Category Archives: Undergraduate Physiology

Synchronous and asynchronous experiences in Advanced Exercise Physiology Courses: what teaching tools work best for my students?

Covid-19 caught all of us off guard, but educators were hit particularly hard and uniquely. I already have flipped classroom teaching and active learning, so the transition was not too difficult for me. However, I found myself incorporating many technological innovations. Was I doing too much? Which features were helping my students, and which ones were overwhelming? In this blog, I want to share some of the strategies I used with undergraduate students taking Advanced Exercise Physiology synchronously and asynchronously.

 

Additionally, within this blog, I am sharing the student’s perceptions of these technological innovations. In total, fifty-two students enrolled in different sections of “Advanced Exercise Physiology” culminating undergraduate experience (CUE) were invited to participate in a short survey regarding their learning experiences during this current Spring 2021 semester. A total of thirty-nine (n=39) students completed the confidential survey about whether different technological innovations helped them understand the material and study.

Who completed the survey?

Figure 1: Fifty-two students enrolled either in synchronous or asynchronous undergraduate advanced exercise physiology sections were invited to participate, and thirty-nine (n=39) responses were obtained. Seventy-two percent of the responders were enrolled in the asynchronous section, and 27.78% were enrolled in the synchronous section.

 

 

Video assignment for glucose metabolism

 During pre-COVID-19 times, I would teach using active-learning team-based instruction. For the first team-based assignment, student teams were asked to discuss and explain in easy terms one of the most difficult topics for my students: glucose metabolism. For this activity, I would bring Legos, markers of different colors, magnets, and other toys; and students were asked to use the materials and make a video of the complete oxidation of a glucose molecule. This in-class, graded assignment seem to help students to understand the metabolic pathways.  I modified the project due to distance learning, so each student has to create a video using any material desired to explain in simple words (without chemical formulas). This assignment is based on the constructivism theory of learning. It makes it innovative because the students learned that glucose is a six-carbon molecule that has to be fully “broken down” (oxidated) through different stages. Once they understand the steps, they could “name” each step and each enzyme. Some students used coins, Legos, or wrote down the step while explaining the process verbally. Some examples of the submissions can be seen in the links below:

Example submission glycolysis  one and example complete glucose oxidation.

 Students perception on making a video assignment for glucose metabolism

Figure 2: Students’ responses to the question “Having to make the video of metabolism in assignment two helped me understand glucose metabolism.” 71.43% responded true (it was helpful), and 28.57% responded false (it was not helpful)

 

 

 

Incorporation of Virtual Lab Experiences using Visible Body and Lt Kuracloud platforms.

One of the main concerns for me was to maintain and increase engagement while teaching virtually or remotely. I incorporated the Lt Kuracloud, a platform for interactive assignments, immediate feedback, videos, and physiology laboratory experiences in all my courses. I took advantage of the free trial, and I used it for some assignments. I received unsolicited emails from students expressing how helpful they found these assignments.  I also used Visible Body Anatomy and Physiology, which I used for lectures. I recommended it to students as supplemental material and for self-graded quizzes. Visible Body Anatomy and Physiology is available at no cost to students as our Institution’s library obtained the subscription for all the students.

Students’ perceptions: “How helpful do you find the following features? “

Figure 3: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for assignments in Lt Kuracloud was 79.08/100 (sd= 21), and for Visible Body was 74.74/100 (sd= 24)

 

Old Reliable Discussion Board

I recently completed my training on Quality Matters (QM) certification (1), and so my courses follow the rubrics of QM Higher Education General Standards. Specifically, QM Module 1 suggests using an introductory welcoming video encouraging the students to introduce themselves to the class using a video, a meme, a photo, or text. The best, and probably the only feature on Blackboard to do this is the “Discussion Board.” The discussion board is a great feature that allows students to increase participation. After all, students are the biggest consumers of social media, videos, and memes. The Discussion Board should be the closest FERPA approved version of TikTok or Facebook, right? WRONG! It worked fine for the first thread entitled “welcome,” most of the students responded by typing to answer the questions. Nobody made a voice thread, a meme, or a video. Afterward, I encouraged participation on the discussion board by posting questions and suggesting posting questions on the discussion board. After a few “virtual crickets” on Discussion Board, I quit posting questions there and developed interactive lectures with pop-up quizzes. As expected, Discussion Board was not very popular among my students.

Students’ perceptions: “How helpful do you find the discussion board on Blackboard? “

 Figure 4: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for the discussion board was 43.08/100 (sd= 25).

 Interactive pre-recorded lectures

Pre-recorded lectures are integral components of my synchronous and asynchronous course sections. These are developed using the interactive feature in Camtasia, in which I developed animated lectures. Thus, students are asked to watch the lessons and complete short quizzes that provide immediate feedback. If the concept is mastered, the student continues watching. If not, they are redirected to the lecture or part of the lecture where the concept is explained.

