Tag Archives: Vision and Change

Protecting yourself means more than a mask; should classes be moved outside?

Mari K. Hopper, PhD
Associate Dean for Biomedical Science
Sam Houston State University College of Osteopathic Medicine

Disruption sparks creativity and innovation. For example, in hopes of curbing viral spread by moving classroom instruction outdoors, one Texas University recently purchased “circus tents” to use as temporary outdoor classrooms.

Although circus tents may be a creative solution… solving one problem may inadvertently create another. Moving events outdoors may be effective in reducing viral spread, but it also increases the skin’s exposure to harmful ultraviolet (UV) radiation from the sun. The skin, our body’s largest organ by weight, is vulnerable to injury. For the skin to remain effective in its role of protecting us from pollutants, microbes, and excessive fluid loss – we must protect it.

It is well known that UV radiation, including UVA and UVB, has deleterious effects including sunburn, premature wrinkling and age spots, and most importantly an increased risk of developing skin cancer.

Although most of the solar radiation passing through the earth’s atmosphere is UVA, both UVA and UVB cause damage. This damage includes disruption of DNA resulting in the formation of dimers and generation of a DNA repair response. This response may include apoptosis of cells and the release of a number of inflammatory markers such as prostaglandins, histamine, reactive oxygen species, and bradykinin. This classic inflammatory response promotes vasodilation, edema, and the red, hot, and painful condition we refer to as “sun burn.”^1,2

Prevention of sunburn is relatively easy and inexpensive. Best practice is to apply broad spectrum sunscreen (blocks both UVA and UVB) 30 minutes before exposure, and reapply every 90 minutes. Most dermatologists recommend using SPF (sun protection factor) of at least 30. Generally speaking, an SPF of 30 will prevent redness for approximately 30 times longer than without the sunscreen. An important point is that the sunscreen must be reapplied to maintain its protection.

There are two basic formulations for sunscreen: chemical and physical. Chemical formulations are designed to be easier to rub into the skin. Chemical sunscreens act similar to a sponge as they “absorb” UV radiation and initiate a chemical reaction which transforms energy from UV rays into heat. Heat generated is then released from the skin.³ This type of sunscreen product typically contains one or more of the following active ingredient organic compounds: oxybenzone, avobenzone, octisalate, octocrylene, homosalate, and octinoxate. Physical sunscreens work by acting as a shield. This type of sunscreen sits on the surface of the skin and deflects the UV rays. Active ingredients zinc oxide and/or titanium dioxide act in this way.⁴ It’s interesting to note that some sunscreens include an expiration date – and others do not. It is reassuring that the FDA requires sunscreen to retain their original “strength” for three or more years.

In addition to sunscreen, clothing is effective in blocking UV skin exposure. Darker fabrics with denser weaves are effective, and so too are today’s specially designed fabrics. These special fabrics are tested in the laboratory to determine the ultraviolet protection factor (UPF) which is similar to SPF for sunscreen. A fabric must carry a UPF rating of at least 30 to qualify for the Skin Cancer Foundation’s Seal of Recommendation. A UPF of 50 allows just 1/50th of the UV rays to penetrate (effectively blocking 98%). Some articles of clothing are produced with a finish that will wash out over time. Other fabrics have inherent properties that block UV rays and remain relatively unchanged due to washing (some loss of protection over time is unavoidable) – be careful to read the clothing label.

Some individuals prefer relying on protective clothing instead of sunscreen due to concerns about vitamin D synthesis. Vitamin D activation in the body includes an important chemical conversion stimulated by UV exposure in the skin – and there is concern that sunscreen interferes with this conversion. However, several studies, including a recent review by Neale, et al., concluded that use of sunscreen in natural conditions is NOT associated with vitamin D deficiency.5,6 The authors did go on to note that at the time of publication, they could not find trials testing the high SPF sunscreens that are widely available today (current products available for purchase include SPFs over 100).

Additional concern about use of sunscreens includes systemic absorption of potentially toxic chemicals found in sunscreen. A recent randomized clinical trial conducted by Matta and colleagues investigated the systemic absorption and pharmacokinetics of six active sunscreen ingredients under single and maximal use conditions. Seven Product formulations included lotion, aerosol spray, non-aerosol spray, and pump spray. Their study found that in response to repeat application over 75% of the body surface area, all 6 of the tested active ingredients were absorbed systemically. In this study, plasma concentrations surpassed the current FDA threshold for potentially waiving some of the additional safety studies for sunscreen. The authors went on to note that the data is difficult to translate to common use and further studies are needed. It is important to note that the authors also conclude that due to associated risk for development of skin cancer, we should continue to use sunscreen.

Yet another concern for using sunscreen is the potential for harmful environmental and human health impact. Sunscreen products that include organic UV filters have been implicated in adverse reactions in coral and fish, allergic reactions, and possible endocrine disruption.8,9 In some areas, specific sunscreen products are now being banned (for example, beginning January of 2021, Hawaii will ban products that include oxybenzone and octinoxate). As there are alternatives to the use of various organic compounds, there is a need to continue to monitor and weigh the benefit verses the potential negative effects.

Although the use of sunscreen is being questioned, there is the potential for a decline in use to be associated with an increase in skin cancer. Skin cancer, although on the decline in recent years, is the most common type of cancer in the U.S. It is estimated that more than 3 million people in the United States are diagnosed with skin cancers each year (cancer.net). Although this is fewer than the current number of Americans diagnosed with COVID-19 (Centers for Disease Control and Prevention, July 20, 2020) – changes in human behavior during the pandemic (spending more time outdoors) may inadvertently result in an increase in the number of skin cancer cases in future years.

While we responsibly counter the impact of COVID-19 by wearing masks, socially distancing, and congregating outdoors – we must also continue to protect ourselves from damaging effects of the sun. As physiologists, we are called upon to continue to investigate the physiological impacts of various sunscreen delivery modes (lotion, aerosol, non-aerosol spray, and pumps) and SPF formulations. We are also challenged to investigate inadvertent and potentially negative impacts of sunscreen including altered Vitamin D metabolism, systemic absorption of organic chemicals, and potentially adverse environmental and health outcomes.

Again, solving one problem may create another challenge – the work of a physiologist is never done!

Stay safe friends!

Mari

References:

Lopes DM, McMahon SB. Ultraviolet radiation on the skin: a painful experience? CNS neuroscience & therapeutics. 2016;22(2):118-126.
Dawes JM, Calvo M, Perkins JR, et al. CXCL5 mediates UVB irradiation–induced pain. Science translational medicine. 2011;3(90):90ra60-90ra60.
Kimbrough DR. The photochemistry of sunscreens. Journal of chemical education. 1997;74(1):51.
Tsuzuki T, Nearn M, Trotter G. Substantially visibly transparent topical physical sunscreen formulation. In: Google Patents; 2003.
Passeron T, Bouillon R, Callender V, et al. Sunscreen photoprotection and vitamin D status. British Journal of Dermatology. 2019;181(5):916-931.
Neale RE, Khan SR, Lucas RM, Waterhouse M, Whiteman DC, Olsen CM. The effect of sunscreen on vitamin D: a review. British Journal of Dermatology. 2019;181(5):907-915.
Matta MK, Florian J, Zusterzeel R, et al. Effect of sunscreen application on plasma concentration of sunscreen active ingredients: a randomized clinical trial. Jama. 2020;323(3):256-267.
Schneider SL, Lim HW. Review of environmental effects of oxybenzone and other sunscreen active ingredients. Journal of the American Academy of Dermatology. 2019;80(1):266-271.
DiNardo JC, Downs CA. Dermatological and environmental toxicological impact of the sunscreen ingredient oxybenzone/benzophenone‐3. Journal of cosmetic dermatology. 2018;17(1):15-19.

