Category Archives: Undergraduate Physiology

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

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

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

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

The Quests

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

Clinical case studies

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

The Creative Part

Illustrations

An example of a student’s histological drawing.

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

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

3-D Modeling

Student synovial joint models with notes on function

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

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

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

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

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

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

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

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

Contact: ferklein@unicamp.br

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

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

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

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

Embracing the Instability of Positive Feedback Loops

Feedback loops are a physiology professor’s bread and butter.  From blood sugar to body temperature, negative feedback ensures that no physiological variable strays from its set point (or range) and that homeostasis is maintained.  Positive feedback loops, on the other hand, are inherently unstable.  In these loops, the response elicited by a stimulus drives the variable further from its set point, reinforcing the stimulus rather than reducing it, and continuing until some outside influence intervenes1.  The classic physiological example of positive feedback is childbirth – pressure from the baby on the mother’s uterus and cervix triggers the release of the hormone oxytocin, which triggers uterine muscle contractions that further push the baby toward the cervix.  This loop of pressure, oxytocin release, and contractions continues until an intervening event occurs – the delivery of the baby.

While physiological positive feedback loops are fascinating, they are greatly outnumbered by negative feedback loops; thus, they don’t usually get much attention in our physiology classrooms.  We usually tell students that the instability of positive feedback loops is what makes them so uncommon.  However, I’d like to use my platform here to argue for a larger place for positive feedback loops in not just our physiology courses, but all of our courses.

 

Positive Feedback Loop Learning

I mentioned above that positive feedback loops are inherently unstable because they drive variables further from their set points, so you may be thinking, “why would I ever want my classroom to be unstable?”  Imagine it this way:  in this feedback loop, the stimulus is an idea, concept, or problem posed by the instructor.  The response is the student’s own investigation of the stimulus, which hopefully sparks further curiosity in the student about the topic at hand, and drives him or her toward more investigation and questioning.  Granted, this system of learning could certainly introduce some instability and uncertainty to the classroom.  Once sparked, the instructor does not have control over the student’s curiosity, which may take the student outside of the instructor’s area of expertise.  However, I maintain that this instability actually enriches our classroom by giving students the space to think critically.

 

Why Encourage Positive Feedback Loops?

Though often misattributed (or even misquoted), Oliver Wendell Holmes, Sr. (poet, essayist, physician, and father of US Supreme Court Justice Oliver Wendell Holmes, Jr.) once wrote “Every now and then a man’s mind is stretched by a new idea or sensation, and never shrinks back to its former dimensions.”2 Neuroscience research supports this assertion.  In rodents, exposure to novel stimuli in enriched environments enhances neuronal long-term potentiation, the cellular correlate of learning and memory in the brain3.  Human brains both functionally and structurally reorganize upon learning new information.  A magnetic resonance imaging study examined gray matter volume in the brains of German medical students who were studying for their “Physikum,” an extensive exam covering biology, chemistry, biochemistry, physics, human anatomy, and physiology4.  Brain scans taken 1-2 days after the Physikum demonstrated significantly increased gray matter volume in the parietal cortex and hippocampus compared to baseline scans taken 3 months prior to the exam (and prior to extensive exposure to new information during the study period)4.  Thus, while the brain may not literally be “stretched” by new ideas, as Holmes proposed, the process of learning (acquisition, encoding, and retrieval of new information) certainly reshapes the brain.

In the model I’ve presented above, new ideas, concepts, and questions are the stimuli in our positive feedback loop.  These stimuli promote changes in our student’s brains.  And, if these stimuli spark curiosity, these brain changes (and thus learning) will be amplified as students respond – meaning, as they construct new ideas, concepts, and questions based on their own interests.  Thus, the loop feeds into itself.

 

Designing Stimuli That Elicit Positive Feedback

How can we structure our teaching so that the stimulus we present to our students is strong enough to elicit a response?  First, it is crucial that our stimuli elicit curiosity in our students. In his essay surveying recent research on the role of curiosity in academic success, David Barry Kaufman wrote, “Stimulating classroom activities are those that offer novelty, surprise, and complexity, allowing greater autonomy and student choice; they also encourage students to ask questions, question assumptions, and achieve mastery through revision rather than judgment-day-style testing.”5  Project-based learning, a teaching technique focused on extended engagement with a problem or task as a means of constructing knowledge, checks many of Kaufman’s boxes6.  As an example, in the past two iterations of my Physiology course, my students have participated in the “Superhero Physiology Project” in which they develop interactive lesson plans for middle school students.  Based on the work of E. Paul Zehr, Ph.D. (author of Becoming Batman: The Possibility of Superhero7 and multiple APS Advances in Physiology Education articles), my students choose a superhero to base their lesson upon, and work over the course of several weeks to create interactive, hands-on activities to teach kids about a physiological system.  While I give my students feedback on the plausibility of their ideas (within our time and budgetary constraints), I leave much of the structure of their lessons open so that they have the opportunity to work through the complexities that come with keeping 20 or more middle schoolers engaged.  Often, my students tell me that figuring out the best way to communicate physiological concepts for a young audience encouraged them to go beyond our textbook to search for new analogies and real-life examples of physiology to which middle schoolers could relate.

Another way to design stimuli that elicit curiosity and positive feedback learning is by capitalizing on a student’s naiveté.  In this approach, described by education expert Kimberly Van Orman of the University of Albany in The Chronicle of Higher Education8, “students don’t need to know everything before they can do anything” – meaning, curiosity is most easily sparked when possibilities aren’t limited by your existing knowledge, because you don’t have any!  For me, this approach is somewhat difficult.  Like all instructors, I regularly feel the pressure to ensure we “get through the material” and often plow through concepts too quickly.  However, my physiology students last fall showed me the power of the “naïve task” firsthand when I observed the Superhero Physiology lesson9 they gave at the middle school.  They decided that before teaching the middle schoolers any physiological terms or concepts didactically, they would present them with a hands-on experiment to introduce the concepts of stroke volume and vasoconstriction.  Their rationale and approach (below) illustrate their mastery of using naiveté to spark curiosity.

Rationale:

The students should be provided with very little, if any, background information on the heart models and the reasoning behind the varying sizes of the materials. By providing little information up front, we hope to intrigue their curiosity regarding the lesson and its significance. Students will be told what to do with the instruments; however, they will not receive any advice on which instruments to use.

