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Episode 52 Transcript
The Case for Case Studies
Kevin Patton: The comedian W.C. Fields once quipped, “If the left half of the brain controls the right half of the body, then only left-handed people are in their right mind.”
Aileen: Welcome to The A&P Professor. A few minutes to focus on teaching human anatomy and physiology with host Kevin Patton.
Kevin Patton: In this episode, I discuss case studies. I have some updates in left-handedness, mapping the brain, and reversing biological age, plus hints on responding to students.
Kevin Patton: One in ten of us is left-handed. I’m not one of them. I’m right-hand dominant, but when we look at handedness, that is which had is dominant or not, the question always comes up, “Well, why is that so?” Is it based in genetics? Is there something in our genes that tells us to be left-handed, or is that something in our environment that pushes us in the direction of being left-handed or right-handed? And the best guess based on people who study these things right now, is somewhere in the neighborhood of 25% of it is probably based on genetic factors, and about 75% of it is based on environmental factors. So in my mind, “Nope, we don’t have an answer yet,” but it’s an interesting question.
Kevin Patton: We’re now starting to tease out some genetic factors that may, in fact, play a role in whether we’re left-handed or not, and one of those genes was recently teased out as being a gene that affects the cytoskeleton of our body’s cells. And that is somehow playing out in the white matter of our brain to kind of push us in the direction of being left-handed when we have such a gene that is associated with left-handedness. Now again, this is all very preliminary, but I don’t know about you, but I get questions about this sometimes, is what makes us left-handed or right-handed, especially when I’m talking about crossing over in the central nervous system and so on. And people will ask us those kinds of questions, and now I can say, “Well, there’s a lot of questions about that. We don’t know that but there’s some recent studies that’s been done that suggests maybe the cytoskeleton. Remember the cytoskeleton?”
Kevin Patton: And that gives us an opportunity to bring up one of those core ideas of science that just keep coming up. The cytoskeleton does all kind of things in our body. And here’s another role that possibly the cytoskeleton plays in our overall function, so interesting little story. I’m going to keep following it. Maybe you’ll want to as well. I have a link to this story in the show notes and episode page.
Kevin Patton: Something I hear a lot from colleagues, and think about and struggle with myself in dealing with students, is when they ask me questions that could be answered easily by just glancing at their course syllabus. Back in episode 24, The Syllabus Episode, I agree with the commonly held belief that only half our students ever read the syllabus, but on the bright side, that means that half our students do read the syllabus, so yay. But we still have to deal with the half that aren’t reading it, right? Is there anything we can do to get them to read it, or at least raid it, that is look for just that part of the syllabus that can clarify things at that moment when they have a question or find themselves in some sort of pickle?
Kevin Patton: The short answer, and my opinion, is no. No, we can’t. At least, I’ve not found the magic method for doing that. I gave up on that and now I focus on a much more obtainable quest: turning lead into gold. I think that’s going to be much easier than getting 100% of my students to read or raid their syllabus. But there are some things I’ve learned as coping mechanisms, which I’m going to share with you right now.
Kevin Patton: The first tip is, tell them about both the reading and raiding strategies. I do this at the beginning of the course, emphasizing that their syllabus is not just for syllabus day. It’s there to answer their questions quickly when they need help all throughout the semester. Just telling them this has moved the dial a little bit for me. Okay, not a lot. I admit that. Not a lot, but I’ll take any movement at all, won’t you?
Kevin Patton: Another thing, and this is something that I’ve covered in detail before in episode 24, The Syllabus Episode, and that is have a meaningful syllabus activity on the first day, where students get some experience of having their questions answered by the syllabus. I think that kind of primes the pump a little bit and makes it more likely that they’re going to think of the syllabus when they have another question, or more than likely, it’s the same question that they had the first day that they found the answer to in the syllabus.
Kevin Patton: Another tip is working on taking a glass-half-full attitude. And that’s hard, I know. It’s hard for me to do that, but I really do some metacognition when I get these questions from my students and think to myself, “Okay. Okay, I’m going to have a glass-half-full attitude. This could be even more students asking me this easily answered question, and not just this one who has popped up on my screen right now.” It seems like answering all those individual student questions that trickle in all semester take up a lot of my time and whittle away at my psychological well-being. But when I realized that they don’t really take up much of my time, it really is only a trickle of these kind of questions after all, that sort of deflates the imagined size and scope of the problem and takes away some of the power to harm my daily enjoyment of teaching.
Kevin Patton: And that’s another thing I do. Here’s another tip. Try to focus on the enjoyment of teaching. Most of my satisfaction in teaching is not that huge paycheck I get from the college. It’s mostly from getting to be part of the growth of my students, helping them go from A&P nothings to A&P masters slowly over the course of a year, getting out of trouble and me helping them get out of trouble and over the obstacles that they find themselves facing now and again and again. So when they have questions, I try to look at that as a precious opportunity to be a valued mentor or coach to them, an opportunity I might not otherwise have to interact individually with that student. So when we’re having these mentoring moments, as I like to call them, even when they deal with some simple question that is easily answered by the syllabus, how can I handle it quickly, effectively, and also maybe teach them something about how to do it themselves the next time?
Kevin Patton: Well, I have some tips for that too. And if we go back to episode 50, which isn’t very far back… This is episode 52, so we go back a couple episodes to one of the summer specials where I actually linked together a bunch of classic segments from way past episodes… And episode 50 is called Connecting in The Distance Course Special. In that episode, I talked about some specific tips… Some of which I’m going to give here and kind of expand upon, and I have some other tips as well. But you might want to go back and revisit episode 50, where I really go into a few of these that I’m going to mention in a little more detail, so you can see better where I’m coming from, and hopefully, that will spark some ideas to put your own twist on it and figure out a way you can adapt what I do to your situation.
