjoys mentoring not only her students but also her peers. She regularly conducts workshops and participates in panel discussions related to higher education. Dr. Gopalan is very active in the teaching section of the APS and has served on many committees. She has published numerous manuscripts and case studies and contributed several textbook chapters and question banks for textbooks and board exams.
 

What do I really want my students to learn about animal physiology?

Each spring semester my colleague and I teach an undergraduate course in animal physiology that emphasizes primary literature and incorporates multiple evidence-based teaching strategies. Using an integrative and comparative approach, students investigate strategies that vertebrate animals use to meet their energy needs, take up and transport oxygen, and maintain hydration and salt balance, with a special emphasis on how animals have adapted to extreme environments. Our course incorporates a flipped teaching (FT) format (2, 4), where students are assigned readings from the textbook and articles from the primary literature outside of class and class time is spent discussing the material and applying that information to explore physiological mechanisms. Instead of lecturing, class time is focused on interactive learning through group work – teamwork is emphasized throughout the course, with students working in groups both inside and outside of class.  Our course learning goals are:

 

1.       Acquire a fundamental knowledge of “how animals work”

2.       Recognize how prior and new knowledge relate to current/future work

3.       Appreciate the importance of animal physiology

4.       Understand how to collect, integrate, and communicate information

5.      Exercise responsibility and teamwork.

 

When Rice University moved all classes online due to the COVID pandemic in spring 2020, we were at mid-semester. So like most other educators around the United States, we moved our class to Zoom. The transition from face-to-face to online instruction went fairly smoothly. Although we had only two weeks to make this shift, we did not have to frantically record lectures since our class meetings were discussion based. Additionally, students had been working in teams since the beginning of the semester so we had an established community in our classroom. Students still attended class online and were engaged for the most part. That being said, we observed that students did not turn on their cameras unless we asked them to and definitely seemed more hesitant to answer and ask questions in Zoom. Student engagement and participation increased dramatically when we put students in small groups in breakout rooms; here they interacted as a team, just like they did at round tables in the classroom pre-COVID. Student feedback at the end of the semester revealed that most of them felt like class didn’t change that much after moving online – however, they did miss the in-person interactions with us and their classmates, and some activities did not translate well to an online format; they truly appreciated our efforts to adapt our teaching and made some great suggestions for how we could improve the course in the future for online and/or face-to-face teaching.

 

After the semester ended, I finally had some time to reflect upon my teaching pre-COVID and during the pandemic. Over the summer, I spent many hours thinking about the course structure and what we would revise for our next offering of the course. As the COVID pandemic continued to rage throughout the fall semester, my colleague and I decided that we would teach our animal physiology course fully online for the spring 2021 semester. And we just learned that due to a spike in COVID cases after Christmas in the Houston area, classes at Rice will be fully remote at least until mid-February. During the pandemic last spring, throughout the summer and fall, and now with classes starting in just two weeks, one key question has guided me as I work on this course: “What do I really want my students to learn about animal physiology?”

How were we assessing student learning?

During the spring 2020 semester, student learning was assessed in multiple ways including individual exams, group exams, a semester long team project, homework, reading quizzes, reflections, etc. Although these mostly formative assessments and the team project require a great deal of effort and time from the students, exams contributed to 70% of the total grade for the course; the team project accounted for 20% of the grade, and all other assignments (e.g., homework, quizzes, reflections) were worth just 10% of the grade. Although there were short “mini exams” every other week, some students still became stressed and anxious when taking the exams, even though they demonstrated an understanding of course material in class discussions and on homework assignments. Once the pandemic forced us to remote instruction, we did modify the exam format to give them more time to take the exam online than they would have had in the classroom; they had a flexible window so they could choose what time/day to take the exam; and the final exam was “open resources.” And we dropped a third exam based on a research article since we lost about two weeks of instruction. We were not overly concerned about cheating since all of our exam questions are short answer format and typically require application and/or synthesis of foundational knowledge to answer the questions (i.e., you can’t just Google the answer).

Overall, student performance on the exams did not change much from pre-COVID to during the pandemic. Still, this weighting of assignments seemed imbalanced to me, with too much emphasis on student performance on exams. I started thinking about how I could shift the weighting of assignments to better reflect student achievement of learning goals. For example, the semester long team project, where students create a fictional animal (1) and showcase their animal during the last week of classes, requires students to understand integration of body systems as well as explain how the systems work together (or don’t) and recognize tradeoffs and physiological constraints. Shouldn’t this creative outlet that requires the highest level of Bloom’s taxonomy count as much towards their course grade as exams? What about all of the other work they do inside and outside of class?

 How did I intentionally redesign my course with strategies to promote student success?

Never having taught a course online before the spring 2020 semester and not being sure how to help students cope with additional stresses caused by the pandemic, I attended or participated in numerous webinars, such as the National Institute on Scientific Teaching SI Happy Hours (https://www.nisthub.org), the APS Institute on Teaching and Learning Virtual Week (https://www.physiology.org/detail/event/2020/06/22/default-calendar/institute-on-teaching-and-learning?SSO=Y), and the APS Webinar Series – Physiology Educators Community of Practice (https://www.physiology.org/detail/event/2020/07/23/default-calendar/physiology-educators-community-of-practice-webinar-series?SSO=Y). Support and resources from the Rice Center for Teaching Excellence (https://cte.rice.edu/preparing-for-spring-2021#resources) have been invaluable as I redesign my course.