The Experiment:

  1. Divide the class into two groups (within each group there should be 4-5 “holders” for the tubes and 4-5 “pumpers” managing water and pipets). Group 1 will be given large diameter tubing, a large funnel as well as 3 large volume pipettes. Group 2 will receive smaller tubing, a smaller funnel and only one smaller volume pipet.
  2. Instruct the students that they will be transporting the water from a large bucket into another bucket 8-10 feet across the room without moving the bucket.
  3. The groups will have 10 minutes to construct their apparatus, and 5 minutes for the actual head-to-head “race” in which the winner is determined by who moves the most amount of water in the allotted time.
  4. After the students have completed the first experiment they will return to their seats for the lecture portion of the lesson which will connect the different parts of the build to different portions of the cardiovascular system.

 

Not only did the middle school students have a fantastic time building their apparatus (and accidentally on purpose getting each other wet!), but as the experiment progressed, they began to get curious about why the other team was so behind or ahead.  Soon after, discussions between groups about tubing diameter and pipet size emerged organically among the middle schoolers, and they were able to easily apply these concepts to later discussions of blood flow and cardiac output.

 

Embracing Instability

While I think most educators aspire to elicit positive feedback learning in their students, there can be barriers to putting it into practice.  As I mentioned above, pressure to cover content results in some of us shying away from open-ended activities and projects.  Not all students in a given class will come in with the same motivations for learning (as discussed in Dr. Ryan Downey’s December 2018 PECOP Blog post10), nor will they all respond to the same stimuli with curiosity.  However, it just takes one stimulus to put a positive feedback loop into action – and once it gets going, it’s hard to stop.  Once a student’s curiosity is piqued, the classroom may feel a bit unstable as their interests move out of the realm of your expertise as an instructor.  But ultimately, we all as educators live for that moment when a connection crystallizes in a student’s mind and they discover a new question they can’t wait to answer.

 

Acknowledgements

The author is grateful to Wabash students James Eaton, Sam Hayes, Cheng Ge, and Hunter Jones for sharing an excerpt of their middle school lesson.

 

References

1 Silverthorn DU. (2013).  Human physiology, an integrated approach (6th Ed.). Pearson.

2 Holmes OW. (1858). The autocrat of the breakfast-table. Boston:  Phillips, Sampson and Company.

3 Hullinger R, O’Riordan K, Burger C.  (2015).  Environmental enrichment improves learning and memory and long-term potentiation in young adult rats through a mechanism requiring mGluR5 signaling and sustained activation of p70s6k.  Neurobiol Learn Mem 125:126-34.

4 Draganski B, Gaser C, Kempermann G, Kuhn HG, Winkler J, Büchel C, May A. (2006).  Temporal and spatial dynamics of brain structure changes during extensive learning.  J Neurosci 26(23):6314-17.

Kaufman,SB. (2017, July 24).  Schools are missing what matters about learning.  The Atlantic.  Retrieved from https://www.theatlantic.com/education/archive/2017/07/the-underrated-gift-of-curiosity/534573/

6 What is PBL? (n.d.) Retrieved from https://www.pblworks.org/what-is-pbl

7 Zehr, EP. (2008).  Becoming Batman: the possibility of a superhero.  Baltimore: Johns Hopkins University Press.

8 Supiano, B. (2018, June 7). How one teaching expert activates students’ curiosity. Retrieved from https://www.chronicle.com/article/How-One-Teaching-Expert/243609

9 Eaton J, Hayes S, Ge C, Jones H. (2018).  Superhero cardio: the effects of blood vessel diameter, stroke volume, and heart rate on cardiac output. Unpublished work, Wabash College, Crawfordsville, IN.

10 Downey, R.  (2018, December 13).  Affective teaching and motivational instruction: becoming more effective educators of science. [Blog post]. Retrieved from https://blog.lifescitrc.org/pecop/2018/12/13/affective-teaching-and-motivational-instruction-becoming-more-effective-educators-of-science/

 

Heidi Walsh has been an Assistant Professor of Biology at Wabash College since 2014. She received a B.S. in Neuroscience from Allegheny College, a Ph.D. in Neuroscience from the University of Virginia, and completed post-doctoral work in the Department of Metabolism & Aging at The Scripps Research Institute’s Florida campus.  Heidi’s research lab studies the impact of obesity-related stressors, including endoplasmic reticulum stress, on gonadotropin-releasing hormone (GnRH) neurons. She teaches courses in Cell Biology, Physiology, and Molecular Endocrinology, and enjoys collaborating with students on science outreach projects.
Where does general education fit into an undergraduate degree?

I am currently serving on a taskforce which has been given the job of revising our general education program. As a member of this taskforce, I have been reading, analyzing, and using data to design and implement a program that many faculty struggle to explain and that many students often question. This made me think. What do schools mean by general education?

If we look at definitions, most people would say this is the part of a student’s education which is meant to develop their personalities or provide skills and knowledge which will help students succeed not only in their chosen major but also in their careers and life. If we look at this more closely, many faculty members see general education as the place for students to develop some of those soft skills that are often talked about by employers. These soft skills include communication skills, listening skills, critical thinking/problem solving, and interpersonal skills to name a few.

If general education is the place for the learning of these skills, where do we as faculty fit into general education? After all, isn’t it my job to provide the knowledge for Biology classes? That is why I have my Ph.D. and the institution hired me. Surely, there are other members of the campus community that can also guide students on successful acquisition of these skills? For example, I was never taught how to teach writing so why should I teach writing? But is this statement true? I was taught how to write. In elementary, junior high, and high school, I was taught how to construct sentences to ensure that all verbs had a subject. I was taught how to put together an outline so that my thoughts were organized in a logical manner. In college, I was taught how to now take difficult concepts and use them to develop a hypothesis. I was taught how to present the methodology of my experiments. And finally, I was taught how to analyze and present data and then discuss what that data meant. Graduate school asked me to use these skills and bring them to a higher level. I could list similar instances and experiences for thinking and problem solving, collaboration, and other soft skills as well. Are these experiences enough for me to be able to teach writing in our general education program? That is the million dollar question our taskforce is trying to answer. There is a part of me, that says, “YES! I can teach students how to write.” I have had papers published. I write all the time for different committees, classes, and other activities. There is a second part of me that is terrified of the idea of teaching writing in a more general class. Those scary terms like logic and rhetoric seem overwhelming to this Biology professor. Can I even give an example of rhetoric? I know that if I stepped back and took a breath, I could give an example of rhetoric. But this raises another question. Do the students deserve someone better trained (and less afraid of these terms) to guide them while learning these skills? That question is still one our taskforce is trying to answer.