Kevin Patton: So one of the things I refer to in episode 50 are canned responses, and that can be true of any kind of question we get from our student, but certainly, it works very well for these questions that can be answered by the syllabus or some other course document, some other information the student already has available to them, and we kind of wish they had gone there first rather than bothering us with it. So the way you do this is… The way I do it at least, is when I get a question from a student, I’ll answer that question and then I’ll copy and paste into a document that I have, a Word document, that is full of those answers.
Kevin Patton: And because I know that if that student has that question… I’ve been around long enough to know… there’s going to be others that are going to have that or a similar question. So rather than typing out that full response every single time, I type it out once or twice. Once I realize, “Oh, this is a pattern,” now I can just cut and paste it. And maybe I’ll massage the message a little bit, add their name, something about them that I know about, in particular, to personalize it so that students know that I am thinking about them, but not necessarily typing out every word just for them.
Kevin Patton: So you could just use regular cut and paste techniques. Now, what I often do in a semester is I will take that Word document and put it on my computer desktop, over in the corner… Over in the right-hand corner for me, upper right-hand corner… so it’s always there. I don’t have to go look at it in my file folders and figure out where’s the syllabus, so when that syllabus is always there, and also this set of canned documents are on my desktop, so I can go in and cut and paste very easily.
Kevin Patton: Something else I’ve been using over the past… Oh, year, year and a half… is some software called TextExpander. It’s all mushed into one word. It’s condensed. It’s not expanded. It’s condensed into one word, TextExpander, and if you go to theAPprofessor.org/textexpander… And I’ll have a link in the show notes and episode page… it’ll take you to this software site. And that is an affiliate link by the way, so if you end up buying the pro version and so on, then I’ll get… I don’t know, three cents or something for it. But it is something I’ve been using more and more and more and relying on more and more and more in a lot of different areas of my professional life, not just in teaching. I use it for planning out my podcast, for example.
Kevin Patton: So what I do is I give a response to a student, and assuming that lands well and they don’t have follow-up questions or they’re not confused by my answer, then I put that in TextExpander. And what TextExpander does is it keeps those snippets, and it allows you to just type in a shorthand. I can go right into my email response to the student and type in some little odd combination that I wouldn’t normally be typing like maybe… I usually start mine with a single quote because I hardly ever use single quotes for anything, and then I’ll have some short answer, like test dates, all run together, so single quote test dates, and that’ll be the shortcut. And TextExpander will go find it in my text expander database, and it’ll just drop it right into my email. I don’t have to go cut and paste or anything. It just drops it right in there.
Kevin Patton: So I’ve been using that more and more for all kinds of things, including these responses to student messages, and it really makes short order of it. I really do find that most of those questions that drive me nuts are the ones that can be easily answered by something that I already have in my database. I said, “Make sure it lands well,” so you might want to try testing different messages, and maybe even taking an extra moment to make sure that it’s worded in a way that is going to land well when the student reads it. It’s not going to be real curt and brief and possibly be misread as being irritated, which we might be at that moment, but we don’t want to send that message. Also, you might want to think about saving different versions of an answer to the same question. That’ll help you avoid sending the same canned message to the same student later. So you might want to rotate through a few different answers to, “When is our next test?”
Kevin Patton: And that kind of leads to this idea that attitude is really key here when you’re responding. And so a trick that I’ve mentioned before is I always smile first, even if I don’t feel like smiling. I kind of try to think of something funny. I smile. Just that smiling, I think, gets me in the mood. Then when I respond, I try to not only have a kind of happy affect in my writing but maybe even kind of silly, because if you throw in a little joke or a pun or something like that, the students don’t feel like your irritated with them. And a lot of students really, really, really hesitate to contact their instructor, believe it or not. They hesitate to contact their instructor because they really do feel like they’re bothering their instructor, and that irritates me more than them asking me a question.
Kevin Patton: I will be honest with you, I hate when they have that attitude because that’s what I’m there for. That’s what I’m being paid for. The part of teaching I like is answering student questions because that’s where the rubber meets the road, and I really get to help them overcome that obstacle. Even if it’s a small, easily overcome obstacle they could have done themselves, I still enjoy that, or at least, I try to enjoy that, because that really is helping the student master what they need to master.
Kevin Patton: And students, in general, half of them don’t follow directions. So when they’re not following directions, I don’t say, “You should have done it this way. I told you to do it this way.” What I do is I pretend, for the moment, that I’m teaching kindergarten. And I just picture them having a sweet young face looking up at me and having done it the wrong way, and I try to be kind to them and say, “Look, it didn’t work because we were going to be doing it a different way remember?” And you need to do this, and you need to do that, and here’s how I’m going to help you do that. Treat them… Not talk down to them.
Kevin Patton: If you’ve ever been around kindergarten teachers, good kindergarten teachers, they don’t talk down to their kids. They meet their kids where they’re at and talk to them in an encouraging, kind way. And that’s what we need to do, I think. At least, that’s what I’m recommending, and that has worked really well for me, especially at those times when I’m feeling irritated. It brings me back into the moment as it actually exists, and it brings me back to being the kind of teacher that I want to be.
