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Shifting course expectations as well as the mode of delivery during the spring 2020 COVID-19 pandemic
Kristen L.W. Walton, PhD
Biology Department
Missouri Western State University

COVID-19 (Coronavirus Disease 2019) is caused by infection with SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2).  Current evidence suggests that this zoonotic coronavirus originated in China in late 20191, and it subsequently spread rapidly across the globe, causing significant morbidity and mortality.  To help contain the spread of this virus, many countries have implemented policies and orders aimed at reducing contact between people.  The terms “social distancing” and “flatten the curve” have been rapidly imbued in our culture. Indeed, a Google Trends search shows a significant surge in searches for “social distancing” between the week of March 1-7, 2020 and the week of March 29-April 4, 20202.  In the United States, to help mitigate the rapid spread of SARS-CoV-2, a few colleges and universities began to announce in early March that they would be suspending face-to-face classes and shifting to all-online instruction, and soon most postgraduate institutions in the USA followed suit, including my institution.

In early March, as the situation became recognized as increasingly urgent by the higher education institutions in our region, the administration at my institution, Missouri Western State University (MWSU), made a decision to extend spring break by one week, through March 22.  Then, in the middle of that second week of spring break, the university administration announced that MWSU would cancel all face-to-face classes for the rest of the semester, and students would have several options regarding their grades for the spring 2020 semester3.  Higher education institutions across the USA have grappled with how to handle grades in this unprecedented time.  Students who did not sign up for online classes are finishing their face-to-face courses, in many if not most cases, as hastily-constructed online versions.  Many institutions have chosen to make all classes pass/fail, others have opted to keep letter grades as the only option, and still others, including MWSU, have given students flexible options to choose a pass/fail option or a letter grade.  The MWSU administration also gave faculty flexibility in determining whether to create a “culminating experience” for students who elected to complete their courses. This could mean anything from reducing the amount of content and/or assessments, changing the format of assessments (for example, a final paper in lieu of a final exam), or essentially continuing as originally planned but with online course delivery and assessments.  This flexibility for faculty was intended to recognize that some types of classes are more amenable than others to a shift to online delivery.  Students whose midterm grade was a C or higher could elect to choose the “credit” (pass) grade option for the course if they chose not to complete the culminating experience; students who chose to complete the culminating experience earned a letter grade based on their course grade at the end of the semester.  To increase flexibility for students, this option was available to students up until the last day of classes, April 24.  The deadline for a withdrawal from the class was also extended to April 24.

For me, as a biology faculty member, the flexibility allowed by our administration in how to structure the last five weeks of my classes led to a lot of thought about my courses and how to best achieve the course objectives for each of them.  I spent many hours considering this, discussing options with my colleagues in a socially distant manner, through emails and our first Zoom department meeting, a somewhat difficult transition for our close-knit group of faculty used to frequent in-person conversations.  I also spent time reading a flurry of articles and blog posts about the importance of being understanding of the major disruption to our students’ lives and college experience4; the importance of recognizing the difficulty in creating a high-quality online course experience with a few days’ notice5; and, not to be overlooked, the importance of tending to one’s own needs, both professional and personal, in this high-stress time.  

Depending on one’s personal situation, a faculty member could also be dealing with changes in family schedules and responsibilities due to children who were suddenly not attending school or day care.  Illness could strike any of us or our friends and family members, certainly adding to the stress and anxiety experiences.  Partners could be furloughed as businesses shuttered their doors due to the pandemic.  While some academics touted their ability to be highly productive during the quarantine and even cited the invention of calculus by Sir Isaac Newton during the black plague as inspiration, others pointed out that quarantine is not universally a time when one can focus solely on work and scientific discovery.  This is true for me, on a personal level.  I have two elementary school-aged children whose school closed a week after my university suspended face-to-face classes.  I have had sole responsibility for child care and helping them with their school work at home, while also moving my classes online and maintaining other work responsibilities.  Many of the students in my classes are non-traditional and have similar child care and “home school” responsibilities.  Others have financial stress due to job layoffs, or, conversely, increased work stress and time demands for those working in the health care field.  Another concern is that many of our students have poor access to broadband internet and technology to access class materials online.  Several of my students emailed me during the transition stating that they were using only a smartphone to access course materials and had no access to a laptop or desktop computer, printer, or other technology, and no high-speed internet.

Consideration of my students’ access to technology, stress, and other burdens, as well as the other factors described above led me to make different choices for each of my three classes this spring.  For my honors colloquium, titled, ironically enough, Plagues That Changed the World, my co-instructor and I decided not to try to coordinate the student-led presentations that were scheduled for the last 6 weeks of the semester and instead only required a final paper.  Seven of 13 undergraduates in this course chose the credit grade based on their midterm grade, and did not complete this rather minimal culminating experience. For my upper-division biology majors course, Molecular Basis of Disease, which is a capstone-type elective course that is not a prerequisite for any other classes, I chose to culminate the lab portion by keeping a scheduled lab quiz, but not attempt to recreate the planned five-week group research project.  For the lecture portion of that class, students who elected to complete the culminating experience wrote a literature review article as originally planned and were given one online exam instead of two in-class exams.  Even with this reduced workload, 6 of the 15 undergraduates enrolled in the course chose to take a credit grade and did not complete the course.  My third course this spring, Pathophysiology, is primarily populated by pre-nursing majors and population health majors, with a few pre-health-professions biology majors.  It would not have been appropriate to drop content or assessments of content knowledge from this course, because the overwhelming majority of students in the course needed to learn that content for success in later coursework.  As it happens, I have taught this lecture-only course in an online format in the summer for several years, so transitioning it to an online delivery mode was relatively easy, with a few exceptions: increased modes of accessing the material, and exams.  I have structured the all-online previous version of that class to be asynchronous, based on knowledge of my student population, many of whom work full time while also taking classes.  I felt that was still the best choice in these uncertain times.  However, in addition to posting video lectures, I downloaded the audio-only podcasts and posted them separately for students who did not have regular high-speed internet access or were working solely from a smartphone with a small screen.  I also made additional course notes available.  

As for the exams, I have always required proctored exams in the online version of this course, and structured them similarly to the written exams taken by students in the traditional, face-to-face version of the course.  Proctored online exams would not have been feasible in the COVID-19-induced chaos that ensued in late March and early April, as some of my students were moving home many states away, finding themselves under self-quarantine, caring for family members, etc., and I myself had schedule considerations to juggle with children and their school work and Zoom meetings which competed for our limited bandwidth home internet.  I tried to strike a balance between several considerations:  best practices for online unproctored exams, such as making them open-book and not easily Google-able; the format and level of rigor students were used to from the first two written, face-to-face exams; and being mindful of unequal access to technology among my students.  In this class, 81 of 86 undergraduates completed the culminating experience, a high proportion driven largely by the requirement of their specific majors for a letter grade in this required course.

As I write this, I still have several papers to grade and final course grades to enter.  I can say with certainty, however, that the choices for assessments and content coverage that I made for my Pathophysiology course did not appear to substantially disadvantage the majority of students, and the course grade distribution will be noticeably higher than usual, aside from the small number of students who did not complete the course.  Several of my colleagues have observed similar increases in their course grades this semester.  In that course, I erred on the side of leniency with the exams, but since I could not in good conscience drop content from that course – pre-nursing students still need to have learned about diseases of the digestive tract, even if COVID-19 interrupted their semester! – I am comfortable that they will at least have a reasonable degree of preparation for their subsequent courses.  For my other two courses, grades will not be higher and in some cases students submitted work that was of lower quality than I expected from their work earlier in the semester.  I strongly suspect that many students who chose to complete those courses did not have the focus or the ability to do so as well as they would have in the face-to-face courses.  I do not have survey data to help clarify what the students were thinking, but I suspect the students who needed the letter grade for subsequent coursework approached this altered, online part of the semester differently from those who were only taking an elective where a credit grade would suffice or a GPA issue was not anticipated.  Informal feedback from all three of my classes included several students commenting about how they did not sign up for online classes because they prefer traditional-format classes, comments about family issues (helping children with school work, moving back home because of job loss, stressful quarantine situations), and comments about missing deadlines because of work or other outside responsibilities.

