15- Why Do We Do This?


I’m on week five of my 16 week semester.  It is 11:30pm and I haven’t yet solidified the activities I will do in class tomorrow…in just 9 hours.  I could probably benefit from using that 9 hours to sleep…but sleep becomes disposable as I tackle these new approaches in my classes.  It is easy to get discouraged by the work load, especially when I know that everything I am doing could be so much better…because I’m trying to get it all done in this 9 hour time slot that I have left before I need to show up in my classroom, bright eyed and bushy tailed, and ready to motivate my crew to tackle the anatomy of articulations.

I find it really interesting to think about WHY I keep doing this…and the fact is, I am hugely motivated to do this work because my students love it.  I am struck by the moment when I realized just how much they loved it.  It was almost exactly one year ago, in the middle of flipping Anatomy for the first time, when a dear friend of mine was killed by a crazy person in a hit and run incident while she was out on a morning run.  I was in class when her husband called me…my students were incredible as I processed the news.  They packed me up to go help, they completed the lab on their own, they called me to check in, and they offered hugs and food and cleaning and support.  As I became a primary support person for my friend’s husband and her small children, I inevitably found myself getting behind in the flip.  So I asked my students an anonymous survey question: “How would you FEEL if we stopped flipping?”  I halfway hoped they would be indifferent so we could return to the old methods, which would just be easier. But in spite of everything I was going through, 80% of my students said, essentially, that they would fall, writhing upon the ground, if I stopped flipping the class.

I think back on that moment, when I embraced the rewards of having my efforts so valued.  You’ve probably all experienced something like this.  It is what keeps us working so hard, isn’t it…

Flipping A & P: The Benefit of the Second Chance

Typewriter Eraser by Claes Oldenburg and Coosje van Bruggen
Typewriter Eraser by Claes Oldenburg and Coosje van Bruggen
National Gallery of Art, Washington

I really want my students to understand Anatomy and Physiology, not just memorize the terms and some factoids.  So I try to design assignments that challenge them to connect ideas, delve into ramifications and apply information in new ways.  When my students complete these group assignments I hope that they have a deeper understanding of the concepts covered.  At least on the questions they got right.  The missed questions are a different story.

Students rarely asked why they got a question wrong or what the correct answer was.    I could write insightful comments to guide them and it would mostly be a waste of ink. I handed back these assignments only to have the grade glanced at and then the paper stuffed into a binder, never to be looked at again.  I thought “If they would just go back over these missed questions, they would learn so much more.”

Of course, the only sure way to get students to do something is to attach points to it.  So I borrowed an idea from mastery learning, and started to allow students to resubmit work for a higher grade.  Unlike mastery, I only allow an assignment to be resubmitted once. When given unlimited attempts, I find that students just start guessing, hoping to hit the right answer eventually.

My students work in groups of 3-4, so re-grading work isn’t as daunting for me as it may sound.  Don’t get me wrong, I do a considerable amount of grading, but I have really seen a benefit from the “redo”.

The biggest benefit is the clearing up of misunderstandings for the students. For example, on a recent protein synthesis assignment, students were confusing amino acids with codons. Because they went back and tried again, they realized the difference. Ideally, they won’t have the same confusion on the exam.

You may not want to let your students resubmit every assignment you give them, but consider trying it for an assignment that they find especially difficult.  I find a little extra grading pays big dividends.


Cooperative Quizzes – The First Step To Flip Your Classroom

Most of us in HAPS thrived in high school, college, and even graduate school classrooms that were driven by educators who lectured.  At the start of class, the instructors would walk into the room and begin to talk .. draw on the whiteboard .. talk .. show a slide.. and talk some more.  A few lectures were dynamic and inspiring while others provided opportunities to read the school newspaper.  But all of us survived our student years  – and we learned quite a bit of anatomy and physiology in the process.

Now we’re the educators and find ourselves on the other side of the desks. Sadly, most of us are obeying the first rule of education: teach the way you’ve been taught.  If you experienced lectures as a student, well, now as an instructor, you probably lecture.  There is indeed an art to lecturing – not everybody can do it.  My own lecture style took several years to develop.  Where do I stand in the room?  How fast should I talk?  How much content do I cover each day?   How many Power Point slides do I show?  Should I tell a joke or two, or make reference to pop culture? According to my student evaluations, I could lecture pretty well –even won a couple teaching awards largely through the lecture method.

