Another look at the core concepts of physiology: revisions and resources

Teaching pathological physiology of sepsis using a high-fidelity simulator

A good knowledge of the theoretical foundations of medicine helps students and physicians to better recognize and treat patients with complex medical conditions, including sepsis and septic shock. The article describes the authors' experience in implementing the analysis of sepsis and septic shock using a high-fidelity simulated clinical scenario in the course of pathological physiology for preclinical medical students. The unique aspect of our approach is the integration of core physiology concepts, such as homeostasis, causality, structure-function relationships, and fundamental pathophysiology concepts (e.g., etiology, pathogenesis, cell and tissue damage, inflammation, symptoms, and syndromes) in the analysis of the patient's condition on the high-fidelity simulator with preclinical medical students. According to the students' feedback, the use of a high-fidelity simulator to analyze the sepsis and septic shock scenario increased their interest in the class, improved their motivation to learn the material, and helped them adapt in a safe environment to making decisions based on a large amount of data about a complex patient condition in a time-sensitive situation.NEW & NOTEWORTHY The authors applied core theoretical concepts of physiology and the fundamental concepts of pathological physiology for teaching sepsis and septic shock clinical scenarios on the high-fidelity simulator in the course of pathological physiology for preclinical medical students. It elevated students' interest and motivation, enhanced the educational experience, and prepared students better for real-world clinical decision-making. We consider that this idea might be an inspiration to colleagues and invite further discussion.

To disrupt the traditional compartmentalized learning of nutrition functions, a proposition for integrative teaching at undergraduate level

Rather than an anatomy-centered study of the nutrition functions of the body (circulation, respiration, food digestion, and intestinal absorption of nutrients) as found in undergraduate physiology textbooks, a more integrative, mechanistic approach to teaching human physiology at the undergraduate level in science faculties is presented. Starting from the cell's needs for nutrients and oxygen, this proposal highlights the way in which each organ or apparatus ensures cell function. Then the fundamental physiological concepts of structure-function relationships and matter gradients can be constructed by considering the physicochemical mechanisms involved. The diversity of devices found in circulatory, ventilatory, and digestive systems is then examined through the prism of the mechanisms used to maintain gradients in nutrient concentration or gas partial pressure through exchange surfaces. Finally, the systems controlling nutrition functions are studied in fluctuating physiological contexts, such as during physical exercise or fasting. The presented pedagogical approach emphasizes the integration of functions on an organism-wide scale and focuses teaching on basic mechanisms rather than on the description of structures, while ensuring the transferability of physiological concepts. This pedagogical approach seems particularly relevant for the training of undergraduate students intending to teach biology in secondary education.NEW & NOTEWORTHY A proposal for teaching of human physiology at the undergraduate level in a science faculty outlines a pedagogical progression centered on cellular requirements for nutrients and oxygen. Rather than being taught independently, the three nutrition functions, circulation, respiration, and digestion, are interrelated and functional similarities are highlighted. The core concepts of physiology are thus more integrated at the organism level, with an emphasis on common mechanisms rather than specific structures.

The impact of instruction on undergraduates' understanding of homeostasis: results from administering the homeostasis concept inventory

The Homeostasis Concept Inventory (HCI) is a validated instrument for measuring students' knowledge of homeostasis. It is comprised of 20 multiple-choice questions covering key components of the previously validated Homeostasis Conceptual Framework (HCF). In this paper, we present the first multi-institutional study of the impact of physiology instruction on students' HCI performance. Five cohorts of physiology or anatomy and physiology (A&P) students at four academic institutions took the HCI both at the start of their academic term (pretest) and at the end of their term (posttest). Statistically significant but relatively modest improvements in overall scores were seen from pretest to posttest. Among the 20 questions, 8 questions had incorrect choices identified as "attractive distractors" on the pretest, meaning that they were chosen at higher-than-random frequencies. From pretest to posttest, there were only modest declines in selections of incorrect answers generally and of attractive distractors in particular. Three attractive distractors that all target one specific misconception, that homeostatic mechanisms are active only when a regulated variable is not at its setpoint, remained persistently attractive except for students of one instructor who directly addressed that misconception in lecture and lab. These data are sobering in that they show a limited impact of instruction on HCI performance. However, these data also include encouraging evidence that instructional targeting of a specific misconception may help students overcome that misconception.NEW & NOTEWORTHY How is undergraduate students' understanding of homeostasis impacted by a physiology course? This study indicates that many students do not improve that much on a validated multiple-choice concept inventory but may improve noticeably on questions about a misconception if that misconception is specifically targeted by the instructor.

