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Best Practices for Success in Teaching Physiology, Part II – Using the Tools
Thomas M. Nosek, Ph.D.
Professor Emeritus, Department of Physiology and Biophysics
Case Western Reserve University

In last week’s article, 9 aspects were discussed on what to bring to a classroom for the methods of effective teaching of physiology.

10. Encourage all faculty to use PowerPoint presentations during class
These files are made available to the class in the CMS at least a day before each lecture. Sometimes faculty modify these files right before the lecture is given. Therefore, we provide both a pre- and post-lecture PowerPoint presentation in the CMS.

Advantages: Students report that they like PowerPoint presentations. Many will review this file before lecture and take notes on their computers in the pre-lecture PowerPoint during lecture. Faculty have become very creative using the advanced features of PowerPoint, linking to video files, sound files, animations, etc.
Disadvantages: Faculty must create the PowerPoint file for uploading into the CMS at least a few days before the scheduled class. Some students report that they find the presentation of one PowerPoint after another to be monotonous.


11. Encourage all faculty to use computer/Internet-based simulations, sound files, videos, and animations during class.
There are extensive physiological simulations/animations/sound files/videos available on the Internet. We encourage faculty to use these whenever they think they enhance the learning experience. For example, when teaching the nerve action potential, we use a Hodgkin and Huxley nerve simulation computer program. We give students in small groups a series of questions to answer using the simulation. Another example is during the muscle physiology lectures; an animation of action potential conduction along the muscle fiber and into the t-tubules upon activation of the neuromuscular junction is presented and discussed in class along with an animation of the cross-bridge cycle.

Advantages: Active learning is always better for retention than passive learning. When students use computer simulations to answer a set of questions they engage the material to a greater extent and have a deeper understanding of the physiological principles. Viewing animations also helps students to understand difficult concepts. Students rate the use of these learning resources very favorably.
Disadvantages: Students are all required to own a personal notebook computer. They will often have problems installing computer simulations and animations on their personal computers. Thus, a staff member must be available to assist them so that they have access to these learning resources.


12. Provide Learning Objectives for each lecture in the CMS.
A Learning Objective (LO) is a statement of what a student is expected to be able to DO after they have heard a lecture. It is not a statement of what the lecturer presented. For example, “Know the cross-bridge cycle” is not a valid LO. “Be able to draw from memory the 6 stages of the cross-bridge cycle for a typical skeletal muscle” is a valid LO.

Advantages: The students will know exactly what they are supposed to be able to DO after they hear a lecture. We have a policy that no quiz or Block exam question can be asked unless it links to one of the provided LO’s.
Disadvantages: The faculty giving the lecture must create these LO’s for their lectures and make them available to the students far enough ahead of the lecture to be useful. It is not always easy for faculty to write specific LO’s, LO’s that are not too general and therefore useless.

13. Live stream each lecture and record it for posting in the CMS
We are provided a staff member from the university’s Teaching & Learning Support division to be present at all lectures and review sessions to live stream and record each lecture using Echo 360. The recording is posted in the CMS as soon after the lecture as possible. Because the videos must be processed to some extent before they can be posted, this cannot be immediate. Two hours after the lecture is a reasonable time to have these posted online.

Advantages: This year, 26% of the class is taking the MSMP program over the Internet. Only a small percentage of these students are able to view the lectures live and they rely on the recordings to access the material. It is interesting to note that attendance at the live lectures falls off the further into the two semesters of core courses one gets. At times, as much as 50% of the resident students opt to skip class and view the lectures online. Feedback from the students indicates that they do this for many different reasons. Foul winter weather in Cleveland is often cited. However, many students indicate they find it to be a great advantage to be able to speed up the lecture (up to 2x normal speed is available) when a faculty member is lecturing slowly over something they find easy to understand. On the other hand, if they don’t understand something that the professor says in class, they have the option of stopping the video and replaying it and even looking the material up in the textbook so that they will understand what has been presented before they move on with the next aspect of the lecture. Also, students with learning disabilities requiring accommodations report that they are often unable to focus their attention for a 2-hour lecture. Being able to stop the lecture to take a break before refocusing on the material prevents them from wasting time in a lecture setting where they report being totally overwhelmed and lost.
Disadvantages: This resource encourages students to skip the live lectures. Faculty often complain about low student attendance at their presentations. However, there is no evidence that student performance is compromised when they view videos of a lecture rather than physically attending it. Because of the dependence of students on this resource, we have trained all of the Teaching Assistants to back up the staff member charged with making the recordings.


14. Use an audience response system (ARS) during lecture.
We use TurningPoint as our ARS. It seamlessly integrates with PowerPoint. Each student is given a “clicker” at the beginning of the year after making a deposit in the amount of the cost of the clicker. This deposit is refunded when the clicker is returned at the end of the academic year. Faculty are encouraged to stop the lecture approximately every 15 minutes (approximately the length of time a student can effectively concentrate on lecture material) and present a question to the class in PowerPoint. Students are given a few minutes to reflect on the question before they are asked to register their answer to the question via their clicker. The number of students responding is observed on the PowerPoint slide. When a plateau is reached in the number of students responding, the faculty advances the slide to show the right answer to the question. If the class overwhelmingly answers the question correctly, no further discussion is necessary although the faculty member may want to go through each answer and explain why it is right or wrong. However, if less than 50% of the class answers the question correctly, the ARS will have helped the faculty identify a concept that has not been well understood by a majority of the students. This is an opportunity for the faculty not to progress to the answer slide but to further discuss the material. The system allows for revisiting a question, having the students to answer the question a second time after further discussion of the topic. If the students’ answers are split evenly among a number of choices, faculty are encouraged to use the “Peer Instruction” technique discussed below.