The other question our taskforce has had to face is, “How do we get students to buy into general education?” What can we as faculty and staff do to promote the importance of those skills learned in our institution’s general education programs? Are we so focused on the knowledge and skills of the major that we forget that those soft skills can make or break a successful employee? Knowledge and skills specific to a job can get the applicant to the interview. It is the soft skills that can get the applicant the job. If this is the case, then isn’t it our job as professors and teachers to not only help our students gain the knowledge but also to help them gain those skills that will help them to succeed in their careers and lives? And if that is our job, how do we as faculty support and allow for equal importance of both technical knowledge and skills and these so-called soft skills?

Let me preface, I am certainly not telling faculty that they need to get rid of their grading scales. And I am not telling students they should forget about their grades. But I am questioning how we measure success in today’s academic world and in our global society. If we look at surveys and reports that have been published, employers are having trouble finding students/potential employees with soft skills. Does this mean all of these higher education institutions are failing in their general education of students? I would like to think that we aren’t failing. But I am suggesting we might need to find a better way to illustrate the importance of the skills learned in general education classes. This could be in how we discuss general education to how we define successful completion of general education. Most teachers always ask how to assess soft skills. Is it possible that maybe a grading scale isn’t the only way to define success when it comes to learning some skills? Again, our taskforce hasn’t come up with the golden answer yet.

Serving on this taskforce has been eye opening and I have learned that putting together a successful general education program requires a great deal of guesswork. There have been questions raised that I truly do not have answers for, and I don’t know that answers are available for these questions. But these questions and this process have made me question what the future of general education looks like.  The current generation of students have access to technology and possess skills and talents that did not even exist when many faculty were students. As faculty we learned skills that helped us succeed back when we were graduating and looking to move to the next phase of life. And we have adapted as changes to the world have come. While I cannot say for sure what general education will look like in the future, I can say that we need to be training students for the requirements of today’s workforce and the ability to adapt for the future workforce. And unless we have a crystal ball which can predict the future, what that looks like will remain unknown.

 

Melissa A. Fleegal-DeMotta, Ph.D. earned her BS in Biology from Lebanon Valley College in Annville, PA. After working at Penn State’s College of Medicine, she then earned her PhD from the University of Florida in Gainesville, FL. Following postdoctoral fellowships at the University of Florida, University of Arizona, and Saint Louis University, she has been a professor at Clarke University in Dubuque, IA for over 10 years. During her time at Clarke, she has developed an interest in how the general education of a liberal arts university fits with the education of science majors.
It was Just a Bag of Candy, but Now It’s a Lung – Don’t Be Afraid to Improvise When Teaching Physiology

Many of us have been teaching the same course or the same topic in a team-taught course for many years.  I have been teaching the undergraduate Anatomy and Physiology-II (AP-II) course at a community college for four years.  People often ask, “Doesn’t it get old?  Don’t you get bored, teaching the same topic?”  Without hesitation, I answer, “No.” Why?  First, on-going research continually brings new details and insight to nearly every aspect of cell and integrative physiology.  You’re always learning to keep up with the field and modifying lectures to incorporate new concepts.  Second, you truly want your students to learn and enjoy learning and continually seek out ways to teach more effectively.  You try new approaches to improve student learning.  However, the third reason is truly why teaching physiology will never get old or dull.  No two students and no two classes are alike; individual and collective personalities, career goals, academic backgrounds and preparedness, and learning curves vary from class to class.  About half my students have not taken the general biology or chemistry courses typically required for AP-I or AP-II (these are not required by the college).  The unique combination of characteristics in each group of students means that on any given day I will need to create a new makeshift model or a new analogy for a physiological mechanism or structure-function relationship to help students learn.  Thus, even if all physiological research came to complete fruition, the teaching of physiology would still be challenging, interesting, and entertaining.  Many of my peers share this perspective on teaching physiology.

Irrespective of one’s mastery of integrative physiology, as teachers we must be ready and willing to think creatively on our feet to answer questions or clarify points of confusion.  A common mistake in teaching is to interpret the lack of questions to mean our students have mastered the concept we just explained, such as the oxygen-hemoglobin dissociation curve.  Despite the amazing color-coding of green for pH 7.35, red for pH 7.0 and blue for pH 7.5 and perfectly spaced lines drawn on that PowerPoint slide, your Ms./Mr. Congeniality level of enthusiasm, and sincerest intentions – you lost them at “The relationship of oxygen saturation of hemoglobin to the partial pressure of oxygen is curvilinear.”  You know you lost them.  You can see it in their faces.  The facial expression varies: a forehead so furrowed the left and right eyebrows nearly touch, the cringing-in-pain look, the blank almost flat stare, or my favorite – the bug-eyed look of shock.  Unfortunately, it will not always be obvious.  Thus, it is essential we make an effort to become familiar with the class as a group and as individuals, no matter how large the class.  Being familiar with their baseline demeanor and sense of humor is a good start.  (I have students complete ‘Tell Me About Yourself’ cards on the first day of class; these help me a great deal.)  During lecture, we make continual and deliberate eye contact with the students and read their faces as we lecture and talk to them, rather than at them.  In lab we work with and talk to each group of students and even eavesdrop as a means to assess learning.  Time in class or lab is limited, which tempts us to overlook looks of confusion and move on to the next point.  However, when students do not accurately and confidently understand a fundamental concept, they may have even greater difficulty understanding more integrated and complicated mechanisms.  You must recognize non-verbal, as well as subtle verbal cues that students are not following your logic or explanation.  In that immediate moment you must develop and deliver an alternative explanation.  Improvise.

As per Merriam-Webster, to improvise is to compose, recite, play, or sing extemporaneously; to make, invent, or arrange offhand; to fabricate out of what is conveniently on hand.  What do you have on hand right now to create or develop a new explanation or analogy?  Work with what you have within the confines of the classroom.  These resources can be items within arm’s reach, anything you can see or refer to in the classroom.  You can also use stories or anecdotes from your own life.  Reference a TV commercial, TV show, movie, song, or cartoon character that is familiar to both you and your students.  Food, sports, and monetary issues can be great sources for ideas.  I cook and sew, which gives me additional ideas and skills.  Play to your strengths.  Some people are the MacGyvers of teaching; improvisation seems to be a natural born gift.  However, we all have the basic ability to improvise.  You know your topic; you are the expert in the room.  Tap into your creativity and imagination; let your students see your goofy side.  Also, as you improvise and implement familiar, everyday things to model or explain physiological or structure-function relationships you teach your students to think outside the box.  Students learn by example.  My own undergraduate and graduate professors improvised frequently.  My PhD and post-doc advisors were comparative physiologists – true masters of improvised instrumentation.