A workshop to enrich physiological understanding through hands-on learning about mitochondria-endoplasmic reticulum contact sites

Physiology is an important field for students to gain a better understanding of biological mechanisms. Yet, many students often find it difficult to learn from lectures, resulting in poor retention. Here, we utilize a learning workshop model to teach students at different levels ranging from middle school to undergraduate. We specifically designed a workshop to teach students about mitochondria-endoplasmic reticulum contact (MERC) sites. The workshop was implemented for middle school students in a laboratory setting that incorporated a pretest to gauge prior knowledge, instructional time, hands-on activities, interactive learning from experts, and a posttest. We observed that the students remained engaged during the session of interactive methods, teamed with their peers to complete tasks, and delighted in the experience. Implications for the design of future physiological workshops are further offered.NEW & NOTEWORTHY This manuscript offers a design for a workshop that utilizes blended learning to engage middle school, high school, and undergraduate students while teaching them about mitochondria-endoplasmic reticulum contact sites.

Teaching the distribution of pulmonary blood flow using a Starling resistor model and turbine flowmeters

The distribution of pulmonary blood flow is uneven and can be described as a three-zone model, the West zones: zone 1 occurs whenever alveolar pressure exceeds arterial pressure; zone 2 when the arterial pressure is greater than alveolar but the alveolar pressure exceeds the venous pressure; and finally zone 3 when both arterial and venous pressures exceed alveolar pressure. Consequently, the blood flow is almost determined by the difference between the arterial and venous pressures in zone 3 and between arterial and alveolar pressures in zone 2 and ceases in zone 1. The understanding of this subject may be difficult to some medical students. Therefore, to improve the learning of this topic in our physiology course, we used a didactic model to demonstrate the core concept of flow down gradients and its application to pulmonary blood flow. We modeled a Starling resistor by placing a collapsible tube inside a hermetic chamber of variable pressure. Transparent turbine flowmeters were connected to the upstream and downstream extremities of the Starling resistor, and we generated a constant airflow with a brushless motor. By maintaining the input (arterial) pressure constant and varying the chamber (alveolar) pressure, we could simulate the three zones and demonstrate the resulting flow through the turbines. In conclusion, our demonstration using a Starling resistor model combined with visible turbine flowmeters can be used to facilitate comprehension of important concepts in physiology involving flow down gradients, such as pulmonary blood flow.NEW & NOTEWORTHY The understanding of respiratory physiology is a challenge to medical students. To improve the learning of pulmonary blood flow distribution through lung vessels in our physiology course, we modeled a Starling resistor model combined with visible turbine flowmeters. Our model can significantly improve the core concept of flow down gradients teaching and its application to West zones.

General skills amidst the details: alternative learning objectives and a framework of competencies for human anatomy

The field of anatomy is often seen by nonanatomists as concerned primarily with the tasks of locating, naming, and describing structures; these tasks, in turn, are often assumed to require only lower-order cognitive skills (LOCSs), i.e., the Knowledge or Comprehension levels of Bloom's taxonomy. Many nonanatomists may thus believe that studying anatomy does not develop transferable higher-order cognitive skills. Published lists of anatomy learning objectives (LOs) might reinforce this view by focusing attention on numerous details of specific structures and regions. To explore this issue further, we have analyzed the structure of published peer-reviewed LOs by characterizing their organization (single-tiered or multi-tiered), inclusion of function, use of action verbs, and dependence on or independence of context. Our results suggest that previously published LO lists, despite their value, may not fully showcase opportunities for students to develop higher-order skills. In the hope of stimulating further discussion and scholarship, we present here a two-tiered framework of human anatomy competencies, i.e., generalizable skills beyond straightforward recognition and memorization. This framework, which is intended to be both student-facing and faculty-facing, illustrates how anatomy courses may be reframed as opportunities to think critically and develop sophisticated, professionally relevant skills.NEW & NOTEWORTHY Although skilled anatomists know that anatomy is much more than memorization, nonanatomists are often unsure how to emphasize general skills and problem-solving in their teaching of the subject. Here we show how a multi-tiered approach to defining and assessing learning objectives (LOs) can reframe anatomy courses as more than long lists of structures to remember.