In an article submitted to Inside Higher Ed about helping students in times of trauma (3), Mays Imad said,

As teachers, we don’t simply impart information. We need to cultivate spaces where students are empowered co-create meaning, purpose and knowledge — what I have termed a “learning sanctuary.” In such a sanctuary, the path to learning is cloaked with radical hospitality and paved with hope and moral imagination. And it is our connections, the community of the classroom and our sense of purpose that will illuminate that path.”

How can I create a “learning sanctuary” in my classroom environment? What approaches can I take to minimize stress and maximize engagement for students? Here are some strategies I’ve adopted for this upcoming semester to promote student success as we teach our animal physiology course fully online:

  • Shift weighting for assignment categories to an even distribution – exams are worth only 25%!
  • Further modify the exam format to decrease student anxiety and likelihood of cheating – all exams are open resources!
  • Incorporate new assignments to assess student learning – students write a mini review paper about their favorite vertebrate animal.

 How will I know if my students learned animal physiology?

Our overall course goal is “We aim to have you learn mechanisms by which animals solve day to day problems of staying alive; learn skills, strategies, and ways of thinking that are particularly relevant to the study of physiology; and perhaps most important of all, enjoy learning the marvelous phenomena of the animal world.” Throughout the course we strive to help our students learn, not just memorize a bunch of facts that they will forget as soon as they take an exam. In their final reflection about the course, we ask these questions:

1.       What impact has something you learned had on your own perceptions?

2.       What long-term implications did a specific discovery/piece of information have on you/on society?”

3.       What is one or more specific thing that you learned about animals this semester that you will never forget?

I love reading their reflections where they share what they learned in our course. Here are a few of my favorites from the spring 2020 semester:

  •        …This class totally changed my mindset. I’m glad it was animal examples, with maybe a handful of human connections, rather than human examples with animal connections. I think in my past reflections, I have said repeatedly my favorite part was the animal examples, whether it’s a specific example or the comparative examples. I think my very favorite animal we “did” this semester were the diving seals – every kid who has ever been on swim team always had those competitions to see who could hold their breath the longest and the seals were an interesting callback to that. But even before that, I think I learned new information about how animals lived and worked each and every week of this class. Just ask my friends: every week, I’d be sharing some interesting fact from “animal class,” like the reindeer eyes… I now have learned a lot more about animals and have a greater appreciation for them as they compete to survive in their own circumstances. I can safely say I haven’t been this passionate about animals since I was little, going through my “animals” phase, and am hoping to keep this excitement and stay a lifelong learner about different animals and how special they are!
  •         …My perceptions of the importance and complexity of different organisms in physiology has been strongly shifted by this class. I’ve gained an appreciation of different animal systems as they function in different kinds of vertebrates. While I previously had a more human-centric view of physiology from taking the MCAT, I am glad I was able to broaden my perspective to learn more about the different tricks and systems animals employ to suit themselves to their environments…
  •       …It was cool to see the adaptions that different species of animals have to cope in their environment. Some of them seemed so wild, like being able to change how blood flows through your heart, or lungs collapsing in diving mammals. Even mammalian life on our own planet can seem so alien at times. Most of us are familiar with how the human body works, at least in broad strokes, but there are so many other ways to live…
  •       …when you understand how an animal works. When you understand why they do what they do and why they look the way they look, a lot of fear and misunderstanding melts away. It not only cultivates a sense of amazement but also one of understanding and respect.

Even in the midst of a pandemic, I feel confident that my students not only learned physiology but also gained an appreciation for the importance of studying animal physiology. After taking this course, most if not all of them would agree with me that “Animals are Amazing!” And that is what I really want my students to learn about animal physiology.

NOTE: All protocols were approved by the Institutional Review Board of Rice University (Protocol FY2017-294).

References

1.       Blatch S, Cliff W, Beason-Abmayr B, Halpin P. The Fictional Animal Project: A Tool for Helping Students Integrate Body Systems. Adv Physiol Educ 41: 239-243m 2017; doi: 10.1152/advan.00159.2016.

2.       Gopalan C. Effect of flipped teaching on student performance and perceptions in an Introductory Physiology course. Adv Physiol Educ 43: 28–33, 2019; doi:10.1152/advan.00051.2018.

3.       Imad M. Seven recommendations for helping students thrive in times of trauma. INSIDE HIGHER ED, June 3, 2020; https://www.insidehighered.com/advice/2020/06/03/seven-recommendations-helping-students-thrive-times-trauma.

4.       McLean S, Attardi SM, Faden L, Goldszmidt M. Flipped classrooms and student learning: not just surface gains. Adv Physiol Educ 40, 47-55, 2016; doi:10.1152/advan.00098.2015.