All images from:
Royalty Free Stock Pictures – Public Domain Images
www.dreamstime.com/

Prior to accepting the Dean’s positon at Sam Houston State University, Dr Hopper taught physiology and served as the Director of Student Research and Scholarly Work at Indiana University School of Medicine (IUSM). Dr Hopper earned tenure at IUSM and was twice awarded the Trustees Teaching Award. Based on her experience in developing curriculum, addressing accreditation and teaching and mentoring of medical students, she was selected to help build a new program of Osteopathic Medicine at SHSU. Active in a number of professional organizations, Dr. Hopper is past chair of the Chapter Advisory Council Chair for the American Physiological Society, the HAPS Conference Site Selection Committee, and Past-President of the Indiana Physiological Society.

Evolution of Teaching Physiology and Accommodating Social Distancing

Andrew M. Roberts, M.S., Ph.D., FAPS
Associate Professor
Department of Physiology
University of Louisville School of Medicine
Louisville, KY

Our graduate physiology courses at the University of Louisville School of Medicine evolved from a lecture-based format supplemented by recitation sessions and modules for each topic. Students work in groups to identify learning issues and discuss concepts needed to understand and solve assigned questions. They present their findings to the class and respond to questions from faculty and students. We found this to be an important forum whereby students gain experience applying their physiological knowledge.

An additional step that fostered student understanding was problem-based learning modules where student groups discussed and answered exam type questions. For the “pre-test” component, each group discussed and chose their answers together. This was followed by a “post-test” with different but, similar questions answered by each student individually. Our metrics clearly indicated students’ ability to apply their knowledge increased significantly.

Another component which bolstered student performance and encouraged use of multiple resources for information was online quiz questions for each learning module. Questions were made available on “Blackboard” and answered according to a schedule. Students received notification whether they answered correctly and could change their answer choices within an allotted time. Team-based learning with activities that encouraged students to incorporate multiple information sources improved students’ grasp of physiological concepts and mechanisms.

In summary, we developed ways to effectively engage our students who have diverse educational backgrounds and learning preferences. It is important to note that the classroom environment, with face to face instruction, provides the opportunity to teach and motivate students through interactions with faculty members and fellow students. However, other types of activities work well to augment and encourage student learning.

In the last year, our faculty has been discussing the possibility and usefulness of supplementing our program with online course options that could enhance students’ academic backgrounds whether they were on or off campus. Online learning has become prevalent as another teaching tool for a diverse student group and accommodates a variety of learning preferences. It offers flexibility whether used to supplement a “classroom” physiology course, or course taught exclusively online. Over the last year, our experience with online learning platforms indicated instructors could teach to an entire class simultaneously.

Students can be divided into discussion groups for problem-based learning and instructors can virtually interact by “joining” the groups. In addition, the platforms allow everyone to be seen and to be heard. Furthermore, it is easy to link slide as well as video presentations and record class sessions. Traditionally, we posted lecture notes and supplemental material on “Blackboard” for students to read before class and provided access to recorded lectures. There also is a forum for students to interact with each other and faculty members.

Educational methods are ever changing and can go forward and back again. With this in mind, online learning is not necessarily a replacement for face-to-face learning but, can be an additional learning tool. Even faculty less familiar with online learning have found the latest learning platforms to be relatively easy to use and actually to enhance their teaching styles. A key ingredient to the success of our program, is having designated faculty members and staff available as teaching resources! With the necessity for implementing social distancing during the COVID- 19 pandemic, online learning and video conferencing allowed us to continue and sustain our courses and academic program during this difficult time hopefully without jeopardizing student lifelong learning.

Andrew M. Roberts, MS, PhD, FAPS is an Associate Professor in the Department of Physiology at the University of Louisville School of Medicine in Louisville, Kentucky. He received his PhD in Physiology at New York Medical College and completed a postdoctoral training program in heart and vascular diseases, as well as, a Parker B. Francis Fellowship in Pulmonary Research at the University of California, San Francisco at the Cardiovascular Research Institute. His research focuses on cardiopulmonary regulatory mechanisms with an emphasis on neural control, microcirculation, and effects of local endogenous factors. Current studies include microvascular responses altered by inflammatory diseases and conditions, which can lead to acute respiratory distress syndrome. Additional studies include obstructive sleep apnea. He teaches physiology to graduate, medical, and dental students and has served as a course director as well as having taught allied health students.

Scientific Literacy: A Challenge, a Task, a Poem

Scientific literacy allows citizens to get involved in issues and ideas related to science as a reflective citizen[1]. A scientifically literate person can:

Recognize, offer and evaluate explanations for a variety of scientific and technological phenomena
Describe and evaluate scientific research and propose ways to answer questions and solve problems following the scientific method
Analyze and evaluate data, concepts and arguments in a variety of contexts, reaching appropriate conclusions for the data received[1]

The challenge

Quality education is the key to achieving literate societies. Unfortunately, scientific literacy is generally very low in most developing countries. Results of the PISA tests, for example, reveal that competencies in mathematics and sciences in developing countries are below the average of the countries evaluated[2]. This has enormous consequences for the communities by negatively impacting their political, economic and social decision-making.

Figure 1. Performance in mathematics and science of different countries in the 2015 Pisa tests. Images Taken from http://www.oecd.org/pisa/.[2]

The task

It is very important to open spaces for the general community in developing countries to learn about the practice of science. Many scientific organizations develop training activities that are usually directed at specialized audiences. For this reason, it is important to highlight the task of scientific associations that are concerned with bringing science to the general community such as the American Physiological Society through events such as PhUn week. In the particular case of Colombia, the Colombian Association for the Advancement of Science (ACAC) organizes every two years a very large science fair “Expociencia” that is visited by more than 40,000 elementary, middle and high school students.

These science fairs have several objectives:

Allow students to present the results of scientific projects. Students are exposed to an essential component of science, sharing and communicating research. In addition, they have the opportunity to learn from their peers and receive feedback from more experienced researchers.
Open the doors of academic, governmental or industry laboratories to the community. Visitors have the opportunity to know what scientists do, interact with them, expose their visions about science. In addition, visitors can express doubts they have about different concepts, and sometimes they can find answers to their questions.
Generate academic spaces so that researchers can discuss how to work with the community, address their most pressing needs and communicate their results to the public.

Figure 2. Participation of students in academic activities at Expociencia 2018. Images courtesy of Deiryn Reyes, ACAC.

Recently with the support of the Faculty of Medicine of the Universidad de los Andes, I had the opportunity to participate in Expociencia[3]. It was gratifying to see how the children ran from one side to the other having the opportunity to learn about electronics, physics, programming, biology, medicine and anthropology. These children are like sponges that quickly absorb the information they receive and are willing to ask questions without filtering them through mechanisms that adults have learned. In addition, Expociencia promotes spaces for university students to share their experiences and for a moment to be role models for school students. I believe that many lives are changed thanks to the experience of living science.