Pressure never sucks, pressure only pushes: a physiological exploration of the pushing power of pressure

The movement of air into and out of the lungs is facilitated by changes in pressure within the thoracic cavity relative to atmospheric pressure, as well as the resistance encountered by airways. In this process, the movement of air into and out of the lungs is driven by pressure gradients established by changes in lung volume and intra-alveolar pressure. However, pressure never sucks! The concept that pressure never sucks, pressure only pushes encapsulates a fundamental principle in the behavior of gases. This concept challenges common misconceptions about pressure, shedding light on the dynamic forces that govern the movement of gases. In this Illumination, we explore the essence of this concept and its applications in pulmonary ventilation. Pressure is one of the most important concepts in physics and physiology. Atmospheric pressure at sea level is equal to 1 atmosphere or around 101,325 Pascal [Pa (1 Pa = 1 N/m2)]. This huge pressure is pushing down on everything all the time. However, this pressure is difficult to understand because we do not often observe the power of this incredible force. We used five readily available, simple, and inexpensive demonstrations to introduce the physics and power of pressure. This extraordinarily complex physics concept was approached in a straightforward and inexpensive manner while still providing an understanding of the fundamental concepts. These simple demonstrations introduced basic concepts and addressed common misconceptions about pressure.NEW & NOTEWORTHY The concept that pressure never sucks, pressure only pushes challenges common misconceptions about pressure, shedding light on the dynamic forces that govern the movement of gases. In this Illumination, we will explore the essence of this concept and its applications in pulmonary ventilation. Specifically, we used five readily available, simple, inexpensive demonstrations to introduce the physics and power of pressure.

Why ask why? Toward coordinating knowledge of proximate and ultimate explanations in physiology

In physiology education, students must learn to recognize and construct causal explanations. This challenges students, in part, because causal explanations in biology manifest in different varieties. Unlike other natural sciences, causal mechanisms in physiology support physiological functions and reflect biological adaptations. Therefore, students must distinguish between questions that prompt a proximate or an ultimate explanation. In the present investigation, we aimed to determine how these different varieties of student knowledge coordinate within students' written explanations. Prior research in science education demonstrates that students present specific challenges when distinguishing between proximate and ultimate explanations: students appear to conflate the two or construct other nonmechanistic explanations. This investigation, however, demonstrates that analytic frameworks can distinguish between students' proximate and ultimate explanations when they are provided explanatory scaffolds that contextualize questions. Moreover, these scaffolds and prompts help students distinguish between physiological functions and the cellular and molecular mechanisms that underpin them. Together, these findings deliver insight into the context-sensitive nature of student knowledge in physiology education and offer an analytic framework for identifying and characterizing student knowledge in physiology.NEW & NOTEWORTHY Why ask why? How questions posed in physiology task students with developing their mechanistic reasoning. Why questions sometimes undermine this reasoning. Prior research, however, also illustrates that framing the context of a question explicitly supports students in distinguishing between question types. We further illustrate how providing such context in the form of explanatory scaffolds and prompts allows students to tap different and useful varieties of knowledge when constructing written explanations.

Creating the HAPS Physiology Learning Outcomes: terminology, eponyms, inclusive language, core concepts, and skills

Learning outcomes are an essential element in curriculum development because they describe what students should be able to do by the end of a course or program and they provide a roadmap for designing assessments. This article describes the development of competency-based learning outcomes for a one-semester undergraduate introductory human physiology course. Key elements in the development process included decisions about terminology, eponyms, use of the word "normal," and similar considerations for inclusivity. The outcomes are keyed to related physiology core concepts and to process skills that can be taught along with the content. The learning outcomes have been published under a Creative Commons license by the Human Anatomy and Physiology Society (HAPS) and are available free of charge on the HAPS website.NEW & NOTEWORTHY This article describes the development of competency-based learning outcomes for introductory undergraduate human physiology courses that were published and made available free of charge by the Human Anatomy and Physiology Society (HAPS). These learning outcomes can be edited and are keyed to physiology core concepts and to process skills that can be taught along with the content.

