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Anatomy & Physiology: Combo or Split? | TAPP 124

by Kevin Patton

Anatomy & Physiology: Combo or Split?

TAPP Radio Episode 124

Episode

Episode | Quick Take

Dr. Krista Rompolski joins us for a Journal Club episode discussing a study regarding whether it’s best to have a separate anatomy course followed by a physiology course, or to combine anatomy & physiology into an integrated two-semester sequence. We’ve all considered this question, haven’t we? Now we have some data to discuss!

  • 00:00 | Introduction
  • 00:45 | Journal Club
  • 02:46 | Summary of Article
  • 07:23 | Long-Term Retention Sucks Either Way
  • 19:39 | Sponsored by AAA
  • 20:35 | Cover Everything?
  • 33:33 | Sponsored by HAPI
  • 34:44 | Detailing the Level of Detail
  • 50:00 | Sponsored by HAPS
  • 50:48 | What’s Best?
  • 54:27 | Staying Connected

survey

Episode | Listen Now

Episode | Show Notes

May your choices reflect your hopes, not your fears. (Nelson Mandela)

 

Journal Club

2 minutes

It’s time for another Journal Club with Dr. Krista Rompolski!

Anatomy & Physiology: Combo or Split? | Journal Club with Krista Rompolski | TAPP 124

Summary of the Article

4.5 minutes

Krista briefly summarizes the key elements of the study that serves as the jumping-off point for this episode’s discussion. All the facts, with no filler.

  • Student preference for course approach to pedagogically different methodologies in anatomy and physiology (article from Advances in Physiology Education) AandP.info/fgm

Long-Term Retention Sucks Either Way

12.5 minutes

Which is better? Anatomy, then Physiology—or combined Anatomy & Physiology?> Let’s face it, as Krista points out in this segment, long-term retention sucks either way. In this segment, we go beyond that rather flip gut reaction we can all identify with to some more profound ideas about what this study means for us.

 

Sponsored by AAA

53 seconds

A searchable transcript for this episode, as well as the captioned audiogram of this episode, are sponsored by the American Association for Anatomy (AAA) at anatomy.org.

Searchable transcript

Captioned audiogram 

Don’t forget—HAPS members get a deep discount on AAA membership!

AAA logo

Cover Everything?

13 minutes

Continuing the conversation in this segment, we wonder how much we should be teaching in our courses and whether integrated A&P courses allow us to “have it all” by allowing us to “remember less” because we can revisit important concepts later on, as needed. We also remind ourselves that we don’t have to cover every objective recommended for the A&P course or that is in the textbook.

Sponsored by HAPI Online Graduate Program

67 seconds

The Master of Science in Human Anatomy & Physiology Instruction—the MS-HAPI—is a graduate program for A&P teachers, especially for those who already have a graduate/professional degree. A combination of science courses (enough to qualify you to teach at the college level) and courses in contemporary instructional practice, this program helps you be your best in both on-campus and remote teaching. Kevin Patton is a faculty member in this program at Northeast College of Health Sciences. Check it out!

northeastcollege.edu/hapi

Logo of Northeast College of Health Sciences, Human Anatomy & Physiology Instruction

Detailing the Level of Detail

15 minutes

We explore the idea of the amount of content in the A&P course as “being easy” versus “being manageable.” Is an overwhelming course really best for students? Or is the main goal to provide a foundation upon which students can slowly build after leaving our course?

  • General trends in skeletal muscle coverage in undergraduate human anatomy and anatomy and physiology courses (one of the studies from “the land of O’Loughlin” referenced in this episode) AandP.info/mlq
  • Skeletal muscle coverage in undergraduate courses: a comparison of stand-alone human anatomy and anatomy and physiology (A&P) courses (another study from “the land of O’Loughlin) AandP.info/5m0
  • “What Bones And Bony Features Are You Teaching Your Students?” A Survey Of Skeletal System Coverage In Undergraduate Human Anatomy And Physiology Courses (yep, another one) AandP.info/ei0

 

Sponsored by HAPS

44 seconds

The Human Anatomy & Physiology Society (HAPS) is a sponsor of this podcast.  You can help appreciate their support by clicking the link below and checking out the many resources and benefits found there. Watch for virtual town hall meetings and upcoming regional meetings!

Anatomy & Physiology Society

theAPprofessor.org/haps

HAPS logo

What’s Best?

3.5 minutes

The definitive, immutable answer to the question of which is better, combined A&P or separate A and P.

People

Contributors: Krista Rompolski

Mentions: Jessica A Adams, Bryan M. Dewsbury, Valerie O’Loughlin

Production: Aileen Park (announcer), Andrés Rodriguez (theme composer,  recording artist), Rev.com team (transcription), Kevin Patton (writer, editor, producer, host)

Need help accessing resources locked behind a paywall?
Check out this advice from Episode 32 to get what you need!

Episode | Transcript

The A&P Professor podcast (TAPP radio) episodes are made for listening, not reading. This transcript is provided for your convenience, but hey, it’s just not possible to capture the emphasis and dramatic delivery of the audio version. Or the cool theme music.  Or laughs and snorts. And because it’s generated by a combo of machine and human transcription, it may not be exactly right. So I strongly recommend listening by clicking the audio player provided.

AAA logoThis searchable transcript is supported by the
American Association for Anatomy.
I'm a member—maybe you should be one, too!

PDF icon

Introduction

Kevin Patton (00:01):
The late South African leader, Nelson Mandela, famously advised, “May your choices reflect your hopes, not your fears.”

