Tag Archives: classroom culture

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.
Creating Unique Learning Opportunities by Integrating Adaptive Learning Courseware into Supplemental Instruction Sessions

Teaching a large (nearly 400 students), introductory survey course in human anatomy and physiology is a lot like trying to hit a constantly moving target. Once you work out a solution or better path for one issue, a new one takes its place. You could also imagine a roulette wheel with the following slots: student-faculty ratios, student preparation, increasing enrollments, finite resources, limited dissection specimen availability (e.g., cats), textbook prices, online homework, assessment, adaptive courseware, core competencies, learning outcomes, engagement, supplemental instruction, prerequisites, DFW rates, teaching assistants, Dunning Kruger effect, open educational resources, GroupMe, student motivation, encouraging good study habits, core concepts, aging equipment … and the list goes on.

If the ball lands on your slot, are you a winner or loser?

Before getting ahead of myself, I need to provide an overview of A&P at the University of Mississippi. Fall semesters start with 390 students enrolled in A&P I within one lecture section, 13 lab sections at 30 students each, anywhere from 10-13 undergraduate teaching assistants, 2 supplemental instruction (SI) leaders, and at least six, one-hour SI sessions each week. The unusual class size and number of lab sections is the result of maxing out lecture auditorium as well as lab classroom capacities. I am typically the only instructor during the fall (A&P I) and spring (A&P II) terms, while a colleague teaches during the summer terms. The two courses are at the sophomore-level and can be used to fulfill general education requirements. There are no prerequisites for A&P I, but students must earn a C or better in A&P I to move on to A&P II. Approximately one-third of the students are allied health (e.g., pre-nursing) and nutrition majors, one-third are exercise science majors, and the remaining one-third of students could be majoring in anything from traditional sciences (e.g., Biology, Chemistry, etc.) to mathematics or art.

The university supports a Supplemental Instruction program through the Center for Excellence in Teaching and Learning (https://cetl.olemiss.edu/supplemental-instruction/). The SI program provides an extra boost for students in historically demanding courses such as freshman biology, chemistry, physics, accounting, etc. SI leaders have successfully passed the courses with a grade of B or better, have been recommended to the program by their professors, agree to attend all lectures for the courses in which they will be an SI leader, and offer three weekly, one-hour guided study sessions that are free to all students enrolled in the course. SI leaders undergo training through Center for Excellence in Teaching and Learning and meet weekly with the course professor. Students who regularly attend SI sessions perform one-letter grade higher than students who do not attend SI sessions.

It can be as easy for an instructor to be overwhelmed by the teaching side of A&P as it is for the student to be overwhelmed by the learning side! I know that a major key to student success in anatomy and physiology courses is consistent, mental retrieval practice across multiple formats (e.g., lectures, labs, diagrams, models, dissection specimens, etc.). The more a student practices retrieving and using straightforward information, albeit a lot of it, the more likely a student will develop consistent, correct use. Self-discipline is required to learn that there are multiple examples, rather than one, of “normal” anatomy and physiology. However, few students know what disciplined study means beyond reading the book and going over their notes a few times.

To provide a model for disciplined study that can be used and implemented by all students, I developed weekly study plans for A&P I and II. These study plans list a variety of required as well as optional activities and assignments, many of which are completed using our online courseware (Pearson’s Mastering A&P) and include space for students to write completion dates. If students complete each task, they would spend approximately 10 out-of-class hours in focused, manageable activities such as:

  • Completion of active learning worksheets that correlate to learning outcomes and can be used as flashcards.
  • Practice assignments that can be taken multiple times in preparation for lecture exams and lab practicals.
  • Self-study using the virtual cadaver, photographic atlas of anatomical models, interactive animations of physiological processes, virtual lab experiments, and dissection videos.
  • Regular graded assignments aligned with course learning outcomes.