The poem

In the nineteenth century lived a poet who wrote and translated from other languages several of the best-known stories that are known by children and adults in Colombia. His influence on Colombian literature is similar to that of the Grimm brothers in Europe. The name of this writer was Rafael Pombo. A few weeks ago, thanks to my son, I had the opportunity to learn that he also wrote about the importance of knowledge and science. On this occasion I want to share a personal translation of one of Rafael Pombo´s poems, that can be used to discuss with small children and adults the importance of science in our lives.

THE CHILD AND THE OX

Rafael Pombo (1833-1912)

The boy

-What do you think about all day

Lying on the grass?

You seem to me a great doctor

Enraptured in his science.

The ox

-The science, dear child

It is not what feeds me;

That is the fruit of study,

With what God gives humans.

Out thinking for me,

Poor animal, hard enterprise;

I prefer to make thirty furrows

Before learning two letters.

Chewing well, I care more

that a lesson at school.

With the teeth, I chew,

You, child, with your head.

But if you want to be wise

Hopefully seeing me you´ll learn

To ruminate, and ruminate a lot,

Every bit of science.

Digesting, not eating,

It is what the body takes advantage of,

And the soul, invisible body,

has to follow such a rule.

Without ruminating it well, do not swallow

Not a line, not a letter;

The one who learns like a parrot,

Ignorant parrot stays.

References

National Academies of Sciences, E., and Medicine., Science Literacy: Concepts, Contexts, and Consequence. 2016.
OECD. Results by Country. [cited 2018 November 4th]; Available from: http://www.oecd.org/pisa/.
Ciencia, A.C.p.e.A.d.l. Expociencia 2018. 2018 [cited 2018 October 31st]; Available from: https://expociencia.co/home/.

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.

A Fork in the Road: Time to Re-think the Future of STEM Graduate Education

“Rather than squeeze everyone into preordained roles, my goal has always been to foster an environment where the players can grow as individuals and express themselves creatively within a team structure” –Phil Jackson (1)

Recently, I was reading the PECOP blog “Paradigm Shifts in Teaching Graduate Physiology” by Dr. Andrew Roberts. His discussion focused on how we need to change the way physiology is taught to graduate students as technology has evolved. But, one particular line caught my eyes as I was preparing my blog: “if it was good enough for Galileo, it is good enough for me.” Many university faculty members believe the “If it was good enough for Galileo, it is good enough for me” approach is the major issue with the current biomedical graduate student training system, which stands at a crossroad and is threatening its own future if appropriate corrections are not made (2, 3).

The document I read for this blog, Graduate STEM Education for the 21st Century (4) is an updated version of the report published in 1995 (5). It is rather large (174 total pages) and contains information on various topics about the current status of STEM graduate education and a call for systematic change. I will limit my discussion to the current status of the PhD training system and recommendations for changes in the programs.

Issues at the heart: Gap between the Great Expectation and Hard Reality

Both the 1995 and the current documents list several issues associated with the STEM graduate training programs in the U.S. However, the common thread that runs through both documents is associated with the gap between how our graduate students are trained and what has been happening in the job market. The current STEM graduate program still is designed with the general expectation that students will pursue a career in academia as a tenure-track faculty member at a research institution. However:

The majority of growth in the academic job market has come from part-time positions, adjunct appointments, and full-time non-tenure-track positions (i.e. instructors, lecturers, research associates) rather than tenure-track positions in research-intensive institutions.
The employment trend for STEM PhDs is shifting away from academia to non-academic positions.

The gap in the expectation of the training programs and the reality of job market creates several problems, including:

Those who wish to pursue a career in academia often require a longer time to secure permanent employment and often work in positions that under-employ them (i.e. part-time, non-tenure track) and/or under-utilize their training (i.e. positions that do not require a PhD).
Graduates who pursue non-academic positions, especially in the private sector, lack adequate preparation to enter their positions and become successful.

Many non-academic employers have voiced concerns that current STEM education is no longer acceptable for the current job market, as it does not provide sufficient training to make students more attractive and versatile to be employed outside of academia, which is becoming more international and diverse. In particular, employers are concerned that current STEM graduates lack skills in areas such as:

Communication
Teaching and mentoring
Problem solving
Technology application
Interdisciplinary teamwork
Business decision making
Leadership
The ability to work with people from diverse backgrounds in a team setting

Changes needed for the system: Let students discover their destiny

The major change needed in the current STEM education system is that we need to let students figure out which career path is for them and provide appropriate training opportunities, rather than trying to force them to fit into one mold. Phil Jackson, whom I quoted earlier, writes: “Let each player discover his own destiny. One thing I’ve learned as a coach is that you can’t force your will on people.” (1). Jackson goes on to say: “On another level, I always tried to give each player the freedom to carve out a role for himself within the team structure. I’ve seen dozens of players flame out and disappear not because they lacked talent but because they couldn’t figure out how to fit into the cookie-cutter model of basketball that pervades the NBA.” We need to foster a graduate training environment that encourages each student to discover their role without any pressure, stigma, or discouragement.

Dr. Keith Yamamoto from the University of California San Francisco says that graduate training needs to be student-centered so that graduates can find their roles and meet the needs of the society (3). Faculty mentors have the responsibility of training students so that students become successful in what they choose to do. Faculty mentors, academic departments, and institutions also need to make a concerted effort to provide opportunities for students to develop additional skills necessary to become successful in what they choose to do. This includes teaching, especially if they want to work in a teaching-intensive institution (like the one in which I work). Faculty mentors may fear that allowing students to work on skills unrelated to the research area may hinder student success. They may also fear that students serving as graduate teaching assistants may extend the time needed to complete their degree. However, students need opportunities to develop these other skills, along with discipline-specific skills to become competitive in the job market and competent employees. Again, the focus needs to be on the students and what they want to pursue, as well as what is needed for them to succeed after they walk out of the laboratory. And, we need to trust students that they will find their paths on their own. Dr. Yamamoto concludes his seminar by saying: “Inform/empower students to make appropriate career decision…. Students will get it right.” (3)

References and additional resources:

Jackson P, Delehanty H (2013). Eleven Rings: The Soul of Success (Penguin, New York).
Alberts B, Kirschner MW, Tilghman S, Vermus H (2014) Rescuing US biomedical research from its systemic flaw. Proc Natl Acad Sci USA 111(16):5773-5777.
Yamamoto K (2014) Time to rethink graduate and postdoc education. https://www.ibiology.org/biomedical-workforce/graduate-education/
The National Academies of Science, Engineering, and Medicine (2018) Graduate STEM Education for the 21st Century (The National Academics Press, Washington DC).
The National Academies of Science, Engineering, and Medicine (1995) Reshaping the Graduate Education of Scientists and Engineers (The National Academics Press, Washington DC).

Yass Kobayashi is an Associate Professor of Biological Sciences at Fort Hays State University in Hays, KS. He teaches a human/mammalian physiology course and an upper-level cellular biology course to biology majors, along with a two-semester anatomy and physiology sequence to nursing and allied health students. He received his BS in agriculture (animal science emphasis) with a minor in zoology from Southeast Missouri State University in 1991. He received his MS in domestic animal reproductive physiology from Kansas State University in 1995. After a brief stint at Oklahoma State University, he completed his Ph.D. at the University of Missouri-Columbia in domestic animal molecular endocrinology in 2000. He was a post-doctoral research associate at the University of Arizona for 2 years and at Michigan State University for 4 years before taking an Assistant Professor of biology position at Delta State University in Cleveland, MS in 2006. He moved to Fort Hays State in 2010 and has been with the institution ever since.