Advantages: Many years ago, we tested the effectiveness of an ARS on medical students at CWRU and found that student performance on a standard exam was enhanced by as much as 10% with the use of an ARS. Student feedback from MSMP students indicate that they very much appreciate the use of the ARS. Online students who watch the lectures live are encouraged to register their answers to ARS questions in the streaming software. A TA is always available during class to answer questions from the Internet students or to ask the lecturer questions on behalf of an Internet student. Online students who are watching the lectures asynchronously are encouraged to write down their answers on a piece of paper while they are watching the lecture.
Disadvantages: Students do not always remember to bring their clickers to class. The number of students responding to ARS questions is never equal to the total number of students in attendance. Faculty must create the ARS questions and incorporate them into their lectures. Some faculty do not feel comfortable doing this or just refuse to cooperate even with strong coaxing. TA’s have offered to help faculty create these questions with limited success.

 

15. Utilize “Peer Instruction”
“Peer Instruction” has been popularized by Eric Mazur at Harvard University (Miller et al., 2015 – https://journals.aps.org/prper/abstract/10.1103/PhysRevSTPER.11.010104). When an instructor identifies a topic that the students do not clearly understand (often prompted by the use of an ARS question that generates an ambiguous set of answers), the professor directs the students to gather in small groups of 3-4 where they are sitting in a large or small class setting and discuss among themselves the question. We have used this technique effectively in a large classroom setting with up to 150 students.

Advantages: The hypothesis is that one of the students in the small group will know the answer to the question and will be able to teach their peers the concept even more effectively than the professor. Mazur has reported positive results in students’ comprehension using this technique. Using this technique has the advantage of breaking up the flow of the class and invigorating the students as it actively engages them in the learning process. Our students have rated the use of this technique very favorably.
Disadvantages: Using this technique does take up class time and can disrupt the flow of the lecture. Not all students are willing to actively engage in this process and would prefer a passive learning experience.

 

16. Use the “Flipped Classroom” technique.
By a “Flipped Classroom” I mean providing students with pre-recorded lectures or other learning resources in the CMS that they are required to view/use before class. Class time is reserved for using the ARS to ask students questions over important aspects of the physiology presented in the pre-recorded lecture or in the other supplied learning resource – no lecture is given.

Advantages: The majority of students indicate that they enjoy the “Flipped Classroom” and that the use of ARS questions during the class time helps them to learn the material.
Disadvantages: Faculty must take the time to record this specialized lecture, often without an audience. Only approximately 70% of the students attending a “Flipped” class will have reviewed the assigned material before class. Because there is no lecture, they are not prepared to actively learn from the ARS questions. Some students complain that the required viewing of material before class is an added study time burden from which they do not see a clear benefit.

In the final week of the series, aspects that have been shown to provide a return of investment in the classroom will be discussed.  

Dr. Nosek earned his B.S. in Physics from the University of Notre Dame in 1969 and his Ph.D. in Biophysics from The Ohio State University in 1973.  After post-doctoral research in the Cardiovascular Physiology Training Program in the Department of Physiology and Pharmacology at the Bowman Gray School of Medicine of Wake Forest University, he went to the Department of Physiology at the Medical College of Georgia (1976-1997) where he was the Coordinator of the Muscle Cell Biology Research Group (conducting research on the cellular basis of muscle fatigue) and the Coordinator of the Computer Aided Instruction Research Group (editing and being a section author of “Essentials of Human Physiology:  A Multimedia Resource” published by the DxR Group).  He served as Director of the medical physiology course taught to first year medical students and was the Director of the Departments Ph.D. program.  In 1997, he moved to Case Western Reserve University School of Medicine where he was Associate Dean of Biomedical Information Technologies (creating the Computer-Based Integrated Curriculum through 2006) and Professor of Physiology and Biophysics until he retired in 2014 becoming Professor Emeritus.  He served as the department’s Director of Medical Education.  He was founding Director of the MS in Medical Physiology Program at CWRU from 2010 – 2019 when he became Director Emeritus.

Best Practices for Success in Teaching Physiology, Part I – The Toolbox
Thomas M. Nosek, Ph.D.
Professor Emeritus, Department of Physiology and Biophysics
Case Western Reserve University

I have been actively involved in graduate and medical student education since 1972 – 47 years.  From my first time before the students, I have been searching for the optimal way to engage the students during class time, to provide alternatives to standard lectures, and to encourage active learning – all with the desire to help them understand physiological principles.

Over the years, I have had experience directing the Medical Physiology course team-taught to first year medical students and directing departmental MS and PhD programs.  Since 2011, I have served as the Program Director of a 32-credit hour MS in Medical Physiology program at Case Western Reserve University – a program designed to aid students gain admittance to professional medical programs; MD, DO, POD, DDS, PA, and PhD. It is classified as a Special Post-Baccalaureate program.  The program consists of 20 credit hours of lecture-based core Physiology courses (Medical Physiology I and II, Translational Physiology I and II, and Physiology Seminar I and II) which are designed to be taken in the first year of study to establish a strong understanding of physiological principles.  Twelve credit hours of graduate level electives, preferably taken in the second year of the program in any department at the university, round out the 32 credit hour degree requirement.  The program has grown from 43 students in the first class to 175 this past year, 45 of whom are taking the program over the Internet.  My responsibilities as director of this program and serving as the course director for the core courses have allowed me to test many of my ideas to optimize student learning of physiology, gaining feedback from the students along the way via surveys.

In this series of articles, I will introduce and discuss each of the aspects of the courses/program that I hope my colleagues will find useful as they consider how they may construct or modify the physiology courses/program for which they are responsible.  I will also present the advantages and disadvantages of each of these features.  I prefer to create hyperlinked text so that you can access detailed information only when you want it.  In lieu of that here, I suggest you read the bolded headers below and only read the detailed text that follows if this topic is of interest to you.