Content Coverage as a Persistent Exclusionary Practice: Investigating Perspectives of Health Professionals on the Influence of Undergraduate Coursework

STEM undergraduates navigate lengthy sequences of prerequisite courses covering volumes of science content. Given that these courses may contribute to attrition and equity gaps in STEM, research is needed to test the assumption that prerequisite content benefits students in their future studies and careers. We investigated the relevance of prerequisite course content for students' careers through semistructured interviews with practicing nurses regarding their undergraduate anatomy and physiology (A&P) courses. Nurses reported that A&P content does not align with the skills and knowledge needed in the nursing profession. Interviewees averaged 39% on a brief A&P assessment, suggesting A&P prerequisites failed to impart a high degree of long-term A&P knowledge among nurses. Further, practicing nurses perceived overcommitment to A&P content coverage as an exclusionary practice that eliminates capable individuals from the prenursing pathway. These findings challenge assumptions surrounding the justification for prerequisite course content and raise questions of whether content expectations actively exclude individuals from STEM or healthcare careers. We aspire for this study to stimulate conversation and research about the goals of prerequisite content, who is best positioned to articulate prerequisite content objectives, and the influence of content coverage on equity and justice in undergraduate STEM education.

"Local control": another core concept of physiology

The maintenance of a more or less constant internal environment by homeostatic (negative feedback) mechanisms is well understood, and "homeostasis" is regarded as an important core concept for students to understand. However, there are critically important control mechanisms that operate at the local level and are more or less independent of homeostasis. Here we define a core concept of "local control," present examples of it in many different organ systems, and propose a conceptual framework for it. Local control, like all of the other core concepts, can provide students with a learning tool that can facilitate understanding physiology.NEW & NOTEWORTHY Local control of many physiological phenomena occurs to meet the needs of certain systems and to enable these systems to meet the episodic challenges that occur. The mechanisms by which local control is exerted include locally released chemical messengers, physical stimuli acting on the structures, and local neural networks. Examples of important local controls are present throughout the body.

Exploring progressive mental model representation of core physiology concepts in physician assistant students through word frequency and association analyses

A well-developed mental model is crucial for effectively studying physiology core concepts. However, mental models can be difficult for students to represent and for instructors to evaluate and correct. Systems modeling as a visualization cognitive tool may facilitate mental model development. On the other hand, evidence of mental model development may also be represented verbally, in writing, and therefore, be evaluated. In this study, analysis of writing prompt completions illustrated progress in physician assistant student mental model formation of physiology core concepts, such as homeostasis and cell-cell communication, over time. Two cohorts of physician assistant students were invited to voluntarily submit completions of writing prompts five times over 16 months. Sessions included submissions pre- and post-small group systems modeling participation. Word frequency and word association cluster dendrogram analyses were conducted on submissions using the tm text mining package in R to provide insight into progressive changes in core concepts of word use and associations. Students demonstrated expanded core concepts systems thinking over time. This was apparent through the increased use of systems process terms, such as homeostasis, in submissions immediately following systems modeling activities. Students also increasingly included terms and associations emphasizing cell-cell communication and systems integration. The inclusion of these concepts within student mental models was demonstrably enhanced by participation in systems modeling activities.NEW & NOTEWORTHY This study applies text mining, an artificial intelligence form of natural language processing, to evaluate a series of physiology student-written prompt completions. Text mining of student writing in physiology has not yet been reported in the literature. Through the application of this technique, longitudinal trends in student development of mental models of core concepts were identified and visualized through word frequency distributions and cluster dendrograms.

