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.

The IUSM Medical Education Scholarly Concentration: Training Medical Students to Become Future Clinical Educators.

Indiana University School of Medicine - Bloomington launched the Medical Education Scholarly Concentration in 2020. This application-based enrichment program trains medical students to become effective clinical educators through pedagogical coursework, introduction to education research methods, and the development of a scholarly concentration product for publication.

Do the benefits continue? Long term impacts of the Anatomy Education Research Institute (AERI) 2017.

BACKGROUND: The Anatomy Education Research Institute (AERI) was held in Bloomington, Indiana in July of 2017. Previous research has shown that AERI was successful in meeting Kirkpatrick's first two levels of evaluation via positive initial reactions and learning gains identified at the end of AERI. This manuscript demonstrates continued success in Kirkpatrick levels two and three via six-month and thirty-month follow-up surveys and nine-month follow-up focus groups and interviews. METHODS: Quantitative analyses were completed using Microsoft Excel (2019) and SPSS version 26 while qualitative analyses were completed for both survey responses and focus groups/interviews using thematic analyses. RESULTS: Results demonstrate that the learning gains seen immediately post-AERI 2017 were sustained for all participants (accepted applicants and invited speakers). Qualitative results continued to demonstrate positive reactions to AERI 2017. Both quantitative and qualitative results demonstrated that the main obstacle to educational research for most participants is time, while collaboration, IRB, institutional roadblocks, and devaluing of educational research were also identified as obstacles. CONCLUSIONS: The research presented here indicates positive outcomes to Kirkpatrick Levels 1, 2, & 3 of evaluation following AERI 2017. However, substantial obstacles still exist for researchers in medical education. The need for a sustained community of practice for educational researchers was suggested as a potential buffer against these obstacles and multiple options for providing that community are discussed.

Skeletal muscle coverage in undergraduate courses: a comparison of stand-alone human anatomy and anatomy and physiology (A&P) courses.

Anecdotal data suggest great variation in breadth and depth of skeletal muscle coverage between undergraduate human anatomy (HA) and anatomy and physiology (A&P) courses. This manuscript is the second in a series (Reynolds A, Goodwin M, O'Loughlin VD. Adv Physiol Educ 46: 309-318, 2022. doi:https://doi.org/10.1152/advan.00084.2021) that methodically assesses skeletal muscle content coverage across undergraduate HA and A&P courses. The authors developed an online skeletal muscle coverage survey and collected 342 responses worldwide, 156 from instructors of HA courses and 186 from A&P course instructors. Demographic results showed that HA courses are primarily taught at 4-year baccalaureate institutions, have relatively larger class sizes, and are more likely to use human (vs. animal) prosections or dissections. In contrast, A&P courses are primarily taught at community colleges, have relatively smaller class sizes, and are more likely to use animal (vs. human) dissections. HA courses tend to require their students to learn all skeletal muscle aspects (i.e., identification, action, attachments, innervation), whereas A&P courses tend to focus on muscle identification or action only. The proportions of courses that require identification of large, superficial skeletal muscles are similar between the two course types. However, HA courses are more likely to require their students to identify deeper and smaller muscles, including more distal appendicular muscles and pelvic muscles. These differences likely are due, in part, to the more anatomical focus of HA courses and the slightly different student populations between these courses. These findings provide much-needed information about muscular system coverage between HA and A&P courses and may guide instructor discussions about curricula.

General trends in skeletal muscle coverage in undergraduate human anatomy and anatomy and physiology courses.

There is a widely variable breadth of coverage of skeletal muscle content across both undergraduate human anatomy and undergraduate anatomy and physiology (A&P) courses. In response to the need for a more global understanding of the content taught in undergraduate anatomy courses, we developed an online survey (administered through Qualtrics) where both human anatomy and A&P faculty could report skeletal muscle coverage in their courses. The survey also collected comparative demographic institutional data such as the type of institution (community college vs. 4 year), course format, and geographic location of the undergraduate institution. Skeletal muscles surveyed included those listed and described in a typical undergraduate human anatomy text (McKinley MP, O'Loughlin VD, Pennefather O. Human Anatomy (5th ed.), 2017, p. 960). The data indicated some interesting instructional trends regarding muscular system coverage. First, both the "identification" and "action" of specific muscles are taught at a higher frequency than the teaching of either "attachments or innervation." Innervation of specific skeletal muscles is the least taught concept. In each body region, certain muscles were taught with higher frequency than others. This research shows there is a global trend in teaching identification of specific skeletal muscles within each body region and often this is accompanied by teaching actions of said muscles. These general instructional trends may increase our understanding of the anatomical and physiological education our undergraduate students are receiving and will lead to further critical conversations about content development and curriculum.