1. Have an Administration Committee to help administer the courses/program.
We have a 7 faculty member Administration Committee constituted from our primary and secondary faculty which I chair that established the program and now administers it, conducting constant quality assessments. Members of the committee help to recruit faculty from across the university to present lectures and continue to fill vacancies when they arise.

Advantages: The faculty have a wealth of experience and wisdom that cannot be matched by one person alone trying to administer a course or program. The committee reviews the student evaluations and recommends changes to improve the quality of the course/program.
Disadvantages: Faculty are not always available to meet on a monthly basis to keep a close eye on the courses and the program.


2. Have an Administration Assistant.
An administrative assistant (AA) is essential to process class registrations/program applications, to answer basic student questions about the details of the courses/program – referring detailed or difficult questions to faculty when appropriate, and taking care of administration of the courses. The AA also serves as a liaison with the Graduate School.

Advantages: Many tasks associated with administering a course/program are routine and do not need faculty involvement. An AA can save faculty a great deal of time.
Disadvantages: Of course hiring an AA costs money that hopefully can be recouped from the tuition generated by the course/program. Finding an AA with the right personality who can be understanding but yet firm with the students is challenging.


3. Organize the course around a textbook.
We chose to use Boron and Boulpaep’s “Medical Physiology” as the textbook for the core Medical Physiology courses. We start the courses with Chapter 1 and end it two semesters later with Chapter 62.

Advantages: Faculty are instructed as a minimum to present the material covered in the chapter associated with their assigned lecture. However, they have the academic freedom to teach the material in the order and in the style that they find most effective and consistent with their own personality/teaching style. Unless a professor states otherwise, the textbook becomes the authority in any disputes over quiz, homework, or Block exam questions.
Disadvantages: There are many physiology textbooks to choose from, with none being equally strong on all topics. In a medical physiology course I directed at the Medical College of Georgia many years ago, we tried using monographs for each section of the course, choosing what we thought was the best learning resource for that block of material. This was more expensive than recommending a single textbook and was not viewed favorably by the students.

4. Arrange the course/program so that it can be given over the Internet
For a wide variety of reasons, not all students are able to come to your campus to take courses or to enroll in your program. We recommend that all students come to campus to become immersed in the rich learning environment only physical presence on campus can provide. However, making your course/program available over the Internet gives access and opportunity to many more students. Some students do our entire program over the Internet. The degree requirements and standards of performance are exactly the same for resident and Internet students. A few take the first year of the program over the Internet and then come to Cleveland for the second year so that they can engage in clinical experiences at one of our affiliated hospitals (The Cleveland Clinic, University Hospitals, MetroHealth Medical Center, The Cleveland VA). A few students are resident students for the first year and then move back home to take the elective courses over the Internet. A very few resident students take elective courses as Internet classes even when they are in Cleveland because of scheduling conflicts often caused by recruiting visits to medical school and other health professions programs.

Advantages: This option provides flexibility and availability of the courses/program to students who just are unable to move to Cleveland. This has a positive impact on enrollment. In the 2019 matriculating class, 45 students are taking the MSMP program over the Internet.
Disadvantages: Internet programs must be approved at the level of the university’s academic governing body. Internet courses must also be specifically approved. Extra effort must be expended to make the Internet courses/program as engaging as possible with standards that are equal for resident and Internet students. Students who take the program over the Internet often do so because they are working and cannot afford to leave their jobs. If they agree to decelerate the program (taking no more than 6 credit hours of courses/semester), their performance is essentially equal to resident students. Internet students cannot take advantage of the rich learning community that we have created for the MSMP students nor can they develop the personal friendships that naturally occur among students mutually engaged in a very demanding academic experience.


5. Allow students to begin the program or take the courses any semester.
The preferred starting semester for our program is fall semester. The core courses are available only fall and spring semester and must be taken in sequence. However, we have made the electives offered by the Physiology Department available all semesters. One semester/year, lectures in the electives are given live, are video recorded, and available to both resident and Internet students. The recorded lectures are used in the other two semesters to make the course available only over the Internet.

Advantages: This gives the students the flexibility of beginning the program at any time of the year. Since providing this option, we have increased our enrollment with ~10-15 students starting spring semester and another ~10 starting summer semester.
Disadvantages: When we originally established the program, we designed it to have the students take the core courses before they took the electives. Students starting spring and summer semesters can only take electives these semesters because the core physiology courses must be taken in sequence and are only offered once/year. Although we think that it is somewhat of a disadvantage for students to take electives before they have had the core physiology courses (they have not mastered core physiological principles before taking specialized courses), for some students it is actually an advantage because we can steer them to take elective courses which will better prepare them for the rigorous core physiology courses.

6. Discourage students from working during the course/program.
Our data shows a negative correlation between the number of hours a student works/week and their performance in the core physiology courses. During the second year in the program when students are taking electives, we actually do encourage students to work part time in a medically related position. This often takes the form of involvement in a clinical trial which is a very beneficial experience for our students. Student success in getting into a professional program is contingent upon a very good performance in our program. We consider a good performance being a final GPA of 3.5 and above. Students should be warned that working too many hours can jeopardize their chances of getting into a medical professional program.

Advantages: The MSMP program is essentially the last opportunity students have to enhance their credentials for admittance to a professional medical program. If they do not perform well in the program, they will have to move on to another career. Therefore, we must do everything to optimize their chances of success. Almost all students with a final GPA of 3.6 or above have been successful getting into a medical professional program. As their GPA tends more toward 3.0, their probability of success decreases.
Disadvantages: The students must incur additional debt in order to not work while they are enrolled in our program. If a student absolutely must work, we recommend that they decelerate the program, taking no more than 6 credit hours/semester. This often increases the time it takes the students to complete the program.


