We recently published two papers that collectively highlight the essential nature of causality in the development of higher order cognitive skills (analysis and evaluation) during the teaching of physiology. Prediction, an ability derived from these skills, is the pinnacle of learning outcomes and depends upon comprehension of the biological, chemical, or physical causal links between events in physiological cascades. The challenge in creating essential cognitive frameworks is to effectively present complex topics as a series of linked causal events. Presented individually and as a logical unit, each event stays within working memory capacity, while the causal links connecting them provide the very framework students need to reason with the content rather than merely recall it. We’ve found that the difficulty in proposing such an approach is not in conveying the value of it but rather in expressing what that instruction looks like in practice. To complete our trilogy of papers, we will here describe how we would develop such a logic-driven explanation using the classical Wiggers diagram, a complex summary of all cardiac electrical and mechanical activity during a single heartbeat. We will derive every element of the graph, each from its prior stimulus, using cause-and-effect core principles such that students can cognitively follow a clear progression of falling biological “dominoes”. In this way, students will more fully understand the multifaceted Wiggers plot and realize that even the most challenging topics in physiology can be mastered via sound cause-and-effect reasoning.
NEW & NOTEWORTHY A medical school faculty member deals with the blow dealt by a student’s public, all-caps dismissal of her physiology textbook.
Undergraduate teaching assistants (UTAs) can provide valuable peer-supported learning opportunities in large physiology courses, but encouraging students to use these resources meaningfully can be challenging. In a large flipped undergraduate human physiology course, students were initially required to attend UTA-led review sessions for a small number of course points. Although this attendance-point system increased session use, it also produced unintended consequences. Near the end of course units and especially near the end of the semester, attendance often increased sharply as students attended primarily to earn points rather than to engage with physiology content. These crowded sessions were difficult for UTAs to manage and reduced the value of the sessions for students seeking help. To address this problem, direct attendance points were replaced with a future-oriented token system. Students earned tokens by actively participating in two UTA-led review sessions, and tokens could be used only on future coursework, such as making up selected missed assignments or revising missed exam questions. This article describes the rationale, design, implementation, and lessons learned from this token system. Although the change was not implemented as a formal education research study, instructor and UTA observations suggest that the token system may have reduced check-the-box attendance and better aligned the incentive with the intended purpose of the sessions: proactive, collaborative engagement with physiology content. This model may be useful for instructors seeking to encourage help seeking without directly awarding points for attendance.NEW & NOTEWORTHY This article describes a future-oriented token system used to encourage meaningful participation in undergraduate teaching assistant (UTA)-led review sessions in a large undergraduate physiology course. Rather than awarding points for attendance, students earned limited-use tokens by actively participating in two sessions. The approach shifted the incentive away from check-the-box attendance and toward proactive help seeking, repeated engagement, and collaborative learning.
Initiatives to improve physiology majors' social and behavioral professional skills development would be remiss without an understanding of the emotional culture affecting intended audiences. To characterize the emotional hidden curriculum in undergraduate life science education, this study explores feeling rules that influence how undergraduate pre-health students navigate emotional expression-an important aspect of emotional intelligence-in life science classrooms. We conducted semistructured interviews and culturally responsive focus groups at an R1 university in the southeast. Our findings from interviews with 21 students revealed four feeling rules: (1) No feelings allowed - successful scientists suppress emotions, (2) Please them or else - social hierarchies and acceptance take precedence over feelings, (3) Just like me - relatable peers and approachable instructors foster emotional expression, and (4) There's a reason - emotional expression should comply with cultural norms and identity-based expectations. Although pre-health students are aware of the benefits of emotional expression in learning, they perceive a cultural pressure to be emotionally suppressive if they want to maintain a favorable impression and achieve their goals. We highlight implications for biology education research with examples of possible future research areas related to the expansion of social-emotional learning in STEM higher education.