TAPP Orchestra (00:10):
[music]

Aileen Park (00:13):
Welcome to The A&P Professor. A few minutes to focus on teaching Human Anatomy & Physiology with a veteran educator and teaching mentor, your host, Kevin Patton.

Kevin Patton (00:27):
Dr. Krista Rompolski joins us for this episode. Yep, it’s time for Journal Club.

TAPP Orchestra (00:33):
[theme music]

Journal Club

Kevin Patton (00:45):
Okay, I’m here once again with Krista Rompolski, so you know what that means. It’s a Journal Club episode. Welcome, Krista.

Krista Rompolski (00:54):
Hi, Kevin. It’s been too long since our last one. I don’t know where the time goes.

Kevin Patton (00:59):
Oh, I know. And I’ve really missed it. I love these articles that you bring to us and I especially love discussing them and teasing out what the meaning is and what some other possibilities might be and so on. You brought us a really good one this time. It’s called student preference for a course approach and pedagogically different methodologies in anatomy and physiology. But that boils down to what? Whether we’re what?

Krista Rompolski (01:29):
Well, whether should we teach anatomy and physiology, the introductory series as separate anatomy and then physiology or the integrated A&P as we call it. You are The A&P Professor. Is that because you approach it from an integrated? We’re separated. I thought we could all use a break from probably consuming literature on outcomes of COVID-19 and learning and online learning and that type of thing. I was like, “I need something different that’s been maybe debated for a really long time, but maybe not studied.” So I thought this was a good one.

Kevin Patton (02:08):
Well, this fits that description perfectly, because who among us has not discussed this and thought about this numerous times? And you’re right, there really hasn’t been anything done to figure out, “Well, what is the best answer to that question?” As usual, Krista, you’ve done a summary for us. And so we’re going to do that next. And then after the summary, we’ll come back with some discussion about what’s going on in this paper. So we’ll be back right after this.

TAPP Orchestra (02:42):
[music]

Summary

Krista Rompolski (02:47):
Student preference for course approach to pedagogically different methodologies in anatomy and physiology by Jessica A. Adams and Bryan M. Dewsbury. Introductory anatomy and physiology courses are either taught as discipline specific courses or integrated sequences, which combines human anatomy and physiology, often referred to as A&P one and two. Oftentimes there are also different level courses in each of these disciplines suggesting that there is no agreed upon standard for timing, sequence or level of detail within a specific course. The content covered and credit load has implications for students taking these courses to fulfill the requirements of prerequisites for graduate programs or their major. The purpose of this investigation was to determine the course approach preference for either discipline specific or an integrated A&P sequence and the underlying reasons for their preferences among undergraduate students and how their preferences reflected the opinions of professors, TAs and undergraduate teaching assistants…

Read the Entire Transcript →

Krista Rompolski (03:53):
Approximately 2,500 students enrolled in human anatomy, human physiology and then after integration, A&P one and A&P two at a large doctoral granting university participated in this study during the years 2017 to 2020. Students were surveyed at the start of their courses and they were asked which they prefer, integrated or standalone and if they had a preference why. Thematic analysis was performed on the given reasons to identify key themes. Pros and cons for integration or against integration were provided from students, faculty and TAs. The results indicated that students enrolled in human physiology as well as the integrated A&P series overwhelmingly preferred the integrated A&P course approach to a discipline specific sequence. The only difference was among students in a standalone human anatomy course in which 53% preferred the standalone approach. Among those that preferred integration, building on prior knowledge, it being easier and integration leading to increased understanding emerged as the top themes for their preferences.

Krista Rompolski (05:08):
Some examples of pros for integration included increased retention due to more relevance of form with function and the ability of this connection to improved critical thinking, as well as better transferability of credits into graduate programs. Some cons for integration included less time to dive deep into specific disciplines and less subject matter expertise by faculty to teach both disciplines. Some examples of pros for keeping its separate included the ability to place greater emphasis and detail on the subject, the built-in need to refresh anatomy during physiology and the flexibility if a student only wants to take one course, rather than having to commit to a whole year of courses. They also cited that it may be useful to learn the vocabulary or language of anatomy first before physiology. Cons for keeping courses separate included increased textbook costs since students would need to buy two textbooks, credit transfer issues and a disconnect between form and function.

Krista Rompolski (06:14):
The authors did feel that among the students in human anatomy who preferred separate courses, the fact that integrating A&P might influence anatomical content retention was an important insight. Since significant increases in content retention result from retrieval practice and more importantly spaced retrieval practice, this thinking and subsequent integration of A&P might work against long term anatomical content retention by decreasing that opportunity for spaced retrieval practice. Why does this matter for us A&P educators? Literature suggests that understanding students’ preferred learning environment influences learner satisfaction, level of achievement and socio-emotional adjustment in the classroom. Designing courses based on learner preference may improve retention and success in the course and feeling of belonging, particularly in STEM courses for underrepresented minority students. This study contributes to the understanding of what course design students prefer and why and can be useful for curriculum development and change.

TAPP Orchestra (07:18):
[music]

Long-Term Retention Sucks Either Way

Kevin Patton (07:23):
Okay. Well, now we have an overall idea of what is in this paper and what they discovered in trying to address that question of what’s the best approach? Combined A&P or A then P? Krista, when we were chatting before I hit the record button, you had one statement that I thought was a good one to start with.

Krista Rompolski (07:54):
Really? Okay.