 Students’ perceptions: “How helpful do you find the interactive pre-recorded lectures? “

Figure 5: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for interactive pre-recorded lectures was 79.27/100 (sd= 16.8), and for Visible Body was 81.74/100 (sd= 17.8)

 

Quizlet and Quizlet live game

Like many educators worldwide, I teach my students and support their learning throughout our virtual synchronous meetings. Indeed, this is not easy. One day, as I was finishing my class, I heard screams and laughs! My ten-year-old was having so much fun in his most favorite subject. What is going on? I asked, “it was a close one,” my son said, “I got second place.”  It turned out that he was playing a “Quizlet Game.” Quizlet and Quizlet live have been used by teachers and students to reinforce learned material. I decided to try it, and I created a teacher profile to play games during the remote lectures. Every class, I started a Quizlet game; students use their phones or computers to play a race (team and individual). They play a “race” at the beginning of the class and again at the end of the class. This low-risk activity provides me with important information about misconceptions or concepts that are not mastered yet. Students play again towards the end of the class. This simple activity takes 10 minutes of instruction (5 minutes each “race”). However, it has been proven to be both helpful and fun for the students. Quizlet live was used only in my synchronous classes, but the Quizlet study sets were available to both synchronous and asynchronous sections.

I used this with graduate students enrolled in Human Physiology in the previous semester, and it was a hit! Students loved it, and class after class, this became very competitive. Not only were my students very well prepared for class, but also the competition made it so much fun!

Similar to Quizlet are such programs as Kahoot, Brainscape,  and others that are available for free or very affordable options.

Students’ perceptions: “How helpful do you find Quizlet study sets and Quizlet live? “

Figure 6: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for Quizlet sets was 76.86/100 (sd= 24), and for Quizlet live was 68.31/100 (sd= 28). One limitation is that most responders were students in the asynchronous section who did not participate in Quizlet live games.

 

MS Teams meetings and/or virtual office hours

 I chose Microsoft Teams (MS) for my virtual meetings simply because it is widely adopted at my Institution, and I prefer to keep it simple for students. For my synchronous section, I used a flipped virtual model, in which we meet once per week, and the other day they work on their own on assignments. I did this to avoid screen burnout students in the synchronous section. However, I have been happily surprised with students attending remote classes and the various office hours I provide. Yes, I do provide different office hours; very much this semester, I made every space available on my calendar as extra office hours. I realize that for many, meeting online for “virtual office hours” is more accessible to them (and perhaps less intimidating) than attending office hours in my office, as we did pre-pandemic.

Why did I offer so many office hours? First of all, because I could. Since I can’t conduct research studies with humans during the pandemic, it freed some time I had set aside for data collection to teaching.

Additionally, not driving to and from campus saved me an average of 75 minutes per day, which allowed me to have another office hour option. In reality, I did not use all these hours in meetings with students. Many times nobody needed to meet. However, there were a couple of times in which I’d meet with a student who was struggling. Not with the class or the content. But struggling with life, some students had somebody close to them sick or dying; some lost their job or financial aid, some were working exceptionally long hours as essential workers. For some, isolation was too much. One student, in particular, told me recently, “I do not have any questions today; I just needed some social interaction.” Flexible and various virtual office hours seemed beneficial for students, particularly for those in asynchronous e-learning experiences.

Students’ perceptions: “How helpful do you find the MS Teams meetings and virtual office hours? “

 

Figure 7: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for MS Teams and Virtual Office Hours was 75.86/100 (sd= 21).

 

 

 Conclusions

 Like most higher education instructors, I had to adapt quickly and shift to e-learning due to the pandemic. Fortunately, I had already taught online several times before and introduced several components to my flipped courses. However, I still struggled to find more interactive ways to keep my students engaged. Not only educators have to deal with the mental exhaustion of finding pedagogical tools that work in this new scenario when we have not had the time to produce evidence-based successful approaches to teaching remotely. But also, we are teaching distraught students. From the scarce but rapidly growing literature, we know that “our college students are currently struggling to stay hopeful and positive in the wake of the COVID-19 pandemic” (2). When asked about their feelings during the transition to virtual classes, students reported that they felt “uncertain” (59.5%), “anxious” (50.7%), “nervous” (41.2%), and “sad” (37.2%). (3) We have to teach students that are dealing with a lot of negative emotions and stress. We, educators, are also living with many of those emotions. My goal with this blog was to share some of my experiences teaching virtually and provide some ideas for any physiology educator that may need them.