The shortened preclerkship phase in integrated medical curricula has raised concerns about whether medical students retain and apply foundational basic science knowledge during clerkship. Yet few studies incorporate perspectives of clerkship faculty, who directly observe students' mechanistic reasoning and are well positioned to inform curricular interventions for vertical integration. This mixed-method study addresses that gap by conducting a clerkship faculty-centered needs assessment evaluating basic science integration, students' preparedness, and priorities for physiology-focused electives during clerkship. Faculty overwhelmingly affirmed the importance of basic science integration during clerkship (83%). However, fewer than half believed that the curriculum adequately achieves this. Whereas 71% reported opportunities to assess students' application of basic science knowledge during clerkship, only 53% felt that students possessed adequate baseline knowledge. These findings suggest that integration on the wards is opportunistic, completely dependent on individual faculty initiative or clinical encounter rather than deliberate curriculum design. Clerkship faculty identified renal/electrolyte physiology, pharmacology, and neuropsychiatric physiology as potential high-yield elective topics for the elective course. Additionally, 79% of faculty agreed that students would benefit from proposed fourth-year physiology electives, with the course on obesity pathophysiology receiving the highest number of first-choice rankings. Overall, the findings demonstrate a persistent gap in basic science integration during clerkship and support the development of a clerkship faculty-informed, need-based physiology elective to reinforce mechanistic understanding and enhance receptivity among clinical educators, who cite time constraints and dense curricular expectations as major barriers to basic science integration.NEW & NOTEWORTHY This study is among the few to use perspectives of clerkship faculty, those who directly observe students' clinical reasoning, to evaluate basic science preparedness and integration during clerkships. Faculty reported strong support for basic science relevance but identified gaps in its structured integration and in students' application of foundational knowledge. Findings highlight high-yield domains for reinforcement and demonstrate broad support for targeted fourth-year physiology electives, offering a data-driven model for strengthening vertical basic science integration.
The potency of an antagonist is a key concept in pharmacology, with multiple implications that range from the basic science to the clinical scenario, e.g., from receptor characterization to the dosage schedule of a patient. However, teaching the concept of antagonist potency may be a challenge because, unlike agonists, antagonists lack intrinsic efficacy, meaning they do not activate the receptor they bind to produce a biological response. In experiments in isolated tissues without spontaneous tonus, such as the rat aorta, students might observe that prazosin (an antagonist of α1-adrenergic receptors) does not induce observable effects alone, although it is able to relax a contraction elicited by phenylephrine (α1-adrenergic agonist) because prazosin competitively antagonizes phenylephrine at α1-adrenoceptors. Experimental approaches to analyzing antagonist potency have been proposed, with the Schild method being the most widely accepted. However, such an analysis can be time-consuming if adopted in a practical class because it necessitates the generation of complete concentration-response curves for an agonist under control conditions and in the presence of a series of increasing concentrations of an antagonist. Alternative methods, such as the Cheng-Prusoff approach, have been proposed to estimate the value of the equilibrium dissociation constant (Kb) in functional studies, a parameter that represents the affinity of the antagonist for one receptor. Based on these approaches, the present study proposes an experimental protocol designed to help students understand the concept of antagonist potency using phenylephrine and prazosin in isolated rat aorta preparations.NEW & NOTEWORTHY By utilizing phenylephrine and prazosin in isolated rat aortas, students can better understand the concept of antagonist potency. This activity provides a practical opportunity to discuss key aspects of cell-drug interactions, including efficacy and intrinsic activity, via parameters such as EC50, IC50, equilibrium dissociation constant (Kb), and antagonist potency (pA2).