Weekly study plans are also useful during office visits with students. I can easily assess student progress and identify changes for immediate and long-term improvement. An advantage of using online courseware to support course objectives is the ability to link various elements of the courses (e.g., lecture, lab, SI sessions, online homework, group study, and self-study) with a consistent platform.

All of this sounds like a great sequence of courses, doesn’t it? Yet, the target has kept moving and the roulette wheel has kept spinning. Imagine for the story within this blog that the roulette ball has landed on “using adaptive courseware to improve supplemental instruction.”

In 2016 the University of Mississippi was one of eight universities chosen by the Bill and Melinda Gates Foundation with support of the Association for Public and Land-Grant Universities to increase the use of adaptive courseware in historically demanding general education courses. Thus, began the university’s PLATO (Personalized Learning & Adaptive Teaching Opportunities) Program (https://plato.olemiss.edu/). The PLATO grant provides support for instructors to effectively incorporate adaptive courseware into their courses and personalize learning for all affected students. Administrators of the grant were particularly supportive of instructors who could use adaptive courseware to support the SI sessions. This challenge was my personal roulette ball.

I decided to use diagnostic results from Mastering A&P graded homework assignments to prepare for weekly meetings with SI leaders. Diagnostic data on percent of University of Mississippi students correctly answering each question as well as percent of UM students answering incorrect options are compared to the global performance of all Mastering A&P users. For each question incorrectly answered by more than 50% of the students, I write a short (4-6 sentences) explanation of where students are making errors in expressing or using their knowledge and how to prevent similar errors in the future. I then searched for active learning activities and teaching tips associated with the challenging questions from the LifeSciTRC (https://www.lifescitrc.org/) and Human Anatomy and Physiology Society (HAPS; https://www.hapsweb.org/) websites. I specifically search for active learning exercises that can be conducted in a small, group setting using widely available classroom resources (e.g., white board, sticky notes, the students, etc.).

By using online courseware diagnostics, selecting focused learning activities, and communicating regularly with SI leaders, I was able to create value and unique learning opportunities for each student. The SI session format has been extremely well-received by the students and they immediately see the purpose in the study session experience. The best part is that it takes me only 30-40 minutes each week to write up explanations for the diagnostics and find the best learning activities.

I would say that we are all winners with this spin of the wheel.

Carol Britson received her B.S. from Iowa State University and her M.S. and Ph.D. from the University of Memphis. She has been in the Department of Biology at the University of Mississippi for 22 years where she teaches Vertebrate Histology, Human Anatomy, Introductory Physiology, and Human Anatomy and Physiology I and II. In 2018 she received the University of Mississippi Excellence in Teaching award from the PLATO (Personalized Learning & Adaptive Teaching Opportunities) Program supported by the Association of Public and Land-Grant Universities and the Bill and Melinda Gates Foundation.
Affective Teaching and Motivational Instruction: Becoming More Effective Educators of Science

As educators, we’re intimately familiar with learning objectives such as, “Using Fick’s principle, calculate the diffusion of a substance across a membrane.” Also, as scientists, we are familiar with technical objectives such as, “Using a micropipette, transfer 5μL of Solution A into the chromatography chamber.” In terms of learning conditions, the first is an intellectual skill and the second is a motor skill.1 One area in which we don’t often give much thought is the third type of skill that was identified by Gagné and Medsker — the affective skill. This is the area that is most often neglected by educators because it is the hardest to evaluate and quantify. We can’t explicitly say to a student, “By the end of the semester you will develop a love of physiology.” We can hope to achieve this through the semester, but as educators, the best that we can do is hope to instill these attitudes, choices, and values in our learners that persist beyond our brief time with them in the classroom.