7. Choose an Internet-based Course Management System (CMS)All information about the course and learning resources for each lecture are posted at the beginning of the semester in the CMS. We have used both Blackboard and Canvas as CMSs with equal success.

Advantages: There is one easily accessible location where students can find all information about the course. Students expect all their learning resources to be in a CMS – this has become a requirement for all our courses.
Disadvantages: None


8. Provide a course syllabus
The course syllabus details which chapter in the assigned textbook will be covered during each class and lists any supplemental learning resources that will be useful to the students in the calendar of the CMS.

Advantages: Students know well ahead of time which lectures covering which textbook chapters will be given on any particular day.
Disadvantages: The details of the course must be established at the very beginning of a semester for posting in the CMS.


9. Only have experts teach their area of expertise
It is our preference to have an expert/active researcher in an area teach that area in the core courses. The electives are typically taught by faculty in their area of expertise.

Advantages: Because they are experts in the areas they teach, lecturers are best able to organize the material, create the learning resources associated with the lecture, write quiz and test questions, and answer student questions.
Disadvantages: This goal is not always achievable because there is not always a faculty member with a particular area of expertise. Therefore, faculty are sometimes asked to lecture outside their area of expertise. Experts in a particular area are not necessarily the best lecturers. Although they know the material, they may not present it in an optimal, engaging way.

Next week, the series will continue with the aspects that are important for implementation of teaching in physiology classrooms!

Dr. Nosek earned his B.S. in Physics from the University of Notre Dame in 1969 and his Ph.D. in Biophysics from The Ohio State University in 1973.  After post-doctoral research in the Cardiovascular Physiology Training Program in the Department of Physiology and Pharmacology at the Bowman Gray School of Medicine of Wake Forest University, he went to the Department of Physiology at the Medical College of Georgia (1976-1997) where he was the Coordinator of the Muscle Cell Biology Research Group (conducting research on the cellular basis of muscle fatigue) and the Coordinator of the Computer Aided Instruction Research Group (editing and being a section author of “Essentials of Human Physiology:  A Multimedia Resource” published by the DxR Group).  He served as Director of the medical physiology course taught to first year medical students and was the Director of the Departments Ph.D. program.  In 1997, he moved to Case Western Reserve University School of Medicine where he was Associate Dean of Biomedical Information Technologies (creating the Computer-Based Integrated Curriculum through 2006) and Professor of Physiology and Biophysics until he retired in 2014 becoming Professor Emeritus.  He served as the department’s Director of Medical Education.  He was founding Director of the MS in Medical Physiology Program at CWRU from 2010 – 2019 when he became Director Emeritus.

Make Cooperation Great Again: Peer Assisted Learning as a Strategy to Develop Collaboration in Medical Education
Oriana Escobar-López 
Last year medical student
Universidad de los Andes, School of Medicine

In medical school, it is somewhat of a tradition to learn entirely new concepts from multiple disciplines in a single day. And of course, we are being assessed on these topics frequently. Sometimes, you encounter an idea you don’t get. You feel like you are the only one of your classmates who doesn’t understand, and you feel too ashamed to ask the professor a question. Before you know it, you find yourself cramming all the content the night before the test, searching on YouTube for videos that explain the subject, and even start to wonder if you honestly need to become a doctor at this point in your life. 

As medical students, we are continually facing challenges when it comes to learning, and we are regularly seeking different methods to approach new subjects in ways that can help us understand in a better and more efficient fashion. In that process, we often find ourselves lost, without knowing where to begin or which course materials are best. Professors usually try to help. Yet we sometimes feel they do not quite understand our concerns. At this point, only another student who understands the struggles, someone who recently faced the same challenges can help us get through it. There comes a time when we, the students, must not only own up to our education process but to that of our peers. This is the core of Peer-Assisted Learning (PAL). This learning methodology is not new. Ancient philosophers used to question each other as a way of discovering new truths (1). It has since been developed and implemented in several disciplines, including medical learning.

For the past decade, we have seen an explosion in the amount of literature exploring the benefits (and challenges) that come along with PAL. Many medical schools have implemented some variation of it in their programs. For instance, at our school, the Universidad de los Andes, students who excel in a subject are hired as teaching assistants, to help with the organization of the course and act as a sort of counselor for students. 

Interestingly, a variation of this approach has been implemented in our medical pharmacology and physiology courses. In our strategy, students with higher grades tutor their peers who have inadequate performance. This strategy appears to help underperforming students to improve their grades and study methods, and has been received with great enthusiasm by the students.

But what makes this so appealing? To answer that question, we must first know a bit of the theory behind PAL. Peer Assisted Learning is defined by Topping as “the acquisition or knowledge and skill through active helping and supporting among status equals as matched companions” (2), and its main traits are the shared background of tutors and tutees and the fact that tutors are not experts in teaching. These two qualities give way to a more informal setting that offers tutees the confidence to express their concerns and freely ask questions (3).

There are several benefits of PAL for both tutors and tutees, and even some for the schools. For tutors, the time and effort it takes to prepare each teaching session makes them review the material and reinforce the concepts. After all, “to teach is to learn twice” (Joseph Joubert). On top of that, it appears that teaching modifies the way a person approaches certain topics, which might lead to a better understanding (2). Tutors also develop a set of abilities, such as leadership, self-confidence, and empathy, all necessary in the medical field. Being taught by peers also brings advantages for tutees; the atmosphere is much more relaxed, which helps them overcome their fears and express their opinions with more confidence. Furthermore, tutors act as role models and this may encourage tutees to become tutors themselves as well. Finally, for schools, PAL may be seen as a cost-effective and practical strategy to tend to the necessities of a growing student body (2).