Teaching science with the "universal language" of music: alignment with the Universal Design for Learning framework

The idea of teaching science through music has undeniable appeal in implying that learning can be engaging and fun while also covering content efficiently. Indeed, there is little doubt that songs can be uniquely memorable, suggesting mnemonic options for core content. However, many classroom implementations of science music have limitations such as an overemphasis on rote memorization, rather than a constructivist building of understanding. In this brief review, we ask how music might facilitate the learning of science content in a manner consistent with the well-known pedagogical framework of Universal Design for Learning (UDL). In our view, UDL suggests certain distinct possible benefits of incorporating music into curricula, leading us to propose four models of practice. These four models are as follows: 1) students enjoy music together, 2) students critically analyze songs as texts, 3) students creatively augment existing songs, and 4) students create new songs. Model 1 can contribute to an inclusive learning environment, while models 2-4 can encourage cognitively rich active learning, and models 3-4 can additionally help students channel scientific understanding into the creation of authentic products. We conclude with comments on logistical issues that arise in implementing these four models, including the use of appropriate rubrics and the prioritization of artistic quality.NEW & NOTEWORTHY Instructors and students often find it fun to incorporate music into science classes. However, the casual usage of music in this context can unintentionally convey that science courses are mostly about memorizing scientific facts. In this article, the authors argue for a more nuanced approach to teaching science with music, rooted in Universal Design for Learning (UDL).

Establishing consensus for the core concepts of physiology in the Australian higher education context using the Delphi method

A set of core concepts ("big ideas") integral to the discipline of physiology are important for students to understand and demonstrate their capacity to apply. We found poor alignment of learning outcomes in programs with physiology majors (or equivalent) from 17 Australian universities and the 15 core concepts developed by a team in the United States. The objective of this project was to reach Australia-wide consensus on a set of core concepts for physiology, which can be embedded in curricula across Australian universities. A four-phase Delphi method was employed, starting with the assembling of a Task Force of physiology educators with extensive teaching and curriculum development expertise from 25 Australian universities. After two online meetings and a survey, the Task Force reached agreement on seven core concepts of physiology and their descriptors, which were then sent out to the physiology educator community across Australia for agreement. The seven core concepts and their associated descriptions were endorsed through this process (n = 138). In addition, embedding the core concepts across the curriculum was supported by both Task Force members (85.7%) and educators (82.1%). The seven adopted core concepts of human physiology were Cell Membrane, Cell-Cell Communication, Movement of Substances, Structure and Function, Homeostasis, Integration, and Physiological Adaptation. The core concepts were subsequently unpacked into themes and subthemes. If adopted, these core concepts will result in consistency across curricula in undergraduate physiology programs and allow for future benchmarking.NEW & NOTEWORTHY This is the first time Australia-wide agreement has been reached on the core concepts of physiology with the Delphi method. Embedding of the core concepts will result in consistency in physiology curricula, improvements to teaching and learning, and benchmarking across Australian universities.

Advancing physiology education by understanding the multiple dimensions of homeostasis

Homeostasis of the internal environment has been considered the central organizing concept of physiology. However, current definitions of it in textbooks and online teaching sources do not sufficiently reflect how homeostasis serves its central unifying role. Meanwhile, scientific understanding of the functions of the body's structures at multiple levels (molecular, cell, tissue, organ, organ system, and organism) has advanced significantly, but the understanding of homeostasis is still in the same place. In this article, the author describes some issues and insufficiencies in teaching about homeostasis in physiology education and proposes that homeostasis needs to be understood in terms of four dimensions rather than a simple definition: internal, functional organization; functional manifestation; mechanism; and effect or consequence. Each dimension has two subdimensions or sides. Throughout the elucidation of these dimensions and subdimensions, the original meaning of homeostasis is reinforced, what is lost in current understanding of homeostasis becomes clear, some insufficiencies mentioned above are supplemented, new insights into homeostasis develop, and how the four dimensions of homeostasis can be applied to physiology education is exampled. This new, comprehensive conceptualization advances the understanding of homeostasis and can facilitate teaching and learning about homeostasis and physiology.