Developing Student Metacognition through Reflective Writing in an Upper Level Undergraduate Anatomy Course.

Incorporating metacognitive strategies in the classroom helps students monitor and adjust their learning strategies throughout the semester, and helps students progress from novice to expert learners in a subject. Journaling (i.e., reflective writing) is one metacognitive task that allows students to contemplate and articulate their skill development as they learn a new subject. The research reported here examines the use of 'blogs' (i.e., online journals) in an upper level undergraduate human anatomy course. The blogs both facilitated development of students' metacognitive skills and provided researchers insight into student metacognitive process. Data were examined from 92 students from three successive semesters (spring 2010, 2012 and 2014). Each student reviewed 10 radiology online cases throughout the semester and then reflected on their understanding of anatomy and radiology in an online blog for each case. A total of 927 blogs were examined for this research. The researchers used a grounded theory approach to analyze the blog narratives and develop a codebook based on common themes. The 927 blogs yielded 11,082 statements that were coded with the codebook. As the semester progressed, the blog entries showed that students demonstrated greater self-confidence in their abilities to understand the subject matter, expressed greater enthusiasm for anatomy in general, and they improved their metacognitive skills. This research illustrates that reflective writing in an undergraduate anatomy course not only facilitates improvement in student metacognitive skills, but also provides the instructor with evidence how a student progresses from novice to more experienced learner in anatomy.

Knowledge Gains and Changing Attitudes from the Anatomy Education Research Institute (AERI 2017): A Mixed Methods Analysis.

The inaugural Anatomy Education Research Institute (AERI 2017) was held in Bloomington, Indiana in July of 2017. This workshop style conference paired experienced educational researchers (invited speakers) with individuals interested in learning more about the field (accepted applicants). In 2017, AERI was held over a five-day period and entailed plenary style presentations, break-out sessions, and specific times for small group mentorship. All participants (applicants and invited speakers) completed a pre-conference survey at the beginning of the institute and a post-conference survey at the end of the institute. Both surveys included categorical and Likert scale questions as well as open-ended questions for participant feedback. Quantitative and qualitative analyses indicate that both applicants and speakers increased their knowledge of anatomy education research, but that additional obstacles remain. Funding, time, and a lack of respect for the field remain problematic for faculty that wish to complete educational research. Mentorship and a community of practice also emerged as major themes necessary for educational research to be successful.

Impact of cardiovascular embryology animations on short-term learning.

An understanding of human embryology is essential for students to better understand the subjects of human anatomy and physiology. However, human embryology is a challenging subject for many, since they must learn how anatomic structures and physiological processes develop over a period of time. Embryology texts typically use static, two-dimensional images to illustrate the dynamic three-dimensional developmental processes, making it difficult for a student to understand spatial relationships and sequential steps. To help students conceptualize these series of complex dynamic developmental events that occur over time, two of the authors and a graphic artist developed six web-based cardiovascular embryology animations and housed them on an Indiana University website. This research study examines knowledge gains and user satisfaction of students, faculty, and laypeople around the world who accessed these six website animations. Data collection spanned 6 yr, and pretest/posttest assessments (ranging from 4 to 7 multiple-choice questions each) were used to determine immediate knowledge gains of cardiovascular embryology. The total number of completed pretest/posttest assessments ranged from 555 to 1,449 per animation. The number of correct posttest scores was significantly improved over matched pretest scores (confidence interval range 1.3-3.2, depending on the animation, P < 0.001), suggesting the animations are useful for embryology learning (at least in the short term). Demographic and user satisfaction information was gathered with an anonymous survey at the end of each animation. Survey data from all animations indicated participants found the animations easy to use and very effective for their learning. This research highlights the positive impacts of web-based animations on learning complicated events of cardiovascular embryology.