Kevin Patton: Another thing I do in those moments, besides picturing them as little kindergartners, is I think of all those times that I don’t follow directions. Yes, at least half the time, I don’t follow directions. Haven’t you had that experience where something goes wrong somewhere, and you call the support hotline, and they say, “Well, did you unplug your computer first and reboot it?” I’m like, “Oh, I know that I’m supposed to do that. Why didn’t I think of doing that?” And sure enough, that’s what cures it. Or some other thing that I already knew, or there’s something in the directions that I skipped.
Kevin Patton: I mean, I often skip directions, thinking, “Oh, I can handle this. I can do this.” Well, students do the same thing that we do, and so if I can kind of relate to that aspect of myself, that helps me treat them in a kinder, more compassionate way. I think it improves that bond that we have between student and teacher. And research shows that the better that bond is, the more positive that bond is between student and teacher, the better that student’s going to do, no matter what we’re talking about. Just that part of it is going to help the student.
Kevin Patton: So another thing that can kind of help us reduce the need for this, is to just spell out everything in more than one place. Don’t rely entirely on your syllabus. Try to repeat things. Yes, repeat them over and over in your class, in your course website, in other places. Spell it out everywhere. Now, even if you do that, half of them aren’t going to read it, so just get over it. That’s just the way it’s going to be, but again, half will read it, so yay. And just think of all those extra annoyances that are now invisible to you because you’ve taken the time to put them in multiple places and maybe headed off a few of those questions.
Kevin Patton: One other tip that I want to give before I forget, and that is when you respond to a student, remind them where they could have found the answer, but in a gentle and upbeat way, of course. And this might help them find other information later when then need it. So what I’ll often do is cut and paste or embed into my snippet, in TextExpander, a passage or a sentence or whatever, bullet point, from my syllabus, and say, “Well, remember in the syllabus it lists all the dates. In section two it lists all the dates of all the tests. And this test that you’re asking about is going to be on,” such and such a date. By doing it that way, you’re gently reminding them that, “Yeah, you could have found this answer on your own, but I’m giving it to you.” But it kind of plants the seed that next time they have a similar question, maybe check the syllabus first.
Kevin Patton: Another thing that often annoys me is they’ll ask me questions that aren’t necessarily in the syllabus, but they don’t give me enough information about what they’re asking. I do a lot of online tests, as I’ve mentioned in a lot of previous episodes. So a student will have an online item, and it’s scored as being incorrect, and they work and work and work and try to figure out what’s wrong with it, and they just can’t figure out what’s wrong with it, or they suspect that it’s been misgraded. Of course, that’s always kind of their go-to attitude, right? Like, “Well, it must have been graded wrong because I think that’s the right answer.” And so they’ll come to me with that item, and they’ll say, “You know that one question about cells on test one?” I’m like, “Are you kidding me? There were 50 questions about cells on test one.” And my students can do multiple attempts, so is this the third attempt of test one in its one of 50 cell questions? How am I going to find that needle in the haystack?
Kevin Patton: So I have to get back to them and say, “Well, yeah. I’m happy to help you with this item, but you need to tell me what’s your name, first of all. Secondly, which test is it, which attempt is it, which item number is it, and can you be a little more specific about why you think your answer is right? Not just, ‘check this, I think it was scored wrong.’ Well, tell me something about why you think it’s scored wrong because I want to see what your thinking process is too, and use that as a teaching moment.”
Kevin Patton: So what I do when that comes across my desk is I once again take a breath, intentionally smile, picture a kindergartner, and say, “You know what? I need this additional information but I’m glad to help you, so get back to me right away with that information.” And at some point, maybe multiple points, maybe at each point in that back and forth with them, I remind them that the more details they give me in the future, the more quickly they can get their answer because they want the answer right away. I mean, we know this because they’re sending us emails like at 3:00 in the morning, right? And so we know that they’re wanting some kind of response as soon as possible. If you package it that way and say, “This will help me respond to you really fast,” then that might spark them to change their behavior.
Kevin Patton: Another thing that you might want to consider… Now, I’ve never done this, but it’s come up in some conversations that I’ve been having recently about how to deal with this… What about trying something like a Google form or some other kind of form. Sometimes your learning management system might have a way to use a form… Maybe imbed a Google form… in your learning management system, where they can fill out the form where it asks them, maybe it requires them, to fill in what their name is, what their test number… Or test title or whatever… is, which attempt it is, which item number it is, specifically what their question is, or other kinds of things that you might need to get from them in order to answer their questions. But when you use forms like that, then you also want to kind of look into privacy and security issues to make sure that whatever it is you’re using is… That privacy is maintained between you and that student if you’re not using email directly.
Kevin Patton: So lots of tips there. Lots of things to maybe spark one little idea. If you have additional ideas, please, please, please, contact us at podcast@theAPprofessor.org, or call the podcast hotline at 1-833-LION-DEN, and I’ll repeat the contact information at the end of this episode.
Kevin Patton: This podcast is sponsored by HAPS, the Human Anatomy & Physiology Society, promoting excellence in the teaching of human anatomy and physiology for over 30 years.
Kevin Patton: Hey, there are a couple of regional conferences coming up soon. I plan to going to at least one of them. Go visit HAPS at theAPprofessor.org/haps, that’s H-A-P-S, to find out more.
Kevin Patton: I recently ran across a preprint of a research article that is entitled There’s No Single Functional Atlas Even for a Single Individual. And the subtitle is Parcellation of the Human Brain is State Dependent. Now, keep in mind that this is a preprint and has not gone through the peer-review process, but the general idea that they’re presenting here is an interesting one and a useful one, especially for those of us who are teaching students about brain function, particularly the cortex, and all of those functional areas that we show them maps of. I mean, every A&P textbook has a map of the functional or the major functional areas of the cortex.