Using Test Question Templates to teach physiology core concepts

The past ∼15 years have seen increasing interest in defining disciplinary core concepts. Within the field of physiology, Michael, McFarland, Modell, and colleagues have published studies that defined physiology core concepts and have elaborated many of these as detailed conceptual frameworks. With such helpful definitions now in place, attention is turning to the related issue of how to maximize student understanding of the core concepts by linking these "big ideas" to concrete student-facing resources for active learning and assessment. Our practitioner-based view begins with the recognition that in many if not most undergraduate physiology courses assessment drives learning. We have therefore linked published conceptual frameworks to Test Question Templates (TQTs), whose structure promotes transparent assessments as well as the active learning needed to prepare for such assessments. We provide examples of conceptual framework-linked TQTs for the physiology core concepts of Homeostasis, Flow Down Gradients, the Cell Membrane, and Cell-Cell Communication. We argue that this deployment of TQTs has at least two distinct benefits for the teaching and learning of core concepts. First, documenting the connections between conceptual frameworks and TQTs may clarify coverage and assessment of the core concepts for both instructors and students. Second, misconceptions about core concepts may be directly targeted and dispelled via thoughtful construction, arrangement, and iteration of TQTs. We propose that the TQT framework or similar approaches may be applied fruitfully to any sufficiently articulated physiology core concept for high school, undergraduate, or graduate students.NEW & NOTEWORTHY Our students often focus on the grades they need to advance through academic programs. How can instructors harness this understandable interest in grades to help students gain a true understanding of core concepts? The new framework of Test Question Templates (TQTs) shows promise in linking student priorities like test scores to instructor priorities like core concepts.

Oaks to arteries: the Physiology Core Concept of flow down gradients supports transfer of student reasoning

The Physiology Core Concept of flow down gradients is a major concept in physiology, as pressure gradients are the key driving force for the bulk flow of fluids in biology. However, students struggle to understand that this principle is foundational to the mechanisms governing bulk flow across diverse physiological systems (e.g., blood flow, phloem sap flow). Our objective was to investigate whether bulk flow items that differ in scenario context (i.e., taxa, amount of scientific terminology, living or nonliving system) or in which aspect of the pressure gradient is kept constant (i.e., starting pressure or pressure gradient) influence undergraduate students' reasoning. Item scenario context did not impact the type of reasoning students used. However, students were more likely to use the Physiology Core Concept of "flow down [pressure] gradients" when the pressure gradient was kept constant and less likely to use this concept when the starting pressure was kept constant. We also investigated whether item scenario context or which aspect of the pressure gradient is kept constant impacted how consistent students were in the type of reasoning they used across two bulk flow items on the same homework. Most students were consistent across item scenario contexts (76%) and aspects of the pressure gradient kept constant (70%). Students who reasoned using "flow down gradients" on the first item were the most consistent (86, 89%), whereas students using "pressures indicate (but don't cause) flow" were the least consistent (43, 34%). Students who are less consistent know that pressure is somehow involved or indicates fluid flow but do not have a firm grasp of the concept of a pressure gradient as the driving force for fluid flow. These findings are the first empirical evidence to support the claim that using Physiology Core Concept reasoning supports transfer of knowledge across different physiological systems.NEW & NOTEWORTHY These findings are the first empirical evidence to support the claim that using Physiology Core Concept reasoning supports transfer of knowledge across different physiological systems.

Undergraduate students' neurophysiological reasoning: what we learn from the attractive distractors students select

The basis for mastering neurophysiology is understanding ion movement across cell membranes. The Electrochemical Gradients Assessment Device (EGAD) is a 17-item test assessing students' understanding of fundamental concepts of neurophysiology, e.g., electrochemical gradients and resistance, synaptic transmission, and stimulus strength. We collected responses to the EGAD from 534 students from seven institutions nationwide, before and after instruction. We determined the relative difficulty of neurophysiology topics and noted that students did better on "what" questions compared to "how" questions, particularly those integrating concentration gradient and electric forces to predict ion movement. We also found that, even after instruction, students selected one incorrect answer, at a rate greater than random chance for nine questions. We termed these incorrect answers attractive distractors. Most attractive distractors contained terms associated with concentration gradients, equilibrium, or anthropomorphic and teleological reasoning, and incorrect answers containing multiple terms were more attractive. We used χ² analysis and alluvial diagrams to investigate how individual students moved or did not move between answer choices on the pre- and posttest. Interestingly, students selecting the attractive distractor on the pretest were just as likely as other incorrect students to move to the correct answer on the posttest. In contrast, of students incorrect on both the pre- and posttest, students who selected the attractive distractor on the pretest were more likely to stick with this answer on the posttest than students choosing other incorrect answers. Combining the EGAD results with alluvial diagrams can inform neurophysiology instruction to address points of student confusion.NEW & NOTEWORTHY Investigating students' alternative reasoning in neurophysiology, this research is the first to investigate how analyzing the most common incorrect answer can shed light on the concepts students struggle with when reasoning about neurophysiological problems, especially those dealing with both chemical and electrical driving forces to predict ion movement across cell membranes.