References

Standards from the Quality Matters Higher Education Rubric, Sixth Edition. Quality Matters. Retrieved from Specific Review Standards from the QM Higher Education Rubric, Sixth Edition

  • Munsell, S. E., O’Malley, L. & Mackey, C. (2020). Coping with COVID. Educational Research: Theory and Practice, 31(3), 101-109.
  • Murphy, L., Eduljee, N. B., Croteau, K. College Student Transition to Synchronous Virtual Classes during the COVID-19 Pandemic in Northeastern United States. Pedagogical Research,5(4), em0078. https://doi.org/10.29333/pr/8485
Dr. Terson de Paleville teaches Advanced Exercise Physiology, Neuromuscular Exercise Physiology, and Human Physiology courses. Her research interests include motor control and exercise-induced neuroplasticity. In particular, Dr. Terson de Paleville has investigated the effects of activity-based therapy on respiratory muscles and trunk motor control after spinal cord injury. Additional research project involves the assessment of the effects of exercise training in elementary and middle school students on balance, visual efficiency, motor proficiency, motor control and behavior in the classroom and at home. Dr. Terson de Paleville is interested in elucidating any links between physical activity and academic skills and performance.

 

Person First Teaching in Physiology

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

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

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

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


Anne Crecelius 
(@DaytonDrC) is an Associate Professor in the Department of Health and Sport Science at the University of Dayton..  She teaches Human Physiology, Introduction to Health Professions, and Research in Sport and Health Science. She returned to her undergraduate alma mater to join the faculty after completing her M.S. and Ph.D. studying Cardiovascular Physiology at Colorado State University.  Her research interest is in the integrative control of muscle blood flow.  She is a member of the American Physiological Society (APS) and on the leadership team for the Physiology Majors Interest Group (P-MIG).
Balancing Coursework, Student Engagement, and Time
Jennifer Rogers, PhD, ACSM EP-C, EIM-2
Associate Professor of Instruction
Director, Human Physiology Undergraduate Curriculum
Department of Health and Human Physiology
University of Iowa

First, a true story. Years ago, when my son was very little, he and his preschool friends invented a game called “What’s In Nick’s Pocket?” Every day before leaving for school my son would select a small treasure to tuck into his pocket.  The other 3- and 4- year olds at school would crowd around and give excited “oooh’s” and “aaah’s” as he presented his offering, which had been carefully selected to delight and amaze his friends.  And so it is with the PECOP blog forum—as each new post arrives in my inbox I wonder with anticipation what educational gem has been mindfully curated by colleagues to share with the PECOP community.

My contribution? Thoughts on the balance between coursework, student engagement, and time.  Student engagement in this context refers to a wide range of activities that exist outside of the traditional classroom that offer valuable opportunities for career exploration and development of professional skills.  Examples include:

  • Internships: either for course credit or independently to gain experience within a particular setting
  • Study Abroad opportunities
  • Participation in a student organization
  • Peer tutor/mentoring programs
  • Research: either as a course-based opportunity or as a lab assistant in a PI’s lab (paid or unpaid)
  • Job experiences: for example, as a certified nursing assistant, medical transcriptionist, emergency medical technician
  • Volunteer and community outreach experiences
  • Job shadowing/clinical observational hours

These are all increasingly popular co-curricular activities that allow students to apply concepts from physiology coursework to real-world scenarios as an important stepping stone to enhance career readiness and often personal development.  At the same time, however, students seem to more frequently communicate that they experience stress, anxiety, and concerns that they “are not at their best,” in part due to balancing coursework demands against time demands for other aspects of their lives.  If you are interested in learning more about the health behaviors and perceptions of college students, one resource is the American College Health Association-National College Health Assessment II (ACHA-NCHA II) Undergraduate Student Reference Group Data Report Fall 2018 (1).  Relevant to this blog, over half of the undergraduates surveyed (57% of 11,107 participants) reported feeling overwhelmed by all they had to do within the past two weeks.

I recently gave an undergraduate physiology education presentation that included this slide.  It was an initial attempt to reconcile how my course, Human Physiology with Lab, (a “time intensive course” I am told), fits within the context of the undergraduate experience.

I was genuinely surprised by the number of undergraduates in the audience who approached me afterward to essentially say “Thank you for recognizing what it feels like to walk in my shoes, it doesn’t seem like [my professors, my PI, my parents] understand the pressure I feel. “

In response, and prior to the changes in higher education following COVID-19, I began to ponder how to balance the necessary disciplinary learning provided by formal physiology coursework and participation in also-valuable experiential opportunities.  The Spring 2020 transition to virtual learning, and planning for academic delivery for Fall 2020 (and beyond), has increased the urgency to revisit these aspects of undergraduate physiology education.  As PECOP bloggers and others have mentioned, this is a significant opportunity to redefine how and what we teach. 