Improvise now, and improve later.  Some of my improvised explanations and demonstrations have worked; some have fallen flat.  In some cases I have taken the initial improvised teaching tool and improved the prototype and now regularly use the demonstration to teach that physiological concept.  Here are three examples of improvisational analogies I have used for the anatomy of circular folds in the intestine, the opening and closing of valves in the heart, and the role of alveoli in pulmonary gas exchange.  Disclaimer:  These are not perfect analogies and I welcome comments.

Surface area in the small intestine.  Students understand that the surface area of a large flat lab table is greater than the surface area of a flat sheet of notebook paper.  A sheet of paper can be rolled into a tube, and students understand that the surface area of the ‘lumen’ is equal to the surface area of the paper.  In AP-I, students learned that microvilli increase the surface area of the plasma membrane at the apical pole of an epithelial cell, and many teachers use the ‘shag carpet’ analogy for microvilli.  Similarly, they understood how villi increase surface area of the intestinal lumen.  However, some students did not quite understand or cannot envision the structure of circular folds.  As luck would have it, I was wearing that style of knit shirt with extra-long sleeves that extend just to your fingertips.  I fully extended the sleeve and began to explain. “My sleeve is the small intestine – a tube with a flat-surface lumen (my arm is in the lumen) – no circular folds.  This tube is 28 inches long and about 8 inches around.  As I push up my sleeves as far as I can, and the fabric bunches up.  These messy folds that form are like circular folds.  And, now this 6 inch tube with all these circular folds has the same surface area as the 28-inch plain tube.”  (I sew; I know the length of my own arm and am great at eyeballing measurements.)

Heart valves open and close as dictated by the pressure difference across the valve.  This is integral to ventricular filling, ejection of blood into the lung and aorta, and the effect of afterload.  Heart valves are one-way valves.  A few students heard ‘pressure difference’ and were lost.  Other students had trouble understanding how stroke volume would decrease with an increase in afterload.  What can I use in the room?  There’s a big door to the lab, and it has a window.  It opens in one direction – out, because of the doorframe, hinges and door closure mechanism; it only opens, if you push hard enough.  I ran over to the door.  “The lab door is a heart valve.  It’s the mitral valve, the lab is the atrium, and the hallway is the ventricle.  The door only opens into the hall – the mitral valve only opens into the ventricle.  When it closes, it stops once it sits in the frame.”  I asked a student about my size to go outside the room, and push against the door closed – but let me open it; she could see and hear me through the window.  “As long as I push with greater force than she applies to keep it shut, the door or valve will open.”  The student played along and made it challenging, but let me open the door.  ‘Blood flows from the atrium into the ventricle, as long as the valve is open.  But, as soon as the pressure in the ventricle is greater than the pressure in the atrium the valve closes.”  The student forcefully pushed the door shut.  They got it!  Now, afterload …?  Back to the lab door.  “Now the lab door is the aortic valve, the lab is the left ventricle, and the hall is the aorta.  This valve will open and stay open as long as the pressure in the ventricle is greater than the pressure in the aorta.  The longer the valve is open, the greater the volume of blood ejected from the ventricle.  The volume of blood ejected from the ventricle in one beat is the stroke volume.  The pressure that opposes the opening of the aortic valve is afterload.  What happens with afterload?”  I then asked the tallest, strongest student in class to play the role of Afterload; he too got into the role.  “Afterload has now increased!  The pressure that opposes the opening of the valve has increased.  Will I or won’t I have to push harder to open the door – now that afterload has increased?”  The student is very strong; I can barely push the door open.  “I not only have to push harder, but I can’t keep the door or valve open for very long.  Look.  Even though the ventricle pressure is greater, the valve is open for a shorter period – so less blood is ejected and stroke volume decreases.”

Alveoli increase the surface area for gas exchange.  Students see the lungs as 2 large sacs, and the surface area available for gas exchange between air and blood is simply the inner lining of each sac.  However, each lung is made of millions of tiny air sacs or alveoli into which air flows.  How this anatomical arrangement greatly increases surface area for gas exchange is not intuitively obvious.  The overall size of the lung does not increase, so why would the surface area increase?  As luck would have it, it was Halloween.  I had brought a big bonus bag of individually wrapped bite-size candies to class.  “One lung is like this bag.  If we cut open the bag and measure the sheet of plastic, it would be about 18 inches by 12 inches or 216 square inches.  But if we completely fill it with candy, it might hold at least 150 pieces of candy.”  I quickly unwrapped one piece of candy, held up the wrapper, and estimated a single wrapper was 4 square inches.  “If we fill one bag with 150 pieces of candy, we then have 600 square inches of surface area.  Which would provide greater area for gas exchange: one big lung or millions of alveoli?”  I revised this particular improvised explanation using scissors, a ruler and two 11-oz bags of Hershey’s® kisses.  I carefully opened both bags and transferred kisses from one bag to the other, until it was completely full, i.e., 112 kisses, and taped it shut.  I then fully opened up the other bag; it was 10 inches x 8 inches or 80 square inches.  An individual kiss wrapper is 4 square inches; all 112 individual wrappers are 448 square inches.

My improvised analogies are not perfect, but they have served as great teaching tools.  If you can improve upon these, please do.  Share any suggestions you have and lastly, share your improvised explanations and analogies.  Thanks.

Alice Villalobos received her B.S.in biology from Loyola Marymount University and her PhD in comparative physiology from the University of Arizona-College of Medicine.  She has been in the Department of Biology at Blinn College for 4 years where she teaches Anatomy and Physiology II and Introduction to Human Nutrition.  She guest lectures in undergraduate courses at Texas A&M University on the topics of brain barrier physiology and the toxicity of heavy metals.
Teaching for Learning: The Evolution of a Teaching Assistant

An average medical student, like myself, would agree that our first year in medical school is fundamentally different from our last, but not in the ways most of us would expect. Most of us find out that medical school not only teaches us about medicine but it also indirectly teaches us how to learn. But what did it take? What is different now that we didn’t do back in the first year? If it comes to choosing one step of the road, being a teaching assistant could be a turning point for the perception of medical education in the long run, as it offers a glimpse into teaching for someone who is still a student.

At first, tutoring a group of students might seem like a simple task if it is only understood as a role for giving advice about how to get good grades or how to not fail. However, having the opportunity to grade students’ activities and even listen to their questions provides a second chance at trying to solve one’s own obstacles as a medical student. A very interesting element is that most students refuse to utilize innovative ways of teaching or any method that doesn’t involve the passive transmission of content from speaker to audience. There could be many reasons, including insecurity, for this feeling of superficial review of content or laziness, as it happened for me.