Beth Beason-Abmayr, PhD, is a teaching professor of biosciences at Rice University in Houston, TX, and a faculty fellow of the Rice Center for Teaching Excellence. She has developed multiple course-based undergraduate research experiences and a student-centered integrative animal physiology course. Beason-Abmayr is a longtime judge for the International Genetically Engineered Machine (iGEM) competition and a member of the iGEM Executive Judging Committee. She is a past recipient of the George R. Brown Award for Superior Teaching and the Teaching Award for Excellence in Inquiry-Based Learning at Rice and has published in Advances in Physiology Education and the Journal of Microbiology & Biology Education. A National Academies Education Mentor in the Life Sciences, Beason-Abmayr is chair of the Organizing Committee of the American Physiological Society’s 2022 Institute of Teaching and Learning and is an associate editor for Advances in Physiology Education. She earned her PhD in physiology and biophysics at The University of Alabama at Birmingham.

 

 

 

 

Motivating students to make the most of group projects

Implementation of group projects in class represents an important pedagogical strategy to engage students in active learning. Specifically, it may promote collaborative learning, problem-based learning, evidence-based learning, team-based learning, and peer instruction. Students may benefit from group projects in different ways, including but not limited to: (1) practicing teamwork skills (e.g., communication, collaboration, interdependence, and accountability), and (2) building problem-solving skills (e.g., reasoning, critical-thinking, knowledge applying, trouble shooting, and concept constructing). As such, implementation of group projects has been increasingly observed in higher education across disciplines including nutritional and metabolic physiology [1-4].

 

However, not all students favor group projects. The common complaints may arise from time commitments and unequal contributions [2]. Some students may prefer to work alone on assignments in which they can easily take control of the pace and spend less time to earn high scores. This view is true in some sense, but students will miss the benefits of collaborative learning, team-based learning, and peer instruction. In general, it takes more time to accomplish a project as a group than as an individual because time is needed to build an effective team. However, the effects or benefits of group projects on student learning are profound, as mentioned above. To be society or career ready, for instance, students are not evaluated by scores alone but also by soft skills such as teamwork, accountability, adaptability, flexibility, and resilience. In terms of contributions, some students may feel short of chances to express themselves because of dominating group members, while others may complain about free riders who take less responsibility in group projects but earn the same scores [2]. The paradoxes can be addressed by motivating students to actively participate in and make the most of group projects.

 

First, let students enjoy the freedom to select topics of interests for their group projects. Interest can significantly motivate students to make efforts exploring evidence for answers. Nevertheless, the project topics proposed by students are by no means random; instead, the themes should fit in with the course content and learning objectives. In order for a project to overarch the interests of a group of students, the instructor may facilitate setting up the groups based on student interests. In addition, the instructor’s guidance is critical for the project initiation, where adjustments are necessary to customize the project question or theme such that it takes into account every member’s interests and learning objectives.

 

Secondly, balance group size to fulfill key roles. Group size affects group dynamics and the performance. Group oversizing increases the difficulty of engaging each member in the discussion or activities within limited time, which results in free riding and unequal contributions. A group size of 3-5 students is considered reasonable; a group size of 2 students may still work, but it lacks the typical group dynamics of assigning and rotating roles. In a 5-student group, the roles can be assigned as a facilitator (to moderate group discussion), a challenger (to raise counter-arguments and alternative explanations), a recorder (to take notes of group discussion), a reporter (to summarize and report the outcome of group discussion), and a timekeeper (to keep the group on track of time and deadlines). For a smaller group, the facilitator may take an additional role of “timekeeper”, and the challenger or recorder may take an additional role of “reporter”. More importantly, role rotation motivates students to play different roles in a group, which can prevent students from dominating in a group discussion or project and eliminate free riding. Role rotation motivates students to put themselves in others’ shoes, which promotes mutual understanding and trust that foster stronger teamwork. To this end, the instructor may direct students to divide a group project into sub-sections such that the key roles can be played by each member of the group via role rotation.

 

Third, have individual contributions weighed for group project grading. It is common that all members earn the same score for a group project. However, having individual contributions weighed for group project grading will motivate students to maximize their talents and potential in solving problems and executing the project. Practically, let students acknowledge or sign their contributions when they submit the assignment, and accordingly, grading rubrics can be designed such that both individual and collective merits of a group assignment are weighted. For instance, an oral presentation can be easily assessed by the relevance, depth, innovation, readiness, and communication skills for each individual portion, and by the overall hypothesis, rationale, logical flow, presentation transitions, and convincingness for the collective merits. This practice may increase the workload on the instructor and teaching assistants, but it significantly boosts the motivation of students to do the best they can for a group project.