Thoughts from the Future

April 23, 2028

Dear Dave Harris of 2018,

It has been a long time my friend, in fact 10 years. I have plenty of good news to share with you, which may be shocking or expected!

First, I am happy to inform you that the past decade has been extremely good for your Philadelphia Eagles! After winning Super Bowl LII in 2018, they have gone on to win 3 more with Carson Wentz running new “Philly Specials” year after year! Tom Brady finally retired after he dropped another wide-open pass in Super Bowl LV. However, the biggest surprise for you may be that the Cleveland Browns won Super Bowl LV!

I am also happy to tell you that the educators survived the Great Medical Education Transformation of the 2020s! I knew that you saw this coming around 2015, but the speed at which the Transformation occurred was mind-blowing for many faculty! We lost a few good “soldiers” in the process when they failed to adapt their educational views and styles, but as of now, medical education has never been better and there have been substantial improvements in patient safety and outcomes! I am sharing some of the changes with you to prepare the faculty of the future!

One of the first recognizable changes was the manner in which students approached medical school curricula. Even during your time, schools saw drastic reductions in class attendance and student engagement with the formal curriculum. The millennial students were used to obtaining information how they wanted and immediately when they wanted. Recording of lectures led to students remaining at home so that they could double speed your voice to sound (you have no idea how they describe you!), allowed them to view these lectures at midnight in their pajamas, and gave them the ability to stop and take notes. Many faculty mistook this as student disengagement and tried to “force” them into class by making mandatory sessions or increasing the frequency of assessments. However, students responded by stating that some sessions were a “waste of time” and “took time away from studying for Step 1”. They continued to vote with their feet and migrate away from the classroom!

However, what caught most faculty of your time off guard was the use of external resources outside of your own curricular items. The emergence of the “hidden curriculum”! Students were presented with alternative options such as Anki, Sketchy Medical, Osmosis, First Aid, Khan Academy and Pathoma to name a few! At first faculty were unaware and put up a staunch resistance. It was even postulated by some that the core curriculum of basic science could be delivered as a shared Medical Curricular Ecosystem (Le and Prober) that would help reduce redundancy in medical schools. This caused an imbalance in the galaxy and many of the upset faculty tried to prevent this from coming. However, many astute faculty quickly realized that it was already there!! At that point the faculty rebel forces decided to become proactive instead of reactive!

Town hall meetings, focus groups, and interviewing revealed many weaknesses in the medical school schema to date. Faculty struggled to realize that the millennial students grew up with the internet and basically a cell phone attached to their hand. Finding content was not an issue for them and what faculty discovered was that much of the content delivered in lectures was identical to what could be viewed in a video in 8 minutes. They also discovered that students grew up in a world where everyone was connected through social media and available almost 24 hours a day! They expected responses from their friends on a chat within seconds! After all, how many people sleep with their cell phone next to them? Faculty also discovered in these town halls that the generation valued work/life balance and anything that was deemed inefficient cut into this time that they could be doing something else. Through these important meetings, faculty also discovered that students were excellent at recalling facts and regurgitating knowledge. However, when asked to apply that knowledge to a problem, the students went back to recalling the facts. Students had mistaken memorizing for learning! And many faculty had mistaken learning for telling! Some faculty reflected back and actually admitted that we may have enabled the behaviors with our constant barrage of standardized tests of knowledge!

At least, the good news is that this led to some drastic changes in medical education! Gross anatomy has been severely trimmed down in an effort to focus on clinically relevant anatomy for undifferentiated medical students. Gross anatomy dissection is reserved for students interested in a surgical career as an elective. Much of that experience of cutting through muscle layers and isolating each artery, nerve and vein, and picking through layers of fat to get there has been replaced by complex computer programs that help students visualize the anatomy in 3D! Since ultrasound is currently available to any physician through their phone, more emphasis of anatomy related to ultrasound aspects has been a focus of instruction. For many of the pathological or anatomical variations, 3D printing has allowed for much cheaper and better alternatives for learning. Everything is currently related to clinical medicine and focuses on key concepts that are necessary to master as opposed to “knowing” everything! However, the changes did not stop there!

Much of the basic physiology content knowledge is now presented to the students in alternative ways using directed, short videos or providing references. The class time has been reserved for higher level threshold concepts where students are placed in situations in which misconceptions and dangerous reasoning can be identified and corrected. Simulations and standardized patients (robots) have become common place where students have to integrate what they were learning in Doctoring courses with real life physiology. Students enjoy the safe environment and as faculty discovered the role of affect in cognition, they quickly realized that this was a time efficient pedagogy. Faculty have discovered that 1 hour of intense, clinically oriented, and high yield threshold concept learning is much more beneficial and time efficient than 4 hours of didactic lecture. And faculty discovered it was fun!

Another aspect under appreciated by faculty of your time is that students enjoy being able to learn in their own environment as opposed to in the classroom. In your day coffee shops were filled with students studying away, but technology has allowed for large communities of learners to “get together” from their own homes. Time spent traveling from various hospital sites during the clerkships was saved by developing online communities for learning and using technology to facilitate discussion. Students felt more at ease critiquing another’s differential with this new design and appreciated the time saved from travel.

As I said my friend, medical education has been transformed in exciting and very positive ways! Successful faculty have worked with the students to enhance the learning experience as opposed to trying to teach the way we were taught! Faculty focused more on the learning process as opposed to trying to relay knowledge to the students. It was discovered that technology could not substitute for poor teaching. Faculty learned to develop activities to get students out of their comfort zones so that true learning could occur. And lastly, faculty realized that their roles were not eliminated. Rather the role of faculty had to change from the expert sage on the stage to the facilitator of student learning!

Well, I can’t wait to see what the next ten years will bring! You will be happy to know that your two daughters have grown up to be beautiful, caring people!

See you in 10 years and Fly Eagles Fly!!

Dave Harris of 2028

———————————————————————————————————————————————————————

I realize that this letter may be viewed as provocative, crazy, and aspiring! However, I hope that the conversations in medical education can begin to REALLY improve patient safety and outcomes in the future. What changes do you think will occur in medical education in the next 10 years?

David M. Harris, PhD, is currently an Associate Professor of Physiology at the University of Central Florida College of Medicine in Orlando, Florida. He received his PhD from Temple University School of Medicine, completed his post-doctoral research at Thomas Jefferson University, and was offered his first faculty position at Drexel University College of Medicine. He moved away from Philly to Orlando in 2011. He has written several educational research manuscripts, mostly about the use of high fidelity mannequin simulators in medical physiology and currently serves as an Associate Editor for Advances in Physiology Education. He is also on the Aquifer Sciences (formerly MedU Science) leadership team developing a curriculum that provides tools or how to integrate basic science knowledge with clinical decision making to prevent harm.