Then YouTube came along.

YouTube made me think about lecture as a teaching method.  Why not just record lectures and let students watch them wherever and whenever they liked?  If students were confused by a topic, they could just go back and re-watch the video.   And if they did not like my video, they could watch one of the other hundred or so video clips on the same topic.

SO .. if lectures are on YouTube, what should happen in the classroom where I used to lecture?

This is where the notion of ‘flipping’ comes in.  Historically, students have listened to lectures during lecture time, and engaged in other activities such as group projects and study-sessions outside of lecture time.  A flipped classroom is one where students learn the basic content outside of class and then engage in group projects, discussion, etc., during in-class “lecture” time.

The concept of a flipped classroom is easy to understand.  But to actually do it is quite difficult. Two components are necessary for a successfully flipped class – instructional methods (teaching skills) & curriculum.

Instruction.  The classroom leader of a flipped classroom must have the pedagogical skill set required to facilitate student-student interactions. Because most of us have spent quite a bit of time lecturing, we are quite accustoming to talking in front of large groups of students and answering direct, and sometimes difficult, questions.  But these presentation skills, and our vast knowledge of anatomy and physiology, are typically not enough to flip a classroom.  You need a broader set of teaching skills to facilitate curiosity and independent thought in a classroom that is far more noisy and chaotic than the traditional lecture hall.

Curriculum.  These are the activities and materials that instructors use to generate student discussion and to facilitate learning.  Creating good curriculum is difficult. Sometimes the curriculum is too easy and students are bored, and sometime it’s too difficult and students are confused and frustrated.  “Dialing in” effective curriculum for students is indeed an art form.


So where to start?

This is where I recommend cooperative quizzes.

Cooperative quizzes represent an easy to develop (curriculum) / easy to implement (instruction) technique that can be viewed as a first step toward the flipped classroom.

There are two parts to a cooperative quiz:  First, students complete a quiz on an individual basis, just like a regular quiz, and turn it in.  Second, students complete the same quiz again, but this time working in groups of two, three or four, and using only one answer sheet.  Students must agree to one answer for each question, thus promoting discussion between students.  All students must put their names on this one answer sheet at the end of the quiz. Grading a cooperative quiz is completed by averaging of the individual and group scores.

(A few years back the University of Minnesota created a free, on-line, tutorial for instructors who wished to learn how to use cooperative quizzes.  )

I give one cooperative quiz every week.  Typically, the individual quiz takes about 5 minutes to complete (10 – 15 questions per quiz), and the group quiz takes a bit longer due to student discussions.  This amounts to a total of 15 minutes of class time per week, and only about 10 minutes of a “flipped” environment where students are already working in groups.  Not much, but the tone of the classroom has been changed; students learn that that they are expected to work with each other, and they begin to converse with each other using the language of the discipline.  They use words like hypoinsulinism, hyperglycemia, and diabetes in ways that help them develop a conceptual understanding of physiology.  Nice!

Flipping a classroom is difficult when you are accustomed to more traditional teaching methods such as lecture, but if you wish to take the first step, I recommend trying a cooperative quiz.

Go HERE to see a short video on how to implement cooperative quizzes

The second step?  That would be POGIL, and that’s fodder for my next HAPS Blog entry.

(Murray Jensen is a member of the HAPS Board of Directors and represents the Midwest Region.)

14- The External Brain

External brains are handy…as long as internal brains are used as well.

As some of you probably know, I got a little bit fired up about the External Brain as presented by Jon Runyon (Go Ducks) at the annual conference in Vegas this year.  I have incorporated the External Brain into my course this semester and am curiously observing its effects in my classroom.  When I decided to have my students create their own External Brains, I did so with the goal that they would come to class more prepared to participate in active learning.

The External Brain is a unique resource built throughout the semester by each individual student.  There is an External Brain assignment due at the beginning of each class and my original vision was to immediately check this assignment for completion and return it to the student.  I quickly found this to be logistically impossible with my mere 55 students and then remembered Runyon talking about his “army of TA’s” that helped him carry out this task.  I tend to be a relatively pragmatic human, so when I realized the error of my plan, I started having students check each others’ brains during the first 5 minutes of class. I like the idea of students discussing and evaluating their work with each other.   Students are then rewarded for the quality of their product when they are allowed to use the resource on an “External Brain” portion of each exam.  This part of the exam ends up being about 20% of the total exam points.