Another Nail in the Coffin for Learning Styles? Disparities among Undergraduate Anatomy Students' Study Strategies, Class Performance, and Reported VARK Learning Styles.

The concept and existence of learning styles has been fraught with controversy, and recent studies have thrown their existence into doubt. Yet, many students still hold to the conventional wisdom that learning styles are legitimate, and may adapt their outside of class study strategies to match these learning styles. Thus, this study aims to assess if undergraduate anatomy students are more likely to utilize study strategies that align with their hypothetical learning styles (using the VARK analysis from Fleming and Mills, , Improve Acad. 11:137-155) and, if so, does this alignment correlate with their outcome in an anatomy course. Relatedly, this study examines whether students' VARK learning styles are correlated with course outcomes regardless of the students' study strategies, and whether any study strategies are correlated with course outcomes, regardless of student-specific VARK results. A total of 426 anatomy students from the 2015 and 2016 Fall semesters completed a study strategies survey and an online VARK questionnaire. Results demonstrated that most students did not report study strategies that correlated with their VARK assessment, and that student performance in anatomy was not correlated with their score in any VARK categories. Rather, some specific study strategies (irrespective of VARK results), such as use of the virtual microscope, were found to be positively correlated with final class grade. However, the alignment of these study strategies with VARK results had no correlation with anatomy course outcomes. Thus, this research provides further evidence that the conventional wisdom about learning styles should be rejected by educators and students alike. Anat Sci Educ. © 2018 American Association of Anatomists.

Development and Implementation of the Inaugural Anatomy Education Research Institute (AERI 2017).

Education research is increasingly being recognized as a legitimate route for faculty development in universities. However, many anatomy faculty lack the appropriate training and access to experienced mentors who can help them develop their own education research projects. Inspired by the American Physiological Society's Institute for Teaching and Learning, the coauthors proposed and developed the inaugural Anatomy Education Research Institute (AERI 2017). Funded by an American Association of Anatomists Innovations grant, the five-day institute was held in Bloomington, Indiana in July 2017. The coauthors spent two years preparing the conference schedule, inviting speakers who could discuss education research topics and mentor applicants, reviewing applications, developing assessment instruments for the institute, and hosting the institute. A total of 62 registered participants (applicants and invited speakers) attended AERI 2017. Through a series of presentations and workshops, participants were introduced to many aspects of education research and the Scholarship of Teaching and Learning, including developing rigorous education research questions, determining appropriate methods to assess these questions, and searching the education research literature. Each day also included regular time devoted to work on their own education research project with help from more experienced mentors. Throughout the conference, participants were encouraged to post information on Twitter, using the hashtag #AERI2017. Participants had strong positive impressions of the conference and strongly requested future AERI conferences be held. Follow-up analyses will assess the institute in alignment with Kirkpatrick's Four Levels of Evaluation Model, though preliminary evaluation indicates AERI 2017 met the original aims of the proposal.

Implementation of an education-focused PhD program in anatomy and cell biology at Indiana University: lessons learned and future challenges.

In 2008, the Indiana University School of Medicine, in collaboration with the School of Education, admitted its first student to a newly approved PhD program in Anatomy and Cell Biology focusing on educational research rather than biomedical research. The goal of the program is twofold: (1) to provide students with extensive training in all of the anatomical disciplines coupled with sufficient teaching experience to assume major educational responsibilities upon graduation and (2) to train students to conduct rigorous medical education research and other scholarly work necessary for promotion and tenure. The 90 credit hour curriculum consists of biomedical courses taught within the School of Medicine and education courses taught within the School of Education, including courses in health sciences pedagogy, curriculum development, learning theory, quantitative, and qualitative research methods, statistics, and electives. To date, 16 students have entered the program, seven have passed their qualifying examinations, and five have earned their PhD degrees. Four students have received national recognition for their educational research and four graduates have obtained faculty appointments. Going forward, we must adapt the program's biomedical course requirements to incorporate the new integrated curriculum of the medical school, and we must secure additional funding to support more students. Overcoming these challenges will enable us to continue producing a small but stable supply of doctoral-level anatomy educators for a growing academic market.