Although I still need to submit my final course grades for the spring 2020 semester, the summer session is already looming.  My institution chose a few weeks ago to offer only 100% online summer classes, so my usual summer online Pathophysiology class will need to have exam structure revamped away from the written, proctored format that I have previously used.  In addition, many institutions including my own are having discussions about the fall semester.  At this time, we just don’t know what the COVID-19 situation will be in late August.  We have been told to prepare for something unusual, whether it will be a fully online semester, a restructured semester with two or three shorter block sessions, or some other plan.  In preparing for that, I will be considering these questions for each of my classes:

1. How can the course learning objectives best be accomplished in an altered course format?

2. What are the best ways to transition a heavily hands-on lab course to an online or shortened course format?

3. What are the needs of the student population in this course?

4. What is the appropriate balance between flexibility versus maintaining appropriate expectations in the course?

Considering the course goals and learning objectives is a critical component of any course design or transition to a different format, and the course may need to change if the different format is not amenable to the original goals and learning objectives.  In this time of forced transitions to altered course structures and the impacts of COVID-19 mitigation strategies on us and our students, choices might be different from the choices we would otherwise make. It’s also important for faculty, administrators, and students to recognize that different types of courses may be more or less easy to convert to an all-online format.  And while online instruction can be excellent and perhaps this experience will encourage broader use of certain online course components in future face-to-face classes for many faculty, it is not the “college experience” that many students expect and there is speculation among higher education administrators that enrollments will be down this fall, adding to the financial distress that many universities and colleges are already experiencing. Although I have read some opinion pieces that higher education should use this spring as a springboard to shift to more online courses permanently, I would argue that it’s also important to recognize that a large proportion of our students and faculty, myself included, strongly prefer those face-to-face classes and hope to return to them as soon as we can.  I am certain that as a global community of physiology educators we will continue to interact and support each other as we navigate all of the upcoming transitions.

References:

Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5:536–44.

Google Trends, search term “social distancing”. URL  https://trends.google.com/trends/explore?geo=US&q=social%20distancing  , accessed April 30, 2020.

Missouri Western State University COVID-19 information. URL https://www.missouriwestern.edu/covid-19/keep-learning/ , accessed April 30, 2020.

Barrett-Fox, Rebecca. “Please do a bad job of putting your classes online” URL https://anygoodthing.com/2020/03/12/please-do-a-bad-job-of-putting-your-courses-online/ , accessed April 30, 2020. 

Darby, F.  5 Low-tech, time-saving ways to teach online during COVID-19.  The Chronicle of Higher Education  URL  https://www.chronicle.com/article/5-Low-Tech-Time-Saving-Ways/248519  accessed April 30, 2020.

Kristen Walton is a Professor in the Biology Department at Missouri Western State University.  She earned her PhD in Physiology from the University of North Carolina-Chapel Hill in 2001 and was a SPIRE (Seeding Postdoctoral Innovators in Research and Education) Postdoctoral Fellow at UNC-Chapel Hill from 2001-2006.   In 2006, she began her current position at Missouri Western State University, a primarily undergraduate institution.  She has taught a variety of undergraduate courses including animal physiology, pathophysiology, immunology, molecular basis of disease, introductory cell biology, public health microbiology, and human anatomy & physiology.  Her research interests are in intestinal inflammation and inflammatory bowel disease, and in discipline-based education research.

A Sabbatical in Australia Cut Short and the Rapid Transition of Course Delivery of an Australian University due to the COVID-19 Global Pandemic
Emilio Badoer, PhD
Professor of Neuropharmacology
School of Health & Biomedical Science with the College of Science, Engineering & Health
Royal Melbourne Institute of Technology (RMIT) University, Bundoora (Melbourne, Victoria, Australia)

Patricia A. Halpin, PhD
Associate Professor of Biological Science and Biotechnology & Visiting Associate Professor at RMIT University
Department of Life Sciences, University of New Hampshire at Manchester (Manchester, NH)

I was thrilled to spend my sabbatical performing education research at RMIT University in Australia during the spring semester of 2020. I met my collaborator Emilio Badoer at the APS ITL in 2016 and at that time we vowed to collaborate someday. I had a smooth flight to Melbourne AU and as we left the airport, I got my first view of the city covered in a smoky haze from the bushfires to the north1. The radio broadcast playing on the car stereo was alerting everyone to the tropical cyclones headed for the east coast and these would soon cause massive flooding in New South Wales. “Welcome to Australia” Emilio said, little did we know at the time that the worst was yet to come. The COVID-19 outbreak in China had caused Australia to close its borders on February 12,3 to foreign nationals who had left or transited through mainland China.  I arrived February 9 and the focus of my attention was the excitement and anticipation of starting our two research projects.  At my small college, my courses usually enroll 10-24 students, at RMIT our first study was working with a large nursing class (n =368) with the primary goal of using Twitter to engage them outside of class with the course content. 

The nursing cohort started two weeks prior to the start of the term, and in the third week, the students went on clinical placements for five weeks. This course is team-taught and Emilio taught during the first two-week period so that content was the focus of our research for this study. We designed the study to collect data using paper surveys to be distributed at face-to-face class meetings at the beginning and end of the term to ensure a high rate of survey completion. The second study performed with his Pharmacology of Therapeutics class (n=140) started on March 2 with one face-to-face meeting followed by four weeks of flipped teaching (FT). During the FT period, we would engage them on Twitter with course content and they would meet during weekly face-to-face Lectorial sessions for review during the usual scheduled class time.  Students completed the paper pre-survey in the first class meeting and the scheduled paper post-surveys were to be distributed during the final Lectorial sessions on March 19 and 20.  Then on Monday March 16th everything changed; Victoria declared a state of emergency to combat the COVID-19 pandemic4 and Qantas announced that they would cancel 90% of their international flights5, with the remaining flights cancelled on March 31. 

I was contacted by friends and family back home urging me to come home right away. RMIT announced the decision that learning would go online starting March 23. In the United States, colleges had previously announced that students heading home for spring break should stay home as their classes would be delivered online due to the COVID-19 concerns 6. The faculty at the US schools had spring break to prepare the transition of their course content for the new delivery mode. At RMIT, they had recently started their semester with no spring break normally scheduled and the only break on the horizon was the distant Easter holiday (April 10-13) long weekend. Our hopes for data collection were quickly dashed as during the last Lectorial sessions only a few students attended, and we would not be able to survey the nursing students in person when they returned from placements.

My focus shifted to leaving the country as soon as possible. The only way to change my airline ticket home was through a travel agent and my personal travel agent spent a total of 11.5 h on hold with Qantas over a two-day period to secure my ticket home. I left Australia with hordes of anxious Americans. The airports were overwhelmed as we formed long lines trying to check in and then go through security. Everyone had a story to tell of how they had to cut their trip short and then changed their tickets. In Los Angeles I was joined by more Americans who were coming from New Zealand. Many of the American travelers were undergraduates very disappointed that their universities had called them home and they were leaving their semester abroad adventures. We would all soon arrive home safely to a country living in a new reality.