Kevin Patton (07:54):
It kind of sums things up. So go ahead, if you want to, go ahead and…

Krista Rompolski (08:01):
All right. I just said long term retention sucks either way, if you want me to be that open about it. And for me, that comes from having taught the… Like many, I’m sure listeners, having taught the spectrum of where learners are, both at the undergraduate and graduate levels. So I’ve taught A&P, I taught upper level junior, senior human physiology and advanced gross anatomy courses. And now for the past three years, I’ve been teaching first semester students gross anatomy and exercise physiology in a graduate physical therapy program and it’s starting from scratch every time. We could spend the rest of the year talking about why long term retention isn’t great. I think the answer is obvious in that anything that we don’t consistently use, we lose because our brains are incredibly lazy. And that’s the first thing I talk to my neuroscience students about when we teach the limbic system, that something has to be hammered in terms of importance and salience for our brains to invest the energy on forming those long-term memories.

Krista Rompolski (09:18):
So I think so much of our debates come down to our passion about teaching and learning more rather than just wanting to face the brain’s capacity to remember stuff. But that was my perspective that I think that overall it’s all about the delivery and what makes the most sense for the students wherever you are.

Krista Rompolski (09:43):
So in terms of my, not critiques, but the comments that I would start off with on this study beyond just my very flip comment about long term retention, I think that the problem with interpreting the results of this study is it’s hard to say… How do you ask someone what their preference is if they’ve not taken it both ways? But there’s also no way to do that because you can’t have students take A&P in the series and then take what would’ve been the separated because they’d remember things from A&P and that would influence how they interpreted the separate and vice versa. So that would be my one… I’m glad the study was done, my one critique about surveying student preference is how can they know if they haven’t had both experiences? So I love your thoughts on that, having taught a lot longer than me. No offense on age meant there.

Kevin Patton (10:43):
Right, right. Well, no, that’s something I have found that once I started really getting a lot of years under my belt teaching, I think there are certain aspects that I feel like I understand a little bit better than earlier in my career or understand differently. I shouldn’t say understand better, but understand maybe different aspects of them than I did earlier. And I completely agree and that’s why I really liked what you call a flip comment at the beginning. I think that really gets to the heart of it is A&P is hard. And if it’s not hard, then I don’t think we’re doing it right because you can only have learning if there’s some difficulty. Difficulty is a characteristic of learning. So if it’s super easy, then they already knew it. You’re not helping them any and they’re not helping themselves any. And that’s just true because we always feel like we have to do more in our courses than I think we really need to do. And so there’s another whole episode we’ll do on that topic. And it has come up before I think in our discussions.

Kevin Patton (12:01):
But the thing is, is that yeah, okay, it’s hard. And so we’re looking for in what ways should it be hard and in what ways need it not be that hard? And so I think that is what leads to this question of which is best? Meaning, which works better for this student? Is it combined A&P or is it A then P? And I have done it both ways and I’ve been asked this question a number of times. I think my general preference myself is to do the combined A&P. When I taught it separately, I didn’t teach both parts. I didn’t teach the anatomy part, I only taught the physiology part. So that was after they had their anatomy.

Kevin Patton (12:46):
And some of the things that came up in this paper, some of the comments like, “Well, if you’re teaching physiology after anatomy, you have to review the anatomy because they’ve forgotten it all.” And I agree with that. Yeah, you have to review it. But as they pointed on in the paper, that might be a benefit because even though that takes some time, it’s also doing retrieval practice and you will have spaced out that practice. So these are things that have been shown to be effective in long term retention. So there’s that. But I think you can do retrieval practice and spacing of practice in a combined A&P course too.

Krista Rompolski (13:27):
Right. If it’s separated, let’s just take the assumption that they take anatomy in the fall and physiology in the spring. Well, I think there’s many opportunities to refresh anatomy through integration of body systems and a greater focus on that because then you would inevitably be coming back to tissues or the nervous system and the anatomy of nerves when talking about the GI system or any other system relevant when you’re talking about nerve control, the cardiac muscle depolarization and repolarization. So I think focusing on, “How do we integrate body systems more?” And I know that many textbooks have those little snippets or sections in their books. So they’re getting that. And many professors have lamented, “We taught neurophysiology. How have you forgotten the action potential? We did it last semester in the combined A&P series.” So I think that there’s always opportunities for retrieval practice no matter which way that you do this.

Krista Rompolski (14:42):
The big picture, the conclusion, the takeaway from the study was that understanding students learning environment influences learner satisfaction and level of achievement. And I think that no matter whether we think that it was fair for students to… Or a true measure if they haven’t taken it both ways, the bottom line is students overwhelmingly say it should be integrated. And no matter what we think of their ability to judge that or not or how we feel about it, that is important because learner satisfaction improves feeling of belonging. And we talked, I’m not sure how many Journal Club episodes ago, but it might have been, God, a year now we talked, we did the paper about underrepresented minorities feeling the importance of feeling of belonging for success in STEM. So no matter what, being responsive to and listening to the way our students prefer to learn is important for their long term retention and success and feeling of belonging.

Krista Rompolski (15:46):
So that’s very important. I thought having now been on the graduate side and being really part of looking at transcripts, I will say that the transferability of credit is a major issue. Most of the time the students that have the combined A&P series with lab are not the ones that are having the problem with credit transferability. It’s the students that come from that maybe bio background or schools where they were separated that are having trouble because maybe this anatomy course didn’t have a lab or maybe it’s only three credits or so on and so forth. So that stood out as something that I’ve had to deal with having being someone reviewing transcripts for graduate programs. And I also… It really stood out to me the textbook cost. That’s tremendous today. And if you take an A&P series, typically you’re buying one book, whereas you’d be having to buy two separate books for the separate courses. And we can’t ignore those things today, especially as we want more and more students to have access to higher education.