However I believe, that overall the most essential element that PAL provides is generating a culture of cooperation, solidarity and empathy among the learners. We need to start shifting the current paradigm that forces students to compete with each other as a strategy to promote learning. Collaboration between peers may bring far more advantages than competing not only in terms of personal gain but also for the entire learning community. Robert D. Putnam, an American sociologist and political scientist developed a theory centered around the importance of investing in Social Capital; “the features of social organization such as networks, norms, and social trust that facilitate coordination and cooperation for mutual benefit” (4). 

Even though Putnam developed his work in the field of civil engagement and the decline in forms of association in the United States in the last few decades, I consider that the concept of Social Capital also applies to the medical learning setting. If we create an environment in which older or more experienced students feel it is their responsibility to share what they know with others, and students who are struggling feel confident enough to ask for help, then the faculty as a whole benefit from this cooperation. 

Medical school isn´t what most people would call easy, and I have come to learn that no one is good at every single thing. And, eventually, you will come across a challenge. But that does not mean you must face it alone. More often than not, you will find someone who already went through the same experience. Peer-Assisted Learning provides a framework that allows students to connect and work in a level that offers an atmosphere of collaboration, and as we have seen, a broader culture of cooperation. Furthermore, in the future, you will no longer be a student, but you will (hopefully) become a resident and someday you will have to guide others as you once needed to be guided yourself. Perhaps if we make cooperation a habit, we wouldn´t struggle as much in an already difficult (yet rewarding, I must add) career. 

References:

  1. Walberg HJ. Foreword. In: Topping K, Ehly S, editors. Hrsg. Peer-Assisted Learning. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 1998. p. ix–xi. 
  2. Herrmann-Werner A, Gramer R, Erschens R, Nikendei C, Wosnik A, Griewatz J, et al. Peer-assisted learning (PAL) in undergraduate medical education: An overview. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen. 2017;121:74–81.
  3. Loda T, Erschens R, Loenneker H, Keifenheim KE, Nikendei C, Junne F, et al. Cognitive and social congruence in peer-assisted learning – A scoping review. Plos One. 2019Sep;14(9)
  4. Putnam, Robert (1995) ‘Bowling Alone: America’s Declining Social Capital’, Journal of Democracy 6. 
  5. Gillinson S. Why Cooperate? A Multi-Disciplinary Study of Collective Action. Overseas Development Institute [Internet]. 2004Feb [cited 2019Oct21]; Available from: https://www.odi.org/sites/odi.org.uk/files/odi-assets/publications-opinion-files/2472.pdf

The idea for this blog was suggested by Ricardo A. Pena Silva M.D., Ph.D. Professor of Physiology and Pharmacology at The Universidad de los Andes, College of Medicine, who provided guidance to Oriana in the writing of this entry. For further discussion on this topic he can be contacted at rpena@uniandes.edu.co. Twitter: @medicinart

Oriana Escobar is a last year medical student at the Universidad de los Andes School of Medicine in Bogotá, Colombia. There, she has been a teaching assistant for the course of pharmacology numerous times. She is interested in medical education and public health, as well as anesthesiology. Outside the medical setting, she enjoys reading, swimming and traveling.

Save the Date: APS Institute on Teaching and Learning (ITL) in 2020!

Save the date!  The Teaching Section of the American Physiological Society (APS) will host its fourth biennial APS Institute on Teaching and Learning (ITL) in 2020.  

What is the ITL? You can learn more about the APS-ITL by watching this short video.


After much anticipation and intense negotiations the APS Meeting Office has completed arrangements to hold the 2020 APS-ITL at the McNamara Alumni Center on the University of Minnesota campus. Details about registration and lodging will be coming in September – we will be staying in Centennial Hall and either single or double dorm rooms will be available; most of the meals will be included with registration. Additional information will be posted on the APS website in November.

For a sneak peek of the venue, take a look at the award-winning McNamara Alumni Center.  The Institute is scheduled from the evening of Monday, June 22, until lunchtime on Friday, June 26. 

We are planning a pre-conference workshop/boot camp for new instructors.

Now that we have the venue, we are organizing the schedule and inviting plenary speakers and concurrent session leaders.  Although we don’t have all the details yet, we can promise an exciting, relevant slate of activities. More details will be forthcoming as they are developed – for now, mark your calendars! We hope that you will join us at the 2020 ITL and help us grow the Physiology Education Community of Practice. 

Beth Beason-Abmayr is a Teaching Professor of BioSciences at Rice University and a Faculty Fellow of the Rice Center for Teaching Excellence. She earned her B.S. in Microbiology from Auburn University and her Ph.D. in Physiology & Biophysics from the University of Alabama at Birmingham. She teaches multiple course-based undergraduate research experiences (CUREs) as well as a student-centered course in comparative animal physiology. She is a co-PI on the Rice REU in Biomolecular Networks, PI of the Rice iGEM team and is a member of the iGEM Executive Judging Committee. As a National Academies Education Mentor in the Life Sciences (2012-2020), Beth is co-chair of the American Physiological Society – Institute of Teaching and Learning (APS-ITL) and is an Associate Editor for Advances in Physiology Education.

What is the Physiology-Majors Interest Group (P-MIG)? Who are we?