Instilling attitudes in our learners is a complex goal. This is, in part, because stating an affective goal is at times counterproductive to the goal and interferes with learning. In the example above, it is clearly ridiculous to expect that all students will leave our classrooms with a true passion for our subject matter. Some clearly will, but others will not. That will be shaped by the attitudes with which students enter our classrooms. Those attitudes consist of the knowledge that a learner has about a subject – the cognitive aspect, how the person feels about the subject — the affective aspect, and how the person behaves in response to those influences — the behavioral aspect.2 So despite our best interests to instill a care for the animal and human models we frequently use in experiments, it is completely beyond our ability to control the behavior of our learners outside of the classroom. That doesn’t mean that we shouldn’t still try because the majority of our students will come away with those lessons intact. Additionally, affective learning is difficult to assess. We can test the knowledge and skills necessary and ask about student feelings3, but at the end of the day, our students will make a choice on their behaviors on their own. For that reason, we should not make affective learning objectives part of our formal instruction plan. Because there are so many methods that depend on the affect you might want to influence, I’m going to focus on two areas that are most common: attitude and motivational instruction.

 

Katz and Stotland identified five types of attitudes.4 These types of attitudes vary with differing levels of affective and cognitive components, but the key takeaway is that individual experiences and the results and consequences of previous choices dramatically shape the attitudes with which our learners enter our classrooms. Reward for behavior not only reinforces the behavior, but also the cognitive and behavioral components that drive that behavior.1 When we focus purely on the cognitive and the motor skill aspects of learning, we can often get away with a fair amount of do-as-I-say-not-as-I-do-style instruction. The problem with this is that students look to the faculty and other instructors for role model behavior.  Thus, the more accurately that we reflect the attitudes that we want to instill in our learners, the more the students will reflect those ideals.3 One of the easiest ways to bring about these changes of attitudes are through in-class discussions.5 This positive benefit is most likely due to differences that are raised during discussion, sometimes prompting the discovery of a discrepancy between existing attitudes in a learner and new facts that are being presented. The learners then have a choice on how to adapt to the new desired attitudes. Most importantly, never underestimate group acceptance of attitudes, as immediate social reinforcement can be a powerful driver in solidifying attitudes.

 

Having discussed attitude, motivational instruction is another key area that is relevant to affective learning. No two students enter the classroom with the same motivation. One student may be enrolled in your class because of a deep passion for your subject matter while another is there simply to satisfy a requirement for their major. This mix of intrinsic and extrinsic motivations will drive the overall outcomes of affective learning. The student who is highly motivated by an intrinsic interest in your subject or the student who is extrinsically driven by the reward of a good grade (or fear of a bad grade) will generally excel in class, albeit for different reasons. The student who is there out of obligation to meet a requirement may have very little motivation to do anything beyond what is required of them to get by. To help with those students who are lacking in motivation, JM Keller broke motivational instruction into four components: attention, relevance, confidence and satisfaction.6 Gaining the attention of students through demonstrations, discussions, and other active learning techniques may help keep student motivation high. Practical application of concepts and ideas will generally inspire higher motivation than abstract or arbitrary examples.7 Keeping the material relevant will generate motivation for intrinsic learners by providing self-improvement and for the extrinsic learners by providing a reward, such as doing well on the exam. Confidence is a harder area to approach, as students must first believe they are capable of meeting the stated objectives. Making the material too easy will not lead to feelings of accomplishment, while making the material too challenging will undermine confidence in all learners.1 Finally, satisfaction can be achieved by learners of all types, regardless of motivation type when outcomes match objectives. Keeping motivation high by providing opportunities to apply learning will drive further motivation to continue learning.

Last week I completed a comprehensive review of our capstone thesis writing course, which has changed dramatically over the past year and a half while I have been the course director. Initially, the goal of the course was to have students write a literature research paper on a physiological topic of their choosing where their grade was entirely dependent upon the finished paper. The students were frequently frustrated with a lack of guidance in the course and the faculty regularly complained about the burden of reading papers of sometimes-questionable quality. Clearly there were issues with the affective components of this course from both the student and faculty side. I’ve de-emphasized the actual paper and refocused the course on the process of writing with stated learning outcomes such as: 1) Develop the language that helps us talk about science; 2) Strengthen research skills to become educated consumers of science; and 3) Gain specialized knowledge in a selected area of physiological research. Focusing the course in this way has yielded measurable results in course evaluations and faculty perceptions of paper quality from the students. By focusing on the affective components of writing and giving students more opportunities to apply their new skills, overall satisfaction has improved. Like all works of science, though, this course continues to evolve and improve. In short, to be effective teachers, we need to go beyond the intellectual and motor skills and make sure we address the affective learning of our students as well.