There are, in fact, many educational models that attempt to objectively describe the effects of educating and being educated as active processes. Kirkpatrick’s model is a four-stage approach which proposes the evaluation of specific aspects in the general learning outcome instead of the process as a whole (1). It was initially developed for business training and each level addresses elements of the educational outcome, as follows:

  • Level 1- Reaction: How did learners feel about the learning experience? Did they enjoy it?
  • Level 2- Learning: Did learners improve their knowledge and skills?
  • Level 3- Behavior: Are learners doing anything different as a result of training?
  • Level 4- Results: What was the result of training on the business as a whole?

Later, subtypes for level 2 and 4 were added for inter-professional use, allowing its application in broader contexts like medicine, and different versions of it have been endorsed by the Best Evidence in Medical Education Group and the Royal College of Physicians and Surgeons of Canada (1) (2).  A modified model for medical students who have become teachers has also been adapted (3), grading outcomes in phases that very closely reflect the experience of being a teaching assistant. The main difference is the inclusion of attitude changes towards the learning process and the effect on patients as a final outcome for medical education. The need for integration, association and good problem-solving skills are more likely to correspond to levels 3 and 4 of Kirkpatrick’s model because they overcome traditional study methods and call for better ways of approaching and organizing knowledge.

Diagram 1- Modified Kirkpatrick’s model for grading educational outcomes of medical student teachers, adapted from (3)

These modifications at multiple levels allow for personal learning to become a tool for supporting another student’s process. By working as a teaching assistant, I have learned to use other ways of studying and understanding complex topics, as well as strategies to deal with a great amount of information. These methods include active and regular training in memorization, deep analysis of performance in exams and schematization for subjects like Pharmacology, for which I have received some training, too.

I am now aware of the complexity of education based on the little but valuable experience I have acquired until now as a teacher in progress. I have had the privilege to help teach other students based on my own experiences. Therefore, the role of a teaching assistant should be understood as a feedback process for both students and student-teachers with a high impact on educational outcomes, providing a new approach for training with student-teaching as a mainstay in medical curricula.

References

  1. Roland D. Proposal of a linear rather than hierarchical evaluation of educational initiatives: the 7Is framework. Journal of Educational Evaluation for Health Professions. 2015;12:35.
  2. Steinert Y, Mann K, Anderson B, Barnett B, Centeno A, Naismith L et al. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40. Medical Teacher. 2016;38(8):769-786.
  3. Hill A, Yu, Wilson, Hawken, Singh, Lemanu. Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school. Advances in Medical Education and Practice. 2011;:157.

The idea for this blog was suggested by Ricardo A. Pena Silva M.D., Ph.D. who provided guidance to Maria Alejandra on the writing of this entry.

María Alejandra is a last year medical student at the Universidad de Los Andes, School of Medicine in Bogota, Colombia, where she is has been a teaching assistant for the physiology and pharmacology courses for second-year medical students. Her academic interests are in medical education, particularly in biomedical sciences.  She is interested in pursuing a medical residency in Anesthesiology. Outside medical school, she likes running and enjoys literature as well as writing on multiple topics of personal interest.
In Defense of the “Real” Thing

Society has moved into the age of virtual reality.  This computer-generated trend has wide-sweeping implications in the classroom.  Specific to anatomy, impressive 3D modeling programs permit students to dissect simulated bodies pixel by pixel.  It is exciting and often more cost-effective.  Virtual dissection, without doubt, can play a significant role in the current learning environment. However, as stated by Rene Descartes, “And so that they might have less difficulty understanding what I shall say about it, I should like those who are unversed in anatomy to take the trouble, before reading this, of having the heart of a large animal with lungs dissected before their eyes (for it is in all respects sufficiently like that of a man)”. This idea leads me to my argument; there is no replacement for the real thing.

 

We as teachers must incorporate a variety of learning tools for a student to truly understand and appreciate anatomical structure. Anatomical structure also needs to be related to physiological function. Is there anyone reading this that has not repeated the mantra “form determines function” hundreds or thousands of times during their teaching?  The logistical and financial restrictions to human cadavers, necessitates the frequent incorporation of chemically preserved specimens into our laboratory curriculum. Course facilitators often employ a cat or a pig as a substitute for the human body. I am not advocating against the use of preserved specimens or virtual programs for that matter (and kudos to my fellow facilitators who have learned the arduous techniques required to dissect a preserved specimen). However, it is my opinion that it is a time consuming assignment with limited educational end points. Not to mention the rising specimen costs and limited vendor options. The cost of a preserved cat is now ~$40, while the average cost of a live mouse is only ~$5. Two very important components necessary to understand the concept that form determines function are missing from preserved specimens (even cadavers). These two components are: texture and color. With respect to color, the tissues of preserved specimens are subtle variations of gray, completely void of the Technicolor show of the living organism. Further, texture differences are extremely difficult to differentiate in a preserved specimen. Compare this to a fresh or live specimen and the learning tools are innumerable. You might argue that mice are much smaller, but dissecting microscopes can easily enhance the dissection and in my experience far outweigh the noxious experience of dissecting a chemically preserved organism.

 

To further convince you of the value of dissecting fresh tissue I would like to present a couple of examples. First, why is the color of tissue important? One of the most important bodily pigments is hemoglobin. Hemoglobin, as we all know, is the pigment that gives blood its red color. Therefore the color of a tissue often reflects the level of the tissue vascularity and often (but of course not always) in turn the ability of that tissue to repair or regenerate. Simply compare the color of the patellar tendon (white) to the red color of the quadriceps. Muscles being highly vascularized have a much greater ability to regenerate than non-vascular connective tissue such as the patellar tendon. In addition, muscles contain myoglobin, a red protein very similar to hemoglobin. Two clear examples of teaching opportunities that would be missed with the traditional use of preserved specimens.

 

Texture is completely lost with chemical preservation as tissues become hardened and rubbery. My students are always blown away by the fact you can completely eliminate the overall structure of the brain by pressing it between their two fingers. The tactile experience of holding the delicate brain allows students to explore how form begets function begets pathology. Traumatic brain injury (TBI) has become a hot topic in our culture. We no longer see children riding bicycles without helmets, the National Football League has new rules regarding tackle technique and my 8-year-old soccer player is penalized for headers during game play. What better way to educate a new generation of students just how delicate nervous tissue is than by having them “squash” a mouse brain? Regardless, of the amazing skull that surrounds the brain and the important fluid in which it floats, a hit to the head can still result in localized damage and this tactile experience emphasizes this in a way no virtual dissection could ever accomplish.