Meanwhile, in Australia, the situation at universities evolved rapidly. In line with the Australian Government mandate, students were told that all new arrivals into the country must self-isolate for 14 days effective March 16. Public gatherings of over 500 people were no longer allowed. Although universities were specifically exempt from this requirement, RMIT University proactively cancelled or postponed any events that were not related to the core business of learning, teaching and research. It also foreshadowed a progressive transition to lectures being delivered online where possible.  The University also indicated that students would not be disadvantaged if they chose not to attend face-to-face classes during the week of March 16. In response to the rapid changes occurring internationally, on March 20, the Australian Government restricted all non-Australian citizens and non-Australian residents from entering the country.  While Australian Universities could remain open and operating it was clear that this would not last for long 7. In response, RMIT University mandated that from Monday March 23 lectures were to be made available online but tutorials and seminars and non-specialist workshops could continue face-to-face until March 30.

On Sunday March 22 the State Government of Victoria (where the main RMIT University campus is based) mandated the shutdown of all non-essential activity from Tuesday March 24 to combat the spread of COVID-19 7. Immediately, RMIT University suspended all face-to-face learning and teaching activity on all its Australian campuses. Overnight, faculty became online teaching facilitators. Emilio produced and is continuing to produce new videos (15-30 minutes duration) covering the content normally delivered during the face-to-face large lecture session. Each week 3-5 videos are produced and uploaded onto Canvas (RMIT’s online learning management system) for the students. 

Unlike many of the US schools that are using Zoom, RMIT is using Collaborate Ultra within Canvas as its way of connecting with students on a weekly basis. Collaborate Ultra has the ability to create breakout groups and faculty can assign students to a specific breakout group or allow students to self-allocate to a specific breakout group. Emilio has allowed students to move between breakout groups to increase engagement. The only stipulation was to limit the group size usually to no more than six. Each student was originally registered to attend one small group Lectorial session that meets once per week for one hour and these groups have between 45-50 students each. The Lectorials were replaced by Collaborate Ultra sessions that were organized for the same times and dates as the normally scheduled small Lectorial sessions. The students and facilitators would all meet in the so-called “main room” where Emilio would outline the plans for the session. The main room session was conducted with Emilio’s video turned on so the students were ‘invited “into his home” and could feel connected with him. Dress code was also important. Emilio was conscious of wearing smart casual apparel as he would have worn had he been facing the students in a face-to-face session. In this way he attempted to simulate the normal pre-COVID-19 environment.

Following the introductory remarks outlining the tasks for the session, students were ‘sent’ to their breakout rooms to discuss and work on the first problem / task discussed in the main room. The analogy used by Emilio was that the breakout rooms were akin to the tables that were used in their collaborative teaching space in which he normally conducted the Lectorial sessions. Each table in that space accommodated approximately six students (hence the stipulation of no more than six in each breakout group). Emilio and another moderator ‘popped’ into each breakout room to guide and facilitate the students in their discussions. To date, the level of engagement and discussion amongst the students themselves generally appears to be much greater than that observed at face-to-face sessions which was a fantastic surprise. After a set time had elapsed, students re-assembled in the main room where the task was discussed with the whole class. This ensured that all students understood the requirements of the task and they had addressed all points that were needed to complete the task to the satisfactory standard. Next followed another task that differed from the first providing variety and maintaining the interest of the students.

Examples of tasks performed.

1 – Practice exam questions

A short answer question requiring a detailed response that would normally take at least 10 minutes in an exam environment to answer properly. Such questions were based on that week’s lecture (now video) course content and was contextualized in a scenario in which physiological/pathophysiological conditions were described and the pharmacological treatments needed to be discussed in terms of mechanisms of action, adverse effects, potential drug interactions or pharmacogenomic influences etc.

2 – Multiple choice questions – Quizzes

Emilio ran these using the Kahoot platform. By sharing his screen, Emilio could conduct such quizzes live providing instant feedback on student progress. This allowed Emilio to provide formative feedback, correct any misconceptions and discuss topics. Additionally, students were able to gauge their own learning progress. These tasks were performed in the main room with all participants.

3 – Completing sentences or matching answers

These could be done effectively in the breakout rooms, where a ‘lead’ student could utilize the whiteboard function in Collaborate Ultra which allowed all students in the group the opportunity to write on the whiteboard allowing discussion regarding the answers written.

4 – Filling in the gaps

Here Emilio would share his screen in which a diagram / figure / a schematic of a pathway etc. with labels/ information missing was provided and students were asked to screenshot the shared information. Then in breakout rooms, one student shared the captured screen shot with the group and the missing information was completed by the members of the group.

The Collaborate Ultra sessions were also utilized to provide students with a platform in which group work could be performed. With a lockdown in force and gatherings of groups forbidden, this utility was very important for enabling connection between students working on group projects. It also provided a sense of belonging within the student cohort.

In conclusion, with minimal preparation, a huge Australian University converted face-to-face teaching and learning to an online digital teaching and learning environment where working remotely was the new norm. It is almost inconceivable just a few short weeks ago that such a transformation could have happened in the timeframe that it did. It is a truly remarkable achievement.  

References

1 Alexander, H and Moir N. (December 20, 2019). ‘The monster’: a short history of Australia’s biggest forest fire. Sydney Morning Herald Retrieved on April 10, 2020 from https://www.smh.com.au/national/nsw/the-monster-a-short-history-of-australia-s-biggest-forest-fire-20191218-p53l4y.html

2 Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV) (Jan. 30, 2020). Retrieved on April 10, 2020 from https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)

3 Travel Restrictions on China Due to COVID-19 (April 6, 2020). Retrieved on April 10, 2020 from https://www.thinkglobalhealth.org/article/travel-restrictions-china-due-covid-19

4 Premier of Victoria, State of Emergency Declared in Victoria Over COVID-19. (March 16, 2020) Retrieved on April 10, 2020 from https://www.premier.vic.gov.au/state-of-emergency-declared-in-victoria-over-covid-19/

5 Qantas and Jetstar slash 90 per cent of international flights due to corona virus (March 16, 2020). Retrieved on April 10, 2020 from https://www.abc.net.au/news/2020-03-17/qantas-coronavirus-cuts-capacity-by-90-per-cent/12062328

6 Hartocollis A. (March 11, 2020). ‘An Eviction Notice’: Chaos After Colleges Tell Students to Stay Away. The New York Times. Retrieved on April 10, 2020 from  https://www.nytimes.com/2020/03/11/us/colleges-cancel-classes-coronavirus.html

7 Worthington B (March 22, 2020). Coronavirus crackdown to force mass closures of pubs, clubs, churches and indoor sporting venues. Retrieved on April 10, 2020 from https://www.abc.net.au/news/2020-03-22/major-coronavirus-crackdown-to-close-churches-pubs-clubs/12079610

Professor Badoer has held numerous teaching and learning leadership roles including many years as the Program Coordinator for the undergraduate Pharmaceutical Sciences Program at RMIT University in Bundoora AU and he coordinates several courses. He is an innovative instructor that enjoys the interactions with students and teaching scholarship. He has also taught pharmacology and physiology at Melbourne and Monash Universities. In addition, he supervises several postgraduate students, Honours students and Postdoctoral Fellows.