1 Gagné RM and Medsker LK. (1996). The Conditions of Learning. Training Applications. Fort Worth: Harcourt Brace College Publishers.

2 Baron RA and Byrne D. (1987). Social Psychology: Understanding Human interaction. 5th ed. Boston: Allyn and Bacon.

3 Dick W and Carey L. (1996). The Systematic Design of Instruction. 4th ed. New York: HarperCollins Publishers.

4 Katz D and Stotland E. (1959). A preliminary statement to a theory of attitude structure and change. In Psychology: A Study of Science. vol 3. New York: McGraw-Hill.

5 Conrad CF. (1982). Undergraduate Instruction. In Encyclopedia of Educational Research. 5th ed. New York: The Free Press.

6 Keller JM. (1987). Development and use of the ARCS model of instructional design. Journal of Instructional Development. 10;3. 2-10.

7 Martin BL and Briggs LJ. (1986). The Affective and Cognitive Domains: Integration for Instruction and Research. Englewood Cliffs, New Jersey: Educational Technology Publications.

Ryan Downey is an Assistant Professor in the Department of Pharmacology & Physiology at Georgetown University. As part of those duties, he is the Co-Director for the Master of Science in Physiology and a Team Leader for the Special Master’s Program in Physiology. He teaches cardiovascular and neuroscience in the graduate physiology courses. He received his Ph.D. in Integrative Biology from UT Southwestern Medical Center. His research interests are in the sympathetic control of cardiovascular function during exercise and in improving science pedagogy. When he’s not working, he is a certified scuba instructor and participates in triathlons.
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.
Stress and adaptation to curricular changes

 

 

 

…there was a teacher interested in enhancing the learning process of his students. He wanted to see them develop skills beyond routine memorization. With the support of colleagues and the education team at his university, he succeeded and chose a semi-flipped classroom approach that allowed him to introduce novel curricular changes that did not generate much resistance on the part of the students.

The change was made. The students apparently benefited from the course. They worked in groups and learned cooperatively and collaboratively. Students evaluated peers and learned to improve their own work in the process. They not only learned the topics of the class, but also improved their communication skills.

At some point the institution asked the teacher to teach another course. He happily did so, and based on his experience introduced some of the changes of his semi-flipped classroom into the new course. The students in this course were slightly younger and had not been exposed to education in biomedical sciences. To the teacher’s surprise, the students showed a lot of resistance to change. The sessions moved slowly, the test scores were not all that good, and students did not reach the expected outcomes. It was clear that the teacher and the students were going through a period of considerable stress, while adapting to the new model. Students and teachers worked hard but the results did not improve at the expected rate.

Some time ago this was my experience and as I wandered looking for solutions, I started to question the benefits of active learning and the role of stress in educational practice.

Advantages and challenges of active learning

Evidence says that active learning significantly improves student outcomes (higher grades and lower failure rates) and may also promote critical thinking and high level cognitive skills (1, 2). These are essential components of a curriculum that attempts to promote professionalism. However, it may be quite problematic to introduce active learning in settings in which professors and students are used to traditional/passive learning (2).

Some of the biggest challenges for teachers are the following:

  • To learn about backward design of educational activities
  • To think carefully about the expected accomplishments of students
  • To find an efficient way to evaluate student learning
  • To spend the time finding the best strategies for teaching, guiding, and evaluating students.
  • To recognize their limitations. For example, it is possible that despite their expertise, some teachers cannot answer the students’ questions. This is not necessarily bad; in fact, these circumstances should motivate teachers to seek alternatives to clarify the doubts of students. At this point, teachers become role models of professionals who seek to learn continuously.
  • To learn about innovations and disruptive technologies that can improve the teacher role.