Kevin Patton: I also show my students the Brodmann areas, which are zoomed in a little bit more, and they’re numbered, and I talk to my students about the fact that we’re going to see more and more information and understanding about this coming out because we’re doing all these functional MRI studies and other kinds of studies where we’re really getting down to smaller and smaller areas of the cortex and other regions of the brain to really figure out exactly what’s going on functionally in those different areas.
Kevin Patton: When we do that, when we divide up the brain into little areas, we can call those parcels. And so the process of dividing up the cortex into little parcels is called parcellation. In the preview episode that preceded this full episode, I dissected that term and broke it down because I never heard of that term parcellation before, but apparently, it’s used a lot in this particular area of neuroscience. They talk about the fact that once you start to get down into smaller and smaller little parcels and try to figure out what exactly is going on, what they’re finding out is there isn’t a single functional description or functional state that is going to be happening at those small resolutions. That what happens is, it’s flexible. It shifts back and forth as the overall functioning of the brain changes.
Kevin Patton: So it depends on what state our brain is in. Are we performing a task? Are we getting ready to perform a task? Are we sleeping? Are we zoning out in the middle of an A&P lecture? Are we focusing very carefully on a case study in an A&P class? What are we doing? And that little parcel of that region of the brain may be doing different things at different times. So the title, There’s No Singular Functional Atlas Even for a Single Individual, means that we can’t just build this map of the human cortex and say, “At these very small little spots, here’s exactly what’s happening.” All we can say is, “Well, in this larger region, this is probably where this is going on, but at this moment in this individual, we can’t say for sure, much less in all individuals together.”
Kevin Patton: In their conclusion, they say that what they’re looking at is telling us there’s no single functional atlas, and I think that that is a useful thing to be reminding our students. That there is a point where we can’t really represent different areas of the cortex as having particular functions because it’s just so flexible, and that’s a good thing. We want our brain to be flexible, and we can talk about that. So I’ll have a link to this preprint in the show notes in the episode page.
Kevin Patton: A searchable transcript and a captioned audiogram of this episode are funded by a grant from AAA, the American Association for Anatomy. Why not take a moment today to check out membership benefits at anatomy.org.
Kevin Patton: When you’re looking at the prestigious journal Nature, and you run across a news item that has the title First Hint That the Body’s Biological Age Can Be Reversed, you’re going to take a look at it. At least I did, and what I found was something that is pretty intriguing, although it’s also very preliminary and may not really pan out. But it’s based on a journal article that came out in the journal Aging Cell just recently, and it’s where they took a handful of healthy volunteers, older men… Nine of them, so it was a very small group… and they gave them a cocktail of three very common drugs. One was growth hormone, and then there were two diabetes medications. One was DHEA, which is dehydroepiandosterone, and the other was Metformin, which is a very common anti-diabetic drug.
Kevin Patton: So they gave them this cocktail, and they found out that when they were looking at the epigenome of these individuals… Now, I explained the term epigenome in the word dissection segment of the preview episode that came before this full episode, but it’s the whole collection of all the epigenetic factors that are in a person’s genome. Now, we know that the epigenetic factors are things like methyl groups and other factors that are going to influence how our genes actually work in our bodies. So our genes tell our bodies what to build and how to function, but the epigenetic factors modify that and add additional instructions, if you will, to what’s going on in the body.
Kevin Patton: And there’s been some work that hints at the fact that your epigenome changes over time and can be used to assess your so-called the biological age. What they found in this very preliminary study, is that by taking this cocktail of drugs, that it sort of reversed what they would expect to see in that person at that particular age. In other words, their epigenome looked like a younger person based on previous studies of what a younger person’s epigenome would normally look like. Now, there’s a lot of ifs here, right? I mean, there’s these ifs about how accurately we can assess a person’s so called biological age, and what does that even mean biological age?
Kevin Patton: So you have that set of questions and issues, and then you have this other set of questions and issues around the fact that we only looked at it in nine older white men. So how universal this is, is very debatable at this point, but it’s an interesting preliminary result, and it’s an interesting story to tell students when we’re talking about things like aging or the epigenome, or we’re talking about multiple effects of drugs besides the ones that they were developed to treat. Maybe some of the diabetes drugs are going to be used as anti-aging drugs by everyone. Who knows, too early to tell, but an interesting story none the less.
Kevin Patton: The free distribution of this podcast is sponsored by the master of science in human anatomy and physiology instruction, the HAPI degree. I’m on the faculty of this program, and I’ve witnessed firsthand how this program helps A&P teachers. When’s the last time you had a thorough review of all the core concepts of both anatomy and physiology or comprehensive training in contemporary teaching practice? I mean, more than just a workshop here and there. Well, check out this online graduate program at nycc.edu/hapi, that’s H-A-P-I, or just click the link in the show notes or episode page.
Kevin Patton: I think about what most folks call case studies a lot, and so I thought I’d talk about them right now. And it’s my podcast, so there’s nothing stopping me, right? First of all, what do I mean by case study as it relates to teaching and learning anatomy and physiology? Well, it turns out that I mean a bunch of different things when I use that term. I think they all overlap, but they’re not all a case study in exactly the same way. In the preview episode that precedes this full episode, I did some more dissections, as I nearly always do in the preview episodes. One of the words I dissected was case, as in case study, and I talked about how it’s from a Latin word that can mean fall or accident or event, but it has a number of different meaning now that it has been adopted into English.