Kevin Patton (16:52):
Yeah, I think those are all good points. This idea of student satisfaction, I really strongly believe in that and I think that that’s a key element to student success. And there are different aspects of it I think that go into it. It’s how we treat students, it’s how they treat each other. It’s how we design the course. Is it designed to be inclusive so that everyone feels included? There’s all of that in there. But then when we look at these pedagogical choices, I think that if we know that students really like to do things this way, then I’m going to lean toward that rather than this thing that, “Okay, students hate doing this,” but I know it helps them. So what do I do here? We often talk about the art and science of teaching. That’s where the art part of it comes in is, “Well, can I do that and still be inclusive or still promote this feeling of belonging or comfort or preference?”

Kevin Patton (17:52):
And probably sometimes I can. So maybe there are opportunities for me to say, “Look, this isn’t ideal to separate anatomy and physiology because I know you’d rather have it together, but this is the way we’re doing it.” And I want to circle back to why we do it sometimes in a minute. But before we do, the point is, is, “Okay, we’re doing it this way.” Like when I taught physiology that wasn’t my choice, I was offered that position to teach that physiology course and I didn’t have the opportunity to say, “Well, I’d rather teach combined A&P.” It just wasn’t an option. Well, I can then work to say, “Look, I know some of you have been talking to me about your friends at another school taking combined anatomy and physiology and I recognize that and I’ll do what I can in this course to integrate that with what you’ve already learned, but there are some benefits to doing it this way too. And so let’s focus on those benefits and go forward.”

Kevin Patton (18:50):
Maybe I can turn that preference thing around a little bit and increase their level of acceptance of that and feeling of belonging as you put it, which I agree with. I think that’s an important thing. We were talking about another topic before we started recording here that I don’t want to bring up because then we’ll ended up talking about that. But we talked about how sometimes our thinking gets very black and white. It’s either this way or that way and that’s just the way it is, but it’s complicated. And this paper I think does a good job of showing us how complicated it is. There are pros and cons for both ways of doing that, even though there’s a strong student preference, obviously for combined A&P.

Krista Rompolski (19:36):
Yeah.

Kevin Patton (19:37):
Hey, let’s take a quick break.

TAPP Orchestra (19:38):
[music]

Sponsored by AAA

Kevin Patton (19:42):
AAA, the American Association for Anatomy, sponsors this program by supporting the searchable transcript of this or any episode, which you can find at the episode page in the tap app available at no cost in your device’s app store and at ListenNotes.com. And that AAA support also makes possible the caption to audiogram available on our YouTube channel and at the episode page. The American Association for Anatomy has long been a go-to place to get help and encouragement in teaching anatomy and physiology. Check it out at Anatomy.org and maybe you’ll want to join us and become a member.

TAPP Orchestra (20:32):
[music]

Cover Everything?

Krista Rompolski (20:35):
I think what’s really interesting from the summary, the students that were surveyed in A&P one, A&P two and physiology all preferred the integrated. So it’s funny that the students that were in physiology, I wonder what it is about taking physiology standalone, maybe because they’re like, “Well, I have to refresh the anatomy anyway, so I might as well,” whereas the students in anatomy. And some of the reasons that the students that were in sole anatomy as well as the professors and that preferred it that way, were basically… There was already so much information that they wouldn’t be able to cover all of the content. Basically, there was so much detail that they wouldn’t want to have to handle more or really feeling like they would have all the terminology and all the structures before learning how they worked.

Krista Rompolski (21:31):
So I’m interested in focusing in here on the age old question in A&P, which we’re always talking about is, “How much do we have to cover and how much is that always the problem?” And especially for professors that are new to teaching A&P, you probably just pick up the textbook and let the textbook guide what you deliver in class, but you can’t possibly cover an entire textbook. But every textbook is written has to put everything possible that a professor may need or want to cover in there. So I think so much of this comes back down to, “Do we have to teach as much as we are and who is the audience?” So my background, before I was teaching where I currently am, I was at a major R01 university in Philadelphia, Drexel, our health sciences program was a major feeder for the graduate programs, whether that was med school, PA, PT, OT, SLP, all the health professions.

Krista Rompolski (22:37):
So we had a combined A&P series for the sophomores. They had to take bio and chem all of freshman year. But then we offered advanced anatomy, advanced human physiology and in a neuroscience course for the juniors and seniors who both wanted to or needed to dive deeper or refresh that content before going to graduate school. So this was never a problem I even had to think about because opportunities were there to both dive deeper and refresh later on in their curriculum. So it’s made me think having read this paper, why is that not an option that schools have considered? And maybe they are more because I know more… I forget where I read, but that more and more schools are trending towards the integrated, it might have been this paper it was a month ago that I read it, are trending towards that.

Krista Rompolski (23:35):
And I know that textbooks are going that way as well. So I think we can have it all in this sense, but we have to be willing to admit and recognize that students are going to forget a lot. And maybe the answer is expecting them to remember less in the class and then giving them opportunities to refresh it and retake it again or dive deeper if they need later on in their curriculum. So for example, when I taught gross anatomy to my seniors at Drexel, I was teaching them nerves and muscles that they were like, “I didn’t even know these existed from A&P.” They thought it was like, “Oh, we thought the cranial nerves were hard in A&P when we had to learn 12 names and one function.” Then they’re learning the detail of the facial and trigeminal nerves feeling like that was more that they learned in their entire A&P.

Kevin Patton (24:32):
Yeah, right. Exactly.