 

Lastly, effectively apply anonymous peer evaluation. Group projects demand a variety of outside class efforts and activities, and a generic evaluation or rating of peer contributions would not suffice. Instead, the anonymous peer rating should be specified in detail such as the responsiveness, promptness, the amount of literature contributed, and the performance in discussion, presenting and challenging different viewpoints, and setting and achieving goals. The itemized rating or guide can keep the peer evaluators on track and evaluation straightforward. In addition, it is critical to provide timely evaluation so that students know how they are doing and what to improve, and so they may take prompt actions to improve later group work. If a group project consists of multiple subsections, an anonymous peer evaluation can be installed for each subsection with the average being taken as the final rating. If there is no subsection in a group project, an anonymous peer evaluation can be installed in halfway and at the conclusion of the project, with the average being taken as the final rating. Timely and multiple peer evaluations motivate students to reflect and find effective ways to work together as a group. By contrast, using a single peer evaluation for the group project only tells students about their performance but does not produce the motivation or opportunities to identify and fix issues for improvement.

 

In summary, implementation of group projects in class may benefit student learning in many ways [1-4]. Here I described some practical strategies that motivate students to fully participate and make the most of group projects. These practices may also address concerns raised by students and instructors about unequal contributions or free riding [2].

 

References and further reading

[1] Benishek LE and Lazzara EH. Teams in a New Era: Some Considerations and Implications. Front. Psychol. 2019, 10, 1006. doi: 10.3389/fpsyg.2019.01006

[2] Chang Y, Brickman P. When Group Work Doesn’t Work: Insights from Students. CBE Life Sci Educ. 2018, 17(3), ar42. doi: 10.1187/cbe.17-09-0199.

[3] Rathner JA, Byrne G. The use of team-based, guided inquiry learning to overcome educational disadvantages in learning human physiology: a structural equation model. Adv Physiol Educ. 2014, 38(3), 221-8. doi: 10.1152/advan.00131.2013.

[4] Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open 2019, 9, e028280. doi:10.1136/bmjopen-2018-028280

Dr. Zhiyong Cheng received his PhD in Analytical Biochemistry from Peking University, after which he conducted postdoctoral research at the University of Michigan (Ann Arbor) and Harvard Medical School. Dr. Cheng is now an Assistant Professor of Nutritional Science at the University of Florida. He has taught several undergraduate- and graduate-level courses (lectures and lab) in human nutrition and metabolism (including metabolic physiology). As the principal investigator in a research lab studying metabolic diseases (obesity and type 2 diabetes), Dr. Cheng has been actively developing and implementing new pedagogical approaches to build students’ critical thinking and problem-solving skills.
Spring 2020*: The asterisk denotes community made all the difference.

Spring 2020 is often denoted with an asterisk.  The asterisk means different things to different people.  For many people it means, “Things will never be the same.”  COVID-19 has changed the venues from which we teach, but not our commitment to continually improve our teaching.  We have adapted our lectures, labs, and office hours to online platforms to keep students and ourselves safe.  I am no seer, but once classes moved online in mid-March I knew this would be a long haul from which I must learn and never forget.  After submitting final grades, I asked myself, “What have you learned?  Which practices will you continue to implement to create a better learning environment for students irrespective of world health status or platform?”  My asterisk on Spring 2020 is community.

For Spring 2020 I was assigned three sections of an upper level exercise nutrition course and one section of basic exercise physiology.  Each was a critical course.  Kinesiology majors must pass exercise physiology before any other upper level kinesiology course; this was a new course for me.  The exercise nutrition course, which I taught the prior semester, includes an in-class presentation with a hefty point value; it also is the departmental assessment tool for communication skills.  Over the last several years the level of stress and anxiety among undergraduate students in my physiology courses has been progressively increasing, nearly choking their joy of learning.  Colleagues in other fields observe similar trends.  The majority of students taking physiology courses seek careers in health professions.  Given the competitive nature of the respective training programs, students are driven to earn that A.  Add to that the worry of paying for tuition, rent, food, books, computers, and transportation and complicated academic and social transitions from high school to college.  Their family expectations loom over them.  Some students are full-time students, but also full-time parents.  For first-generation college students these circumstances may bear even greater weight.  Thus, while preparing for Spring 2020 I decided to approach that semester with greater compassion for students.  This led to my forming a community of learners in each class a priority.  Ultimately, this helped me better meet the needs of my students during that first phase of the pandemic.

Webster defines compassion as “sympathetic consciousness of others’ distress together with a desire to alleviate it.”  In preparing for Spring 2020, I identified aspects of each course that presented major challenges for students and represented sources of stress, anxiety, frustration, and discouragement.  I hoped to address those challenges and thereby, alleviate a source of stress.  Most exercise physiology students had not taken biology or basic physiology; thus, I had to teach them basic cell biology and basic physiology so they could better understand the significance of acute responses to exercise.  Based on my past experience teaching the exercise nutrition course, students needed more confidence speaking in public.  Furthermore, any given student might have known just two or three other students by name and were hesitant to speak in general.  I had to help them feel more at ease so they could talk and think out loud among their peer group.  We each want to belong to a community.  We value our individuality, but we are social beings.  Students must feel accepted and comfortable in class, so they can ask and answer questions within a small group or entire class.  A critical component of learning is not answering a question, but verbally defending that answer and exchanging ideas with others.  Many are afraid to answer incorrectly in front of others.  The classroom must be a safe place.  As the teacher, I am responsible for creating a sense of community.  While I did a great job getting to know my students’ names, faces and fun facts, I wasn’t helping students know each other.  For both courses I decided to include more activities that required students to talk directly to each other and become accustomed to speaking out loud.  With 20-25 students per class, it was feasible.  I would sacrifice class time and not be able to cover as much material.  So be it.  Students would master the fundamentals, learn to apply the knowledge, and have a shot at enjoying learning and becoming life-long learners.  Coming to class and learning might even become a reprieve from other stressors. 