Constructing the Wiggers diagram using core concepts: a classroom activity

The Wiggers diagram showing simultaneous events of the cardiac cycle in composite graphs is one of the most intimidating figures students encounter in their study of physiology. This paper describes a discovery learning activity that walks students through the construction of the Wiggers diagram by focusing on the core concepts of blood flow down pressure gradients and the structure-function relationship of heart valves and one-way blood flow through the heart. Additional tasks require students to transfer their understanding to previously unstudied scenarios and figures, such as the left ventricular pressure-volume loop.NEW & NOTEWORTHY The Wiggers diagram is one of the most intimidating figures students encounter in their study of physiology. This paper describes a discovery learning activity that walks students through the construction of the Wiggers diagram by focusing on core concepts: blood flow down pressure gradients and the structure-function relationship of heart valves and blood flow.

Exploring physiology instructors' use of core concepts: pedagogical factors that influence choice of course topics

The physiology core concepts are designed to guide instructors in undergraduate physiology courses. However, although past work has characterized the alignment of physiology programs with the core concepts, it is unclear to what extent these core concepts have influenced instructors' pedagogical decisions or how represented these core concepts are across physiology courses. We surveyed undergraduate physiology instructors to determine their familiarity with the core concepts, the impact of the core concepts on their teaching, as well as the alignment of their courses with these core concepts. Instructors report predominantly relying on textbooks and past syllabi of their courses as resources that influence their instructional decisions on which topics to include in a course. However, many instructors report reorganizing their physiology courses in subsequent iterations or reducing the number of concepts covered to allow more time for critical thinking and active learning. In addition, we find that the majority of instructors indicate that they are not knowledgeable about the list of physiology core concepts and that the influence of these core concepts is limited even for those who report familiarity with the list of core concepts. Finally, we find that instructors report uneven coverage of physiology core concepts in their courses, with some core concepts ubiquitous while others are sparsely covered. We conclude by discussing implications of our work for the physiology education community and call for the continued development of resources to support new physiology instructors and the need to promote coverage of certain core concepts in physiology courses.NEW & NOTEWORTHY The physiology core concepts are a critical resource for undergraduate physiology instructors. Despite this, little past work has investigated the impact of these core concepts across institutions. We find that most instructors are unfamiliar with these core concepts and instead rely on other resources when developing and revamping their physiology courses. We also identify uneven coverage of the core concepts in the curriculum and offer implications for the physiology education community.

Use of core concepts of physiology can facilitate student transfer of learning

Students often fail to utilize what they know about one topic (e.g., hemodynamics) when attempting to master another topic involving a similar phenomenon (e.g., airflow in airways). What accounts for this difficulty that students have? And how can students be assisted in doing a better job of applying what they already know to new topics? The phenomenon described above is an example of a failure of transfer of learning. However, much is known about the conditions that foster or promote transfer of learning. Applying this emerging knowledge and focusing on the core concepts of physiology can make learning physiology easier and provide students with tools to support lifelong learning.NEW & NOTEWORTHY Students often fail to utilize knowledge from prerequisite courses while learning physiology. They also fail to use what they know about one physiology topic when attempting to learn another topic. Much is known about the conditions that foster or promote transfer of learning. Applying this emerging knowledge and focusing on the core concepts of physiology can making learning physiology easier and provide students with tools to support lifelong learning.

