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Episode 6 | Transcript
Give Your Course a Half Flip With a Full Twist
Kevin Patton: You may have heard about professors flipping their classrooms, or perhaps, you’ve flipped one, or more of your own courses. Having spent some time in the circus, where I found out, I’m not naturally very acrobatic, when I first heard the term flipping, I was picturing what a teeterboard artist does, and that didn’t sound like something I’m capable of.
Kevin Patton: But here’s the good news. Twisting and flipping on a teeterboard is hard, but flipping a class, is not.
Aileen: Welcome to the and 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 a new blood test, to assess mild traumatic brain injury. I talk about using a green pen, instead of a red ped in grading, and I talk about flipping a classroom.
Kevin Patton: You may have heard the news that the US food and drug administration, that is the FDA, recently permitted marketing of the first blood test to evaluate concussion, or mild traumatic brain injury. mTBI, in adults.
Kevin Patton: If you haven’t heard it yet, your students are probably going to be asking you about it. It might pay for us to be prepared for such a question. I think it’s a good question coming from a student in a variety of ways.
Kevin Patton: One is, it’s telling us that they are really interest in this subject, and they are bringing it to the classroom, and that’s always to be encouraged, right. The other thing is, they are trying to fit what they are learning in A&P class, with what they are hearing on the news, and what they are understanding from various sources of information about their bodies and healthcare and so on.
Kevin Patton: So, what about this new test? First of all, it’s called the Banyan Brain Trauma Indicator, because, well, it’s a company called Banyan that’s given permission to put it out. It was looked at as part of the FDA’s breakthrough devices program, which is a program to promote the development and use of novel medical devices and test and so on.
Kevin Patton: So, just to make sure we’re all on the same page. What is a TBI, or Traumatic Brain Injury? Well, it’s caused by a bump, or blow, or jolt to the head, or a penetrating head injury that disrupts the brains normal functioning. It’s range of severity could go from mild to severe, about 75% of TBIs that occur each year are assessed as mild TBIs or mTBIs, otherwise known as concussion.
Kevin Patton: Most patients with concussion symptoms though, have a negative CT scan. That is there are no lesions visible on a computed tomography image. The potential effects of a TBI, it can include a variety of things, including impaired thinking or memory, impaired movement, impaired sensation, or emotional functioning.
Kevin Patton: US centers for disease control and prevention estimate that there are somewhere around 3 million TBI related emergency department visits, hospitalizations, and deaths in the United States, and of those, TBI contributed to the deaths of nearly 50 thousand people. So, when we have students asking about this test, and they probably will, because they want to know how, what they are hearing on the news, or understanding about how the human body works, fits in with what they are learning in A&P class. They are building their conceptual framework, and of course it would be helpful if we can facilitate that for them.
Kevin Patton: So, how do we answer them. What’s going on with this test? Well this brain trauma indicator is a blood test that’s measuring the levels mainly of two proteins that are released from the brain in to the blood, and it can be measured within the first 12 hours after an injury.
Kevin Patton: Now, what are these two proteins, and where do the come from? Well, one of them is called UCH-L1, which is short for ubiquitin C-terminal hydrolase L1. It’s a protein that breaks down the precursors to the little ubiquitin monomers that have a variety of functions in the cells.
Kevin Patton: In my class, I talk about ubiquitin as a little tag that gets put on to a protein, a misfolded protein that is going to allow it to be broken down by a Proteasome in the cell.
Kevin Patton: So, this UCH-L1 is part of that ubiquitin pathway … the path for producing ubiquitins. It’s found only in neurons and of course in neuro circulatory cells, which are, I guess modified neurons. You could think of them as that.
Kevin Patton: So, if you have neurons damaged, as you might in a TBI, then these proteins are going to be released in to the blood, and picked up by the blood test. These proteins are not going to be released in to the blood from any other tissue, because they are not really found in any other tissue. And, by the way, they are found in very high amounts in neurons. They are not just trace amounts. They are found in high amounts. So, that’s one of the proteins.
Kevin Patton: The other protein is called GFAP, which stands for glial fibrillary acidic protein, and that is one of the major proteins of the intermediate filaments that are in mature Astrocyte, which we know are a type of glial cell. So, again, that makes sense, that if they are found in Astrocyte only, that, when you see them released in to the blood, that means there must have been injury in to the glial cells in the nerve tissues.
Kevin Patton: So we have two different markers for the two different major components of brain tissue. Neurons and glial. So, that fits really well in to what students are already learning about brain tissue.