Some of the challenges for students include:

  • Understanding their leading role in the learning process
  • Working hard but efficiently to acquire complex skills
  • Reflecting on the effectiveness of their learning methods (metacognition). Usually reading is not enough to learn, and students should look for ways to actively process the information.
  • Trusting (critically) on the methods made available by the teachers to guide their learning. For example, some tasks may seem simple or too complex, but teachers have the experience to choose the right methodology. A work from our team showed that strategies that seem very simple for the student (clay modeling) have a favorable impact on learning outcomes (3).
  • Seeking timely advice and support from teachers, tutors and mentors.

Working to overcome these challenges may generate a high level of stress on students and teachers. Without emphasizing that stress is a desirable trait, I do find that some disturbance in the traditional learning process and risk taking motivate teachers and students to improve their methods.

Intermediate disturbance hypothesis and stress in education

In the twentieth century, the work of Joseph H. Connell became famous for describing factors associated with the diversity of species in an ecosystem (4). Some of his observations were presented in Charles Duhigg’s book “Smarter Faster Better” which discusses circumstances related to effective teamwork (5). Duhigg reports that Connell, a biologist, found that in corals and forests there might be patches where species diversity increases markedly. Curiously, these patches appear after a disturbance in the ecosystem. For example, trees falling in a forest can facilitate the access of light to surface plants and allow the growth of species that otherwise could not survive (5). Connell’s work suggests that species diversity increases under circumstances that cause intermediate stress in the ecosystem. In situations of low stress, one species can become dominant and eradicate other species, whereas in situations of high stress, even the strongest species may not survive. But if, an intermediate stress where to appear, not very strong and not very weak, the diversity of species in an ecosystem could flourish.

I propose that the hypothesis of the intermediate disturbance can also be applied in education. In traditional learning, an individual (ecosystem) learns to react to the challenges presented and develops a method for passing a course. In situations of low stress, memorization (evaluated at the lower levels of Miller´s pyramid) may be enough to pass a course. In high stress level situations, students may drop out or feel inadequate. However, courses that involve active learning may include moderate challenges (intermediate disturbance). These well-managed challenges can motivate the student to develop more complex skills (diversity of species) that lead to effective learning and a broader professional development.

 

 

 

 

 

 

 

 

 

Figure 1. Intermediate disturbance hypothesis in education.

 

In the book “Problem-based learning, how to gain the most from PBL”, Donald Woods describes the challenges and stresses associated with the incorporation of active learning (PBL) in a curriculum (6). He describes the stages of grief that a student (and I add, a teacher) must go through while adapting to the new system. This adaptation can take months and generally is characterized by the following phases:

  • Shock
  • Denial
  • Strong emotion (including depression, panic and anger)
  • Resistance to change
  • Acceptance and resignation to change
  • Struggle to advance in the process
  • Perception of improvement in the expected performance
  • Incorporation of new habits and skills to professional practice

 

 

 

 

 

 

 

 

 

Figure 2. Performance adjustment after curricular changes. Adapted and modified from (6).

 

Properly managing stress and finding strategies to advance in the process are rewarded by achieving better performance once the students become familiar with the new method of active learning. However, to better adapt to curricular or pedagogical changes, it is important for all the education actors to recognize the importance of deliberate work and to have clear goals. In addition, students and teachers should have access to institutional strategies to promote effective time, and anger and frustration management.

Stress is not ideal, but some stress may motivate students and teachers to reevaluate their methods and ultimately work together for a classroom focused on professional excellence. The critical question is how big is the intermediate disturbance needed to improve learning outcomes. As is commonly concluded in papers, more research is needed to answer this question, and we can learn a lot from the theories and methods from our colleagues in Biology.