Patricia A. Halpin is an Associate Professor in the Life Sciences Department at the University of New Hampshire at Manchester (UNHM). Patricia received her MS and Ph.D. in Physiology at the University of Connecticut. She completed a postdoctoral fellowship at Dartmouth Medical School. After completion of her postdoc she started a family and taught as an adjunct at several NH colleges. She then became a Lecturer at UNHM before becoming an Assistant Professor. She teaches Principles of Biology, Endocrinology, Cell Biology, Animal Physiology, Global Science Explorations and Senior Seminar to undergraduates. She has been a member of APS since 1994 and is currently on the APS Education committee and is active in the Teaching Section. She has participated in Physiology Understanding (PhUn) week at the elementary school level in the US and Australia. She has presented her work on PhUn week, Using Twitter for Science Discussions, and Embedding Professional Skills into Science curriculum at the Experimental Biology meeting and the APS Institute on Teaching and Learning.

Challenges of migrating online amid the COVID-19 pandemic
Ida T. Fonkoue, Ph.D.
Post-Doctoral Fellow, Renal Division
Emory University School of Medicine

Ramon A. Fonkoue, Ph.D.
Associate Professor, French and Cultural Studies
Michigan Technological University

The COVID-19 pandemic has led to a total and sudden reshaping of the academic landscape across the country, with hundreds of institutions moving administration entirely online and shifting to online instruction for the remainder of the spring semester or for both spring and summer. This sudden transition with practically no time to prepare has major implications for students and faculty alike, and poses serious challenges to a smooth transition as well as effective online teaching on such a large scale. Out of these challenges, two issues in particular are examined here: 

By Phil Hill, licensed under CC-BY. See URL in references.
  • the disparity in resources and preparedness for effective online teaching 
  • the implications of the migration to virtual classrooms for diversity and inclusion

Disparity in resources and preparedness for effective online teaching

Teaching an online course requires just as much, if not more, time and energy as traditional classroom courses. It also requires specific IT skills to be effective. Some teachers have managed to achieve great success engaging students online. However, many challenges remain for the average teacher. While online teaching has now been embraced by all higher education institutions and the number of classes offered online has seen a steady growth over the years, it should be noted that until now, instructors and students had the choice between brick and mortar classes and virtual ones. Each could then choose based on their personal preferences and/or circumstances. What makes the recent changes so impactful and consequential is that no choice is left to instructors or students, as the move to online classes is a mandate from the higher administration. Whether one is willing, prepared or ready is irrelevant. It is from this perspective that the question of the preparedness to migrate online is worth examining. 

With academic units ordered to move classes online, instructors who had remained indifferent to the growing trend of online teaching have had a difficult reckoning. They have had to hastily move to online delivery, often with a steep learning curve. This challenge has been compounded in some cases by the technology gap for instructors who haven’t kept their IT skills up to date as well as the school’s preparedness to support online teaching. But even instructors who had some familiarity with learning management systems (LMS) and online delivery have faced their share of challenges. We will only mention two sources of these difficulties: 

  • First, students’ expectations in a context of exclusive online teaching are different from when most online classes took place in the summer, and were attractive to students because of convenience and flexibility. With online classes becoming the norm, students in some universities are taking steps to demand that school administrators pay more attention to quality of instruction and maintain high standards to preserve teaching effectiveness. 
  • Second, instructors can no longer use LMS resources just for the flexibility and benefits they afforded, such as in blended classes or flipped classes. Moving everything online thus requires extra work even for LMS enthusiasts.

For students, there have been some interesting lessons. Until now, it was assumed that Generation Z students (raised in the boom of the internet and social media) we have in our classes have tech skills in their DNA and would be well equipped and ready to migrate online. Surprisingly, this hasn’t been the case across the board, and these first weeks have revealed real discrepancies in student IT equipment with varying consequences for online classes. Equipment failure and problems with access to high speed internet emerge as the most serious difficulties on the students’ side. Furthermore, online learning requires independence and often more self-discipline and self-motivation. Most online courses are not taught in real time, and there are often no set times for classes. While this flexibility makes online classes attractive, it can also be a drawback for students who procrastinate and are unable to follow the course pace. If left to themselves, only the most responsible students will preserve their chances of performing well. On this last point, one unexpected issue has been students who have virtually disappeared from their classes since the migration of courses online amid the COVID-19 pandemic. The current transition has thus presented major challenges for teachers and students alike. 

Implications of the migration to virtual classrooms for diversity and inclusion

The second issue we think deserves attention is the way in which educational institutions’ commitment to diversity and inclusion would play out in virtual classes. While they are now among the professed core values of all colleges and universities across the country, implementing diversity and inclusion in an online environment presents a different set of challenges for both instructors and students. In traditional classrooms, the commitment to diversity and inclusion typically translates into the following:

  • A diversity and inclusion statement from the school must be included in the course syllabus.
  • Instructors must remind students a few rules at the beginning of the course, including: recognition that the classroom is an environment where diversity is acknowledged and valued; tolerance of and respect for diversity of views in the classroom.
  • Sensitivity to and respect for diversity (gender, age, sexual orientation, etc.).
  • Students are asked to be courteous and respectful of different opinions.

In moving into a virtual environment, instructors have to think about the challenges of virtual classrooms and their potential impact on diversity and inclusion. For instance, the faceless nature of course participation and asynchronous delivery may make it easier for participants to disregard or neglect diversity and inclusion rules. Teachers need to reflect on ways to ensure that the virtual space of online classes remains an environment that fosters diversity and inclusion. One drawback of online classes is the potential impact of the relative anonymity on social engagement. In a traditional classroom, participants are constrained by the physical presence of their peers in the confined space of the classroom. The closed physical space of the classroom, combined with the instructor’s authority and peer pressure contribute to fostering discipline. Reflecting on the way online teaching impacts the instructor, one faculty noted: “I didn’t realize how much I rely on walking around the room and making eye contact with students to keep them engaged.” As an online teacher, one lacks the ability to connect physically with students, to read emotional cues and body language that might inform about the individuality of a student. Moreover, a good grasp of the diversity in the classroom and of students’ learning abilities is needed to plan instruction, and give each of them the opportunity to learn and succeed.

Drawing from the above considerations, here are some key questions that instructors should consider as they migrate online: What skills do instructors need to properly address diversity and inclusion online? How do instructors include diversity and inclusion requirements in online course design? How to create an inclusive online classroom? How do instructors attend to diverse students’ needs during instruction? How do they monitor behaviors and enforce diversity and inclusion rules during instruction?

While the migration might have been abrupt, instructors need not seek perfection in moving their courses online. As in traditional classes, what matters the most, from the student’s point of view, is constant communication, clear directions and support from their teachers. Students understand the challenges we all face. They also understand the rules in virtual classes, provided we emphasize them.

References

Hill, Phil (2020), Massive Increase in LMS and Synchronous Video Usage Due to COVID-19. PhilonEdTech. https://philonedtech.com/massive-increase-in-lms-and-synchronous-video-usage-due-to-covid-19/

Greeno, Nathan (2020), Prepare to Move Online (in a Hurry). Inside Higher Ed. https://www.insidehighered.com/views/2020/03/10/prepare-move-online-continuity-planning-coronavirus-and-beyond-opinion


McMurtrie, Beth (2020), The Coronavirus Has Pushed Courses Online. Professors Are Trying Hard to Keep Up. The Chronicle of Higher Education. https://www.chronicle.com/article/The-Coronavirus-Has-Pushed/248299

Dr Ida Fonkoué is a post-doctoral fellow at Emory University School of Medicine in the Laboratory of Dr Jeanie Park. She trained under Dr Jason Carter at Michigan Technological University, where she graduated with a PhD in Biological Sciences in December 2016. She teaches renal physiology classes and lead small groups in the School of Medicine. Her long-term research goal is to understand how the sympathetic nervous system, the vasculature and inflammation interplay to contribute to the high cardiovascular disease risk of patients living with chronic stress, such as those with post-traumatic stress disorder.