Statistical analysis is central to the study of physiology, yet many undergraduate students struggle to apply statistical reasoning to physiological studies. Although statistics or biostatistics coursework is commonly required in a degree program, students often perceive statistics as disconnected from physiological experimentation, leading to difficulty in selecting and justifying statistical reasoning in a physiological context. Here, we describe a course-level instructional model in an upper-division physiology laboratory that holistically integrates descriptive statistics and inferential biostatistics across a semester-long undergraduate laboratory course. Rather than treating statistics as a stand-alone topic, statistical reasoning is embedded throughout weekly laboratory activities, lecture discussions, in-class worksheets, postlaboratory assignments, and a capstone project. Each laboratory emphasizes a specific statistical test aligned with the experimental design while reinforcing foundational concepts such as hypotheses, variables, experimental conditions, sample size, data visualization, and interpretation. This article outlines the structure of this integrated approach, illustrates how statistical concepts are revisited across physiological systems, and provides a practical, adaptable framework for physiology educators seeking to strengthen statistical reasoning within laboratory curricula.NEW & NOTEWORTHY We describe a model for practicing applied biostatistics in an undergraduate human physiology course. Statistical reasoning is embedded in every activity and assignment. Experiments are aligned with a specific statistical analysis, reinforcing experimental design, hypothesis development, data visualization, and interpretation. Through scaffolding, weekly application, in-class activities, Excel activities, and a capstone project, students practice selecting and justifying statistical analyses in authentic contexts. This framework strengthens quantitative confidence and normalizes statistics as an essential tool.
Understanding cellular physiology, particularly transport across the plasma membrane, remains a significant challenge for undergraduate health sciences students, as these microscopic processes are inherently difficult to visualize. Innovative teaching strategies, such as three-dimensional (3-D) models, may enhance students’ comprehension of these concepts. This study investigated the impact of a 3-D cell membrane puzzle model combined with an interactive online platform on learning about membrane transport. Undergraduate nursing and physical therapy students participated in the activity during a practical class, and learning outcomes were assessed with pre- and posttests, as well as subjective evaluations. The results demonstrated an improvement in students’ self-perceived knowledge of the main mechanisms of membrane transport and highlighted the importance of assessing students’ knowledge in addition to self-perception. These findings suggest that playful and interactive tools can effectively support the teaching and learning of complex physiological concepts.NEW & NOTEWORTHY Cell membranes are invisible to the naked eye, yet vital to life. For health care students, understanding transport across membranes can be challenging. This study combined a 3-D puzzle model with an online platform to make these processes tangible and easier to grasp. Students who used this interactive approach improved their self-perception of cellular function, showing that playful, hands-on educational strategies can facilitate learning of complex biological concepts and promote greater engagement in the learning process.
Physiology is an essential component of clinical education. However, because physiology requires understanding of causal mechanisms and integrated physiological processes, many healthcare students experience difficulties during the early stages of learning, particularly when prior knowledge is insufficient. These difficulties may increase the risk of subsequent academic problems. Therefore, effective approaches are required to support introductory physiology education. In this study, we developed an e-learning tool conceptually based on error-driven learning theory and implemented it in a physiology course for first-year students at a health science university. Unlike conventional tools, this tool was designed to support correction of incorrect recall by linking feedback on errors with the selection of subsequent questions. We then evaluated the effectiveness of the tool using objective measures from students' activity logs and final examination performance. More repetitions were associated not only with higher accuracy on practice questions but also with higher final examination scores, even after adjusting for preadmission academic aptitude test scores and initial accuracy. These results suggest that, in the early stages of the course, engagement with the e-learning tool was associated with improved examination performance, even after adjusting for baseline academic aptitude and prior knowledge, although causal inference is limited by the observational design. Therefore, e-learning tools designed to emphasize error-driven learning may provide an effective approach to support early-stage physiology education for healthcare students.NEW & NOTEWORTHY We developed an e-learning tool conceptually based on error-driven learning and implemented it in a first-year physiology course. The tool was designed to support correction of incorrect recall through repeated corrective feedback. Using objective measures derived from student activity logs, we showed that the number of repeated practices was significantly associated with learning improvement and final examination scores, even after adjusting for baseline academic aptitude and initial accuracy. This approach may support introductory physiology education.
NEW & NOTEWORTHY The Chicken Coop Theory formalizes arousal as a position in a six-dimensional neuromodulatory state space rather than a switch controlled by any single system. Histaminergic latching, cholinergic warming, noradrenergic startling, dopaminergic dispensing, serotonergic nesting, and orexinergic anchoring are each grounded in a functional invariant, and six canonical clinical syndromes are derived as displacements within that space. The framework supports forward reasoning from pharmacological mechanism to phenomenology, and it is explicitly falsifiable.