Kevin Patton: So, the levels of these two blood proteins after an mTBI, or concussion, can help predict, which patients may have inter cranial lesions that would be visible in a CT scan, and also, and just as importantly, it will tell us, which injuries won’t have inter cranial lesions visible in a CT scan.
Kevin Patton: So, being able to predict if patients have a low probability of inter cranial lesions can help healthcare professionals in their management of these patients, and help them make decisions of whether to perform a CT scan, or not.
Kevin Patton: These blood test, by the way, their results can be available within three to four hours. So, when the FDA was looking at this, they looked at data from different centers, and they looked at a clinical study of about 2000 individual blood samples from adults that had suspected mTBI/concussion, and they reviewed this product’s performance by comparing the mTBI concussion blood tests with its CT scan results, so that they could get a good correlation of what was really being shown by the brain trauma indicator blood test.
Kevin Patton: They found it was able to predict the presence of inter cranial lesions on a CT scan, 97.5% of the time, and just as importantly, it was able to show those who did not have inter cranial lesions on its CT scan, 99.6% of the time. That means that this test can reliably predict the absence of inter cranial lesions, and healthcares can use that information to incorporate this tool in to their standard of care for patients to rule out the need for a CT scan, in at least a third of the patients that are suspected of having an mTBI/concussion.
Kevin Patton: An FDA commissioner Scott Gottlieb, who is an MD, said that this approval by the FDA, is part of the FDA’s initiative to reduce unnecessary radiation exposure for medical imaging, which, I didn’t know was an initiative that they had, but I’m glad that they have one, because that is a very important issue with medical imaging.
Kevin Patton: We always want to have the image, want to have the image, but we have to counterbalance that against the exposure to radiation, which is not insignificant, especially when we consider its cumulative effects over the lifetime.
Kevin Patton: So, according to Gottlieb, he says this is an effort to ensure that each patient is getting the right imaging exam, at the right time, with the right radiation dose, which is a really good idea, and I think this is great that we have a blood test that can be used along with these other medical techniques, to address what is clearly an important medical issue.
Kevin Patton: I think it’s great too, that now we have another reason to tell our students that, yes, it’s important to know about cells, and to know about all those things inside of cells, and yes, even chemistry, we need to know about.
Kevin Patton: I don’t know about you, but I get occasional pushback from students saying, I’m going to be a nurse, why do I need to know about proteins in a cell, why do I need to know about all of these organelles, and so on. Well, clearly they need the bigger picture to understand why then need to know it, and they need to trust us that thy need to know it. But in order to help them trust us, I think these kinds of examples, especially if they are the ones bringing it to us, and saying hat about this. These kind of examples can really help them understand why they need to know what we’re telling them what they need to know about human structure and function.
Kevin Patton: As always, I have some links to reference notes in the show notes for this episode, or you can go to theapprofessor.org, and look at the episode page.
Kevin Patton: Okay, so here’s a really little thing, but I think it can have a big impact on the effect of our teaching on students, and that is, what color pen do you use when you’re grading papers, and marking comments on papers, and lab reports and so on. When you’re sketching out things in the margin of a student’s notebook, to help explain an idea.
Kevin Patton: If you’re like me, who began teaching during the dawn of humanity, we were all issued red pens, and that’s what we expect from teachers, right, is using a red pen. I mean, it stands out from whatever blue, or black, or whatever color pencil marks that they are making on their paper. So it’s really clear who wrote what, and the comments really do pop out.
Kevin Patton: The problem is that our students have lived part of their life already, spending decades, being corrected by teachers who had a red pen, and some of them have had some not so good experiences.
Kevin Patton: Not only that, but psychologists tell us that the color red is an alarming color. There’s a reason why fire alarms, and even fire trucks are colored in red, because it has a certain impact on our psyche.
Kevin Patton: Psychologists also tell us that the color green has a more positive impact on our psyche. It’s the dolor of nature. It’s a very peaceful color, and so for, oh gosh, it’s gotta be more than ten years, maybe twenty years now, I have avoided using a red pen, and I almost entirely use a green pen.
Kevin Patton: If you run in to me at a HAPs conference, or somewhere else, sometime, tap me on the shoulder and say, hey, can I borrow your pen for a minute, and I will pull out a green pen. Probably a felt tip, and that’s because that’s my go to color now. It stands out from what color other people are using, especially my students, so when I’m putting grades or comments on papers, I do it in green. I think it has a little bit of a positive impact, and all those little, little, little positives, that we can do in our teaching, I think add up, and add to the kind of atmosphere that we want to build in our course. That is an atmosphere of support and progress and not an alarming red kind of course.
Kevin Patton: Here’s a way you can help yourself, and your colleagues as well.