Dr. Ramon A Fonkoué is an Associate Professor of French and Cultural Studies and the Director of Graduate Studies in the Department of Humanities at Michigan Technological University. He is also a Visiting Scholar in the department of French and Italian at Emory University. He has been teaching online for 9 years and has experience with blended, flipped and full online classes.

Lighting the Spark: Engaging Medical Students in Renal Physiology
Jessica Dominguez Rieg, PhD
Department of Molecular Pharmacology and Physiology
University of South Florida Morsani College of Medicine

Recently, I spent some time reflecting on the way we teach physiology at my institution. One thing that kept coming to my mind- why does renal physiology get such a bad reputation? We often hear medical students commenting that renal physiology was the hardest topic of the first year, that there’s too much math involved, and concepts like acid-base and electrolyte disorders are too difficult to grasp. Does a negative attitude about renal physiology really matter in the long run? If the students can successfully pass USMLE Step 1, can I rest easy knowing they are competent in understanding how the kidneys function? Or can I, a basic science faculty, make a bigger impact on how these students view the renal system?

Chronic kidney disease is a growing public health concern in the United States, affecting roughly 40 million adults. Given the increasing burden of disease, an aging population, and modern medicine that is keeping patients with end-stage kidney disease alive longer, we need a robust workforce in nephrology. However, the field of nephrology is in the middle of a major crisis, and there is significant concern that there will not be an adequate workforce to meet the healthcare needs of patients afflicted with kidney disease. Only 62% of available nephrology fellowship positions were filled in the 2019 National Resident Matching Program match and less than 45% of positions were filled by U.S. MD graduates, making nephrology one of the least competitive subspecialties1. When does the waning interest in nephrology begin? Many think it starts early in a medical student’s academic journey.

I recently surveyed our medical students at the University of South Florida Morsani College of Medicine (250 respondents) and found that 60% of students agreed or strongly agreed that the topic of nephrology is interesting and yet close to one-third of them agreed or strongly agreed that renal pathophysiology is too complex and challenging for them. When asked what makes the biggest impact on their future career choice, 60% indicated that having role models and mentors in the specialty field was high impact; however, less than half of the students felt they had been exposed to encouraging role models or mentors in nephrology. Students ranked rotations during clerkships as having the highest impact in career choice; and yet our students are first exposed to nephrology during their Internal Medicine clerkship in their 3rd year, which only last 8 weeks. Not surprisingly, students ranked didactics in the preclinical years as having the lowest impact on career choice. What if we can change that? Perhaps there is too little done too late- and we just can’t get enough momentum going to gain a critical mass of students interested in nephrology. Is there anything that we, as medical physiology educators, can do to help? We can light the spark!

1. Make it matter. The complexity of renal physiology must be taught with meaningful clinical context. Students need to understand the clinical importance of what they are learning or there is a high chance they will get turned off from the very beginning. One of the best ways I have found to make it matter, is to work closely with my clinical colleagues. Not only can they provide (and co-teach) examples of how to

2. Make it digestible. Students often get overwhelmed by the level of detail that is expected in the renal block. We must ensure we are giving them the important content in bite-sized pieces so they have time to think about it, apply it, and understand it. I give our students a blank nephron map2 at the beginning of the renal block and ask that they work together to fill it out. On the last day of the renal block, we go through the maps together as a summary of renal function. Students like having all the transporters, hormones and key characteristics about each region of the nephron in one place. It helps them organize their knowledge and also gives them something to refer to in Year 2 and beyond.

3. Make it relatable. At our institution, students get renal physiology at the end of Year 1, so they’ve had all other organ systems besides reproductive physiology. I use many analogies throughout the renal system and always to try to highlight the similarities with the intestinal tract, which they are more familiar with at that point in time. After all, the nephron is like a “mini-intestine”, with similar histological features and transporter profiles. By relating the new renal content to something they’ve seen before, it can help make it a little easier to understand (and allows them to make systemic connections).

4. Make it stick. Students struggle with grasping acid-base disturbances. Consistent repetition and practice problems is key! Many times, students learn multiple ways to approach interpreting acid-base disturbances (different formulas, different values for expected compensatory responses, etc.) depending on who is teaching. This can be frustrating and confusing for students. We have found that having all faculty that teach some aspect of acid-base balance use a single resource, a step-by-step guide to interpreting acid-base disturbances3, has been very helpful in ensuring consistency in what we teach. Students also work through many practice problems in interpretation of arterial blood gases, starting in Year 1, again in Year 2, and again during the clerkships. The result is that students have gone from scoring less than 50% on NBME acid-base questions, to close to 90%- it’s sticking!

5. Make it fun! One of the notoriously challenging lectures in our preclinical years is integration of acid-base, volume, and electrolyte disorders. Traditionally, it was a lecture given by a nephrologist and was very technical and clinically oriented. However, students were lost and overwhelmed. So, I partnered with an internal medicine physician and we revamped the session into a fun, interactive series of cases where we co-facilitated discussion. Students were introduced to the 14th book of Lemony Snicket’s A Series of Unfortunate Events: The Hazardous Hospital, where they were asked to investigate the mysterious health issues of Sir Cornelius. The cases we presented were challenging and framed with very relevant basic science concepts, and students loved it! Not only did they have fun while learning, but they really appreciated having a basic scientist and clinician teaching together.

In conclusion, renal physiology is challenging and may be contributing to a lack of interest in a career in nephrology. As medical physiology educators, we have the ability to work with our clinical colleagues and revamp how we teach the renal system. We can get students engaged and excited about renal physiology by making the content clinically relevant, digestible, relatable and fun. After all, there needs to be a spark to light the fire!

References:

  1. National Resident Matching Program, Results and Data: Specialties Matching Service 2019 Appointment Year. National Resident Matching Program, Washington, DC. 2019
  2. Robinson PG, Newman D, Reitz CL, Vaynberg LZ, Bahga DK, Levitt MH. A large drawing of a nephron for teaching medical students renal physiology, histology, and pharmacology. Advances in Physiology Education. 42:2, 192-199, 2018.
  3. DeWaay D, Gordon J. The ABC’s of ABGs: teaching arterial blood gases to adult learners. MedEdPORTAL. 2011;7:9038.

Dr. Dominguez Rieg is a faculty member in the Department of Molecular Pharmacology & Physiology at the University of South Florida Morsani College of Medicine. She is the Course Director for the Gastrointestinal, Endocrine, Renal and Reproductive Systems block and the Physiology Integration Director that is responsible for mapping physiology content objectives across the entire curriculum. She teaches endocrine, renal and reproductive physiology and renal pathophysiology in multiple courses in the pre-clerkship years. She received her PhD in Physiological Sciences from the University of Arizona. Her research interests are kidney-intestine crosstalk and intestinal function in the context of systemic diseases such as obesity and diabetes. When she’s not at work, she is enjoying time with her young daughter and four German Shepherds.