Kevin Patton: One of those dictionary meanings is a particular instance of something that is investigated. So a case study, in its broadest sense, is simply an example of a situation that we’re going to study in some way. This description of a case study fits all the different ways that I think of case studies, that’s what is common among all of them. So what are those different ways I think about them? Well, that’s a very good question, and I’m glad you asked it. A case study can be a big, and maybe even very complicated, scenario that we present to our students and ask them to spend significant time and effort to investigate. They may or may not do this collaboratively, that is, in groups. It may involve stages where they ask for results of additional medical tests or patient assessments, and then build a more and more complete understanding of the situation before they give their final conclusion about what’s going on.
Kevin Patton: For example, a small group could be given a scenario and asked what has gone wrong with this patient’s… Oh, I don’t know… kidney function. They may be given a few facts about this person and their symptoms. Then they investigate, pulling out what they already know about kidney function and maybe some other related concepts like hormone functions or blood pressure, and then they try to gain more understanding by finding and learning more about kidney function and about kidney dysfunctions. And then perhaps they develop a hunch about what’s going on, or maybe they develop a list of possible explanations, and then they come back to the instructor and say, “Hey, we need to run this test,” or that test. Now, not really run the test, but ask for results of this or that test, or, “We have some questions for the patients, so can you tell us does this patient have this kind of history or does this patient have this kind of symptom?” Then they can start to narrow things down. So we give them that information, and they go back to work. There might even be several rounds of this back and forth with the instructor, getting more information, asking questions. And then finally, their answer is presented to and discussed with the instructor or maybe with the entire class.
Kevin Patton: Now, some strategies for carrying out a case study activity are more extensive, but I’m guessing that many are like the one I just described, or sort of like it, or probably a bit less complicated than that back and forth scenario, with few, if any, of those back and forth requests for more information. Some case study activities involve clickers to be used at one stage or another, as a larger group works through the stages of developing a proposed solution to the case, for example, to solve some math problems that calculate different renal functions like glomerular filtration rate or something like that. Or maybe clickers are used for each student in a large group to input their conclusion, and then the resulting set of answers can then be resolved by the whole class. These are often called clicker cases because they involve a student-response system of some sort, whether they’re actual clickers or some kind of web-based tool that acts like a student-response system.
Kevin Patton: And then there are case studies that may be given as shorter scenarios, that have a fairly clear correct answer and are given as an assignment or as a test item. I use case study items on my tests a lot. What I mean by that is I use them on every darn test and exam, every single one. And not just one case study, at least a handful of them. But my case studies are most often what I call mini cases because they’re really brief, and they focus on a particular part of what would be a larger, more complex case. For example, if it’s a renal case, I may simply use the context of the case to ask them a question about glomerular filtration rate or the effect of a particular blood pressure on what’s likely to happen to the GFR or some other variable.
Kevin Patton: Sometimes it’s barely what most of you would think of as a case study. For example, I might give a scenario of a guy or gal being told by a dermatologist that their sunburn has reached the deep part of the epidermis, and then simply ask the student to list all the layers of the skin and use that to identify which region the dermatologist was probably referring to. I could simply ask students to list the layers of the skin in order, and in a way, that’s really all I’m asking them to do in that little case I just mentioned. But when I put it in the form of a case by building a story around it, even if it’s just barely a story, and attach somebody’s name to it and say it’s this person and this is their name, then students seem to get a little more engaged because they’re solving a real-life puzzle. Okay, it’s a pretend real-life puzzle, but it’s something they can imagine happening in real life, and students get to see that these weird lists of facts that we’re asking them to learn really do have real-world applications, that is stratum this and stratum that and stratum this other thing really are important.
Kevin Patton: Even if they’re not thinking that thought in the front of their minds, it’s in the back of their minds, and if done repeatedly, becomes part of their awareness that everything their learning may eventually be used in a clinical situation or some other kind of application from real life. An important concept in all this talk about case studies is that whether they’re simple or they’re complex in the way they’re set up, what case studies do is pull students beyond their comfort zone of memorizing facts and leaving it at that. Case studies really do a great all-around job of not only getting students to understand and apply those facts, but also do some analysis and evaluation that helps them creatively solve scenarios or puzzles or mysteries based on real life.
Kevin Patton: I just realized I sound like a regular Bloom’s Taxonomy here, don’t I? Talking about evaluation and assessment and analysis and blah, blah, blah. But that’s kind of what we do. I could express it differently and say, “When students are asked to describe, explain, and interpret case studies scenarios, they must not only recall concepts but also apply concepts and skills in ways that require strategic thinking and extended thinking to arrive at creative solutions.” And I’d said it that way if I wanted to sound like Fink’s Taxonomy of Significant Learning. Heck, give me any learning taxonomy you like, and I’ll show you how case studies pretty much hit all the buttons, but that’s good. That means that we can use case studies to help students reach their full ability to know and use information in meaningful, long-lasting ways.
Kevin Patton: I think another value of case studies is that they’re… Well, they’re just fun. First of all, aren’t case studies really a form of storytelling? And regular listeners of this podcast know I’m a big believer in teaching through storytelling. Stories are a lot more fun than a recitation of facts, no matter how brilliantly delivered and insightful reciting facts might be in your class. Sure, these stories in the form of a case study are hard to figure out, and they can be frustrating, but they’re hard and frustrating in the same ways trying to figure out what’s going on in a mystery novel or film, or in the same way that puzzles of various kinds are fun, or think of how popular and widespread escape rooms are becoming. I just thought of something, wouldn’t be fun to build an anatomy and physiology case that runs like an escape room? I’m going to work on that. That sounds cool to me. I’m going to do it. Somebody make one of those and I’ll come try and participate. That would be a blast.