Lisa Carney Anderson, PhD, Associate Professor, Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis

Unlike other disciplines who have a national society that manages undergraduate curriculum guidelines, Bachelor’s degree programs in Physiology, which largely serve pre-health students, do not.  Therefore, a grassroots consortium of dedicated educators self-organized to support the development of curricular guidelines for physiology and related undergraduate programs worldwide. P-MIG’s mission is to enhance the success of physiology students/majors on a programmatic level.  We are working to achieve this goal by collecting data from physiology faculty, physiology students, advisers and conference attendees and holding conferences for peer BS/BA programs in physiology and related fields. The goals are to share ideas and resources among programs, to develop and share tools for program evaluation, and ultimately to work toward curricular guidelines and support new program development.

Our group started with concerned educators asking about physiology students who were not finding successful careers after graduation.   Beginning in 2012, these individuals started coming together, collecting data about physiology programs and presenting their findings at physiology conferences.  Today we have a website (https://www.physiologymajors.org/), a list-serve of over 218 physiology educators, an NSF grant submitted (Wehrwein, Aquilar-Roca, Crecelius, McFarland, Rogers) and have just held our 3rd annual meeting.

The Integrative Biology and Physiology (IBP) Department at the University of Minnesota hosted the 3rd Annual meeting of the P-MIG from June 18 -20th

The meeting started on Tuesday evening, June 18, 2019 with a poster session on physiology education including topics such as program organization, learning progression of physiology concepts, active learning activities within physiology courses, surveys of physiology curricula, surveys of physiology students and teaching interventions for helping students.

On Wednesday, June 19th, our group spent a full day engaging in presentations and discussions. Dr.  Joseph Metzger, Chair of IBP, and Dr. Lisa Carney Anderson, Director of Education in IBP, welcomed our 51 attendees to campus.  Our conference consisted of representatives of 17 states and 3 countries (USA, Canada and Portugal). 50% were new attendees! The University of Minnesota has a state of the art active learning classroom building which provided an innovative setting for our conference.

Dr. Erica Wehrwein, P-MIG Director, set the scene by presenting the history of P-MIG and gave an overview of the extensive data collection P-MIG members have done. Data collection and analysis is an essential part of guiding the future actions of P-MIG.

Preparing Physiology students for a meaningful career

Dr. Laurence Savett, Author of the Human Side of Medicine, gave a talk entitled Preparing physiology students for a meaningful career: the role of the teacher/adviser.  Dr. Savett pointed to the similarities between the doctor-patient relationship and the teacher-student relationship.  Through stories and his experience, he shared many pearls of wisdom about 1) developing a relationship with advisees, 2) helping advisees see how school/work experiences are transferable to many professions, 3) considering the past experience of the student in tailoring advice, 4) listening without interrupting  the listening, 5) looking at a situation from different perspectives, 6) encouraging advisees to reflect on lessons learned, 7)  recognizing that advisers can learn from their students, 8) helping advisees to open up and finally 9) viewing academic problems as a presenting complaint with differential diagnoses. 

Good advising leads to good outcomes.

Dr. Anne Crecelius & Dr. Patrick Crosswhite led a session on advising.   First, good advising practices are supported by professional organizations such as National Academic Advising Association (NACASA) and National Association of Advisors for the Health Professions (NAANP). Furthermore, useful data can be derived from online application services and web resources such as http://explorehealthcareers.org/.  They also shared the perspective that career advice has to wait if students are experiencing financial and health distress. 

Dr. Crosswhite presented survey data from 31 institutions.  Many advisors are working with a lot of students, sometimes with very little training and experience. Student passivity and scarce resources (time and money) exert challenges to advising.  P-MIG could have an important role in addressing advising gaps and barriers.

After the advising session, conference participants divided into discussion groups to discuss advising programs of different sizes and types of advising offices (centralized, de-centralized, informal).  The analysis of the discussions are ongoing.

Mindfulness and Physiology

Dr. Aviad Haramati, Professor in Integrative Physiology and Director of the Center for Innovation and Leadership in Education (CENTILE; https://centile.georgetown.edu/) gave an inspiring talk entitled Managing stress in the curriculum and the culture: the unique opportunity for physiologists.  He presented the metaphor of a fish tank filled with beautiful tropical fish.  He asked the group to imagine that half the fish were sick.  Would we conclude there is something intrinsically wrong with the fish or would we conclude there is something extrinsically wrong with their environment?  We would think something is wrong with the tank!  Why, then, do we not recognize that the stress of our students is due to their environment rather than the students themselves?

Physiologists are equipped to support the biological basis of mindfulness and stress management, according to Dr. Haramati.  Stress activates the hypothalamic – pituitary – adrenal axis.  With acute stress, the body returns to baseline.  With chronic stress or multiple stressful events in succession, cortisol levels remain elevated and then the individual is less able to mount a response over time.  Mindfulness training is essential for enabling individuals to return to baseline and developing resilience in the face of stress.  As faculty, we must address mindfulness in the curriculum and model good stress management for the sake of our work and the sake of our students.

Professional Skills Development is as important as Teaching Physiology Content

The professional skills working group has been developing and revising a list of skills that our physiology graduates should hone during their undergraduate programs.  From their work, a baccalaureate prepared physiology major should be able to think critically, communicate effectively, behave in a socially responsible manner and demonstrate laboratory proficiency.  Dr. Michelle French, Dr. Julia Choate and Dr. Randy Bryner crafted an inventory with several examples/descriptors of each main category.  The attendees broke into small groups for discussion of the skills listed in the inventory.