It has been somewhat challenging to me to consider how to restructure my course, specifically the physiology labs, in the post COVID-19 era when lab activities need to be adaptable to either in-person or virtual completion.  My totally-unscientific process to identify areas for change has been the “3-R’s” test. With regard to physiology lab, there may be many important learning objectives:

  • An ability to apply the scientific method to draw conclusions about physiological function
  • The act of collecting data and best practices associated with collection of high-quality data (identification of control variables, volunteer preparation/preparation of the sample prior to testing, knowledge of how to use equipment)
  • Application of basic statistical analyses or qualitative analysis techniques
  • Critical thought and quantitative reasoning to evaluate data
  • How to work collaboratively with others, that may be transferrable to future occupational settings: patients, clients, colleagues
  • Information literacy and how to read and interpret information coming from multiple resources such as scientific journals, online resources, advertisements, and others, and
  • Science communication/the ability to communicate information about human function, in the form of individual or group presentations, written lab reports, poster presentations, formal papers, infographics, mock patient interactions, etc.

Arguably, these are all important lab objectives.  Really important, in fact.

So, what is the 3 R’s test, and how might it help?  The 3 R’s is simply my way of prioritizing.  In order to triage lab objectives, I ask myself: What is Really Important for students to master throughout the semester versus what is Really, Really Important, or even Really, Really, REALLY Important?  For example, if I can only designate one activity that is Really, Really, REALLY Important, which one would it be?  The answer for my particular course is science communication.  It is obviously a matter of semantics, but I like being able to justify that all course activities are still Really Important, even if it is only my inner dialogue.  Going into the unknowns of the Fall semester, this will help me guide how course activities in physiology lab are transformed. 

Another worthy goal, in light of academic stress and allocation of effort for maximum benefit, is to improve the transparency of expectations for students.  A common question that arose during the spring semester was if students would still learn what they needed to in preparation for future coursework or post-graduation opportunities.  The identification of one or two primary learning outcomes (the Really, Really, REALLY important ones) may attenuate feeling overwhelmed by a long list of lab-related skills to master if there is another abrupt shift to virtual instruction mid-semester; course objectives can still be met even if we discontinue in-person lab sessions. 

To return to the original topic of balancing time demands allocated to formal coursework and valuable experiences, the two broad conclusions I have reached fall under the categories what I can do in my own courses and suggestions for conversations to be had at the program level.

In My Courses: COVID-19 has sped up the time course for revisions I had already been considering implementing in physiology labs.  Aligning course activities with what is Really, Really, REALLY important will help me manage preparation efforts for the coming fall semester (and hopefully keep my stress levels manageable).  Another important goal is to improve the transparency of course goals for students, ideally alleviating at least a portion of their course-induced stress through improved allocation of effort.  Ultimately, I hope the lab redesigns reinforce physiology content knowledge AND provide relevant experiences to promote career readiness.  *It is also necessary to emphasize to students that both will require focused time and effort.

At the Program Level:  Earning a degree in physiology is not based on acquired knowledge and skills in a single course, rather it is an end-product of efforts across a range of courses completed across an academic program.  Here are some ideas for program-wide discussion:

  • Faculty should identify the most important course outcome for their respective courses, and we should all meet to talk about it. Distribute program outcomes throughout the courses across the breadth of the program.  (Yes, this is backward design applied to curriculum mapping.)  From the faculty perspective, perhaps this will reduce feeling the need to teach all aspects of physiology within a particular course and instead keep content to a manageable level.  From the student perspective, clear communication of course objectives, in light of content presented within any particular course, may promote “buy in” of effort.  It may also build an awareness that efforts both inside and outside of the classroom are valuable if the specific body of content knowledge and aptitudes developed across the curriculum, relevant for future occupational goals, is tangibly visible.
  • Review experiential/applied learning opportunities. Are there a sufficient number of opportunities embedded within program coursework?  If not, are there other mechanisms available to students, for example opportunities through a Career Center or other institution-specific entities?  Establishing defined pathways for participation may reduce student stress related to not knowing how to find opportunities.  Another option would be to consider whether or not the program would benefit from a career exploration/professional skills development course.  Alternatively, could modules be developed and incorporated into already existing courses? 
  • Lastly, communicate with students the importance of engaging in co-curricular activities that are meaningful to them; this is more important than the number of activities completed. Time is a fixed quantity and must be balanced between competing demands based on personal priorities. 

As we consider course delivery for Fall 2020, the majority of us are reconsidering how we teach our own courses.  There are also likely ongoing conversations with colleagues about plans to navigate coursework in the upcoming semesters.  If everything is changing anyway, why not take a few minutes to share what is Really, Really, REALLY important in your courses?  The result could be an improved undergraduate experience related to balancing the time and effort allocations required for success in the classroom along with opportunities for participation in meaningful experiences.

Reference:

1. American College Health Association. American College Health Association-National College Health Assessment II: Undergraduate Student Reference Group Data Report Fall 2018. Silver Spring, MD: American College Health Association; 2018.

Jennifer Rogers completed 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, 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.

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

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

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

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

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

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

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

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.