 

Finally, I would like to discuss a topic close to my heart that does require a non-preserved large animal specimen. The function of arteries and veins is vastly different based on the structure of elastic or capacitance vessels, respectively. For example, the deer heart allows easy access to the superior or inferior vena cava (veins that are thin and easily collapsed) and the aorta (thick and elastic artery) permitting valuable teaching moments on vessel structural variability for divergent physiological function. These structures on a preserved specimen are usually removed just as they enter the heart making them very difficult to evaluate.

 

These are just some elementary examples. Numerous concepts can be enhanced with the added illustrations of texture and color. When presented with both options, my students always choose the fresh tissue!  The wonder and excitement of handling fresh tissue has become a hallmark of our Anatomy and Physiology course and is regularly mentioned as student’s favorite example of hands-on learning in the classroom.

 

I have to end this with a special shout-out to my dear lab adjunct Professor Elizabeth Bain MSN, RN. Liz has made access to deer heart and lungs an easy task for me.

April Carpenter, PhD is an Assistant Professor in the Health and Exercise Physiology Department at Ursinus College. She received her PhD in Molecular and Cellular Physiology at Louisiana State University Health Sciences Center and completed two postdoctoral fellowships at the Hospital for Special Surgery in New York and Cincinnati Children’s Hospital Medical Center. Her research interests include the molecular regulation of endothelial function and its impact on all phases of skeletal muscle injury.  Dr. Carpenter currently teaches Anatomy and Physiology, Research Methods and a new Pathophysiology course.
What if your students went to a lecture . . . and a concert broke out?

In June I attended the American Physiological Society’s Institute on Teaching and Learning (ITL) for the first time.  It was a fantastic week of presentations, workshops, and networking, from the opening keynote address on “Student-instructor interactions in a large-group environment” by Prem Kumar (University of Birmingham, UK) to the closing plenary talk on “Inclusive practices for diverse student populations” by Katie Johnson (Beloit College).

 

The week is hard to summarize concisely, yet I can easily identify my most memorable moment.  That occurred on Wednesday morning (June 20th).  Robert Bjork, a UCLA psychologist, had just delivered a fascinating plenary talk on learning, forgetting, and remembering information.  He had reviewed several lines of evidence that the memorization process is more complicated than tucking facts into a mental freezer where they persist forever.  Instead, the timing and context of information retrievals can profoundly affect the success of subsequent retrievals.

 

At the end of the lecture, I stood up with a question (or possibly a monologue masquerading as a question). “It seems that maintaining long-term memories is a really active, dynamic process,” I said. “The brain seems to be constantly sorting through and reassessing its memory ‘needs,’ somewhat like the way the kidney is constantly sifting through the plasma to retain some things and discard others. Is that a reasonable analogy?”

 

“Yes it is,” he answered politely.  “Perhaps,” he added, “you could write a paper on the ‘kidney model’ of how the brain learns.”

 

“I can do even better than that,” I said.  “Here’s a song I wrote about it!”  And I launched into an impromptu a cappella rendition of “Neurons Like Nephrons” (http://faculty.washington.edu/crowther/Misc/Songs/NLN.shtml).

 

The audience clapped along in time, then erupted with wild applause!  That’s how I prefer to remember it, anyway; perhaps others who were there can offer a more objective perspective.

 

In any case, singing is not just a mechanism for hijacking Q&A sessions at professional development conferences; it can also be done in the classroom.  And this example of the former, while unusual in and of itself, hints at several useful lessons for the latter.

 

  1. Unexpected music gets people’s attention. In truth, I have no idea whether most ITL attendees found my song fun or helpful. Still, I’m quite sure that they remember the experience of hearing it.  Now think about your own courses.  Are there any particular points in the course where you desperately need students’ undivided attention?  Unexpected singing or rapping is amazingly effective as an attention-grabber, even (especially?) if the performer is not a gifted musician.  Don’t be afraid to use this “nuclear option.”

 

  1. Music is not just for “making science fun” and memorizing facts. Many teachers and students who support the integration of music into science courses do so because they think it’s fun and/or useful as a mnemonic device. Both reasons are legitimate; we do want our courses to be fun, and our students do need to memorize things.  But music can be much more than an “edutainment” gimmick.  “Neurons Like Nephrons” (http://faculty.washington.edu/crowther/Misc/Songs/NLN.shtml), for example, develops an analogy between the way that the brain processes information and the way that the kidney processes plasma.  It’s not a perfect analogy, but one worthy of dissection and discussion (https://dynamicecology.wordpress.com/2016/11/14/imperfect-analogies-shortcuts-to-active-learning/).  Songs like this one can thus be used as springboards to critical thinking.

 

  1. The effectiveness of any musical activity is VERY context-specific. After my musical outburst at ITL, I was flattered to receive a few requests for a link to the song. I was happy, and remain happy, to provide that. (Here it is yet again: http://faculty.washington.edu/crowther/Misc/Songs/NLN.shtml.)  But here’s the thing: while you are totally welcome to play the song for your own students, they probably won’t love it.  To them, it’s just a weird song written by someone they’ve never heard of.  They won’t particularly care about it unless the production quality is exceptional (spoiler: it’s not) or unless they are going to be tested on the specific material in the lyrics.   Or unless you take other steps to make it relevant to them – for example, by challenging them to sing it too, or to explain what specific lines of lyrics mean, or to add a verse of their own.

 

 

In conclusion, music can function as a powerful enhancer of learning, but it is not pixie dust that can be sprinkled onto any lesson to automatically make it better.  As instructors, for any given song, you should think carefully about what you want your students to do with it.  That way, when the music begins, the wide-eyed attention of your incredulous students will be put to good use.