References

  1. Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, et al. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A. 2014;111(23):8410-5.
  2. Michael J. Where’s the evidence that active learning works? Adv Physiol Educ. 2006;30(4):159-67.
  3. Akle V, Pena-Silva RA, Valencia DM, Rincon-Perez CW. Validation of clay modeling as a learning tool for the periventricular structures of the human brain. Anat Sci Educ. 2017.
  4. Connell JH. Diversity in Tropical Rain Forests and Coral Reefs. Science. 1978;199(4335):1302-10.
  5. Duhigg C. Smarter Faster Better: Random House; 2016.
  6. Woods DR. Problem Based Learning: How to gain the most from PBL. 2nd. ed1997.
Ricardo A. Peña-Silva M.D., PhD is an associate professor at the Universidad de los Andes, School of Medicine in Bogota, Colombia, where he is the coordinator of the physiology and pharmacology courses for second-year medical students. He received his doctorate in Pharmacology from The University of Iowa in Iowa City. His research interests are in aging, hypertension, cerebrovascular disease and medical education. He works in incorporation and evaluation of educational technology in biomedical education.

He enjoys spending time with his kids. Outside the office he likes running and riding his bicycle in the Colombian mountains.

Establishing rapport with your class BEFORE they are your class

shutterstock_124813237Think back to some of the best courses/semesters you’ve ever had teaching (or as a student). I can almost guarantee that you fondly remember several of the students who were in the class. You would recognize them today even if you have had thousands of students since they last sat in your classroom. You probably remember specific interactions that you had. Maybe (after they were out of your class and preferably graduated, you even accepted their Facebook friend requests) Why? What made those students so memorable? Maybe it was a common academic interest or passion, some sort of unique personality trait, or maybe some unexplainable, unseen force that developed organically that you can’t pinpoint and think you can never purposefully recreate in future courses. Well, I’m here to tell you that you just might be able to recreate it. In fact, you can actually manufacture it for your future courses. While it does sound like cheating, it will help make your class successful for all of the other students as well.

With the beginning of the fall semester approaching, the first few days of your course will set the stage for the next 16 weeks. Obviously being well-prepared with the syllabus, course objectives, and course schedule well organized and outlined for the students is necessary as Angelina eloquently outlined in the previous article. Further outlining the expectations of yourself as the instructor and the students as the learners will help to start your course on the right trajectory. But a classroom success strategy that is easy to overlook, especially in the hectic first days of the semester, is building an early rapport between yourself and the students. While building rapport with the students comes more easily for some than for others (we all have that colleague who seems to naturally have the right combination of wit, charm, and caring and who never seems to have a problem engaging students), numerous factors contribute to its development, and nearly all of them can be planned for and controlled, manufactured if you will. I did not realize to what extent this was true until very recently though.

Generally, I have a good rapport with most of my classes and my Individual Development and Educational Assessment (IDEA) evaluation scores seem to indicate that is the case. However, the impetus for this article came after I struggled through my recent summer session course. I was left questioning my teaching abilities after every one of the 20, 2-hour-long class meeting times. Since I had taught the course multiple times, in the same time slot, and used all of the same strategies and more in attempts to connect and engage with the students like I successfully had in previous courses, I was baffled as to what the difference might be. Why was this one section so much less engaged, less likely to ask questions, less enthusiastic about the various activities, less likely to stop by my office, and less likely to e-mail with non-course related physiology questions? I had done everything that the literature recommends to develop rapport with students, but after my own post-hoc course evaluation and some serious introspection, I have an idea of what went wrong. I had not laid the ground work to build rapport with even one single student BEFORE the class began. While great articles do exist on building rapport in the classroom (see Meyers 2009 and Buskist & Saville 2001), few of them discuss how to build rapport before you’re in the classroom. It’s easier than you realize.