The incidence of type 1 diabetes mellitus (T1DM) has increased worldwide over recent decades. Early disease recognition reduces the occurrence of complications. This study aimed to determine if a community health education intervention utilizing a storytelling teaching method could increase knowledge and awareness regarding T1DM among underserved communities to promote early recognition. Six pharmacy students delivered educational sessions at various venues using standardized materials, including pamphlets, poster boards, and a narrative case titled “Recognizing the Signs: Bella’s Story.” The story illustrated the progression of unrecognized T1DM leading to complications, and discussions about common symptoms, risk factors, and management. Pre- and postsurveys assessed knowledge and perceived awareness and confidence. A paired t test was used to determine statistical differences. A total of 124 individuals attended the sessions, with 100 completing both surveys. Mean knowledge scores were 54.41% ± 24.19 vs. 87.47% ± 16.32, pre- vs. postsurvey, respectively, with improvements observed across all knowledge-based questions. Participants demonstrated substantial gains in self-reported awareness of symptoms and confidence in recognizing warning signs. Approximately 90% of participants indicated that the storytelling method was effective, and 87% reported learning new information. These findings suggest that storytelling-based community education is an effective strategy to enhance knowledge and awareness of T1DM and may support earlier recognition and prevention of severe complications in underserved populations.NEW & NOTEWORTHY This study addresses a critical gap in type 1 diabetes mellitus (T1DM) education by focusing on early symptom recognition rather than disease management after diagnosis. Using a storytelling-based community intervention, we demonstrated significant improvements in knowledge, awareness, and confidence among adults in underserved populations. Notably, no prior studies have evaluated storytelling to promote earlier identification of T1DM. These findings highlight an innovative, scalable approach to reduce delayed diagnosis and prevent life-threatening complications such as diabetic ketoacidosis.
In science education, student-generated drawings provide valuable insights into students’ developing understanding of complex systems. This study examined how undergraduate physiology students’ drawings reveal changes in their mechanistic reasoning after experiencing an agent-based modeling environment that modeled a complex system. Students’ drawings at pre- and posttests and speech when learning with the agent-based modeling environment indicate that drawing reveals aspects of students’ knowledge not captured by verbal modes during learning. Specifically, students used the agent-based modeling environment to 1) transform their drawings of the entities’ aggregate organization by dynamically integrating prior and newly acquired representational features and 2) identify initially overlooked individual entities and physical properties that play causal roles in the complex system. We illustrate how students’ knowledge manifests dynamically across drawing and speech and discuss the implications of drawing as a key that can unlock the door to productive knowledge resources but also reveal somewhat less productive knowledge in relation to targets for understanding quantified complex systems with multiple causal factors.NEW & NOTEWORTHY This study demonstrates that student-generated drawings provide valuable insights into their developing mechanistic reasoning about complex systems. By integrating drawing with agent-based modeling environments, students dynamically reorganized aggregate representations and identified previously overlooked entities and causal properties. The findings show that drawing can reveal knowledge not accessible through verbal responses alone. This highlights drawings’ value for uncovering both productive and less productive knowledge resources in science learning.
Sexual and gender minority (SGM) adults, as well as Black, Indigenous, and People of Color (BIPOC), face inequities regarding cardiovascular disease (CVD) risk in the United States compared to their heterosexual and White counterparts. We previously found that prehealth students experience low baseline knowledge concerning CVD risks among historically marginalized communities and struggle to propose interventional strategies that could reasonably address these disparities. We hypothesize that incorporating public health approaches that address behavior change (e.g., the health belief model) into a pathophysiology lecture enhances students’ ability to problem solve regarding health disparity in SGM and BIPOC communities. A single lecture intervention was delivered to 100 students enrolled in a cardiovascular pathophysiology course. Paired pre- and postintervention surveys evaluating both subjective and objective learning outcomes were used to assess the efficacy of our intervention. Twenty-nine students answered the prelecture survey, and twelve students answered our postlecture survey. Students’ knowledge of the mechanistic factors contributing to CVD disparities in BIPOC and SGM populations, and their ability to create solutions addressing these disparities, increased after the lecture intervention. Furthermore, the addition of public health intervention frameworks moderately improved students’ ability to propose novel intervention strategies in a population-specific manner. Teaching interdisciplinary models of intervention to physiology students may represent a novel approach that enhances their ability to generate approaches to reducing CVD risk in marginalized communities.NEW & NOTEWORTHY The present study finds that teaching methods from public health disciplines in the physiology classroom improve students’ understanding of how to develop ideas to reduce cardiovascular disease (CVD) inequities. Our data support the notion that a multidisciplinary approach on the part of the instructor, integrating disciplinary knowledge from outside of physiology, is an effective approach to enhance problem-solving skills regarding CVD in marginalized populations.