Krista Rompolski (24:33):
But there would be no need to hit them with all of that because many of them would never ever, ever see it again. And then even teaching graduate gross anatomy to my PT students, there’s still areas where I’m not touching on at all because every PT I’ve talked to said, “Yeah, I have never said that word in my entire clinical practice.” So I think we need to be more willing to look at the need to know and feel comfortable filtering out… My hardest thing is feeling like this guilt that I’m not covering every learning objective that HAPS comes out. But I think the ability to filter and know that it’s okay to do that with confidence comes with time and experience.

Kevin Patton (25:19):
Yeah, I agree with that completely. And even the HAPS learning outcomes, the information that accompanies them, and this would be true of other kinds of lists of recommended things like that, they come out and say, “We’re not expecting everyone to do all of this.” But it’s hard for us as individuals to really believe that. We tend to want to…

Krista Rompolski (25:44):
“I want to get an A.”

Kevin Patton (25:47):
“If it’s in that list, I better cover it.” So that’s an issue. Now, another thing that all of this brings to mind for me is, I like the idea of integrating it. And somewhere in the paper, actually in more than one place in the paper, they referred to this idea that was expressed by some of the students that said, “Well, it just makes sense to put it all together.”

Krista Rompolski (26:13):
Yeah, let’s talk about that.

Kevin Patton (26:15):
Yeah. And it does make some sense to do that. But not everything that’s the best way to do something is the way that first occurs to you or is what is commonly held as the common sense way of doing it. We’re seeing that a lot in pedagogy, aren’t we these days? Like over the last 10, 20 years where things that we’ve always done in terms of teaching, like straight lecture and only lecture is the best way to teach, that’s just common sense. Everybody knows that. And then we examine that and say, “Well, lecturing isn’t bad, but lecturing by itself could be so much better if you added other things in the mix, some active learning and some things like that in the mix,” and that’s harder. And so I can see a lot of students that would balk that and say, “I’d rather have…” If they have a choice of a class that’s all lecture or a class that’s mixed lecture and active learning, they’re going to pick the lecture one because they’re going to feel more comfortable with that, at least some of them are.

Krista Rompolski (27:18):
Yeah. Well, we get a paper on that, the feeling of learning versus actual learning.

Kevin Patton (27:23):
Right, exactly. So here’s that feeling of learning again is integrated A&P feels better. And I said earlier, integrated A&P that’s my preference. But is that because it feels better? Does that necessarily mean it’s more effective? I don’t have an answer to that because having done it both ways, I think that either one can be effective. And that kind of comes out in this paper too, where they talk about that is that they both seem to work and we need to do some more research on it certainly to see if that really is as true as we think it is and whether there is any significant difference between them. But based on what we know now, there probably isn’t and they both seem to work.

Krista Rompolski (28:12):
Right. I think for the introductory level, and this is someone who is an author on an undergraduate human physiology textbook, keep in mind, I think at the introductory, no nothing level, the integration makes sense because it gives them so much more context for both, “Why does this organ look this way?” and “Why does this organ do this?” They have those questions either way. And then for when you start talking about disease and pathology, “Why does this change?”

Krista Rompolski (28:52):
Look at how disease and a tissue’s necessities to adapt change the anatomy, or how can anatomy change based on physiology? How does exercise increase mitochondria in tissues and things like that? So I think at that basic level, coming from an anatomist, at the introductory level, anatomy can be a little dry and boring unless you’re talking about what it does and especially what it does with disease. Because otherwise it’s like, “There’s that bone.” “Okay.” It’s a show and tell and we make anatomy interesting by talking about what it means and what it does by talking about the phys. And then I think we make physiology relatable and tactile and personal by talking about the anatomy of it. Does that make sense?

Kevin Patton (29:49):
Yeah, that makes a lot of sense to me. This being an audio production, nobody can see me nodding my head yes.

Krista Rompolski (30:01):
gesturing…gesturing wildly, as usual.

Kevin Patton (30:05):
Right. But I am. Just imagine me doing that, my little bobble head going up and down. And this kind of puzzles me a little bit too, that I work on some comb ined A&P textbooks, so they’re integrating. And one of the things I like to do in my books is chop the chapters into smaller pieces. And sometimes what we end up doing is we have, “This chapter’s mostly about the anatomy of a system and here’s a chapter about the physiology of a system.” And then I talk to instructors and they’ll say, “Well, yeah, but I teach integrated anatomy and physiology.” But when you look at other anatomy and physiology books and you see how they cover it within a chapter, here’s the part of the chapter on anatomy and here’s the part of the chapter on physiology.

Krista Rompolski (30:51):
Yeah. You can’t talk about cellular mechanisms while you’re describing a tissue. You have to-

Kevin Patton (30:57):
Exactly. Here, I’m using that term myself. It just makes sense to start with the structure. Even if it’s a review in a physiology course, I would review the anatomy and then we’d say, “Okay, now here’s how it all works.” And maybe I would split that up a little bit. So we would talk about anatomy of the kidney and then talk about urine formation and so on. And then maybe in a separate discussion I would talk about the anatomy of the urinary tract and then talk about the processes of storing and releasing urine and all that stuff. But at some point, at some level, I’m still separating them out and then integrating them. So you can do both. I think you must do both. You have separate discussions of structure and function, but then there’s a point at which you pull them together and show how they fit together.

Kevin Patton (31:55):
And that’s something that kept of popping out at me as I read this paper, is that I think that sometimes we tend to view things that are separate as more separate than they really are. Again, we’re kind of getting back to that black and white thinking that maybe isn’t as accurate as more of a spectrum of grays. And that’s what I think we’re doing here because when we’re doing an anatomy course, as you just mentioned, you got to do some physiology in there. I don’t know anybody who teaches anatomy that doesn’t do physiology.