Themes from the discussion centered on the following:

  • Mastery versus familiarity.  There are some skills that we may expect our students to master and other skills we would expect our students to be familiar with.  Mastery versus familiarity might vary from program to program depending on the program goals and department facilities.  PMIG might suggest an inventory of skills and departments could choose which are relevant, doable and measurable for their program.
  • What kinds of lab skills?  Hands on data collection experience is important so that students can understand the essentials of keeping a lab notebook, documenting their work, measurement and error, and ethical interpretation of data. Is there a set of lab skills our students need so they can be employed by academic or industry labs?
  • Reading and analysis of the primary literature.  Should undergraduates be familiar with reading primary literature whereas mastery would come in graduate school?  What are ways we can hold our students accountable when we assign primary literature readings?
  • Assessment.  We can directly measure student’s ability to write and evaluating data by assigning projects in which they perform these skills. There are two aspects of assessment: how students are performing in the classroom and the success of the program in teaching professional skills.  There are validated tools that measure some of the “soft skills” such as empathy, teamwork, and self-efficacy.

Attendees provided written feedback on the paper copies of skill inventories and the professional skill group will revise the inventory based on the feedback.  P-MIG will invite feedback from recent graduates and disseminate the results in journals, faculty meetings and future conference presentations.

The Future of Physiology Panel Discussion

Dr. Luis Rodrigues, Professor and Chair of Human Physiology and Pathophysiology at Universidade Lusófona, led a panel discussion with about 20 of the conference attendees (Chairs, researchers, consultants and educators) regarding the future of physiology.  Dr. Rodrigues is gathering data for a global strategic plan for the discovery and dissemination of physiology knowledge.  A list of panel questions can be found on the P-MIG meeting site (https://www.physiologymajors.org/2019-info). We look forward to reports of his research at future P-MIG meetings.

What are the Core Concepts, how should we use and assess them?

Dr. Claudia Stanescu presented the history of the Core Concepts of Physiology. Physiology core concepts were identified from surveys of physiology faculty at 2-year colleges, 4-year colleges & universities and medical or other professional schools.  The development and unpacking of core concepts has been published in Advances in Physiology Education and captured in The Core Concepts of Physiology: A new paradigm for teaching physiology by Michael, Cliff, McFarland, Modell, and Wright.   The core concepts include: causality, cell-cell communication, cell membrane, cell theory, energy, evolution, flow down gradients, genes to proteins, homeostasis, interdependence, levels of organization, mass balance, physics/chemistry, scientific reasoning and structure/function.  The physiology core concepts are not meant to define the science of physiology, rather they are concepts to guide the 1) teaching of a physiology course, 2) offering of a physiology curriculum or 3) learning by a physiology student.  Data collection from 6 physiology programs thus far suggest that different programs stress different core concepts.  The objective is not for all programs to be the same; the objective is for there to be tools and resources for programs to use core concepts in a way that makes sense to their students.

The Core Concepts working group has been collecting data on the perceptions and use of the core concepts through faculty, program, and student surveys.  This group has developed a framework for using the core concepts in national guidelines.  Dr. Chris Shaltry is developing and testing curricular mapping software to identify gaps and content overlap; Dr. Shaltry presented his work via videoconferencing.  The goal is to better understand our physiology programs and provide evidence that student achievement can be tracked and compared to standards that align with course and programmatic objectives.

Dr. Jennifer Rogers presented data from the student survey.  Several issues from the data stand out.  First, 60% of student respondents have taken course work at community colleges; transferring coursework presents challenges in terms of assessing if and when students have met programmatic outcomes.  Second, student respondents plan to engage in 3 or more experiential learning activities such as job shadowing, volunteering, internships, employment, research, service-based learning or study abroad experiences; P-MIG may be a resource for educating students and programs about experiential learning as students complete their degrees or take gap years.  In this sample, 17 to 29% of the respondents report that they have mastered each of the core concepts, think they are important for their future careers and expect to remember the concepts in 5 years, though there was not a large difference between the core concepts.  Of the 15 core concepts, homeostasis scores the highest, which is consistent with faculty and program rankings which also stress homeostasis. 

The Core Concepts working group is a larger group and discussions after the presentation led to the proposal that the group be split into two subcommittees: one for implementing core concept based teaching in the classroom and a second for curricular mapping and assessment of the core concepts.

University of Minnesota Career Readiness Team: A Model Curriculum for Teaching and Assessing Career Readiness Skills

The College of Liberal Arts (CLA) at the University of Minnesota has 32 departments, 14000 undergraduate students and 69 majors.  CLA invested in a career readiness curriculum because the CLA faculty want desirable graduates who can articulate the value of their degrees.  The focus of the curriculum is to help students translate their educational experience into a language that others, particularly employers, can understand. Development of the curriculum is explained in the U of MN’s curricular guide which can be found at the P-MIG 2019 meeting site. 

Administrators and advisers use various levels of communication to tell students about career readiness and explain the use of an online RATE tool (reflect, articulate, translate, and evaluate).  Students can use online exercises to reflect upon their college experiences, articulate the value of the experience, translate the experience to a professional skill, and evaluate their own progress toward professional skill mastery.  However, students need an incentive to use the tool. Given that faculty have the most contact with students, use of the RATE assessment activities and career readiness outcomes should be embedded in course work. Currently the readiness team is working to help faculty and departments integrate the career readiness tools and assessments into CLA programs.  Faculty can become Career Readiness Teaching Fellows to help other faculty incorporate career readiness into their programs.

WOW what a meeting!

P-MIG brings together many groups and people. This conference allows us to talk about our issues. The grassroots nature of P-MIG speaks to the need and desire for this community.

Questions that often come up:

Are you forming a new society?  No, our group cuts across already established societies such as The American Physiological Society (APS), Association of Chairs of Departments of Physiology (ACDP), Human Anatomy and Physiology Society (HAPS), Society for the Advancement of Biology Education Research (SABER), and others.  We are not a competing society; we are simply a grassroots collective of undergraduate physiology educators creating a space for ideas and innovation.