This study maps and synthesizes the existing body of literature on diagnostic tools and tests used within extended curriculum programs (ECPs) in higher education. Diagnostic assessment plays an important role in informing admission, placement, and early academic support within ECPs. The evidence based on the types, uses, and quality of diagnostic instruments, particularly within the South African higher education system, remains fragmented. This scoping review was conducted in accordance with the Arksey and O’Malley framework, as refined by Levac et al. (Levac D, Colquhoun H, O’Brien KK. Implement Sci 5: 69, 2010). Five electronic databases were systematically searched for empirical studies published between 2017 and 2025. Studies examining diagnostic assessment instruments used for admission, placement, or academic support in higher education were eligible for inclusion. Nine empirical studies met the inclusion criteria. Quantitative designs were utilized eight times (n = 8; 88.88%), representing diverse regions of the world. Three studies (33.33%) focused explicitly on health sciences education, primarily within medical training contexts. Diagnostic instruments commonly assessed cognitive or discipline-specific knowledge, as well as academic literacy or language proficiency. Diagnostic scores were predominantly used to predict how prepared students are for higher education or identify students at risk of academic difficulty. Only one study focused explicitly on ECP students. Evidence supporting the validity and reliability of diagnostic instruments was inconsistently reported, and limited attention was given to fairness, cultural responsiveness, and contextual relevance. The study findings highlight the need for validated ECP-specific diagnostic tools to support equitable student success.NEW & NOTEWORTHY We propose a framework for diagnostic instrument development that incorporates cultural appropriateness, to ensure that the instrument respects and aligns with cultural norms; contextual relevance, ensuring that the instrument is suitable for specific situations; persistence, which evaluates students’ ability to continue despite challenges; psychosocial skills, which assesses social and emotional competencies; life skills, which measures practical abilities needed for daily life; content knowledge, which evaluates understanding of specific subjects; and cognitive abilities, which assesses cognitive abilities.
Medical licensing exams require students in allopathic and osteopathic programs to apply foundational science knowledge to board-style patient presentations. This study aimed to assess Medical Physiology course questions and their alignment with the National Board of Medical Examiners’ (NBME) Item-Writing Guide. The research team obtained practice and exam questions written by 5 physiology faculty members, totaling 316 practice and 187 exam questions. Questions were reviewed by the research team and assessed for word count and then coded into three categories: basic science (lowest complexity), clinical scenario (moderate complexity), or NBME style (highest complexity). A Step-1 practice exam was obtained from the NBME, and questions were assessed for word count and then coded into the same categories. Faculty members completed a survey that assessed NBME-style question familiarity and estimated the percentages of their practice and exam questions in each category. Faculty predicted their practice and exam questions included 14% and 23%, respectively, of NBME-style questions. However, the research team coded and found that only 3% of the practice and 7% of the exam questions met NBME-style criteria. In contrast, the Step-1 practice exam contained 92% NBME-style questions. Significantly lower word counts were identified in course exams compared to practice Step-1 questions. Survey results indicate a high degree of concern over student success on Step-1 licensure. Faculty predictions highlight extensive overprediction of NBME-style questions and may contribute to gaps in student Step-1 preparedness. Training with the NBME’s Item-Writing Guide may be needed to help address this gap.NEW & NOTEWORTHY As national board examinations emphasize patient-centered application, are course exams missing the mark? Analysis of 500+ physiology questions revealed a striking disconnect: faculty believed up to 23% of their exam questions were board style, but fewer than 7% met the standard. Shorter, less complex practice and exam questions may be undermining readiness. These findings expose a hidden gap in assessment design and point to faculty development as a critical step toward improving student success.