Defining core conceptual knowledge: Why pharmacy education needs a new, evidence-based approach

INTRODUCTION

No pharmacy program, however well-resourced, has sufficient time or resources to teach students all current, practice-relevant knowledge. And while the volume of potential pharmacy education curriculum content increases exponentially each year, available time for direct instruction continues to decline. Given these constraints, pharmacy curricula must focus on promoting deep learning of the most critical, fundamental, broadly applicable, and lasting knowledge. Yet, in terms of didactic knowledge, pharmacy education currently has no agreed upon, evidence-based criteria for determining which foundational concepts are most important to teach nor any research-based assessment tools to demonstrate how well students have learned those core concepts.

PERSPECTIVE

This lack of consensus regarding core conceptual knowledge makes disparities in learning outcomes both more likely to occur and less likely to be detected or addressed. Over the past 30 years, several scientific disciplines undergirding pharmacy have developed research-based lists of core concepts and related concept inventories, demonstrating their transformative educational potential. Core concepts are big, fundamental ideas that experts agree are critical for all students in their discipline to learn, remember, understand, and apply. Concept inventories are research-based, psychometrically validated, multiple-choice tests designed to uncover learners' prior knowledge and potential misconceptions and determine their depth of understanding of disciplinary core concepts.

IMPLICATIONS

This commentary proposes adapting and applying this evidence-based core concepts approach to enhance pharmacy education's overall effectiveness and efficiency and outlines an ongoing, multinational research initiative to identify and define essential pharmacy concepts to be taught, learned, and assessed.

Navigating the "COVID hangover" in physiology courses

Undergraduate educators and students must navigate lingering aftereffects of the COVID pandemic on education in the 2021-2022 academic year even as COVID continues to impact delivery of undergraduate science education. This article describes ongoing difficulties for undergraduate science, technology, engineering, and mathematics (STEM) students and educators and suggests strategies and easy-to-use resources that may help educators navigate the "COVID hangover" and ongoing COVID-related disruptions.

Core concepts in physiology: teaching homeostasis through pattern recognition

Homeostasis is a core concept in systems physiology that future clinicians and biomedical professionals will apply in their careers. Despite this, many students struggle to transfer the principles governing homeostasis to concrete examples. Precourse assessments conducted on 72 undergraduate biology students enrolled in an introductory systems physiology course at the University of Belgrade during the February-May semester of 2021 revealed that students had a vague, fragmentary understanding of homeostasis and its related concepts that was often conflated with topics touched on during their previous coursework. We formalized and implemented an approach to teaching homeostasis that focused heavily on consistent reinforcement of physiological reflex patterns throughout the course. To that end, we employed a variety of activities aimed at getting students to view organ system integration holistically. After the semester, postcourse assessment demonstrated that students were better able to provide concrete examples of organ system contributions to homeostasis and were more adept at applying basic principles to novel physiological scenarios. Comparison of final grades with previous semesters revealed that students outperformed their peers who had taken the course previously. In this article, we summarize the findings of pre- and postcourse assessments, describe the general approach we took to teaching homeostasis as well as the specific techniques used in the classroom, and compare student performance with previous semesters.

What do we mean when we talk about "structure/function" relationships?

In multiple studies "structure/function" has been identified as an important core concept in biology and physiology. Teachers expect their students to be able to use this concept in making sense of physiology. However, it is unclear exactly what physiologists are referring to when they use the term "structure/function." Here I first offer examples of four different ways in which I have used the term in the classroom. Then, I propose a conceptual framework that is an explicit statement of the "structure/function" core concept that can be used by teachers and their students as they attempt to master physiology. Determining whether this conceptual framework is completely accurate and whether it will prove useful in the classroom will require feedback from physiology teachers who attempt to use it in their classroom with their students.

Validating The Core Concept Of "Mass Balance"

We have created a conceptual framework for the core concept of "mass balance." Unlike the previous conceptual frameworks that we have created and validated, the framework for "mass balance" is simply a description in words of the fundamental mass balance equation and the implications of the equation. We surveyed physiology faculty and asked them to rate the importance of "mass balance" as defined by the conceptual framework and also to rate the importance for their students of being able to apply the core concept to liquids, gases, solutes, and solids. Respondents indicated that "mass balance" is important and that our conceptual framework provides a useful tool for teaching and learning. We discuss several examples of how "mass balance" can be used in making sense about a variety of physiological phenomena.