Kevin Patton (32:31):
I would venture to say, and maybe I should do a study on this in my spare time is, a lot of people that teach anatomy courses, if you ask them and talk to them about them they say, “Well, my course is more of a functional anatomy course.” Well, sure. It’s got to be. I think any good anatomy course is a functional anatomy course. And again, with the physiology, you can’t teach the physiology without knowing what the structure is. So you got to review that. And some things you have to start from scratch because there are a few anatomical structures that wouldn’t typically be covered in an undergraduate beginning anatomy course. And so you got to really zoom in on that and say, “Well, you may not have gotten into it this much in anatomy, but we need to know it to understand this process.”

Krista Rompolski (33:22):
Right. We keep coming back to that level of detail idea.

Kevin Patton (33:26):
Krista and I will be back with more in a moment.

TAPP Orchestra (33:33):
[music]

Sponsored by HAPI

Kevin Patton (33:33):
You don’t have to pay anything to listen to this podcast, but somebody does. And who is that? Well, it’s the Master of Science and Human Anatomy & Physiology Instruction, the HAPI degree. That’s who sponsors the free distribution of this podcast. I’m on the faculty of this program at Northeast College of Health Sciences and I love the interactive design of our courses and the opportunities that faculty mentors and our students have to learn from each other. If you want to be part of a cohort of both experienced faculty and those new to teaching A&P and want an organized review of all the major topics of A&P, plus a thorough introduction to contemporary teaching practices, well, then you really got to check out this online graduate program at NorthEastCollege.edu/HAPI. That’s H-A-P-I. Or click the link in the show notes or episode page.

TAPP Orchestra (34:40):
[music]

Detailing the Level of Detail

Krista Rompolski (34:44):
We keep coming back to that level of detail idea, coming out of the land of… I call it the land of O’Loughlin. Valerie, out of all her students in Indiana, having done the muscle survey and now the bone survey this past year, looking at, “Well, what are professors in A&P teaching and why? Why that level of detail?” So in the introductory A&P course, I’m doing the major mover at each joint, as far as muscles. Because personally, I would rather my students understand that muscles are grouped by function, innovation and typically blood supply regionally, because I think that will make them understand how the muscular system works. And that’s what I care about more, not that they come out of A&P having 100 muscles memorized and their attachment sites. I want them to understand if the muscle performs elbow flexion, where must it roughly attached to do that?

Krista Rompolski (35:49):
Or if I gave you attachment sites, what is that muscle likely going to do if it shortens? Because that will stick, that concept will stick no matter if they forget all the muscles. But who cares how many muscles they have memorized if they don’t understand how muscles work? So I have over the years just gone less and less and less detail over broad concept because I feel like then the concept carries and they’ll just know the detail that they need to know for whatever they end up doing, practice or clinically speaking. So I just think that this comes back to level of detail over and over again. And I challenge… We are in higher ed and academia’s supposed to be the leaders in progressive thinking and progress and change. And I feel like so often we are so attached to the things we love and have worked so hard and for so many years to learn, that it’s hard then to decide what they actually need to carry long term versus what we value and we think is cool and we think is important.

Krista Rompolski (37:01):
How many of us are talking to… I think undergrad is different because you’re serving a much larger population of… You don’t know where your students are going necessarily. But I know teaching and hopefully many listeners are, graduate physical therapy students in my gross anatomy course, I can talk to any amount of PTs to know what they will ever need to know in their clinical practice, even to their specialties and focus in. And that allows me to filter out a lot. But that means I’m not teaching the muscles of swallowing. And I loved those and worked really hard. It means I’m not teaching the detailed blood supply to the stomach, which I worked very hard to learn. So I don’t view that as I wasted my time and my learning, I’m meeting my students where they are and serving the population.

Krista Rompolski (37:59):
I feel like that was quite a tangent. But I think it’s important for us to self-examine a lot. What is my… what I think is important? Or broadly with this paper, “This is my experience,” versus “What is best and more manageable for the students?” And in this paper, as hard as A&P is, the top theme that students gave for the integrated was that it was easier. And you might balk and think, “Oh, students want it easy,” but no, I think they mean, “I can manage this because I’m learning form and function and they dictate each other. This is more manageable.” And we cannot forget that if students don’t feel it’s manageable, it doesn’t matter how it’s set up.

Kevin Patton (38:49):
Right. That is a really good point. And it gets back to this idea we talked about earlier about the difficulty of anatomy and physiology, the difficulty of learning it. And I think that it’s difficult and it needs to have a certain level of difficulty because that’s where the learning happens. But what is unfortunate is a lot of times, especially at the beginning of A&P one, and that students get overwhelmed by it. And when you’re overwhelmed, sometimes the clearest answer to you as a student is to walk away from it. And so you get students giving up at some level and walking away, whether they actually quit or… What are they calling it now? Silent quitting?

Krista Rompolski (39:44):
Silent quitting?

Kevin Patton (39:44):
Something where they’re still in there but they’re failing and they’re not really putting any effort into it because they just don’t know where they can effectively put that effort in.

Kevin Patton (39:55):
And so we have to consider that and balance that out there. And that’s one of the reasons I love that whole series and I hope it continues, that whole series of articles that you just mentioned with Valerie and her cohorts over in Indiana who are doing these papers on, “Well, what are people doing with muscles? What are they doing with bones? What are they doing with some of these different things?” And one of the things that comes out of there, at least to me, it speaks to me and that is, “Well, there’s some variations here and that’s okay.” So I don’t have to follow anybody’s list, I can do my own list. And that’s kind of what you were talking about, Krista, in your courses that you’re listening to what your users are needing as they go forward in their career and tailoring things according to that.