Can the Flipped Classroom Method of Teaching Influence Students’ Self-Efficacy?
Chaya Gopalan, PhD, FAPS
Associate Professor
Departments of Applied Health, Primary Care & Health Systems
Southern Illinois University Edwardsville

Self-efficacy is the belief in one’s ability to succeed in a specific situation or accomplish a specific task (Bandura, 1977). Students with high self-efficacy have higher motivation to learn and, therefore, are able to reach higher academic goals (Honicke & Broadbent, 2016). Gender, age, and the field of study are some factors that are known to affect self-efficacy (Huang, 2013). Genetics plays a significant role (Waaktaar & Torgersen, 2013). Certain physiological factors such as perceptions of pain, fatigue, and fear may have a marked, deleterious effect on self-efficacy (Vieira, Salvetti, Damiani, & Pimenta, 2014). In fact, research has shown that self-efficacy can be strengthened by positive experiences, such as mastering a skill, observing others performing a specific task, or by constant encouragement (Vishnumolakala, Southam, Treagust, Mocerino, & Qureshi, 2017). Enhancement of self-efficacy may be achieved by the teachers who serve as role models as well as by the use of supportive teaching methods (Miller, Ramirez, & Murdock, 2017). Such boost in self-efficacy helps students achieve higher academic results.

The flipped classroom method of teaching shifts lectures out of class. These lectures are made available for students to access anytime and from anywhere. Students are given the autonomy to preview the content prior to class where they can spend as much time as it takes to learn the concepts. This approach helps students overcome cognitive overload by a lecture-heavy classroom.  It also enables them to take good notes by accessing lecture content as many times as necessary. Since the lecture is moved out of class, the class time becomes available for deep collaborative activities with support from the teacher as well as through interaction with their peers. Additionally, the flipped teaching method allows exposure to content multiple times such as in the form of lecture videos, practice questions, formative assessments, in-class review, and application of pre-class content. The flipped classroom therefore provides a supportive atmosphere for student learning such as repeated exposure to lecture content, total autonomy to use the constantly available lecture content, peer influence, and support from the decentered teacher. These listed benefits of flipped teaching are projected to strengthen self-efficacy which, in turn, is expected to increase students’ academic performance. However, a systematic approach measuring the effectiveness of flipped teaching on self-efficacy is lacking at present.

References:

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review, 84(2), 191.

de Moraes Vieira, É. B., de Góes Salvetti, M., Damiani, L. P., & de Mattos Pimenta, C. A. (2014). Self-efficacy and fear avoidance beliefs in chronic low back pain patients: coexistence and associated factors. Pain Management Nursing, 15(3), 593-602.

Honicke, T., & Broadbent, J. (2016). The influence of academic self-efficacy on academic performance: A systematic review. Educational Research Review, 17, 63-84.

Huang, C. (2013). Gender differences in academic self-efficacy: A meta-analysis. European journal of psychology of education, 28(1), 1-35.

Miller, A. D., Ramirez, E. M., & Murdock, T. B. (2017). The influence of teachers’ self-efficacy on perceptions: Perceived teacher competence and respect and student effort and achievement. Teaching and Teacher Education, 64, 260-269.

Vishnumolakala, V. R., Southam, D. C., Treagust, D. F., Mocerino, M., & Qureshi, S. (2017). Students’ attitudes, self-efficacy and experiences in a modified process-oriented guided inquiry learning undergraduate chemistry classroom. Chemistry Education Research and Practice, 18(2), 340-352.

Waaktaar, T., & Torgersen, S. (2013). Self-efficacy is mainly genetic, not learned: a multiple-rater twin study on the causal structure of general self-efficacy in young people. Twin Research and Human Genetics, 16(3), 651-660.

Dr. Chaya Gopalan received her PhD in Physiology from the University of Glasgow, Scotland. Upon completing two years of postdoctoral training at Michigan State University, she started her teaching career at St. Louis Community College. She is currently teaching at Southern Illinois University Edwardsville. Her teaching is in the areas of anatomy, physiology, and pathophysiology at both undergraduate and graduate levels for health science career programs. Dr. Gopalan has been practicing evidence-based teaching where she has tested team-based learning and case-based learning methodologies and most recently, the flipped classroom. She has received several grants to support her research interest.

Physiology Bumper Stickers for Teaching and Learning
Alice R. Villalobos, BS, PhD
Texas Tech University

As teachers we hope students remember and apply all the physiology they learned in our class.  However, many undergraduate students hope simply to get through this semester of physiology and their other courses.  They dread the amount of material and that ‘so many things go on in the body at one time.’  I asked myself what could be integrated into lecture or lab to help students better learn material in class, study more effectively on their own and ideally, improve recall when taking exams.  Around this time, I attended a teaching workshop focused on short activities and simple tools that could be incorporated into lectures to facilitate learning and recall.  One tool was the ‘bumper sticker’. 

Similar to an actual bumper sticker, the teaching bumper sticker is a short memorable phrase or slogan that encapsulates a thought, principle, or concept.  In this case, a bumper sticker helps students learn and remember a concept or principle.  In all areas of life, we use short sayings or one-liners often of unknown derivation that convey a profound or funny, classic or clever, instructional or encouraging thought.  ‘Righty tighty, lefty loosey.’ means turn the screw to right to tighten and left to loosen.  “I before E except after C.” with the addendum, “… and in words, such as protein or weight.”  Could bumper stickers work in a physiology course?  I already borrowed “Water follows sodium; sodium doesn’t follow water.” from my undergraduate professor.  We all develop short phrases while working on lectures, reading physiology papers and books, or on the fly during lecture.  

Recently, I began using bumper stickers in a more organized manner.  I took a sheet of lined paper, wrote ‘Bumper Stickers for A&P-II’ on the top, and made plenty of copies.  On the first day of class I discussed tips to improve learning and study habits.  I explained the bumper sticker was a teaching/learning tool and gave each student a sheet.  I admitted it was an experiment, but my intention was to give them short phrases to refer to and contemplate when studying on their own or spark a memory on an exam.  That very day we started glycolysis.  The first bumper sticker was “You must spend an ATP to make ATP.”  I explained the first step in glycolysis is phosphorylation, using a phosphate from ATP.  Despite some initial skepticism, bumper stickers caught on and helped many students. 

Rather than repeating your explanation verbatim, students must accurately explain concepts to themselves and others in their own words.  When students study with a partner or in groups, they can refer back to the bumper sticker along with lecture notes, diagrams and textbook to explain the respective concept to each other in their own words and peer-correct.  When students are teaching each other, they are truly ‘getting it’.  Granted, it is essential that students use more exact and scientific vocabulary to describe a mechanism or concept, as is true for any discipline.  For most students this won’t happen the very first time they explain the concept.  Learning physiology or any subject is a process; developing the vocabulary is part of that process.  A memorable bumper sticker is a prompt for stimulating discussion – verbal communication in the context of learning a given physiological mechanism and developing the vocabulary of physiology. 

There is no established technique for the initial delivery of a bumper sticker phrase.  However, its two-fold purpose as a teaching/learning tool is to help students understand and remember a concept; thus, the phrase and initial proclamation must be memorable.  Based on my hits and misses, here are several tips.  First, keep it short, ideally 10 words or less.  Second, timing is key.  Similar to a joke, timing is important but varies with topic and teaching style.  Some use the phrase as a teaser to introduce a topic; others use it to summarize key points.  Third, be as direct as possible and capture students’ full attention.  Some write the phrase on the board or slide and make an announcement, “Listen up.  Write this down.”  Fourth, look directly at your students and state the phrase clearly with meaning, effective voice inflection, dramatic tone, appropriate pause, facial expression, hand gesturing, and/or a little physical comedy.  Fifth, use accurate and scientific terms to explain the meaning of the phrase as it applies to the physiological concept.  This is absolutely critical.  Left to interpretation, students might misunderstand the actual physiological concept.