Gregory J. Crowther, PhD has a BA in Biology from Williams College, a MA in Science Education from Western Governors University, and a PhD in Physiology & Biophysics from the University of Washington. He teaches anatomy and physiology in the Department of Life Sciences at Everett Community College.  His peer-reviewed journal articles on enhancing learning with content-rich music have collectively been cited over 100 times.
Medical Physiology for Undergraduate Students: A Galaxy No Longer Far, Far Away

The landscape of medical school basic science education has undergone a significant transformation in the past 15 years.  This transformation continues to grow as medical school basic science faculty are faced with the task of providing “systems based” learning of the fundamental concepts of the Big 3 P’s: Physiology, Pathology & Pharmacology, within the context of clinical medicine and case studies.  Student understanding of conceptual basic science is combined with the growing knowledge base of science that has been doubling exponentially for the past century.  Add macro and microanatomy to the mix and students entering their clinical years of medical education are now being deemed only “moderately prepared” to tackle the complexities of clinical diagnosis and treatment.  This has placed a new and daunting premium on the preparation of students for entry into medical school.  Perhaps medical education is no longer a straightforward task of 4 consecutive years of learning.  I portend that our highest quality students today, are significantly more prepared and in many ways more focused in the fundamentals of mathematics, science and logic than those of even 30 years ago.  However, we are presenting them with a near impossible task of deeply learning and integrating a volume of information that is simply far too vast for a mere 4 semesters of early medical education.

 

To deal with this academic conundrum, I recommend here that the academic community quickly begin to address this complex set of problems in a number of new and different ways.  Our educators have addressed the learning of STEM in recent times by implementing a number of “student centered” pedagogical philosophies and practices that have been proven to be far more effective in the retention of knowledge and the overall understanding of problem solving.  The K-12 revolution of problem-based and student-centered education continues to grow and now these classroom structures have become well placed on many of our college and university campuses.  There is still much to be done in expanding and perfecting student-centered learning, but we are all keenly aware that these kinds of classroom teaching methods also come with a significant price in terms of basic science courses.

 

It is my contention that we must now expand our time frame and begin preparing our future scientists and physicians with robust undergraduate preprofessional education.  Many of our universities have already embarked upon this mission by developing undergraduate physiology majors that have placed them at the forefront of this movement.  Michigan State University, the University of Arizona and the University of Oregon have well established and long standing physiology majors.  Smaller liberal arts focused colleges and universities may not invest in a full majors program, but rather offer robust curricular courses in the basic medical sciences that appropriately prepare their students for professional medical and/or veterinary education.  Other research 1 universities with strong basic medical science programs housed in biology departments of their Colleges of Arts and Sciences may be encouraged to develop discipline focused “tracks” in the basic medical sciences.  These tracks may be focused on disciplines such as physiology, pharmacology, neuroscience, medical genetics & bioinformatics and microbiology & immunology.  These latter programs will allow students to continue learning with more broad degrees of undergraduate education in the arts, humanities and social sciences while gaining an early start on advanced in depth knowledge and understanding of the fundamentals of medical bioscience.  Thus, a true undergraduate “major” in these disciplines would not be a requirement, but rather a basic offering of focused, core biomedical science courses that better prepare the future professional for the rigors of integrated organ-based medical education.

 

In the long term, it is important for leaders in undergraduate biomedical education to develop a common set of curriculum standards that provide a framework from which all institutions can determine how and when they choose to prepare their own students for their post-undergraduate education.  National guidelines for physiology programs should become the standard through which institutions can begin to prepare their students.  Core concepts in physiology are currently being developed.  We must carefully identify how student learning and understanding of basic science transcends future career development, and teach professional skills that improve future employability.  Lastly, we must develop clear and effective mechanisms to assess and evaluate programs to assure that what we believe is successful is supported by data which demonstrates specific program strengths and challenges for the future.  These kinds of challenges in biomedical education are currently being addressed in open forum discussions and meetings fostered by the newly developed Physiology Majors Interest Group (P-MIG) of the APS.  This growing group of interested physiology educators are now meeting each year to discuss, compare and share their thoughts on these and other issues related to the future success of our undergraduate physiology students.  The current year will meet June 28-29 at the University of Arizona, Tucson, AZ.  It is through these forums and discussions that we, as a discipline, will continue to grow and meet the needs and challenges of teaching physiology and other basic science disciplines of the future.

Jeffrey L. Osborn, PhD is a professor of biology at the University of Kentucky where he teaches undergraduate and graduate physiology. He currently serves as APS Education Committee chair and is a former medical physiology educator and K12 magnet school director. His research focuses on hypertension and renal function and scholarship of teaching and learning. This is his first blog.
Beyond Content Knowledge: The Importance of Self-Regulation and Self-Efficacy

You can lead students to knowledge, but you can’t make them understand it …

Undergraduate physiology education has been steadily morphing from a traditionally instructor-centered, didactic lecture format to a more inclusive array of practices designed to improve student engagement and therefore motivation to learn.  Many excellent resources are available regarding the theory and practice of active learning (4) as well as guidelines specific to teaching physiology (2).  Common questions instructors ask when redesigning courses to be student-centered, active learning environments are often along the lines of:

  1. What specific content areas should I teach, and to what depth?
  2. What active learning strategies are most effective and should be included in course design? Common methodologies may be in-class or online discussion, completion of case studies, team-based learning including group projects, plus many others.
  3. How do I align assessments with course content and course activities in order to gauge content mastery?
  4. How do I promote student “buy-in” if I do something other than lecture?
  5. How do I stay sane pulling all of this together? It seems overwhelming!

These last two questions in particular are important to consider because they represent a potential barrier to instructional reform for how we teach physiology– the balance between student investment and responsibility for their learning versus time and effort investment by the instructor.  All parties involved may exhibit frustration if instructor investment in the educational process outweighs the learner’s investment.  Instructors may be frustrated that their efforts are not matched with positive results, and there may be concerns of repercussions when it comes time for student course evaluations.  Students may perceive that physiology is “too hard” thus reducing their motivation and effort within the course and possibly the discipline itself.

To improve the likelihood of a positive balance between instructor and student investment, perhaps we should add one additional question to the list above: What is the learner’s role in the learning process?   

Students often arrive to a class with the expectation that the instructor, as the content expert,  will tell them “what they need to know” and perhaps “what they need do” to achieve mastery of the factual information included as part of course content.  This dynamic places the responsibility for student learning upon the shoulders of the instructor.  How can we redefine the interactions between instructors and students so that students are engaged, motivated, and able to successfully navigate their own learning?

 

Self-Regulated Learning: A Student-Driven Process

Self-regulated learning is process by which learners are proactive participants in the learning process.  Characteristics associated with self-regulated learning include (4):

  • an awareness of one’s strengths and weaknesses broadly related to efficacious learning strategies (e.g., note-taking)
  • the ability to set specific learning goals and determine the most appropriate learning strategies to accomplish goals
  • self-monitoring of progress toward achieving goals
  • fostering an environment favorable to achieving goals
  • efficient use of time
  • self-reflect of achievement and an awareness of causation (strategies à learning)

The last characteristic above, in particular, is vitally important for development of self-regulation: self-reflection results in an appreciation of cause/effect with regard to learning and mastery of content, which is then transferrable to achievement of novel future goals.  Applied to undergraduate physiology education, students learn how to learn physiology.