Kevin Patton (40:46):
Another thing that occurs to me as you were talking about that is something I’ve mentioned in various venues before too, and this gets back to having all those decades of teaching experience, I used to really worry about what exactly my students were learning in A&P one and then if they took somebody else for A&P two. Now, historically, as I teach combined anatomy and physiology, I typically try to take all the A&P one sections in one semester and then the following semester take as many… All my teaching sections that I teach are A&P two, so that students have the opportunity to follow me if they want to. But not all students follow me, either because it just doesn’t work out time wise for them or because they have to stop out for a semester for whatever reason or because they don’t like me or it was hard in A&P one. “It’s got to be easier if I go to a different instructor.”

Kevin Patton (41:49):
So there are those, but I worry about those students or I have worried about them, I don’t worry about them too much anymore, because I’m always worried that I didn’t cover what I needed to cover in A&P one. Because in A&P two I always have that opportunity to refresh things with them that I think I might have done badly in A&P one or it becomes clear to me that they didn’t remember. But as time went on in my teaching, I realized that nobody remembers all of anything in any one course. I don’t remember everything I took in my Ornithology course when I was an undergraduate. I wish I did. But I look out and look at the birds and think, “Oh my gosh, I used to know what that bird was and now I don’t.” But I can learn it again.

Kevin Patton (42:35):
And I still retain some of the basic skills I learned in Ornithology to apply to that so I can quickly regroup. And I think our students in A&P, that’s what we’re trying to give them is that foundation. And like you were saying, with your muscles, you have certain muscles that you have the students learn, but if they do… Let’s say they do get into some weird situation as a PT where they really need to know the muscles of swallowing and you skip to that part, you know what? They’re going to do okay, because you taught them all those other muscles and how they work and how that all operates that they’re going to pick that up.

Krista Rompolski (43:12):
And they’ll also never not be able to look that up. And this is another conversation, for sure, but I’ve been integrating every year, every semester now more and more… I almost sent you an article that was 21 pages and I was like, “No, no one’s going to read it or listen to that podcast.” But more and more just coming from the school of ungrading, what is called “authentic assessment,” like more types of assessment that actually reflect how they would ever practice. So more group based tests, more open book exams, but that are just more challenging, maybe case based questions because there will never be a scenario in which they won’t be able to ask someone or look up a resource. Now, there might be knowledge they need to have on the fly to really quickly recognize stuff. And I think that’s the things that you want to test the closed book, maybe more straightforward information. Why not incorporate more things that see how well they can use the information at their hands? So again, a separate podcast entirely.

Kevin Patton (44:20):
Well, that’s the thing about this paper is it touches on a lot of different things, doesn’t it?

Krista Rompolski (44:24):
Right. It does. It really gives some good insights. I found the feedback from the professors just as interesting if not more, because I think a lot of it is speaking to our personal biases. And one that I didn’t get to touch on, and I know we’ve been going a long time now, is that professor’s concern about expertise level that, “Well, somebody’s maybe just a physiologist or just an anatomist, they won’t be able to teach the other thing.” There’s no way a PhD level anatomist or physiologist doesn’t know more anatomy or physiology than a first year student, no conceivable way. So I think this is, again, us thinking that we have to be teaching on this level that a student cannot access. I like always HAPS because for better or worse, we end up swapping stories of sometimes just being amazed at how little young adults know about their human body on the most basic levels. But we’re thinking with a PhD in physiology, we can’t teach a first anatomy course or A&P to someone? Absolutely not. And plus, we have books. There’s resources to refresh ourselves.

Kevin Patton (45:44):
Right. Well, and I think too that we… I’m convinced that we learn by building scaffolds.

Krista Rompolski (45:49):
Absolutely

Kevin Patton (45:50):
When I took A&P in high school and then I took various pieces of A&P throughout undergrad and then in graduate school I came back to Human Anatomy & Physiology mostly. And at each level there were things that, “Oh, not this again.” I mentioned mitochondria, “If I have to go through that one more time.” You know what? Each time I learned more about mitochondria and especially how it fits into the bigger story of the human body and how it really does touch everything in terms of function.

Krista Rompolski (46:28):
Well, the more you learn, the more questions you have. We all say a sign of learning is curious, is asking questions.

Kevin Patton (46:36):
Right, exactly. So there’s all these layers and I think sometimes we get a little too focused in our A&P course on what we’re doing in A&P and not really realizing that if they miss something, it’s okay, they’re going to come back to it later if they really did miss it. But the other question is, maybe what we gave them really is enough. And for this point in their learning, that’s just enough to get them to that next level and start applying things. And how many of us have had to go back in later years after our graduate degrees even and relearn something or even learn it for the first time? It’s like, “I don’t remember ever learning this. And maybe it was covered in some course and maybe I did learn it for a week so I could spit it back out on an exam. But that’s totally out of my head now, so I got to relearn it now and go forward if I want to do this.”

Kevin Patton (47:35):
So it does bring up a lot of aspects of learning by asking these questions about which is best A&P. And another thing that they didn’t discuss that kind of is a similar question. And that is when you’re teaching anatomy, is it better to do it by systems or do it by regions? And I’m just going to leave that hang there mostly because I don’t want to start a fight with anybody. And I’m not saying you’re going to start a fight, but I think that gets back to the idea that we come into this, as you just mentioned, it was so interesting when they ask the people who are doing the instruction because they do, we all have these biases. And so in our HAPI program, we review all the major topics, all the major concepts of anatomy and physiology.