The Blooming Anatomy Tool (BAT): A discipline-specific rubric for utilizing Bloom's taxonomy in the design and evaluation of assessments in the anatomical sciences.

Bloom's taxonomy is a resource commonly used to assess the cognitive level associated with course assignments and examination questions. Although widely utilized in educational research, Bloom's taxonomy has received limited attention as an analytical tool in the anatomical sciences. Building on previous research, the Blooming Anatomy Tool (BAT) was developed. This rubric provides discipline-specific guidelines to Blooming anatomy multiple-choice questions (MCQs). To test the efficacy of the BAT, a group of volunteers were randomly split up and asked to Bloom a series of anatomy MCQs using either the BAT or a traditional Bloom's reference called Bloom's Learning Objectives (BLO). Both groups utilized each rubric for a different series of MCQs. Examination question categorizations made using each rubric were tested for accuracy and interrater reliability. In addition, previous experience in anatomy and Bloom's taxonomy were considered. Results demonstrated that volunteers using the BAT had consistently higher levels of interrater reliability, but accuracy varied and was similar between rubrics. Neither measure was substantially impacted by experience in Bloom's taxonomy or anatomy. A poststudy survey indicated that volunteers strongly preferred the BAT and felt it was more helpful in categorizing anatomy MCQs than the BLO. These results suggest that the BAT can be useful in educational research in the anatomical sciences to aid in aligning observer judgment on Bloom taxonomic levels and improve consistency, especially when used in conjunction with a norming session prior to data collection.

A comparison of student performance on discipline-specific versus integrated exams in a medical school course.

Curricular reform is a widespread trend among medical schools. Assessing the impact that pedagogical changes have on students is a vital step in review process. This study examined how a shift from discipline-focused instruction and assessment to integrated instruction and assessment affected student performance in a second-year medical school pathology course. We investigated this by comparing pathology exam scores between students exposed to traditional discipline-specific instruction and exams (DSE) versus integrated instruction and exams (IE). Exam content was controlled, and individual questions were evaluated using a modified version of Bloom's taxonomy. Additionally, we compared United States Medical Licensing Examination (USMLE) step 1 scores between DSE and IE groups. Our findings indicate that DSE students performed better than IE students on complete pathology exams. However, when exam content was controlled, exam scores were equivalent between groups. We also discovered that the integrated exams were composed of a significantly greater proportion of questions classified on the higher levels of Bloom's taxonomy and that IE students performed better on these questions overall. USMLE step 1 exam scores were similar between groups. The finding of a significant difference in content complexity between discipline-specific and integrated exams adds to recent literature indicating that there are a number of potential biases related to curricular comparison studies that must be considered. Future investigation involving larger sample sizes and multiple disciplines should be performed to explore this matter further.

Optical versus virtual: teaching assistant perceptions of the use of virtual microscopy in an undergraduate human anatomy course.

Many studies that evaluate the introduction of technology in the classroom focus on student performance and student evaluations. This study focuses on instructor evaluation of the introduction of virtual microscopy into an undergraduate anatomy class. Semi-structured interviews were conducted with graduate teaching assistants (TA) and analyzed through qualitative methods. This analysis showed that the teaching assistants found the virtual microscope to be an advantageous change in the classroom. They cite the ease of use of the virtual microscope, access to histology outside of designated laboratory time, and increasing student collaboration in class as the primary advantages. The teaching assistants also discuss principal areas where the use of the virtual microscope can be improved from a pedagogical standpoint, including requiring students to spend more time working on histology in class.

The virtual anatomy laboratory: usability testing to improve an online learning resource for anatomy education.