How could I create community among unacquainted 20+ students?  Provide opportunity to interact as a class or in pairs or groups as often as possible.  I had to be persistent, kind, and patient.  The first day of classes I explained my intention was that students become familiar with each other, so that they were comfortable asking and answering questions and contributing to discussions.  This would facilitate learning and help me better gauge their understanding.  This also might help them find a study partner or even make a new friend.  I told them I made it a point to learn everyone’s name as soon as possible and would call on each student numerous times.  I made it clear that I know when people are shy; I promised to be kind and not call on them until they were ready.  Each day I arrived as early as possible and cheerfully greeted each student by their preferred name and asked open ended questions, e.g., ‘How are your other classes going?”  At least once a week, students worked in pairs to complete worksheets or quizzes; we would reconvene as a class and I would call on different pairs to answer.  I called on different pairs each time, so every group had chance to speak.  I encouraged them to work with different classmates for different in-class activities.  Initially, there was resistance, but I consistently commended them for their efforts.  Gradually, more students would proactively raise their hands to be called on, and it could get pretty loud.   

On the first day of the nutrition classes I also announced the presentation assignment and that we’d get started on it the 1st week of classes by forming pairs and by becoming accustomed to talking in front of the class.  To let them know that dread of public speaking is shared by all, I confessed to feeling nervous before every lecture; however, I love teaching and channel that nervous energy to keep the lectures upbeat.  I explained they might never get over the nervousness of public speaking, but they can learn nothing is wrong, being nervous is expected; it will become easier.  The trick is to start small.  So, at the start of every class period, one or two students would be asked to stand up, introduce themselves, and tell the class what they found most interesting from the last lecture.  The other students would give the presenter their undivided attention.  For shy students, I spoke directly but quietly to them before class and suggested that they could focus on me while they spoke.  After each introduction I cheerfully thanked students as positive re-enforcement.  These introductions also served to highlight what was covered in the last class.  Because each nutrition course class met 3 times a week for 50-minute sessions, students interacted frequently.  For the exercise physiology course, students worked in pairs to complete a ‘1-2-3 plus 1’ worksheet with questions on three key concepts from the previous lecture and one question on new material in the upcoming lecture.  They worked on questions for 5 minutes, and then I would call on different pairs to answer questions and explain sticking points for about 10 minutes.  It also was the transition into that day’s new material.  This class met twice per week for 80 minutes each session; thus, plenty of time remained even after the 15-minute Q&A.  They were grasping the integration of cellular mechanisms at the cellular and systems levels.  The time and effort to plan and execute these activities was well worth it.  Students were learning and enjoying class, as well as getting to know each other.  By late February communities had formed.  Each class had a friendly and inclusive feeling, and attendance was nearly perfect.  Even shy students began echoing my greetings or waving and smiling at classmates arriving to class.  Individual classes had their own running jokes.   

The week before Spring Break universities were discussing whether or not students would return to campuses after the break.  COVID-19 was here.  The Thursday and Friday before Spring Break were the last days I met with students in person.  I confirmed the rumors.  Students would not return to campus after the break, and all courses would be entirely online.  I clarified that I would present lectures ‘live’ at the regularly scheduled class times.  I opened the floor to discussion.  If I knew their concerns, I’d have a better chance at maintaining the sense of community.  Students were completely honest.  Seniors were sad, because graduation would be cancelled.  Students were hoping they could keep their jobs here in town to pay rent.  Athletes on scholarships worried that if the season were canceled they’d lose funding.  Others would be learning from their parents’ homes, which had no Internet access.  The most common concern was whether they would be as successful learning online.  They were worried about the lack of accountability.  One student feared he’d stop attending lectures and miss assignments; one reason he came to class was that I called him by name and talked to him every day.  Another student doubted I’d have any personality when giving online lectures; I took this as a challenge.  Students in the nutrition classes were worried about presentations, which were taking shape and now had to be presented somehow.  They were scared.  Now, I was scared for them – but had the wherewithal to not say that out loud.  One student outright asked, ‘Is this even gonna’ work?!”  I admitted it would be a challenge, in part because I had never taught an online class, and this was my first pandemic!  They laughed nervously.  What a relief to hear them laugh!  Then, I remembered my goal to practice compassion and let that guide me.  I calmly stated the following, “This is not an ideal situation, but we will make it work, and I mean WE.  I will do my best to not make this situation any more difficult than it has to be.  I will communicate with you regularly, so read my emails.  If you have any problems or questions you must let me know immediately, so to give me a better chance to help you.  It will be ok.”  That this was the last time I would see my students in person.  It was a sad day.