Kevin Patton: Speaking of creative ways to use case studies and teaching in learning, what prompted me to think of it as a topic for this podcast was an update I recently received from the National Center for Case Study Teaching in Science. This one was a case from Sheri Boyce called A Grumpy Old Man: Hypercalcemia and the Parathyroid Gland. I think it caught my eye because of the term grumpy old man. That just kind of resonated with me. Now, Sheri has contributed several case studies related to A&P to the National Center for Case Study Teaching in Science, as have a lot of other science teachers from all over the country. If you’re looking for some case studies that had been classroom tested to use in your own course, then I suggest you check out the National Center for Case Study Teaching in Science. Besides a whole collection of case studies you can use, a collection that’s growing pretty rapidly, there are all kinds of other resources they have, including workshops, a conference training videos, and books. They’re all about how to use case studies. Now, I have a link to all this in the show notes and at the episode page at theAPprofessor.org if you want to check it out.
Kevin Patton: Another great resource for classroom-tested case studies is the Life Science Teaching Resource Community, or for short it’s often called LifeSciTRC. They have a lot of different resources, among them all kinds of case studies. LifeSciTRC is a joint effort of the American Physiological Society, the Human Anatomy & Physiology Society, the American Association for Anatomy, and a whole bunch of other life science organizations. And their resources are peer-reviewed, so you know that they’ve been looked over carefully. Just go to lifescitrc.org and start exploring, and I’ll have a link to this also in the show notes and episode page.
Kevin Patton: I had just entered the topic of case studies into my podcast planner when I got a note from Christy Pitt in Massachusets telling me about an idea she had for implementing case studies in her A&P course and asking me if I knew of any additional places where she could find more case studies to use. And I knew right then that the universe was confirming my idea to talk about case studies right now. That’s always a good feeling, right? When the universe seems to be on your side? So Christy’s idea is this, she’s going to have what she calls clinical days throughout the year, one clinical day for each body system in her A&P course. And what she’s envisioning is having her students take on the roles of different medical professionals and review some medical cases, make some diagnoses or referrals and present patients to each other in discussions, sort of like they do in grand rounds.
Kevin Patton: I think that’s a great idea, and I got to thinking, many of you have creative ways that you’ve been using case studies in your course. Don’t you think some others of us would like to hear about it? Of course we would, so why not call in right now while you’re thinking about it and tell us your case studies successes, your ideas, your pitfalls, and other stories?
Kevin Patton: One of the ideas that came up during my conversation with Christy is a method that I use in nearly all my online tests. I give students medical images, x-rays, CT scan images, MRIs, sonograms, all kinds of medical images and graphs. And then I ask students to answer questions about them. Questions that they can answer by applying what they’ve learned in our course about anatomy and physiology. For example, early on, I asked them simply about anatomical planes and directions as they’re represented in the images that I’m giving them. I might make up a name to go with the image, so it’s set up as kind of a case study, like here’s so-and-so’s x-ray, and which bone is it that’s broken, or are there any bones broken here, or you can see the break pointed to by the arrow, is that distal to or proximal to the knee joint, things like that. So basically, they’re practicing using directional terminology with actual representations of the body, and planes and sections of the body. Wow, does that help students understand what a sagittal plane is, and what a sagittal section is, because don’t we use planes and sections a lot in medical imagining, like CT scans and MRIs and so on?
Kevin Patton: This is really simple to do and can be done for pretty much every unit of study in an A&P course. I use a lot of randomized test items, so when they get to the medical imaging question, or one of the medical imagining questions, I might have like five or six or ten different versions of it, maybe even using the same x-ray, or maybe I swap out x-rays, so one time they’ll get one from a fracture in the leg, and next time a fracture in the arm. So each attempt they do is going to be a different way to ask that kind of a question. When I do my course debriefings, the students tell me that they really think that these things are fun. Of course, they also tell me that they can be frustrating at times, even maddening at times, but ultimately, they’re fun too.
Kevin Patton: By the way, remember a moment ago when I said that I make up a name and turn a medical image into a case study? Well, that’s kind of the natural evolution of working with case studies as a teacher. At first, you use cases written by others, then you start adapting those, and then you start making up your own, and then you start seeing every question you pose to students is a potential case study or mini case study. And then all of a sudden, as if by magic, we’re making them up as we prepare for the day’s class, or an idea for one pops into our head as we’re in the middle of class explaining some concept to students.
Kevin Patton: To sum up, case studies are a fun variation on storytelling, and they can be a great tool to get students thinking, applying, evaluating, and solving in complex ways. Plus, it’s a great way to keep students engaged and motivated. And if all that isn’t enough, well, I just got nothing else for you.
Kevin Patton: Hey, don’t forget that I always put links in the show notes and at the episode page at theAPprofessor.org in case you want to explore any of the ideas mentioned in this podcast or if you want to visit our sponsors. There are many ways to stay connected to this podcast and get new episodes as soon as they’re released. Just go to theAPprofessor.org/listen to explore the many ways you can do this. And you’re always encouraged to call in with your questions, comments, and ideas and A&P jokes at the podcast hotline. That’s 1-833-LION-DEN. That’s 1-833-546-6336. Or send a recording or written message to podcast@theAPprofessor.org, and you can follow this podcast in Twitter, Facebook, or Instagram using the handle @theapprofessor. I’ll see you down the road.