Why don’t you join your meeting with another conference?  We have given this a lot thought and discussion.  Many of our educators may be teaching during the meeting time of other conferences.  Those that attend other conferences may have students with them.  It really feels right to us that we should find a time when our members can attend when their teaching loads are not as high and they are not supervising students.  We are making a concerted effort to provide opportunities for teachers who may have limited travel funds.  If our group reaches a consensus that joining another conference is the right thing to do, then we will join another conference.

How is P-MIG different than HAPS?  One of our conference attendees who is a member of HAPS, said it best. “I love HAPS!  When I want to learn about what is going on in the classroom, I go to HAPS.  When I want to know what is happening on the program level, I look to P-MIG.”

Will you share your data? Yes!  The data we have collected is freely available to anyone who asks by contacting Erica Wehrwein (wehrwei7@msu.edu) or by visiting the website to listen to recordings of the presentations from all 3 conferences.

Come Join Us!

The 4th annual meeting will be held at the University of Oregon in Eugene Oregon, July 11-13, 2020.  Opportunities abound!

Lisa Carney Anderson Biography

Lisa Carney Anderson is an Associate Professor in the Department of Integrative Biology and Physiology at the University of Minnesota. She completed her doctoral training in muscle physiology at the University of Minnesota. She directs the first year medical physiology course. She also teaches nurse anesthesia students, dental students and undergraduates. She is the 2012 recipient of the Didactic Instructor of the Year Award from the American Association of Nurse Anesthesia.  She co-authored a physiology workbook called Cells to Systems: Critical thinking exercises in Physiology, Kendall Hunt Press. Dr. Anderson’s teaching interests include encouraging active learning through retrieval and assessment of student reflection.  She has joined the APS Teaching Section governance as Secretary.

When words have lost their meaning!

As a start, ponder what you think that title means!

File that thought away for a minute, we will come back to it. For many years now, I have been considering this topic.  As educators, our whole life is spent as conversants in many different situations.  We converse with each other, either one on one, or with small groups or large groups in classes.  Words are how we convey the context of our lectures, instructions, research, or simple daily conversations.  The meaning of each word is important to the conveyed meaning of our intended outcomes. We write texts to support our teaching.  We write articles to publicize our research findings.  We generate a tremendous volume of recorded, typed and spoken communications using words to convey the exact meaning of what we want to say.  The intent of many of these communications is to deliver a very specific meaning to the person or persons who are the intended target of our words.

Let that last statement sink in a minute………….

Now think back to the question I asked earlier about the title of this blog.  What did you think I meant?  Was your first thought a little confusing, trying to think of a word that no longer has any meaning whatsoever. If so, you have just demonstrated my point.  You, as the recipient of my words, took the meaning of my words literally.  However, my intent was to propose and describe words that have so many meanings that the mere use of the word in a conversation introduces significant misunderstandings between the conversants. Even to the point that when the conversation is over both parties are sure they know what was being said by the other participant(s), yet in reality neither party is aware of the actual meaning intended by the other conversant. The intended meaning of the message was not received with the same meaning by the other participant in the conversation.  I first noticed this when discussing curriculum design with colleagues at national meetings.  Over the past 10 years, this has become increasingly apparent to me when discussing the development of “integrated curricula”.  The use of the term “integration” in many conversations has generated my current perspective. 

What does “integration” mean?   Google definition… “The action or process of integrating” which means to combine one thing with another so that they become whole.

In the world of educators, this could be integration between two instructors, between two classes or disciplines, between clinical and basic science curricula or many other combinations.  Many conversations that I have had over the years have led to misunderstandings of meaning to the point of stopping the conversation and having a discussion as to the meaning of the word integration for each person involved.  In the process of curriculum design, a tremendous amount of time is spent trying to force “integration” by teaming faculty together in a single classroom at one time.  Sometimes this works, other times it does not.  I have come to realize that “true integration” must occur in the recipients mind regardless of modality of the delivery.  In summary, for educators this means that as always, integration is an achievement in the mind of the student that comes from the student’s dedication and hard work regardless of the number of faculty involved or the effort expended by their teachers.  I challenge each of you as educators to think about this and try to help me define other words that fall in the same category as “integration” and respond with other words that may similarly have too many meanings to the point that they “have lost their meaning”…

I will start with these: active learning, clinical relevance…

David Osborne has 26 years of teaching and research experience.  He is a whole animal Physiologist, with a research interest in Gastrointestinal Physiology.  He is a member of IAMSE and the American Physiological Society (APS) with primary affiliations with the Teaching Section and the Gastrointestinal Section.  He is a founding member of APPEL (Affiliation of Professional Physiology Education Leaders), which is an organized group of Physiology course directors dedicated to the preparation of students for professional service such as medicine and dentistry. He has taught Physiology, Biochemistry and Histology in undergraduate, graduate and medical school environments.  He joined Burrell College of Osteopathic Medicine (BCOM) as Professor of Physiology and Chair of the Department of Physiology and Pathology, after being a founding member of the faculty that developed the El Paso campus of Texas Tech Health Sciences Center (Paul L Foster School of Medicine, PLFSOM) into a freestanding four-year medical school. He was instrumental in developing the physiology curriculum and driving the integration of basic science disciplines with clinical application.  He is currently the Assistant Dean for Curriculum at BCOM.  His research focus is two-fold. The focus of his scientific research has been to investigate the factors that influence the normal growth of the intestinal epithelial cell lining. His research has applications related to understanding Colon Cancer and in pursuing the successful use of intestinal transplants following removal of the intestines.  His other focus is in education research where he has been investigating methods to deliver complex scientific concepts to naive and experienced students in a more effective manner. Most recently, he has been investigating the use of the “Flipped Classroom” in application to medical education.