Reference: Le TT, Prober CG. A Proposal for a Shared Medical School Curricular Ecosystem. Acad Med, March 6, 2018

Surviving Hurricane Maria: A professor’s story (Part 2)

Previously in our story…Hurricane Maria had just ravaged the island nation of Dominica

Flag of Saint Kitts and Nevis

While I waited, my school did what many said could not be done. Our staff and administration arranged for us to be able to complete the fall semester, on the only-lightly damaged island of St. Christopher (usually called St. Kitts), which had been grazed by both Irma and Maria. They arranged for a large passenger ship which normally ferried cars and people from Italy to Spain and back to sail over to the Caribbean and be modified into a floating campus for our thousand-plus student body for the rest of the year. They arranged for temporary accommodations for faculty and staff on St. Kitts, where our other sister school, Ross University School of Veterinary Medicine (10), is located. They revised the schedule to have us resume our semester in October and finish in early January. And then they set these plans in motion.

In mid-October, I finally got the notice I’d been waiting for, my reporting day to arrive on St. Kitts for my temporary assignment there. I’d lived on St. Kitts before while working at one of my former schools, so I knew that it wasn’t the same as Dominica. It was wealthier, far wealthier, with so many cruise ships coming to call during high season that we were almost an afterthought to them. It had the movie theater and the golf courses and the high-end hotels, and the island infrastructure to handle the mass of tourists who came and went by the planeload and shipload every day. But on the same token, in Dominica we were a part of the community, we were welcomed by the people, and we were careful to try to be good neighbors. In St. Kitts, we were mostly treated like tourists, who were perhaps staying a little longer than usual, and on a ship that wasn’t going to sail away with us. Most of the Kittitians were still the very friendly people you can find everywhere in the Caribbean, of course, but it wasn’t Dominica and I knew it before I arrived. We faculty were to arrive a few days before the students to get situated and find places to live on the island while the student accommodations/our campus continued its journey across the Atlantic to our new home away from home.

Belle Mont Farm Eco-Resort

When I got to St. Kitts, it was…a pleasant surprise. It wasn’t half as hard to get through customs as I had feared, and the Marriott is a nice hotel. We stayed there a day or two before the students started to arrive. To make room for the students, most of the faculty were moved to an eco-resort on the far side of St. Kitts for about a week, which opened in its off-season just for us. While I appreciated their going above and beyond on our behalf, I only stayed one night before moving into an apartment in town. I just wanted to unpack my suitcases, settle in somewhere, and get back into a routine.

Because I left the eco-resort so early, I was available to help the students come in on their arrival day. And come in they did, one charter flight at a time to the airport, and one to three buses (they call them cruisers) at a time to the Marriott. Tired, bleary-eyed, some clearly still suffering the effects of six or more days on Dominica under indescribable conditions ending in evacuation and weeks of uncertainty, the students came. You couldn’t help but feel for the ordeal they had survived… or admiration for their grit to return anyway, when a small group of others had taken a leave of absence. On that day and night when the students came in charter flight after charter flight, wave after wave, a dozen volunteers and I helped each group one by one. We were the friendly faces from home greeting them after their long ordeal. We smiled and shook their hands and took their bags inside, helped them through check-in, provided them some simple meals, and tried to make each returning student feel special. It started for me in the afternoon, and then into the evening, and then into the night, with each group of students arriving more and more exhausted. By 1 a.m. I was feeling pretty exhausted too, but we kept going until the very last group made it in somewhere close to 2 a.m.

I am told that still more planeloads of students flew in the next morning, but I slept in. That afternoon, students were being transported from the hotel to the port, where our ship had come in. The lines were long and the sun was hot and the students just wanted to get inside and get to their new berths. Many of the faculty who were staying at the eco-resort had come into town that morning to help students move in during the morning/afternoon shift. I showed up for the afternoon/evening shift. As we had done the previous day, we volunteers did our very best to keep everyone comfortable at the port, as students went through the tedious process of being identified, cleared to come onto the ship, given berth assignments, and other things past my station at the port. I made a point to smile and joke and most students appreciated it. By mid-evening the last students had made it past my sorting station at the dock entrance and headed into the ship, so I stumbled home for another exhausted sleep.

There was a lot more involved in starting work at the temporary campus than just showing up, but I and the other faculty made do. The ship had just one large cafeteria so we sometimes had to wait in meal lines during its designated breakfast-lunch-dinner times. Many of the prior amenities on the ship (e.g., a movie theater and a pool deck) had been converted into classroom and study areas before we boarded, and other spaces were modified for student use later. This included the conversion of an entire deck of the ship which is usually a car garage into an air-conditioned suite of temporary study spaces, clinical exam rooms, and simulation labs. Since the ship spent most days at sea, it was rather crowded at first. We faculty didn’t have offices per se but like the students we each found our place to be during the day. My place was at the back of the third semester classroom, in a corner with AC, electric hookups, and a view of the harbor. I usually teach in second semester as do most physiologists, so I absorbed a lot of clinical applications even as I worked on lectures and active learning sessions, module directing, pre-mini-workshop design, and all the other routines of a typical teaching-oriented school. And in so doing I, like so many other faculty who don’t get to know a lot of students normally, did connect with many of them. When we had to get up at 3:30 a.m. to catch the 4:15 a.m. bus to get us to the boat before it sailed at 5:00 a.m. to make room for a set of larger cruise ships throughout the day, we shared in the students’ experience of having to make sure they too were up at the same time, early enough to download their most important materials of the day before we sailed, just in case the harbormaster put us far out at sea. When the days came that other ships left late and we didn’t dock until 7:30 at night, the students shared that with us too.

Photo: St. Kitts in the morning light, mid-November 2017. Photo credit: Bruce Wright

Along the way, we made time for some activities. Twice I went scuba diving with fellow members of our RUSM (Med School) Scuba Club (11); others went diving even more regularly. People organized groups for exercise on the outside deck every morning and night. There were religious services, club meetings, and other miscellaneous activities on the boat. Off the boat there was at least one school-planned movie outing, an island tour, and a few students even made it to a “beach bash” hosted by the RUSVM (Vet School) Scuba Club. More informally, the port facilities were nice as one would expect at a regular Caribbean cruise ship stop, with everything that entails. It became a shared experience of life in close quarters, dedicated to a common purpose and with a common spirit that we would make it through, together and with no drop in our commitment to teaching and learning despite it all.

Would I have traded it for a nice quiet semester in Dominica with no Hurricane Maria in the first place? Well, sure! But you have to deal with what life gives you and we made the best of it. And the quality of the teaching did not go down. We might have been in close quarters but we delivered virtually the same curriculum in the fall as we had in the previous spring and summer.

By mid-November, air service to Dominica was spotty but running, so I booked a trip there for a few days including Thanksgiving Day. We’d just found out that we were going to be in Knoxville, Tennessee for the January semester but no one knew much more than that. While some people started actively looking for places to live, I planned my return to Dominica and hoped the school would handle the Knoxville move for me and many others (it did). I booked a room at the only hotel open in Portsmouth, Dominica, just in case my cottage was uninhabitable, and then I hoped for the best.