At one point recently I was curious about student perceptions of course design and what strategies students utilized when they had content-related questions.  The following question was asked as part of an anonymous extra credit activity:

The results of this informal survey suggest that, at least in this cohort , undergraduate students generally did have a strategy in place when they had content-related questions—utilization of online resources, the textbook, or the instructor via e-mail to review how others have answered the question.  The good news (if we can call it that) is that only one student reported giving up and did not attempt to find answers to questions.  However, it is interesting to see that only 14% of respondents reported using critical thinking and reasoning to independently determine an explanation for their original question.  Extrapolating to a professional setting, would I want my health care provider to be proficient at looking up information that correlates with signs and symptoms of disease, or would I prefer my health care provider capable of synthesizing a diagnosis?  Thus, self-regulation and having an action plan to determine the answer for a particular question (or at least where to find an answer) may only be part of the learning process.

 

Self-Efficacy: A Belief in One’s Ability to Achieve a Defined Goal

While self-regulation refers to a collection of self-selected strategies an individual may use to enhance learning, self-efficacy is the confidence that the individual possesses the ability to successfully apply them.

Artino (1) has posed the following practices associated with building self-efficacy in medical education.

  • Help students with the goal-setting process, which could be related to learning or the development of skills and competencies; facilitate the generation of realistic and achievable goals
  • Provide constructive feedback, identifying specific areas for which students are demonstrating high performance and areas for improvement
  • Provide mechanisms to compare self-efficacy to actual performance; this could take the form of instructor feedback, metacognitive strategies, self-assessments, and self-reflections
  • Use peer modeling and vicarious learning; best practices would be to use peers at a similar level of competence who are able to demonstrate successful achievement of a learning goal

I am interested in the relationships between self-regulated learning, self-efficacy, how students learn physiology, and tangentially student perceptions of my role as the instructor.   Thus, here is another example of a self-reflection activity that was offered in an online class-wide discussion forum as extra credit (Hint: extra credit seems to be a sure-fire way to promote student engagement in self-reflection).  Once students responded to the prompt shown below, they were able to review other student’s responses.  Following the due date, I diplomatically consolidated all responses into a “peer suggestions for how to learn physiology” handout.

Three outcomes were in mind when creating this activity:

  1. To encourage students to think about the control they have over their own learning and recognize specific practices they can utilize to empower learning; also peer modeling of learning strategies
  2. To set reasonable expectations for what I can do as the instructor to foster learning, and what I cannot do (I would make it easy to understand all physiological processes, if only I could…)
  3. To plant the seed that course activities build content knowledge applicable to a future career goal, which hopefully translates into increased motivation for active participation in course activities

 

Beyond Content Knowledge: Integration of Self-Regulation and Self-Efficacy into Course Design

Incorporation of activities to build self-regulation and self-efficacy can be included along with content knowledge in the active learning classroom environment.  Moving away from didactic lecture during class time to a more flexible and dynamic active learning environment provides opportunities to discuss and model different learning strategies.  If incorporated successfully, students may experience increased self-efficacy and self-confidence, setting the precedent for continued gains in academic achievement and subsequently the potential for professional success.

It is also important to consider that what we do in the classroom, in a single course, is just one piece of the undergraduate educational experience.  Currently there is a call for undergraduate physiology programmatic review and development of cohesive curricula to promote knowledge of physiology as well as professional/transferrable skills and competencies directed toward a future career (3).

If the overarching goal of an undergraduate education is development of knowledge, skills, and abilities transferrable to a future career, as well as life-long learning, it is vitally important that discussion of self-regulated learning and self-efficacy are included within the curriculum.   Although this seems a daunting task, it is possible to purposefully design course structure, and indeed programmatic structure, with appropriate activities designed to enhance learning and self-efficacy.  One key suggestion is to make the inclusion of knowledge, skills, and competencies transparent to boost awareness of their importance, throughout the educational experience.  Here is one example of what this could look like:

 

Students frequently focus upon content knowledge, and subsequently their grade as the primary outcome measure, rather than seeing the “big picture” for how the sum total of course activities most likely directly relate to their professional goals.

A second key component to building well-prepared and high achieving undergraduates is to involve your colleagues in this process.  It takes a village, as the saying goes. Talk to your colleagues, decide which course/s will emphasize specific attributes, and also be a united front.  If students hear the same message from multiple faculty, they are more likely to recognize its value.

Finally, course or curricular reform is time-consuming process.  Don’t expect the process to be complete within one semester.  There are many excellent resources related to backward course design, core concepts of physiology as conceptual frameworks for student learning, student-centered activities, etc.  Be purposeful in selecting 1-2 areas upon which to focus at a time.  Try it out for a semester, see how it goes, and refine the process for the next time around.

 

Jennifer Rogers, PhD, ACSM EP-C, EIM-2 received her PhD and post-doctoral training at The University of Iowa (Exercise Science).  She has taught at numerous institutions ranging across the community college, 4-year college, and university- level  higher education spectrum.  Jennifer’s courses have ranged from  small, medium, and large (300+ students) lecture courses, also online, blended, and one-course-at-a-time course delivery formats.  She routinely incorporates web-based learning activities, lecture recordings, student response activities, and other in-class interactive activities into class structure.  Jennifer’s primary teaching interests center around student readiness for learning, qualitative and quantitative evaluation of teaching  strategies, and assessing student perceptions of the learning process.

Dr. Rogers is a Lecturer in the Health & Human Physiology Department at The University of Iowa.  She is the course supervisor for the Human Physiology lecture and lab courses.  Jennifer also teaches Human Anatomy, Applied Exercise Physiology, and other health science-focused courses such as Understanding Human Disease and Nutrition & Health.

  1. Artino AR. Academic self-efficacy: from educational theory to instructional practice. Perspect Med Educ 1:76–85, 2012.
  2. Michael J, Cliff W, McFarland J, Modell H, Wright A. The Core Concepts of Physiology: A New Paradigm for Teaching Physiology. Published on behalf of The American Physiological Society by Springer, 2017.
  3. Wehrwein EA. Setting national guidelines for physiology undergraduate degree programs. Adv Physiol Educ 42: 1-4, 2018.
  4. Zimmerman BJ. Becoming a self-regulated learner: an overview. Theory Into Practice, 41(2): 64-70, 2002.