Aileen: The A&P Professor is hosted by Kevin Patton, professor, blogger, and textbook author in human anatomy and physiology.
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Preview of Episode 53
Kevin Patton: Hi there. This is Kevin Patton with a brief audio introduction to episode number 53 of the A&P Professor podcast, also known as TAPP Radio, an audio roundup and trail ride for teachers of human anatomy and physiology.
Kevin Patton: Coming up in the full episode number 53, we’re going to do some updates, and one of those updates is on the shape of the heart and how that relates to what we do in our life, especially related to the kind of activity that we have. Then, another update is talking about exosomes, which are little organelles that we don’t often talk about in the A&P course and their possible role in the spread of cancer. Then, the featured topic is going to be ways that we can amplify learning in our course. So that’s all in the upcoming episode number 53.
Kevin Patton: The free distribution of this podcast is sponsored by the Master of Science in Human Anatomy and Physiology Instruction, the HAPI degree. I’m on the faculty of this program so I know the incredible value it is for A&P teachers. Are you looking to power up your game in teaching A&P? When’s the last time you had a thorough review of all the core concepts of both anatomy and physiology or comprehensive training in contemporary teaching practice? Check out this online graduate program at nycc.edu/hapi, that’s H-A-P-I, or click the link in the show notes or episode page.
Kevin Patton: It’s time for word dissections, and I have five terms that we’re going to dissect. Three of the five are terms that are probably going to be very familiar with you. And all of the parts that we’re going to end up with after we do our dissection are all word parts that I’m sure you’re very familiar with. So let’s get going.
Kevin Patton: The first one is metastasis. That’s a term that we use occasionally in A&P teaching when we’re talking about how things can go wrong in a normal tissue and both in terms of structure and function. So, metastasis is when a cancerous tumor starts a new colony somewhere else, or at least that’s a way to describe it. So we’re going to have additional cancers that move beyond that original primary cancer or tumor.
Kevin Patton: So breaking it apart, we start with meta, which we see a lot in terms used in A&P teaching. That can be translated differently depending on how it’s used, upon its context. It’s like a lot of words in English that have multiple different meanings and sometimes different nuances depending on how you’re using it. So meta is one of those word parts, and it can mean beyond, or it can be translated as among, or sometimes it’s translated as after. There’s a few other variations as well.
Kevin Patton: Then, the next part of the word, stas comes from the word stat. It’s an alternate form of the word stat. Stat means stand. Then, the I-S that comes after that means a state. So when we put those last two word parts together, stat and is, it becomes stasis, and that we can translate as the word standing. So it’s the state of stand, right? I mean, it’s the condition in which we stand. When we put that all together with the meta part, now we have standing beyond or standing after. But it’s often translated as changing, which, yeah, okay, I get that because you’re standing after the state you were in before. You’ve shifted to a different state. But with metastasis, at least when I’m thinking of what the word parts mean, I’m thinking of here’s the tumor and, oh, look, there it is over there now. So it’s standing beyond, right? It’s now, whoops, I thought it was there, now it’s here. And really, it’s a second one. It’s a secondary tumor in that second place. So that’s metastasis is the process of that movement of establishing a secondary tumor.
Kevin Patton: The next term that we’re going to dissect is extracellular vesicle. And in the literature, I noticed that it’s very often abbreviated capital E, capital V for extracellular vesicle. That makes sense. Breaking this apart, we have two parts to that term, and extracellular’s the first part. Extra means outside. Then the next part, cell, it literally means storeroom. But of course, here we know that it means a cell of the body, a biological cell. Then, the U-L part means little. So, cellul means little cell. Then, the A-R ending means relating to. So if we put all those word parts together, we could translate that phrase made up of word parts as outside the little cells. So extracellular, outside the cells, or relating to something outside the cells, yeah, okay, that makes sense.
Kevin Patton: And then vesicle, the second part … And vesicle’s a term we use a lot in A&P teaching, right? If we look at the first part of that word, ves or vesic, it comes from a Latin word vesica which means bladder. That implies that it’s going to be fluid-filled. It’s going to be soft-sided and fluid-filled, expandable. Then, the C-L-E ending means little. So we put that all together, and it’s a little bladder, a little fluid-filled, soft-sided sack. Of course that makes sense, too. So we put the two words together to make extracellular vesicle. We’re looking at a soft-sided, fluid-filled sack that’s outside the cell. Okay, that makes sense.
Kevin Patton: Now let’s move on to our third term, which is exosome. Exo means outside, just like extra does, and some means body. So it’s a body that’s outside. Now, the implication here is that it’s outside the cell because we’re looking at an organelle that has been formed by the cell and sort of pushed out of the cell and that exosome has stuff in it that used to be in that originating cell and now it’s going to move into the extracellular space and it’s going to become an extra cellular vesicle. So an exosome is a kind of extracellular vesicle and it contains substances that are going to move through the extracellular environment, the extracellular matrix, and probably end up at and possibly merging into another cell where those substances that were in the vesicle are going to have some effect in that second cell. So, that’s exosome.