Spreading depolarization (SD) denotes a slowly propagating wave of ionic redistribution resulting in neuronal and glial depolarization, cellular swelling, vascular alterations, and metabolic challenge. Tissue characteristics, including brain region and energy availability, influence both entry into and recovery from SD. Although many paradigms reliably induce SD, a nuanced debate surrounds the fundamental mechanism underlying SD initiation and the primary conductances involved. Emerging mechanistic hypotheses of SD induction share a common theme of disruption in ionic homeostasis, often involving sodium-potassium ATPase insufficiency. The prevalence of SD in traumatic brain injury, stroke, migraine with aura, and seizures underscores the clinical relevance of understanding the physiological basis of SD. This Staying Current article describes the potential mechanisms underlying SD initiation, propagation, recovery, and clinical impact from a mechanistic standpoint.NEW & NOTEWORTHY This Staying Current article details the fundamental mechanisms of spreading depolarization (SD), a common central nervous system phenomenon rarely discussed in neuroscience curricula that is implicated in many neuropathologies, including mild and traumatic brain injury, migraine, and stroke. Therefore, incorporating SD into neuroscience education adds clinically relevant context that engages students and supports deeper understanding of foundational neurophysiology.
Hands-on experience in measuring core physiological parameters like oxygen consumption (V̇o2) is essential for deep conceptual understanding, yet the prohibitive cost of commercial systems often excludes such experiments from science curricula. To bridge this gap, we developed and implemented a ready-to-use educational module centered on a simple, low-cost metabolic apparatus. The apparatus, constructed from commercially available components, enables direct measurement of V̇o2 and respiratory parameters in conscious mice by students. Moreover, the apparatus was successfully used to detect and quantify the opposing physiological effects of two classic metabolic-modulating drugs: levothyroxine sodium (increasing V̇o2 and minute ventilation) and chlorpromazine hydrochloride (decreasing V̇o2, respiratory frequency, and ventilation). This module transforms abstract principles of energy metabolism, respiratory control, and pharmacology into an investigable, inquiry-based learning experience. The apparatus features straightforward assembly and operation and is accompanied by a comprehensive instructional manual. These attributes render it particularly well suited for integration into undergraduate and graduate physiology and pharmacology laboratories, thereby broadening access to advanced physiological measurement techniques.NEW & NOTEWORTHY We developed a simple, low-cost apparatus for measuring oxygen consumption and respiratory function in conscious mice, using readily available components. This device enables students to directly observe and quantify the effects of classic metabolic-modulating drugs (levothyroxine and chlorpromazine) on energy metabolism and breathing. The apparatus provides a practical, hands-on tool for teaching core concepts in physiology and pharmacology, making sophisticated metabolic measurements accessible to undergraduate and graduate education laboratories where commercial systems are often cost prohibitive.
NEW & NOTEWORTHY In a recent editorial, Erica Wehrwein warns that there is a shortage of people well prepared to teach in the disciplines of anatomy (A) and systems physiology (P). Here I elaborate on Wehrwein’s concerns with a personal narrative on how I as a physiologist learned to teach anatomy. My pathway from a new A&P instructor to competent anatomist included three intermediate steps: 1) substituting P for A, 2) seeking help, and 3) evolving new structures.
NEW & NOTEWORTHY This article presents an illustrative pedagogical approach, grounded in my experience with the PhysioArt project, demonstrating how artworks can be used as teaching resources in physiology. Using thyroid physiology as an example illustrates how guided analysis of art can promote student engagement and integrative understanding. Rather than providing a comprehensive evaluation of educational outcomes, this work aims to inspire educators to explore art as a methodological strategy in physiology teaching.