I took my students’ concerns into account and still made my priority community.  If I could maintain that sense of community, they would be more likely to login to lecture and learn. I kept it as simple, direct, and familiar as possible.  I already had been posting all lecture notes and materials on the university’s learning management system (LMS) and using the drop box for homework submissions.  Thus, I opted to use the real-time video conferencing tool in the LMS to deliver, record and save lectures and hold office hours.  An ounce of prevention is worth a pound of cure.  I established the practice of sending each individual class a weekly email on Sunday afternoon that listed the week’s lecture topics, specific links to each lecture and office hours, due dates for quizzes, upcoming exams, announcements, and miscellaneous reminders.  The very first email included step by step instruction for logging into the LMS video conferencing tool (which had been proofread and tested by a colleague), and I attached the revised syllabus.  I kept these emails as upbeat as possible.  On the class website, I also posted important announcements, along with links to the live and recorded lectures.  I kept the class website uncluttered and organized to make it easy for students to find what they needed.  In the middle of a pandemic, it was absolutely essential to keep my promise to my students and myself and not to make learning or teaching online any more difficult than necessary. 

I continued teaching the fundamentals and worked to maintain that sense of community.  I opened and logged into the virtual lecture room 10-15 minutes before lecture started and would allow students to do the same.  I would still greet them as they entered, asked them to turn on the video at least once, so I could see their faces and make sure they were doing ok.  They would also greet each other.  I encouraged them to ask questions or comment directly using their mics or in the chat message feature.  As I lectured, I kept track of questions and answers to my questions; I would address students by name just as I had in person.  They learned quickly that they could use the chat feature to communicate with each other, sometimes not about physiology or nutrition.  I didn’t mind.  I also knew they missed being on campus and seeing classmates and friends, and they were isolated.  For the exercise physiology course, we continued the practice of starting each lecture period with the 1-2-3 plus 1 worksheet and still spend about 15 minutes on that activity; the students really valued this activity.  Because the practice proved to facilitate learning, I posted these questions on the class website, but also emailed the class a copy the day before to be sure they had a copy – a 5-minute task to keep them engaged and coming to class.  For the nutrition class, I offered an extra credit assignment, ‘Who is this?’  For one class, I had a list of 10 walk-up songs from different students; students had to name the artist and tell me the full name of the student who claimed that as their ‘walk-up’ song.  Another class had to name the student learning online the farthest distance from campus and name the student whose birthplace was farthest from campus; they also had to list the exact city, state or country and distance in miles.  The third class had to list the first and last names of all graduating seniors in the class and their career goals.  For extra points, they all participated.  It was meant to encourage them to stay connected and think about something else. 

We had a share of glitches and mishaps, but my students stepped up to the plate.  The lack of equal access to the Internet could not be more painfully obvious.  One exercise physiology student informed me that his only access to the Internet was his cell phone.  He took the initiative to asked whether I would accept images of hand-written 1-2-3 worksheets sent to me by email.  He never missed an assignment and made arrangements to borrow a friend’s laptop for exams.  A nutrition student, I will call Brett was learning from home in a small town about 2 hours from the nearest ‘real’ town; his family home had no Internet and a poor mobile phone signal.  He emailed to explain that once his dad got paid he would buy the equipment and he would be online soon.  He was concerned about missed quizzes and the respective points and missed lectures.  What do you say to that?  When you know you have all the power, you must use that power to do good and not make anyone’s life harder than it has to be.  I re-opened quizzes and sent him links to the recorded lectures; he wasted no time catching up.  Then there was the matter of the nutrition presentations.  Another lifeline.  Students continued to work together, sending presentation files to each other and to me.  Students taught themselves to use Zoom, Google Slides, and the LMS video conference feature.  No one complained.  Multiple pairs wanted to present during the same session, so they could be an audience, lend moral support, and ask questions.  The presentations were impressive.  Students were so enthusiastic.  However, my favorite presentation was by Brett and ‘Josh’; they presented via the LMS conference feature.  Brett’s Internet cut out completely on second slide; he tried to reconnect to no avail.  I remained calm; they remained calm.  They decided Brett would call Josh; Josh would hold his cell phone to the mic on his computer so I could hear Brett narrate his part of the talk.  Teamwork!  Let your students inspire you.

I left time at the end of each lecture to offer encouraging words and reminders to stay safe and take care of themselves.  I also would state that I looked forward our next meeting.  As the semester was winding down end-of-lecture discussions and questions become more serious.  Across all classes the basic questions were similar.  “Will I graduate on time?  How will this impact my career plans?  Do you think this will be over by the Fall?  Do you think they’ll have a cure soon?”  There was no sugar coating this.  I would validate their concerns and offer my honest opinion in a kind-hearted manner.  My last virtual lecture was on a Friday in May.  I decided to name each graduating senior, so the class could congratulate and applaud for them.  A student asked me to give a commencement speech.  She was serious.  I remembered what my gut told me back in mid-March, and so I began.  “I cannot tell you how proud of how hard each of you has worked and how well you worked together.  Life is hard.  It’s ok to be scared.  You have risen to the occasion.  Keep rising.  Learn all you can from this situation.  You are meant to do great things, however subtle or grand.  You will fall and make mistakes.  You will need help along the way and must help others on their journey.  It has been a privilege to work with you.  I will think of you often and wish you well.”  Spring 2020*  *Helping my students form a community, an inclusive safe place to learn, think out loud, be wrong, correct mistakes, and help each other.  That is the practice I will continue to implement to create a better learning environment for students irrespective of world health status or platform. 