Photo: Sunset in Dominica, late November 2017. Photo credit: Bruce Wright

When I flew in, it was afternoon and, well, the island I loved looked different. This was now two months after Hurricane Maria did its damage and still the island was brown, not green. The volcanic ridges were sharp and distinct, and the remains of trees were all over them, standing tall and naked. But if I looked closely, I could see that at the tops of the trees, leaves had started growing again. Not enough to cover the scars on the land, not yet, but enough for some hope. I had the taxi driver take me to my cottage before going to the hotel, and amazingly almost everything had survived. The food and other perishables were gone with a few other items (e.g., my Swiss army knife), but overall I had a lot of things to ship home. When someone had built the place he or she had cemented the window frames into the concrete wall for extra strength, which isn’t standard practice anywhere but it worked there. Whoever it was had also put odd-looking vents under the roof which somehow prevented the roofs from flying. As a result, though my furniture was flooded at floor level, almost everything else was salvageable. It was a miracle compared to the sheer devastation we’d driven through from the airport to town. That night I saw my first sunset on Dominica in many months, and it was beautiful.

Photo: Looking north from Portsmouth, Dominica, Thanksgiving Day 2017. Photo credit: Bruce Wright

I spent the next two days getting almost everything from my cottage packed up and sent to the local shipping agent for transport back to the USA. Since my office had survived intact (another unexpected blessing) I took a couple of textbooks and other important items from there. But I didn’t take everything. I left most things in my office against the day I would return. I also took a few photographs. I chose to avoid taking pictures of the damaged areas. Instead I shot photos of things I’d never seen before, like the caved-in side of a cliff face on the mountain north of town that to me looked just like a monkey’s hand. Along the way I saw the determination of the people to recover even as they all hoped we would be back in May, and I hoped the same thing. But it was not to be. As I flew out with my bicycle sold, my cottage empty, and my most essential items from home and office in two suitcases, I was pretty sure that Dominica wouldn’t be ready for us by then. There were still too many without power, too many living under tarps and in barely-repaired dwellings, too many roofs still off and the insurance companies being slow to pay claims.

The semester ended relatively uneventfully. The students adjusted to where they were going to be in the spring, and so did I. Knoxville, Tennessee is a nice southern city with both friendly people and all the movie theaters one could ever want. I even went once! Most of our students are here with us, though some are still in St. Kitts with some of our faculty. We’ve learned we’re to be here through the September 2018 semester so we have some sense of permanence. Though I would love to return to Dominica as soon as possible, having a safe, happy Dominica with functional buildings, power, water, cell service, and the other non-movie theater basics restored is really important too, so I can’t complain. Here I am, a professor at a medical school in the United States, just like I wanted to be so many years ago. And whether here or Dominica or anywhere else my fate takes me, I’ll get by.

As I told one of my advisees who was having a bad day last December, in the end a school isn’t buildings at all. A medical school is its people, medical faculty training students through increasingly difficult tasks until at the end the students have risen up to a higher level, doctors ready to begin their postgraduate medical education journey. The medical arenas and the classrooms and the simulation labs and the journal collections and the fraternity/sorority homes and even the occasional Italian ship sailing thousands of miles to become a “floating campus” are all just the scaffolding around what is really important. That one student, his or her classmates, his or her basic science and clinical faculty, and everyone else from the Dean to I.T. to the people washing dishes in the back of the cafeteria who make sure everything else runs…these people are the real school. They make it possible for that one student to excel.

And that’s something that no hurricane– however powerful– can stop. Ask LSU if it stopped for either Camille or Katrina. Ask Hofstra if it stopped for Sandy, Baylor if it stopped for either Rita or Harvey, or Nova Southeastern if it stopped for either Andrew or Irma. Like those other disasters, Hurricane Maria is part of history now. And just like those other schools went on after their respective storms, we’ll keep going too, training the next generation of physicians, semester after semester. As we do, I’ll be right there doing my part for my students, my school, and the greater medical education community. Because in the end, that’s not only what I was trained to do, it’s still my passion today.

Bruce E. Wright graduated with a PhD in Physiology from LSU Health Sciences Center in 1993. He had postdoctoral fellowships/research faculty positions at the University of Florida and East Carolina University. He served several years as faculty at a liberal arts college in Georgia. He worked at three Caribbean medical schools from 2005-2008 before joining the faculty at Ross University School of Medicine in 2008. He worked for two years at a US-based osteopathic medical school in 2013 and 2014 before returning to Ross University in late 2014. Dr. Wright is currently Treasurer/Award & Event Coordinator for the American Physiological Society’s Teaching Section. He has served as a reviewer for Advances in Physiology Education. He is National Faculty for the National Board of Osteopathic Medical Educators (NBOME), for whom he has written and reviewed items for different exams. He regularly attends Experimental Biology and was an attendee and presenter for the first Institute for Teaching and Learning meeting in Bar Harbor, Maine in 2014. He is currently interested in educational research involving teaching methodologies.

Photograph: The author with three RUSM students (from left to right, Armin Hojjat, Harenda Ipalawatte, Bruce Wright, and Eddy Mora) just after a double-tank scuba dive, off St. Kitts, November 2017. Used with permission by Harenda Ipalawatte.

References/links/other:

Surviving Hurricane Maria: A professor’s story (Part 1)

It’s funny, as I begin to write this blog, that I realize that it’s nearly 25 years now since I received my Ph.D. in Physiology in New Orleans. Back then, I was sure that my career track would lead me to becoming a full professor at a medical school in the United States one day, though I didn’t know exactly how I would get there. Not being a world traveler, I certainly never expected to spend a day in the Caribbean, but life is funny sometimes.

Like so many other graduates of my day, the “optimal” career track didn’t pan out for me. My postdoctoral experience didn’t involve receiving any federal grants, so instead of moving straight into medical school, I became involved in undergraduate education. Several years later while advising students, I learned about Caribbean medical schools. When I studied them in more depth, I discovered one program in particular in which I could teach college seniors advanced A&P part-time while I took medical school courses part-time too. I took a leap of faith and applied for it. Shortly after they accepted me, I took my first flight over the turquoise-blue of the Caribbean Sea.

That was the day my life changed

There was and is something different about the Caribbean, its varied islands and its colorful people, so friendly in some places and so unfriendly in others, but always full of life and adorned in bright colors. Along the way I picked up medical-level Gross Anatomy and with that extra qualification, moved into full-time faculty positions at a couple of small medical schools in the British and Dutch Caribbean. On those tiny islands I relearned my discipline as a generalist as few others of my generation have done. There I was THE physiologist with no backup and neither a travel allowance for attending conferences or taking trips home to see my family, nor support for any research. Instead I had to not only teach the entire medical physiology course by myself three times per year, I also had to assist the anatomy faculty in cadaver dissection twice per week and occasionally teach in an undergraduate course. My typical medical school course load was 14-16 hours per week of just contact time in lecture and lab, not counting writing exams every three weeks and having many, many meetings with students. It was hard but it changed me, and made me a better teacher. With this Caribbean-acquired training as a medical physiology generalist, in 2008 I moved up to a first-tier Caribbean medical school in the Commonwealth of Dominica (not the Dominican Republic!), initially to teach digestive physiology.