Bumper stickers for better study and testing strategies

*Use common sense at all times, especially on test day.* At times, students forget obvious and intuitive things.  For example, when applying Boyle’s Law to respiration, don’t forget to breathe.  I remind students that lung volume and intrapulmonary pressure will change such that when we inhale air flows in, and when we exhale air flows out.  Physical laws applied to physiological mechanisms explain relationships among different components of a mechanism, e.g., the pressure of a quantity of gas to its volume.  I assure them, they can and will learn the fundamental physics on which Boyle’s law is based, but keep it simple and remember – when you inhale air flows in, when you exhale air flows out. 

            *Understand the question, before you answer it.* My PhD advisor shared this pearl of wisdom before my qualifying exam.  I encourage students to calmly, slowly and deliberately read the entire question.  On any multiple choice or essay exam, they must be certain of what is being asked, before answering a question.  Do not stop reading the question until you come to a period, question mark or exclamation point.  Students are concerned about wasting precious time.  Slowing down just a bit to answer correctly is worth the time and decreases the odds of second guessing or having to go back to the question.  I make another pitch for reading the text book.  It is a way to practice reading calmly and deliberately and catching differences in font or formatting, e.g., print style, italics, bold, underline, that may indicate key terms for an exam question. 

Bumper stickers for general principles in physiology

*Enough, but not too much.* Many students think every physiological end point is maintained at a constant value.  I explain that various parameters are regulated such that they gently fluctuate within a narrow range.  Plasma sodium must be ‘enough’; if it drops too low osmolarity decreases.  If sodium is ‘too much’, osmolarity increases; plasma volume increases; blood pressure increases.  If an endpoint falls below range, regulatory mechanisms bring it back up into range; should it increase above normal range, regulatory mechanisms bring it back down into range.  

*It’s not a mathematical equation; it’s a relationship.* Many students confess they are ‘really bad at math’ or ‘hate math’.  CO, MAP, renal clearance, alveolar ventilation rate – all math.  Understanding and passing physiology requires math.  I tell students math describes physiological relationships between different factors that regulate or dictate a given endpoint, similar to interactions and relationships among friends or a team.  Actual equations represent precise relationships, e.g., CO = HR x SV.  In that case, cardiac output will increase and decrease in direct proportion to heart rate and stroke volume.  Then there is Poiseuille’s Equation.  Students are not required to memorize that equation, but they must learn and apply the principles of the equation: F α DP, F α 1/R and F α r4.  I clarify the α symbol means ‘in proportion to’, not equals.  I repeat, ‘It’s not a mathematical equation; it’s a relationship.”  I suggest they view a as a hug, and embrace the dependence of blood flow on the pressure gradient, vascular resistance, and the luminal radius.  The 4 means when radius changes even just a little, flow changes a lot!  I provide a more technical explanation of how blood flow can decrease significantly with gentle vasoconstriction and increase with gentle vasodilation; this showcases the essential regulatory role of vascular smooth muscle.  This particular bumper sticker serves to remind them math is critical to our understanding of physiology and hopefully, ease their anxiety.  More math awaits in respiratory physiology, and they revisit and apply F α DP, F α 1/R and F α r4 to air flow.

*Know what abbreviations mean, and don’t make up abbreviations.* I explain the names of hormones, especially, are rich in information.  These names indicate source, stimulus for release, and mechanism of action.  For example, atrial natriuretic peptide, ANP, is a peptide hormone secreted from atrial tissue when plasma volume increases that increases urine output (-uretic) and sodium (natri-) excretion.  Not too creative, but self-explanatory.  Couple it with “Water follows sodium …”; problem solved.  

Bumper stickers for chronological order or sequence

For many cellular and organ mechanisms, there is a strict chronological order of events.  During the cardiac cycle, there is a distinct chronological order for each of several different phenomena that occur simultaneously and interdependently.  I use bumper stickers to teach a basic concept of cardiac physiology that help students learn the cardiac cycle – the electrical~mechanical relationship.  First, I show the entire Wiggers diagram and explain it tracks the series of interrelated electrical and mechanical events as they occur in the same timeline of one heartbeat.  I assure them we will take one panel at a time and pull it altogether at the end.  I start with the relationship of the ECG to the 4 ventricular phases, using a set of bumper sticker phrases that I write on the board.  We review the electrical events of P (atrial depolarization), QRS (ventricular depolarization) and T (ventricular repolarization) deflections.  Then, I say, “Pay attention.  Write down each phrase.”

*Electrical then mechanical.* I explain emphatically that first an electrical signal is transmitted and received, then the atrial or ventricular muscle responds.  In the cardiac cycle, electrical events P, QRS, and T each precede atrial or ventricular responses.  

*Depolarizeàcontract.  Repolarizeàrelax.* I explain depolarization triggers contraction; repolarization leads to relaxation.  P wave signals atrial contraction; QRS complex signals ventricular contraction; T wave signals ventricular relaxation.

*Depolarizeàcontractàincrease pressure.  Repolarizeàrelaxàdecrease pressure.*  I remind them changes in pressure gradients across the atrioventricular and semilunar valves determine whether valves open or close and consequently, whether blood flows into or out of the ventricle.  Depolarization leads to ventricular contraction and in turn, an increase in pressure; repolarization leads to ventricular relaxation and in turn, a decrease in pressure. 

*The AV valve is the fill valve; the semilunar valve is the ejection valve.*  A student thought of this phrase!  She explained, “When the AV valve – tricuspid or mitral – is open during diastole, the ventricle fills with blood from the atrium.  When the semilunar valve – pulmonary or aortic – is open during systole, blood is ejected.”  In that moment I thought my work as a teacher was done; my student is teaching herself and others.  I give her full credit, but use her bumper sticker.  I further explain when the ventricle relaxes and pressure drops below the atrial pressure, the AV valve will open, and blood enters the ventricle; when it contracts ventricular pressure exceeds atrial pressure and the AV valve closes; as it continues to contract, eventually ventricular pressure exceeds aortic pressure, the aortic valves opens, and blood is ejected into the aorta. 

Bumper stickers might not be the right tool for every teacher, student, or topic, or be appropriate for undergraduate versus graduate course.  If you decide to implement this tool, you might not have a bumper sticker for every basic or general physiology concept or mechanism or a set of bumper stickers for every organ system.  You might only use a bumper sticker phrase once or twice in a whole semester.  When used appropriately, they truly can make a difference.  On the other hand – if how you teach is working just fine and your students are getting it – then all I have to say is, “If it ain’t broke, don’t fix it!”

Alice Villalobos received her Bachelors of Science in biology from Loyola Marymount University and her PhD in comparative physiology from the University of Arizona-College of Medicine.  For the past several years, she has taught Anatomy & Physiology-II and Introduction to Human Nutrition in the Department of Biology at Blinn College and guest lectured at Texas A&M University on the topics of brain barrier physiology and heavy metal toxicology.  She recently relocated to Texas Tech University to join the Department of Kinesiology & Sport Management where she teaches Physiological Nutrition for Exercise.

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.

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

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

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


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

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

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

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

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

The Benefits of Learner-Centered Teaching

Jaclyn E. Welles
Cell & Molecular Physiology PhD Candidate
Pennsylvania State University – College of Medicine

In the US, Students at Still Facing Struggles in the STEMs

Literacy in the World Today:
According to the United Nations Educational, Scientific, and Cultural Organization (UNESCO), there are approximately 250 million individuals worldwide, who cannot read, write, or do basic math, despite having been in school for a number of years (5, 8). In fact, UNESCO, is calling this unfortunate situation a “Global Learning Crisis” (7). The fact that a significant number of people are lacking in these fundamental life skills regardless of attending school, shows that part of the problem lies within how students are being taught.