I gave my first “External Brain” exam on Wednesday last week during our hour-long lecture period.  My goal was to have the exam questions based entirely on case studies and clinical scenarios.    I ended up with 20 decent questions (though I was still writing the exam at 2am, just 6 hours before I was scheduled to administer it).  Needless to say, my questions will certainly improve over time.  The helpful folks on the HAPS listserv contributed to my favorite question, which asked students to evaluate tracheal tissue samples from smokers and non-smokers.

Unsurprisingly, students performed well on this portion of the exam (82% average with 91% earning a C or higher).  This compares to my written exam (78% average with 66% earning a C or higher) and the practical (73% average with 57% earning a C or higher), both of which were given on the same day.  I was also curious about how students perceived the value of the External Brain.  60% of the students said they found their document helpful during the exam.  40% said it wasn’t that helpful, but many students in this category qualified their responses by explaining that the document hadn’t been very helpful because the act of creating it had been so effective in preparing them for the assessment.

None of this knocks my socks off.  However, the one thing that I find really intriguing about the External Brain is its potential to facilitate a flipped classroom that does not involve video lectures.  I could see an instructor putting together a very well-designed External Brain assignment that guided students through the content, much like a lecture does.  Students who thoughtfully completed the External Brain tasks would then be as prepared for class activities as my students, who watch video lectures online.   I know this works at the University of Oregon with all those pre-meds…would it work for my pre-nursing crew?

High Hopes for the Semester, Part 3

“Can you set up the practical for me next week?  I’m just not ready for it this week.”

Come a little closer and let me explain it to you.
Come a little closer and let me explain it to you.

I slowly unclench my fingers from the mouse as I read this email from a student the evening before our first lab practical of the semester.  Four weeks into the semester, it does seem about time for these kind of desperate requests.  Nonetheless, it is so hard to not be riled up by the request.  I breathe for a few moments, compose a response, delete it (too biting), breathe a little more, compose a new response (better), and send it.  The gist of my reply is “no”.  I elaborate that it would be unfair to do that for one student over all of the others.  I drop their lowest exam or lab practical, so if he bombs this, it will just be his lowest score and not affect his overall course grade.  Later that evening, I get a reply.

“Okay, I can see that reasoning.  I was just stressed with work and wanting to do well.  I’ll crack down on the books tonight and be as prepared for tomorrow as possible.”

Wow…maturity.  Who woulda guessed?  That kicks up my “high hopes” level for the semester by one notch.

Next student:

“I’m sorry that I haven’t completed the syllabus quiz – which was assigned the first day and due the end of the second week – but I was bedridden this past week and the internet where I live is too spotty to get email and I was called into work several times this past week and…”

Where do we begin with how wrong this is?
Not impressed with his focus.

A little background for you.  I assign the syllabus quiz – found online in a test bank – the first day of class.  The students need to get a perfect 10 out of 10 on it by the end of the second week (they can take it as many times as they want).  If they haven’t gotten the 10 by the deadline, they lose 1% of their overall course grade for each day late.

This student is now two weeks late.  I’ve reminded him in person and sent him email reminders.  He’s shown up for half of the classes, usually just long enough to take the exam and disappear before I can catch him to chat.  He has not done well in the exams but did fair in the lab practical (so, I don’t want to give up on him entirely).  Having said that, I’m not thrilled with his inability to complete a simple assignment.  If he’s having such trouble with this one assignment, what does that say about the rest of the semester?  This one drops down the “high hopes” level for the semester by one notch.  We’ll see how/if he progresses.

Next student:

“I’d like to re-enter the class.  After the first week, I had to drop when my work changed my shift schedule.  Now, I’ve got it back into check and wonder if you’ll let me back in and catch up on what I missed.”

How much can you learn in a few nights?
How much can you learn in a few nights?

Breathe.  Re-read the email.  Unclench the fingers.  Breathe.  Look at the schedule.  She attended for the first week and a half, doing fair in the chapter quizzes.  She’s been a student in two previous courses and is stable, solid “B” student usually.  She’s missed a week and a half, which includes two quizzes (which is doable as I drop the two lowest quizzes out of seventeen).  The first major exam is in a few days.  In her email, she mentions that she’s already talked to some classmates, gotten notes, downloaded my PowerPoints, and is reviewing for the exam.  I decide to take a gamble and allow her back into the class.