Kevin Patton: Now, another kind of extracellular vesicle is our fourth term that we’re going to dissect, and that is oncosome. That first word part, as I’m sure you know, is onco, which means, well, literally means a swelling or a mass, but the implication here is a tumor. We usually use it in the context of a malignant tumor or cancer. So we could translate the word part onco as meaning cancer or relating to cancer in some way. And then some … Well, we’ve seen that already a couple times just in the last few minutes, and that means body. So literally means a cancer body, but it is another kind of extracellular vesicle, and it contains substances that came from a malignant tumor cell. Yeah, just like the exosomes, they could end up moving to another cell and having some kind of impact on that cell. It’s probably not going to be a good impact because it’s coming from a source that’s not really the kind of cell we want to have in our body, right? It’s a cell that’s not normal. So it’s probably going to contain some substances that are going to enhance the viability of the tumor and possibly at the expense, either directly or indirectly, of the normal cells in that little microenvironment in whatever tissue that we’re looking at.
Kevin Patton: Okay. So we’ve covered four terms so far, metastasis, extracellular vesicle, exosome, and oncosome. And the last term … And by the way, all these terms are going to show up in the full episode, so that’s why we’re kind of reviewing them here and, of course, just really practicing our word dissection skills.
Kevin Patton: The last term is transcytosis. The first word part, trans, is a commonly used one in scientific terminology, and it means across. Then, the next part, cyt, C-Y-T, means cell. Then, the osis part at the end means a process. It can mean a condition of or state of as well. Transcytosis then is a process of something going across a cell. The way it’s used in most contexts in biology is it’s describing a process where a cell takes up an extracellular vesicle, moves it inside to that cell and transports it, using the cytoskeleton of course, transports it across the cell and then pushes it out the other side. So if you have a membrane made up of cells, like an endothelial membrane for example, then a vesicle could approach the endothelial cell, it could enter the endothelial cell and come out the other side. Now, it’s on the other side of that wall that was formed by the endothelial cells forming an endothelial membrane.
Kevin Patton: So we have transcytosis, and before that we had oncosome. Before that, we had excess exosome. Before that, we had extracellular vesicle, and before that we had metastasis. That’s enough for today, right?
Kevin Patton: Marketing support for this podcast is sponsored by HAPS, the Human Anatomy and Physiology Society, promoting excellence in the teaching of human anatomy and physiology for over 30 years. Go visit HAPS at theAPprofessor.org/haps. That’s H-A-P-S.
Kevin Patton: Last week, I was on a call with a listener from my office. And if I’m ever talking to any of you on the phone for more than about a minute, I’m going to pull the Swiffer out and start dusting my bookshelves. I have lots of bookshelves in my office with lots of books on them, all of which gather what seems to be more than their fair share of dust. So I just hung up with my caller, and I was finishing up dusting that last shelf in the bookcase when I noticed a book that I’ve not looked at in a long time. It’s called Prime Mover: A Natural History of Muscle, and it’s written by Steven Vogel. I smiled because even though it was 10 years ago, I started remembering how much I liked the book and how much it helped me with my of anatomy and physiology.
Kevin Patton: Now, as you can tell from the title, it’s all about muscle. And muscle is an important character in the story we tell our students about the human body, right? The whole first half of the book or so tells that story, but taking quite a bit more time and care with it than we typically do in our A&P course. So, that part of the book was really helpful to me to see how this guy, Steven Vogel, who’d done a lot of research on muscles and spent a lot of time working out a good way to tell the story of muscle, laid everything out for the reader.
Kevin Patton: Now, I had a vague recollection that I’d underlined a bunch of passages and dog-eared a bunch of pages. But when I thumbed through the book the other day, it was like totally unmarked. If I wanted to sell it, I’d get a good price for it. And then I remembered that I’d stuffed a bunch of note cards in the book and jotted notes as I read it instead of marking up the book directly. So the fact that I took notes tells you that I found it valuable, but not just the first part of the book that really was a long and interesting story about the structure and function muscle. The back half of the book, which focused a lot on how we use our muscles for, oh, a variety of different tasks that humans do, well, that was also interesting and useful. It even talked about how the domestication of certain animals has a lot to do with how we humans use our muscles.
Kevin Patton: Besides giving me an opportunity to refresh my learning of muscles, it gave me things that I could bring into my own telling of the story. It also gave me a lot of background and context that I may not bring into my own course but it’s there for me in case I do need it. And even if I never really need, need, need it, it’s still an enjoyment for me and it feeds into and supports that joy and amazement regarding the structure and function of the body that informs the way that I teach.
Kevin Patton: Regular listeners know that I’m all about approaching teaching as a form of storytelling, and Steven Vogel tells a great story about muscle. Reading his version of the story helps improve my version of the story. If you want to find out more or perhaps use our affiliate link to buy a copy, boy, wouldn’t that be great, just go to the show notes or the episode page or check it out at theAPprofessor.org/bookclub.
Kevin Patton: A searchable transcript and a captioned audiogram of this preview episode are funded by AAA, the American Association for Anatomy at anatomy.org. Well, this is Kevin Patton signing off for now and reminding you to keep your questions and comments coming. Oh, yeah. And also, those book club recommendations, I’m still giving away Amazon gift certificates for anybody that contributes a book club recommendation to the podcast. Also, there’s still room in that group of five for a drawing for the Amazon HD 10 Kindle tablet device. So yeah, you want to jump on that one, and you can do that by calling the podcast hotline right now at 1-833-LION-DEN. That’s 1-833-546-6336 or visit us at theAPprofessor.org. Hey, and why not take just a moment this week to share the AP Professor podcast with a colleague? I’ll see you down the road.
Last updated: September 25, 2019 at 10:35 am