An increasing number of instructors are seeking to provide students with online anatomy resources. Many researchers have attempted to identify associations between resource use and student learning but few studies discuss the importance of usability testing in resource design and modification. Usability testing provides information about ease of use and resource flexibility and indicates navigational issues that contribute to extraneous cognitive load for the user. An example of usability testing for modification of an online anatomy resource called the "Virtual Lab" is presented. Usability testing was used to determine whether increased content would impair navigation through the interface. Subjects with varying levels of experience with anatomy content were recruited to assess efficiency and effectiveness (defined by usability standards) of the original resource and of the redesigned resource. Comparisons between usability evaluation of the original "Virtual Lab" (OVL) and of the redesigned "Virtual Lab" (RVL) revealed that subjects were better able to successfully complete tasks using the RVL than they were with the OVL. Results also demonstrated that subjects did not take significantly more time to successfully complete tasks with the RVL. Additionally, usability testing revealed that subjects were able to successfully complete tasks using the RVL regardless of whether they possessed prior experience with anatomy content or not. Results of this study suggest that the modified resource is more effective for users. The example presented here underscores the need for usability testing prior to resource implementation and whenever significant changes are made to a resource interface.

Quantitative and qualitative changes in teaching histology by means of virtual microscopy in an introductory course in human anatomy.

This study compares overall laboratory averages and individual test scores along with a student survey to determine the effects of using virtual microscopy in place of optical microscopes in a large undergraduate human anatomy course. T-tests revealed that the first two laboratory examinations (of four) and the overall laboratory averages were significantly increased compared with the previous year. We hypothesize that this is due to students' ability to use and understand the technology quickly as opposed to learning how to maneuver an optical microscope. Students also responded positively in a survey about the virtual microscope, indicating that increased accessibility, ease of use, and the ability to understand the material were important components of the virtual microscope. In addition, an increase in student collaboration was noted because multiple students were able to view the image at a time. This level of acceptance of virtual microscopy has been reported in previous studies, though this level of increased examination scores is rare. We attribute this to differences between the medical students, with whom this technology has been researched in the past, and undergraduate introductory students.

A "how to" guide for developing a publishable Scholarship of Teaching project.

In order for the efforts of scholarly teaching to be recognized, the work must become public and presented to peers for review. Scholarship of Teaching is not only improving instruction and learning but also methodically assessing whether specific teaching interventions have had the desired effect. In this paper, the author presents a step-by-step guide for how to develop a Scholarship of Teaching project that is well thought out and worthy of publication. Factors to consider before performing such pedagogical research include developing a clear research hypothesis for the classroom, reviewing the background literature, obtaining Institutional Review Board (Human Subjects) approval, and determining which methods of assessment may be used. This "how to" guide discusses how to handle all of these factors and prepare the data for publication and introduces the reader to references related to the Scholarship of Teaching and learning as well as educational research and theory.

Effects of different kinds of cranial deformation on the incidence of wormian bones.

Researchers have debated whether the presence and frequency of wormian bones (sutural bones, supernumerary bones, and ossicles) are attributable to genetic factors, environmental factors, or both. This research examines the effects of many different kinds of cranial deformation on the incidence of wormian bones. A sample of 127 deformed and undeformed crania from New World archaeological sites was examined. An undeformed cranial sample (n=35) was compared to the following cranially deformed groups: 1) occipital, 2) lambdoid, 3) annular, 4) fronto-vertico-occipital, 5) parallelo-fronto-occipital, and 6) sagittal synostosis. Three levels of degree of cultural cranial deformation were qualitatively determined. Type and number of wormian bones along each major suture were recorded for each cranium. Group means were analyzed using Kruskal-Wallis one-way ANOVA statistical tests to test the null hypothesis that cranial deformation does not have an effect on wormian bone incidence. Results indicate that all forms of cranial deformation affect the frequency of some types of wormian bones. In particular, all cranially deformed groups exhibited significantly greater frequencies of lambdoid ossicles. Apical, parieto-mastoid, and occipito-mastoid wormian bones also appeared with greater frequency in some groups of culturally deformed crania. Further, varying degrees of cultural deformation all had more lambdoid wormian bones than the undeformed group. These results suggest that wormian bone development in posteriorly placed sutures may be affected more by environmental forces than are their anteriorly placed counterparts.