Flag of the Commonwealth of Dominica

Dominica will always have a special place in my heart. It is a small volcanic island in the British Caribbean that is shaped like a chrysalis (1). At its widest it’s only about 18 miles and at its longest 29 miles, but it is almost a mile high. It has no five star resorts, no golf courses, and no movie theaters. It’s hard to get to by air, and even cruise ships mostly go past it in favor of better-developed ports on the islands north and south of it. When I first arrived the entire population on-island was only about 73,000, mostly hugging the west (Caribbean) coast. But for several years I lived in a house on a hillside 500 feet above the Caribbean Sea watching the sun set over the ocean every night from my front porch. On Saturday I would sometimes go down to the village of Mero below me where there would be a half mile of pure gray sand beach and only a dozen people on it. On Sunday, I might go down again to where five hundred locals had come to party on the beach, or I might have just sat on my porch and listened to the music from far below, as the stars came out and the Southern Cross hung in the April sky. One time, and only one time, I climbed the 4800 foot mountain in the center of the island where there is no trail up to the cloud-cloaked peak. One time, I swam, dove, and rappelled down a river through a canyon greener than the Emerald City. And along the way, I taught at a very special school, with smart, tough, high quality faculty and students alike, Ross University School of Medicine (2).

Photo: Dominica from my cottage porch, April 2017. Photo credit: Bruce Wright

Through most of my years there, Dominica was spared the worst that Mother Nature could bring to bear. We liked to say that it was in the perfect place in the Lesser Antilles, too far north for the big Cape Verde hurricanes that would not be turned north as they tracked west through the Central Atlantic to hit, and too far south for those Atlantic storms that did get pulled north as they approached the islands. Sometimes a tropical storm would come and dump a lot of rain but that just turned the tap water brown or white for a day, no big deal. The island stayed its radiant green from the tropical rain forests, only browning out for 1-2 months per year in the dry season from January to April.

In 2015, Tropical Storm Erika formed almost on top of us, and hit the island with the worst rainfall it had experienced in decades. Dozens of people died and whole towns were cut off for months. We thought we’d been hit by the Big One, as the estimated damage from Erika’s island-wide flash flooding was about 500 million dollars, or well over half of Dominica’s gross domestic product (3). For two years the island slowly recovered, rebuilding its water treatment facilities, repairing washed-out bridges, and helping rebuild flooded coastal communities.

By August 2017, Dominica was almost completely back. We too were back. Our school had had its own water supply even before Erika hit, and the electricity never went out in Portsmouth afterwards. Like the rest of Dominica, my school did lose cell phone service and internet for several days after that storm, which was a serious concern. Once we were reconnected with the world, we moved to make sure our school would never be caught like that again. My school installed its own satellite, set up evacuation plans, and built a new student center rated to withstand a Category 5 hurricane. Along the way it continued to matriculate three sets of students per year, semester in and semester out. Collectively, we thought we’d survived the worst and recovered very well.

No one expected the hurricane onslaught of 2017. Three major hurricanes, three major disasters, with consequences felt in several parts of the United States, were always theoretically possible but most people didn’t expect more than one to pan out. In the middle of August, I was on vacation at my wife’s home in Georgia as eventual Major Hurricane Harvey formed in the Atlantic and passed south of Dominica as a tropical storm. Most storms that go that way fizzle out in the eastern Caribbean, but Harvey survived and went on to ravage Houston and the surrounding region of the northwestern Gulf of Mexico like few hurricanes ever had (4). The United States’ people and its government mobilized to help Texas and Louisiana, as it so often does after a major disaster. I breathed a sigh of relief that Dominica was spared again even as I too donated to help the Gulf coast.

I returned to work before the beginning of the September semester. Irma was still far out to sea in the Central Atlantic, but it looked like it was going to be trouble almost as soon as it cleared Africa. I told many first semester students days before Hurricane Irma reached the Lesser Antilles that they should invest in a full set of hurricane supplies as if it would be the worst storm they would ever experience in their lives. Then, when it didn’t hit, they could eat the food, drink the bottled water, and cook with the extra propane all semester long. Some took this advice to heart and others didn’t. As Hurricane Irma came closer and closer, it kept heading straight for Dominica, defying days of forecasts that it would turn northwest, and strengthening all the way to one of the strongest Category Five storms of all time. Only at the last minute seemingly did it turn at last.

Irma was a terrible storm, even by historical standards (5). It destroyed St. Maarten and several other islands but all we got from it was severe rain and tropical-storm force winds, with only minor damage to our fragile infrastructure. We grieved for our comrades including our sister school American University of the Caribbean north of us, and then watched as this storm’s heaviest rain bands hit the Miami area, causing even more flooding damage only weeks after Houston’s deluge. As our University headquarters were there, this had some effect on our operations, but again from Dominica we breathed a sigh of relief. We had been spared the worst again.

Chugging along some distance behind Irma, another tropical wave came off of the African coast, looking suspicious right from the start. Maria, as it was to eventually be named, was absolutely the worst case scenario for the island of Dominica and for our basic science campus there (6). It wasn’t supposed to be a major hurricane when it hit. The forecasts all said if it hit at all, it was likely to be a strong tropical storm, maybe a Category One. Nevertheless, in preparing for a business trip to Chicago for the second week of September, I had a group meeting with my mentees a week early, because sometimes even a simple rainstorm over Puerto Rico could delay my return by a day, and I was to return on Monday, September 18^th. I took my work computer with me on the trip on a hunch I might need it before I got back to Dominica. I had no idea how right I was.

As I worked at my business meeting, I kept following the progress of Maria, joking that it might just prevent me from returning on Monday, but hoping that it would turn like so many storms before it. This was not to be. By late Saturday even though it was only tropical storm strength, it was apparent that on Sunday the regional airlines were going to evacuate their small aircraft to havens like Aruba and Curacao to the south and Central America to the west. Since there weren’t going to be any flights, my travel agent arranged for me to go back to my family in Georgia on that Monday to wait out the storm. We expected I probably wouldn’t get back to Dominica until air service was restored to Puerto Rico, probably four to six days after I’d originally been scheduled to return to Dominica.

September 18^th, 2017… Imagine being inside a tornado.

Imagine looking up to see your roof flying away and then the wind and rain coming in on top of your inadequate shelter as you brace your feet against the closet door, hoping it will hold. Imagine hanging on for hours and hours of storm, enduring howling winds and painful rain and your stuff blowing away around you, hoping you wouldn’t die. If you have trouble imagining it, so do I, because I wasn’t there. My colleagues who were there said that I was the luckiest person at the school, to be thousands of miles away that fateful day. From my computer screen at home that night I watched the storm give Dominica a direct hit with 160 mile per hour sustained winds, and turning only as the eye was literally over the island such that the entire west coast of the island was struck by the eyewall of Category Five Hurricane Maria. As I flew home over the United States that day, eighty to ninety percent of the buildings in the country were about to be damaged or destroyed, the hospital, power generators and water reservoirs damaged or destroyed, and the roads and bridges so shakily repaired after Erika destroyed again (6). The morning after the storm, people went out and saw that not one tree had escaped unscathed on the entire island, and in many places the trees had lost their bark or been snapped in two (7). Virtually every telephone pole was either in need of repair or down entirely. The airport was knocked out again from both rain and the river beside it washing through the terminal and over the runway. Unlike with Erika, the seaport and its dock and warehouse capacity on the west coast was heavily damaged as well. And of course, dozens of people were dead and dozens more are still missing to this day. The island was brought to its knees.

A few days after the storm, the prime minister declared in a speech to the United Nations General Assembly that “Eden is broken” (8).