Two Main Styles of Teaching – Learner or Teacher-Centered

Learning and Teaching Styles:
It was due to an early exposure to various education systems that I was able to learn of that there were two main styles of teaching – Learner-centered teaching, and Teacher-centered teaching (2). Even more fascinating, with the different styles of teaching, it has become very clear that there are also various types of learners in any given classroom or lecture setting (2, 6, 10). Surprisingly however, despite the fact that many learners had their own learning “modularity” or learning-style, instructors oftentimes taught their students in a fixed-manner, unwilling or unable to adapt or implement changes to their curriculum. In fact, learner-centered teaching models such as the “VARK/VAK – Visual Learners, Auditory Learners and Kinesthetic Learners”, model by Fleming and Mills created in 1992 (6), was primarily established due to the emerging evidence that learners were versatile in nature.

VARK Model of Learners Consists of Four Main Types of Learners: Visual, Auditory, Reading and Writing, and Tactile/Kinesthetic (touch)

What We Can Do to Improve Learning:
The fundamental truth is that when a student is unable to get what they need to learn efficiently, factors such as “learning curves” – which may actually be skewing the evidence that students are struggling to learn the content, need to be implemented (1, 3). Instead of masking student learning difficulties with curves and extra-credit, we can take a few simple steps during lesson-planning, or prior to teaching new content, to gauge what methods will result in the best natural overall retention and comprehension by students (4, 9). Some of methods with evidence include (2, 9):

  • Concept Maps – Students Breakdown the Structure or Organization of a Concept
  • Concept Inventories – Short Answer Questions Specific to a Concept
  • Self-Assessments – Short Answer/Multiple Choice Questions
  • Inquiry-Based Projects – Students Investigate Concept in a Hands-On Project

All in all, by combining both previously established teaching methodologies with some of these newer, simple methods of gauging your students’ baseline knowledge and making the necessary adjustments to teaching methods to fit the needs of a given student population or class, you may find that a significant portion of the difficulties that can occur with students and learning such as – poor comprehension, retention, and engagement, can be eliminated (4, 9) .

Jaclyn Welles is a PhD student in Cellular and Molecular Physiology at the Pennsylvania State University – College of Medicine. She has received many awards and accolades on her work so far promoting outreach in science and education, including the 2019 Student Educator Award from PSCoM.

Her thesis work in the lab of Scot Kimball, focuses on liver physiology and nutrition; mainly how nutrients in our diet, can play a role in influencing mRNA translation in the liver. 

An inventory of meaningful lives of discovery

by Jessica M. Ibarra

I always had this curiosity about life. Since the very beginning, always wanting to understand how animals’ breathe, how they live, how they move. All that was living was very interesting. – Dr. Ibarra

“I always had this curiosity about life and I wanted to become a doctor, but my parent told me it was not a good idea,” Lise Bankir explained in her interview for the Living History Project of the American Physiological Society (APS).  The video interview (video length: 37.14 min.) is part of a rich collection over 100 senior members of the APS who have made outstanding contributions to the science of physiology and the profession. 

The archive gives us great insight into how these scientists chose their fields of study.  As Dr. Bankir, an accomplished renal physiologist, explain how she ended up “studying the consequences of vasopressin on the kidney.”  She describes her work in a 1984 paper realizing “high protein was deleterious for the kidney, because it induces hyperfiltration,” which of course now we accept that high protein accelerates the progression of kidney disease. Later she describes her Aha! moment, linking a high protein diet to urea concentration, while on holiday. 

“It came to my mind that this adverse effect of high protein diet was due to the fact that the kidney not only to excrete urea (which is the end product of proteins), but also to concentrate urea in the urine.  Because the plasma level of urea is already really low and the daily load of urea that humans excrete need that urea be concentrated about 100-fold (in the urine with respect to plasma).” 

Other interviews highlight how far ahead of their time other scientists were.  As is the case when it comes to being way ahead of teaching innovations and active learning in physiology with  Dr. Beverly Bishop.  In her video interview, you can take inspiration from her 50 years of teaching neurophysiology to physical therapy and dental students at SUNY in New York (video length: 1 hr. 06.09 min.).  Learn about how she met her husband, how she started her career, and her time in Scotland.  Dr. Bishop believed students could learn better with experimental laboratory activities and years ahead of YouTube, she developed a series of “Illustrated Lectures in Neurophysiology” available through APS to help faculty worldwide.

She was even way ahead of others in the field of neurophysiology.  Dr. Bishop explains, “everyone knows that they (expiratory muscles) are not very active when you are sitting around breathing quietly, and yet the minute you have to increase ventilation (for whatever reason), the abdominal muscles have to play a part to have active expiration.  So, the question I had to answer was, “How are those muscles smart enough to know enough to turn on?” Her work led to ground breaking work in neural control of the respiratory muscles, neural plasticity, jaw movements, and masticatory muscle activity.

Another interview shed light on a successful career of discovery and their implications to understanding disease, as is the case with the video interview of Dr. Judith S. Bond. She describes the discovery of meprins proteases as her most significant contribution to science (video length: 37.38 min.), “and as you know, both in terms of kidney disease and intestinal disease, we have found very specific functions of the protease.  And uh, one of the functions, in terms of the intestinal disease relates to uh inflammatory bowel disease.  One of the subunits, meprin, alpha subunit, is a candidate gene for IBD and particularly ulcerative colitis. And so that opens up a window to – that might have significance to the treatment of ulcerative colitis.”

Or perhaps you may want to know about the life and research of Dr. Bodil Schmidt-Nielsen, the first woman president of the APS (video length: 1 hr. 18.07 min.) and daughter of August and Marie Krogh.  In her interview, she describes her transition from dentistry to field work to study water balance on desert animals and how she took her family in a van to the Arizona desert and while pregnant developed a desert laboratory and measured water loss in kangaroo rats.  Dr. Schmidt-Nielsen was attracted to the early discoveries she made in desert animals, namely that these animals had specific adaptations to reduce their expenditure of water to an absolute minimum to survive. 

The Living History Project managed to secure video interviews with so many outstanding contributors to physiology including John B. West, Francois Abboud, Charles Tipton,  Barbara Horwitz, Lois Jane Heller, and L. Gabriel Navar to name a few.  For years to come, the archive provides the opportunity to learn from their collective wisdom, discoveries, family influences, career paths, and entries into science. 

As the 15th anniversary of the project approaches, we celebrate the life, contributions, dedication, ingenuity, and passion for science shared by this distinguished group of physiologists.  It is my hope you find inspiration, renewed interest, and feed your curiosity for science by taking the time to watch a few of these video interviews. 

Dr. Jessica M. Ibarra is an Assistant Professor of Physiology at Dell Medical School in the Department of Medical Education of The University of Texas at Austin.  She teaches physiology to first year medical students.  She earned her B.S. in Biology from the University of Texas at San Antonio.  Subsequently, she pursued her Ph.D. studies at the University of Texas Health Science Center in San Antonio where she also completed a postdoctoral fellowship.  Her research studies explored cardiac extracellular matrix remodeling and inflammatory factors involved in chronic diseases such as arthritis and diabetes.  When she is not teaching, she inspires students to be curious about science during Physiology Understanding Week in the hopes of inspiring the next generation of scientists and physicians. Dr. Ibarra is a native of San Antonio and is married to Armando Ibarra.  Together they are the proud parents of three adult children – Ryan, Brianna, and Christian Ibarra.