That was a week ago.  She took the exam and scored a high “C”, which isn’t bad considering how much she had to catch up to get there.  We have two quizzes this next week and the next exam the week after that.  We’ll see how she does.  My “high hopes” indicator is “pending” for this one so far.  Cross your fingers.

Overall, so far:

This semester is a mixed bag of stories and students.  You’ve had students like these.  You can appreciate how easy it can be to become jaded and not have hope.  By the same token, you know what it’s been like to offer hope and…either they reward your hope or they crush it.  But, that’s one of the amazing thing about being an educator.  We hope.

Flipping A & P: The Drama of Collaboration

Image by Colleen Roxas

It’s that time of the semester again, group assessment time.  I’m hoping it will resolve some of the group drama that I’ve been pulled into.

When I first started flipping my classes, I decided that my students would work collaboratively in groups.  I had been having trouble getting the students to participate in classroom discussions with me and I was hoping they would be more willing to talk to each other.  Boy, do they!  It can get very loud in my class sometimes.  As long as they’re mostly talking about Anatomy and Physiology, that’s a great thing.

During my first flipped semester I formed student groups based on where the students were sitting in one class and randomly in another class.  I would like to be able to say I did this on purpose to see which worked better, but it just happened by coincidence.  I thought that grouping students by where they sat would be random.  I know better now.  And it quickly became clear that a true random assortment worked much better than student selected groups.

Students sat with their friends and the classroom was segregated by type of student.  Students in the front row were go-getters and the back corners were filled with students trying not to be noticed.  I ended up with several super-groups and several flailing groups. Surprisingly to me, the self-selected groups had little drama.  They quietly excelled or quietly floundered.  The randomly formed groups had all kinds of drama.  I was worried about this in the beginning, but I came to realize that groups with issues were passionate and passion is good.

Something I didn’t expect happened in the random groups. These groups would have one or two successful students and several mediocre students.  The mediocre students began to look to the good students for help and the good students were happy to give it.  They became role models to the struggling students.  They shared good study techniques and would keep the group focused.  The drama would start when students felt they were working harder than others in the group or someone was too controlling.  The temptation for me was to step in and separate the warring parties.  But I knew that one of the benefits of working in groups is to learn to resolve problems on your own.  I gave advice and asked them to stick it out one more week.  For several groups it took two weeks and more advice and not a few tears, but the groups would resolve their issues or at least come to a truce.  Interestingly, the groups with the most drama at the beginning usually ended up being the best groups by the end.  They fought because they cared.

I’ve since discussed my early group experience with faculty friends in the Communications department and they just nodded knowingly.  They gave me a lot of great advice and I have implemented two suggestions so far. The first one is to form the groups more purposefully.  I now create teams based on student preparedness for the class.  I’ll elaborate on that process in my next blog post.  The other idea is to assign peer assessments.  Each student must evaluate every other student in the group, including themselves, using a rubric.  They assign points to each other that represent how much they feel that student has contributed to the group.  The average of the points counts as one of their group work grades.  The most helpful aspect of this assessment is the constructive (but polite) comments they make about each other anonymously.  The students receive all the assessment information as feedback and the comments may be the most helpful to counter the drama.  Student cohesion really improves after the assignment.  I’m hoping it works this semester so I can hang up my mediator hat for a while.

Collaborative learning may be noisy and like a soap opera sometimes, but I think it has been the most successful part of my classroom flip.


Image by Colleen Roxas, http://www.simplyaesthetic.net

Old Physiology for Young Students – A Tribute, Part 1


Recently I was lucky enough to be given a very old physiology textbook from a friend in the estate sale business. The book, Applied Physiology, Primary, by Frank Overton M.D. is copyright 1898.  It is so very interesting, that I felt that I would share it with everyone via this blog. For your information, it is pretty easy to find copies for sale on the internet.


In this first installment let me discuss the audience and goal of this textbook. In future installments I will provide some of the text and images for your enlightenment. It is a true treasure to experience reading this text as it shows me what we thought we knew that we didn’t, and more interestingly to me what we knew in the late 1800’s but have chosen to ignore for over 100 years.

Here is the preface verbatim –

“This primary text book of applied…

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