Thinking back to some of the best classes I’ve ever taught, I realized that I have always had at least one “go-to” student from the very first day of class, a student who I knew was reasonably comfortable speaking up in front of the whole class. I would use this student as a bellwether for the whole class in the first couple of days, posing questions directly to him or her and asking for comments and feedback. Inevitably, this would show other students that it was okay to speak up, make comments, and ask questions. Usually this student is pretty outgoing, but not always. Usually this student is good academically, but not always. Sometimes this student could be defined as the “class clown,” but not always. Almost always, however, I have known or at least communicated with this student before the semester has begun. Sometimes the student was in a previous class I taught or was my advisee, but often it is just a student who had trouble registering or had a question that required coming to my office before the first day of class. How did these students become my go-to students? What did I do to make these my go-to students? What makes them different? I have no idea honestly, but something about that first interaction, however innocuous, enables it to occur. Considering my past go-to students, I’ve come up with the three main ways that you can make sure that this interaction occurs in your class.

  1. During the advising and registration period (often the semester before), encourage students that you know to enroll in your class.
    • If you’re an advisor for students who might take your course this is actually pretty easy. Identify several students who might be able to fit your course into their schedules. Encourage them. “I really would enjoy it if you were able to take my course.” I have found this to be a very effective way to get students who are already comfortable speaking with me into my class. Not an advisor? E-mail students you’ve had in other courses or you’ve worked with in some other capacity.
  2. Prior to the semester start, someone is bound to e-mail or stop by your office to ask about your course, tell you he/she is having trouble registering, ask about a textbook, etc. Use this as an opportunity.
    • Obviously in these situations learn the student’s name, but also ask a couple other questions. “How’s your semester going?” “How was your summer?” “What makes you interested in this class?” “Is that shirt from that local 5k? You like running?” These interactions might seem like meaningless chit-chat, but they can really lay the foundations for classroom rapport later on. Latch on to anything the student says that you might be able to use later in class. Now you know you have a runner that went to the beach over summer. Great! You teach a physiology class and now you have a wealth of information that can make your lecture relevant to that student…and likely many more. Mention the student by name when you bring up the topic.
  3. Once you receive your class roster, look at it! E-mail the students even if it is weeks before the course starts.
    • Scan through your roster looking for students you’ve had previously or otherwise know. Send them individual e-mails and tell them you’re glad they’ll be in your class. Look at each student’s major, minor, even club affiliations if you have access. Take note of anything you can use later. Craft an e-mail to all the students to introduce yourself. “Hi! I’m Ed Merritt and I’ll be your professor for exercise physiology. I’m really looking forward to meeting everyone. Looking at the roster I see we have several nutrition majors in this class. Remind me to tell you a story about the time I ate a doughnut right before a hard workout. I also see we have a British literature major. Don’t worry. I’ll find a good story for you too! Let me know if you have any questions or concerns before the first day, otherwise I’ll see you soon!”

These three strategies alone will almost always insure that you have a go-to student for the first day of class. Use this connection. Call on him or her by name and show the class that you care about that student. The class won’t know that this is your go-to student, but once you have your go-to student engaged the rest of the class is much more likely to engage. Rapport is contagious, and once you have it with the class, teaching the material is much more enjoyable, and the student outcomes are much better. And hopefully you won’t have to suffer through a semester questioning your teaching abilities after every class.

Good luck with the upcoming semester!

 

References

Meyers SA. Do Your Students Care Whether You Care about Them? College Teaching, v57 n4 p205-210. 2009.

Buskist W, Saville BK. Creating positive emotional contexts for enhancing teaching and learning. APS Observer. p12-13. 2001.

 

PECOP Merritt picture
 

 

Ed Merritt is an assistant professor in the Department of Health and Exercise Science at Appalachian State University in Boone, North Carolina. Ed received his doctorate in Kinesiology from the University of Texas at Austin and completed a postdoctoral fellowship in Cellular and Integrative Biology at the University of Alabama at Birmingham. Ed’s research focuses on the molecular underpinnings of skeletal muscle atrophy after trauma and with aging, but he is also equally involved in the scholarship of teaching and learning and melding educational outreach activities with service learning.