Alice Villalobos, Ph.D., is an assistant professor in the Department of Medical Education at the Texas Tech Health Sciences Center in Lubbock, Texas.  She received her B.S.in biology from Loyola Marymount University and her Ph.D. in comparative physiology from the University of Arizona-College of Medicine.  Her research interests are the comparative aspects of the physiology and stress biology of organic solute transport by choroid plexus.  She has taught undergraduate and graduate courses in integrative systems physiology, nutrition and toxicology.  However, her most enjoyable teaching experience has been teaching first-graders about the heart and lungs!  Her educational interests focus on tools to enhance learning of challenging concepts in physiology for students at all levels.  She has been actively involved in social and educational programs to recruit and retain first-generation college students and underrepresented minorities in STEM. 
Why demonstrating and embracing uncertainty should be a learning objective, especially in uncertain times?

Uncertainty.  We have all heard that word quite frequently lately.  It tends to carry negative connotations and feelings of uneasiness.  It seems the answer to every question these days is, “well, it depends”.  As physiology educators, this is not new to us.  How many times have we answered a student’s broad question with this same phrase?    Regardless of how much active learning is accomplished in the classroom, students at all levels are tasked with preparing for and taking standardized tests.  My children started taking assessments in preschool, multiple choice tests for grading purposes in kindergarten, and state assessment tests in 3rd grade.  Then there will be standardized tests for admissions to college, graduate admissions, and licensing.  It’s no wonder that some students are conditioned to study ‘to the test’ instead of having the goal of truly learning the material, and are hesitant to express when they don’t know something.   I spent the first decade of my career teaching science at the undergraduate level and have spent the last five years teaching in the professional school setting, including medical, dental, and podiatry students.  I have found that these health professions students in particular become especially aware of uncertainty when they start gaining experience with clinical cases and with patients.  I also notice that they are uneasy with uncertainty even from the interactions in the classroom – they are high achieving students and don’t want to be wrong, to be perceived as not knowing an answer or a concept, of maybe feeling like they don’t belong.  In truth, many students have the same questions, and the same feelings, but are hesitant to express them.   It is known that dealing with uncertainty and ambiguity, especially in professions where people are serving patients whose health is at stake, can result in the experience of stress, anxiety, depression, and burnout (1).  Wellness is an important consideration, especially in a climate where things seem to be changing day-to-day and we are provided limited information and answers.  How one deals with uncertainty can lead to life and professional decisions including which career or specialty to pursue.  While this concept is not novel, actually teaching students how to tolerate or even embrace uncertainty is a relatively new concept, one which I think should be made a more purposeful objective in our courses.   What if instead of shying away from admitting we don’t know something, we learn how to accept it, and how to approach the problem to find the most effective answer?  How do we best learn to tolerate uncertainty, and train our students how to cope with and learn from uncertainty?  What are the benefits of embracing uncertainty?   

Bring uncertainty into the classroom Thoughtfully and purposely embedding uncertainty into activities in the classroom does several things.  First, it allows students to learn that not every question has an absolute answer.  Students need help shifting their mindset.  This also encourages students to work with material at higher levels of Bloom’s taxonomy, like evaluation and application.   Additionally, this helps create a culture in the classroom where asking questions and admitting to what we don’t know is a good thing, and brings value to classroom discussions.  This allows students to bring in their own experiences in an attempt to work through a problem and arrive at an answer, enhancing students’ learning.  Students can build their confidence as they find value in embracing the unknown as they learn to navigate the process to find the answers to their questions.   The learning theory constructivism suggests that students build their own learning, that knowledge is built upon knowledge, and that it works best in context (2). This encourages students to bring their own experiences to the learning process, and the result is that each student may bring a different perspective and answer (3).  These principles match well with the intention of teaching how to manage uncertainty.  A goal is for students to be engaged and motivated in an active learning environment, allowing them to share ideas and build their knowledge based on their prior knowledge and experiences.  

Leading to deeper learning To further expand the idea of students building their mental models, activities designed to allow for more open-ended thinking or answers, which build upon each other, can be utilized.  For example, in the cardiovascular physiology component of our medical course, we build on the basic concepts in a series of small group sessions which encourage students to work in their teams to answer questions pertaining to these concepts.  We may start with the principles of hemodynamics but eventually work our way to the integration of cardiac function and vascular function.  These sessions require students to not only recall knowledge, but also apply information in a manner which may lead to uncertainty.  They learn to question the severity of perturbations, the balance of factors which interact, and the cause and effect.  We find students may become frustrated with the “it depends” answer, but they learn how to view the nuance and ask the appropriate questions.  This type of exploration and learning transitions well to more clinical sessions, where students need to know which questions to ask, which tests to order, and which colleagues to consult.    