Kevin Patton (48:27):
If you take all the courses, we cover all of them, but in different courses we cover different things. And this is a discussion that often comes up because in every cohort we have a significant number of people who have a clinical background and they either have begun teaching or want to teach at the college level, undergraduate A&P. And so their last memory of anatomy was a regionally based dissection course, usually. And so they come into this and we’re teaching it in our program on a system by system basis, not regionally. And so they may never have experienced that before.

Kevin Patton (49:09):
And so that comes up and, “Why are we doing it that way? It just makes so much more sense to do it regionally.” Well, yeah, it makes more sense if that’s how you learned it because that is the sense you have. Whereas if you have someone who’s only experience of anatomy and physiology or even just the anatomy part is doing it system by system, then they’re going to come in and say, “Well, it just makes sense to do it system by system. This doesn’t make any sense to do it regionally.” So I think we always do better by acknowledging our own biases as far as we can and weighing that against things that are outside our comfort zone and our biases.

Krista Rompolski (49:54):
Absolutely.

Kevin Patton (49:55):
We’ll be back with more shortly.

TAPP Orchestra (49:56):
[music]

Sponsored by HAPS

Kevin Patton (50:01):
Marketing support for this podcast is provided by HAPS, the Human Anatomy & Physiology Society. Our continuing mission is promoting excellence in the teaching of Human Anatomy & Physiology. And that’s visible in the many resources that we offer, including online town hall gatherings, regional and national conferences, courses by top A&P faculty, webinars and even a book club. And that’s just for starters. Check out those and a lot more at theAPprofessor.org/HAPS. That’s H-A-P-S.

TAPP Orchestra (50:42):
[music]

What’s Best?

Kevin Patton (50:48):
I’m back with Dr. Krista Rompolski and we’re discussing a study about whether a combined or integrated two semester A&P course sequence is better than the other. So I have a question for you.

Krista Rompolski (51:01):
Yes?

Kevin Patton (51:01):
And that is, what do you think the best practice is? Should it be A&P together, integrated?

Krista Rompolski (51:09):
Yes, I do. For introductory undergraduate students, I do. Because for the reasons I said earlier, I think getting them interested in the anatomy, the physiology is the hook into the anatomy. It’s like the so and so what question. I think the physiology is the hook into the anatomy. And I think the hook for the physiology is seeing how it dictates the anatomy and how the anatomy changes based on new physiological demands. So because I end up having to have those conversations anyway to explain things on a basic level to increase student buy-in and interest and they ask the questions anyway, and I keep things at a very basic level into introductory A&P series, I don’t worry about level of detail, then it just makes more sense. For my students, upper level, junior, seniors or graduate students, I prefer it separate because I need to and can go into greater detail. But that doesn’t mean we don’t talk about certain physiological principles with the anatomy or don’t revisit anatomy when doing more advanced physiology. So that’s what I would say.

Kevin Patton (52:29):
Yeah, I agree with all of that. And I think that this was a very interesting paper. I’m really glad you brought it to us. I think it touches on a lot of things and we could talk about this all day. The fact that these students who are responding, man, they do metacognition, don’t they? They really think about what they’re thinking about in class or what might work best. I was really impressed with that, but there’s all kinds of things that we could talk about.

Kevin Patton (52:56):
So what I would encourage you, the listener to do is get this paper and read it and jot down some ideas and call the podcast hotline or email me or whatever, because I think this would be a very interesting conversation to continue. And I sure do hope that the authors of this paper continue on this quest of trying to tease out what works best and what doesn’t and what some of these nuances are. Krista, once again, wonderful choice for our paper and I really appreciate our conversation that we had today and I hope we don’t leave as long a gap as we did this last time before we do it again.

Krista Rompolski (53:39):
Dear listeners, if you have come across a paper you’d like us to cover, it’s not that I put this off, I have so much on my plate. Four, six months feels like a day sometimes. Send something my way and we’ll get it going if you find something you want to share with the community.

Kevin Patton (53:59):
That sounds good. And if you want to come on the Journal Club episode with us and help discuss it, or maybe you’ve written a paper that you think that everybody would be interested in, you could bring that on. Anyway, Krista, once again, thank you, thank you, thank you.

Krista Rompolski (54:16):
Of course.

Kevin Patton (54:17):
And listeners, thank you for being with us and continuing to think about these and other ideas about teaching A&P.

TAPP Orchestra (54:22):
[music]

Staying Connected

Kevin Patton (54:27):
Well, this question of which way to organize a two semester anatomy and physiology course sequence isn’t a new one, is it? We’ve all pondered it and continue to ponder it. So I’m sure that you have some colleagues that would be interested in listening to this episode. There’s an easy way to share this podcast with a peer by going to theAPprofessor.org/refer to get your friend all set up to listen to this episode.

Kevin Patton (55:00):
There’s a link to the article we discussed in the show notes where you’re listening right now. If you don’t see any links, just go to the show notes at the episode page at theAPprofessor.org/124. And while you’re there, you can claim your digital credential for listening to this episode. If you have an idea for another Journal Club episode, just call us at the podcast hotline. That’s 1-833-Lion-Den or 1-833-546-6336. Or send a recording or written message to podcast@theAPprofessor.org. Well, thanks again to Dr. Krista Rompolski and I’m glad you joined us for this episode. I’ll see you down the road.

TAPP Orchestra (55:49):
[theme music]

Aileen Park (55:55):
The A&P Professor is hosted by Dr. Kevin Patton, an award-winning professor and textbook author in Human Anatomy & Physiology.

Kevin Patton (56:08):
Apply the contents of this episode only to affected areas.

TAPP Orchestra (56:12):
[music]

Episode | Captioned Audiogram

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