Photo: GOES-16 visible image of Maria just before sunset, at 5:17 pm EDT Monday, September 18, 2017. Image credit: NOAA/RAMMB. (9)

At our campus, that brand new hurricane-proof building delivered. All of our people were safe, though many of our older buildings were heavily damaged. The French islands north and south of us weren’t so badly damaged and they were able to get helicopters up to survey the scene of total devastation that Dominica had become. Our campus became a site for them and other rescuers to base, as it was more functional than any other location on the north side of the island. With help from many others including the U.S. military, over a thousand students, faculty, staff, and family members were evacuated off the island through seas crowded with entire forests of dead trees and other debris. Our CEO was there to greet many Ross refugees in Miami as they returned to the US to an uncertain future. And as before, I watched it all from a distance, not personally devastated as they were but a refugee just the same. I found out from a colleague who had been my neighbor that my concrete cottage had held up better than most. Like three of the other cottages in the complex it still had both a roof and windows following the storm, but no one could say if anything inside had survived the flooding, or whether the post-storm looters who sadly went through many other places had broken in after they were evacuated. As soon as I could, I checked in with my school to let them know where I was and that I was safe. I was told to sit tight and wait for instructions, just like everybody else. So that’s what I did, for several weeks.

Stay tuned for next week’s exciting conclusion…

References/links/other:

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

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.
Michael J. Where’s the evidence that active learning works? Adv Physiol Educ. 2006;30(4):159-67.
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.
Connell JH. Diversity in Tropical Rain Forests and Coral Reefs. Science. 1978;199(4335):1302-10.
Duhigg C. Smarter Faster Better: Random House; 2016.
Woods DR. Problem Based Learning: How to gain the most from PBL. 2nd. ed1997.

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

The art of revamping an Introductory Biology course (and curriculum) around Vision & Change

When Vision & Change: A Call to Action was published and distributed, University of Alaska Anchorage (UAA) Biology department (like many other departments across the country) answered the call. The rubrics for Vision and Change gave people a means to evaluate one’s department and how student instruction occurred. This led to great discussions on what needed to be remodeled within our courses and curriculum. This was good. The previous UAA Introductory Biology course had a 20% withdrawal rate and (by estimates only) an additional 20% of students who would not succeed in the course (D or F grade). If we wanted to increase retention in the major and increase the diversity of people pursuing a biological sciences undergraduate education, something needed to be done.

I want to take this opportunity to spend a bit of time on our process; not simply because I am excited about the positive changes that are happening at our biology department, but to share our brief story in hopes to hear from others.

The problem – UAA had a 2 semester introductory biology (survey based) course that had, in some instances, 40% reduction of students for each semester.

Our solution – Create a 1 semester laboratory/experiential learning introductory biology course (Principles and Methods of Biology; BIOL A108) that is founded on the principles laid forth in Vision and Change.

What does this really look like, other than a lot of work?

The basic flow is to have 3, 5-week (10 sessions) modules within the semester, which focus on three core concepts: evolution, information flow, and structure and function. These modules are tied together by principles of the scientific method and student led experiments. Each module has a different content lead instructor. The unifying instruction is led by a lab coordinator that follows the theme of scientific method to ensure students are practicing and utilizing each part of the scientific method throughout the duration of the course.

Module 1 focuses heavily on observation, creating and testing hypotheses, finding and using credible sources, and creating basic graphs for communication purposes.
Module 2 continues to build on observation, creating and testing hypotheses, creating graphs, and adds the component of applying the collected data into a greater context using credible sources.
Module 3 takes the components of modules 1 and 2 and asks the students to interpret their data using credible sources.

These modules culminate at the end of the course by having the students present a hypothetical experiment based on a current biologically relevant observation.

This course set up requires a large amount of group work and coordination among the students. We encourage discussions through specific assignment prompts and ask the students to present their data (6 times) as a group (they switch group members for each module). Presentations are assessed on flow of information, clarity of information, and accuracy of information. We include concept quizzes (3 per module), but no high stakes exams. There are a series of assignments that are formative to allow instructor feedback to be incorporated into summative assignments (presentations and experimental write ups).

Is it working? – We’ve tracked these changes with pre/post tests and student retention rates. Initial data show 96% of students passed (defined as a C or better grade) with a withdrawal rate of 2% in the first semester (Fall 2015). Data from the current semester (Spring 2016) suggest a similar trend. A second goal of the program revision was to increase student learning and engagement about the process of the scientific method; in this our data suggest we were successful. Within one month of BIOL A108, students have improved their use of the scientific method to tackle challenging biological questions and core concepts. Preliminary assessment data show 96% of BIOL A108 students can create and use hypothesis statements correctly. Additionally, BIOL A108 student pre/post data indicate a 25% improvement in their comprehension of Mendel’s principles.

These changes have required a lot of work by many people; including learners from all levels. Transparent communication between instructors and students have been paramount to our initial success. This communication includes informing the students that the changes within the course structure are based on discipline based educational research and is founded by using current data from evidence-based teaching to shape the course.

Additional data that we are collecting include student demographics and end of semester student perception surveys. I hope to gather information regarding how this course is perceived by students and their personal successes as scientists. Why would we care about our student demographics? Anchorage, Alaska has three high schools in the top ten diversity ranking of high schools. A majority of our students enrolled in UAA’s biological science degree program are from the Anchorage and greater Alaska area. Collectively, if we want to increase the diversity of people trained in the biological sciences; UAA’s biological sciences program is one place to start. Maybe our course redesign will help others with their curricular transformations.

I am really interested in learning about how other departments and programs have remodeled their courses following the guidelines of Vision and Change, and what outcomes they are tracking. Let’s share ideas and materials within the LifeSciTRC and PECOP resources!

References:

Aguirre, K. M., Balser, T. C., Jack, T., Marley, K. E., Miller, K. G., Osgood, M. P., & Romano, S. L. (2013). PULSE Vision & Change Rubrics. CBE-Life Sciences Education, 12(4), 579-581.

Brewer, C. A., & Smith, D. (2011). Vision and change in undergraduate biology education: a call to action. American Association for the Advancement of Science, Washington, DC.

Brownell, S. E., & Kloser, M. J. (2015). Toward a conceptual framework for measuring the effectiveness of course-based undergraduate research experiences in undergraduate biology. Studies in Higher Education, 40(3), 525-544.

Farrell, Chad R. (2016). “The Anchorage Mosaic: Racial and Ethnic Diversity in the Urban North.” Forthcoming chapter in Imagining Anchorage: The Making of America’s Northernmost Metropolis, edited by James K. Barnett and Ian C. Hartman. Fairbanks, AK: University of Alaska Press

Hanauer, D. I., & Dolan, E. L. (2014). The project ownership survey: measuring differences in scientific inquiry experiences. CBE-Life Sciences Education, 13(1), 149-158.

Rachel Hannah is an Assistant Professor of Biological Sciences at University of Alaska, Anchorage. Helping people become scientifically literate citizens has become her major career focus as a science educator. As a classroom and outreach educator, Rachel works to help people explore science so they can apply and evaluate scientific information to determine its impact on one’s daily life. She is trained as a Neurophysiologist and her graduate degree is in Anatomy and Neurobiology from the University of Vermont College of Medicine. Recently, Rachel’s research interests have migrated to science education and how students build critical thinking skills.

Mari K. Hopper, PhDAssociate Dean for Biomedical ScienceSam Houston State University College of Osteopathic Medicine

Andrew M. Roberts, M.S., Ph.D., FAPSAssociate ProfessorDepartment of PhysiologyUniversity of Louisville School of MedicineLouisville, KY