Demonstrate uncertainty as educators and professionals In addition to our basic science session, I spend a lot of time teaching with clinical colleagues in the pre-clerkship medical classroom.  We have a small cohort of core educators who participate in a special type of small group learning we call Clinical Reasoning Conferences.  The core educators are either basic scientists or clinicians and come from different disciplines, bringing different experiences and expertise to each session. We are always joined by content experts in our sessions with the students as well.  This means that we are likely to be in a session where we are not the content expert, but have immediate access to one. This gives us an opportunity to demonstrate uncertainty in the classroom, to students who feel constant pressure to know everything and to perform at the highest level.  To be honest, it took a while for us to get comfortable with telling the students, “I don’t know”, but that “I don’t know” was, in reality, “I don’t know but let’s get the answer”, which gave us the opportunity to demonstrate how we get the answer.  It could be a reference from the literature, a clinical resource, or a colleague.  Students not only benefit from getting perhaps a more comprehensive answer to their questions, but also knowledge that no one can know everything or even how much is still unknown.  It is imperative in medicine that they learn and practice how to find appropriate information in order to make the most informed decision when it comes to patient care.  These practices have also been shared by other medical educators (1).  Clinical Reasoning Sessions also include students teaching the material to their colleagues, and we make it clear in our expectations that we much rather they describe their process and maybe come up with an incorrect conclusion than have short, although correct, answers which do not demonstrate process and reasoning.  Another goal is to allow the students plenty of chances to practice answering questions of a clinical nature posed by faculty, and allow them to become comfortable asking faculty questions, well before they start their clerkships.    

Manage expectations In my experience, students appreciate the ability to give feedback and share their expectations of their courses and programs.  They also align these with their own expectations of themselves.  Faculty and course directors work to resolve the students’ expectations with their own, and to assist students in forming and revising their expectations of and their role and responsibilities within the course.  Educating during a pandemic has shined a light on and challenged the way we manage these expectations. A word I have heard my colleagues use lately is grace; we should extend grace to our students, to ourselves, and ask for grace from others.  This is another way we can demonstrate how we deal with uncertainty, which can hopefully serve as a soft teaching point for our students.    

Outside of the science classroom Developing skills to help us manage uncertainty extends to outside of our classroom.  We hope that students will take the lessons and continue to use them in other classes, or outside of school altogether.  Medical schools often offer electives, some of which are tied to wellness or extracurricular subjects.  For example, some of our electives include Artful Thinking, in which students hone their skills of observation, application, and context, and Fundamentals of Improv, so that students can work on skills of listening, support, creativity, and quick thinking and response.  Other schools and programs offer similar experiences for students (4,5).  The narrative medicine program emphasizes skills of reflective writing to focus on the human side of medicine, reminding why we’re here in the first place (6).  

Challenging ourselves and encouraging our creativity One of the most important lessons I learned in the transition to remote and hybrid education over the past six months was to face the uncertainty with planning, reflection, and flexibility.  I am the type to have a backup plan to my backup plan, which I realized gave me the flexibility to be more creative in my course design and preparation.  I feel that my courses benefitted from my ability to challenge myself, because of uncertainty, and I intend to continue to reflect and employ what I consider my ‘best practices’ even when we move back into the in-person classroom in the future.   We are exposed to uncertainty every day.  How we choose to frame our mindset, to help our students and ourselves tolerate or even embrace uncertainty can bring benefits both in and outside of the classroom.  

References and further reading Twelve tips for thriving in the face of clinical uncertainty, accessed 8/28/20  https://www.tandfonline.com/doi/pdf/10.1080/0142159X.2019.1579308 What is Constructivism?, accessed 8/28/20 https://www.wgu.edu/blog/what-constructivism2005.html Inviting Uncertainty into the Classroom, accessed 8/28/20 http://www.ascd.org/publications/educational-leadership/oct17/vol75/num02/Inviting-Uncertainty-into-the-Classroom.aspx Teaching Medical Students the Art of Uncertainty, accessed 8/28/20 https://www.cuimc.columbia.edu/news/teaching-medical-students-art-uncertainty The Alda Method, Alda Center for Communicating Science, accessed 9/4/20 https://www.aldacenter.org/alda-method Narrative Medicine Program, Accessed 9/4/20 https://medicine.temple.edu/education/narrative-medicine-program The Diagnosis, Prognosis, and Treatment of Medical Uncertainty https://www.jgme.org/doi/pdf/10.4300/JGME-D-14-00638.1 The Ethics of Ambiguity: Rethinking the Role and Importance of Uncertainty in Medical Education and Practice https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5497921&blobtype=pdf Helping Students Deal with Uncertainty in the classroom https://www.edutopia.org/blog/dealing-with-uncertainty-classroom-students-ben-johnson Learning: Theory and Research http://gsi.berkeley.edu/media/Learning.pdf          


Rebecca Petre Sullivan, Ph.D.
Associate Professor of Physiology
Lewis Katz School of Medicine at Temple University
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 and 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 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 and a Golden Apple Award in 2017 from LKSOM, and the Excellence in Undergraduate Teaching Award from Neumann University in 2012.