Kevin Patton: To help yourself, why not subscribe to the A&P professor podcast. Just go to the apple podcast app, or Google play, or wherever it is you get your podcast, and subscribe, and while you’re thinking about it, why not share it with your colleagues.
Kevin Patton: You can do that on social media. You can do that by email. Whether they are folks that you know that are new to teaching A&P, or they’ve been doing it for a long time, but they are still interested in upping their game, or maybe even contributing to the A&P professor podcast.
Kevin Patton: I sure do appreciate your help with this.
Kevin Patton: Flipped learning, or flipped classroom. What in the world is that? By now, we know it’s not the same as doing a flip or a twist on the Teeterboard, or in Olympic gymnastics. Let’s all get on the same page with what we mean by flipped learning in the classroom.
Kevin Patton: So, flipped learning, in this context, is most often described as a type of blended learning strategy. It reverses what some call the traditional classroom strategy of presenting content in a lecture, in class, and then assigning homework activities outside of class.
Kevin Patton: In the so called flipped approach, it’s reversed. It’s turned on its head. Students get reading assignments and online presentations, or online activities first. And then they come to class, and there, instead of the usual lecture, they do any of a variety of active, or interactive learning activities.
Kevin Patton: So, a lot of folks trace this back to 1993, when Alison King wrote a very widely read journal article, called, from Sage to the Stage, to Guide on the side. And I’m sure you’ve heard those terms. Sage on the stage, which is, considered old fashioned nowadays, and guide on the side, which is considered, an ideal by a lot of people.
Kevin Patton: And then, not too long after that, 1997, Eric Mazur, at Harvard developed something he called, peer instruction, where students did a lot of learning activity prior to their classroom activity. They came in to the classroom, got together with their peers, and really wrestled with some very depending learning activities.
Kevin Patton: The term flip learning though, didn’t come till 2007, when two folks, Jon Bergmann, and Aaron Sams, proposed the idea, and they give credit for their approach to the method to a group of people, Maureen Lage, Glenn Platt, Michael Triglia, and their idea of an inverted classroom, or the process of inverting the classroom, by having online video presentations before the class, and then you get to class, and do some work with those ideas, rather than having the usual presentation of ideas in a traditional lecture.
Kevin Patton: Now, in my mind, this whole approach is what we old timers used to call lab class. In lab, where you study your material, and then you come to lab, ready to dissect, or measure heart rates, or whatever other fun activity was planned for that session.
Kevin Patton: But of course, that was lab. There was this other big nasty beast called the lecture class, and that’s what we’re focusing on. Flipping the lecture class, or what you could think of is, turning your lecture class in to a lab class, sort of.
Kevin Patton: I’ve been doing this for quite a while. Honestly, I wasn’t aware of this method’s growing use in the so called lecture classes until about 2005, when I started thinking about how to put more of my in class lectures outside the classroom, and use that time inside the classroom, to help students tackle the problem solving, the hand wringing application of ideas, and construction of a useful big picture of human structure and function.
Kevin Patton: So, how do I do that. And I looked around at a variety of ways. I think some of the initial people in this movement, including Bergmann, and Sams and others, they started using Power points that were narrated. That’s for a long time, that has been a built in functionality of Power point. I actually tried that, but I found that the files that you end up with are huge, and back then, my students, a few of them had a hard time even getting to an internet service. They would have to come to campus outside of their normal class times, and do it on campus, or go to their local library or something like that. Even then, it took forever to download the files, and we know how patient our students are sometimes, especially when they are anticipating some required activity. They don’t wanna wait for things to download. And there were some other issues I had with it in terms of being able to go back and edit things as I update my course and so on.
Kevin Patton: So, I eventually found some software that has since been retired, and what I use now is a similar software, that I think works much, much better and is always improving. It’s called ispring, and I have a link to that on my show notes and on the episode page at theapprofessor.org.
Kevin Patton: I actually hae a seminar that you can view on line. A webinar type thing, that you can view online at theapprofessor.org, and I’ll have a link in the show notes and episode page as well, where I kind of walk through how to use ispring, to do some pre lectures before the lecture class.
Kevin Patton: So I started doing that in the fall of 2006, and I never stopped. As long as I was doing an on ground class, that included a lecture course, then, it wasn’t really a true traditional lecture course. It was a blended lecture course, a so called flip lecture course. Although I did continue to do some traditional lecturing within class, so I guess, to a purist, you would call that a half flip.
Kevin Patton: With my own little twist on it, so it’s a half flip, with a twist. Okay, so here we are back to the Teeterboard, circus acrobatic analogies here. Let’s get away from that and get back in to the classroom.
Kevin Patton: What I did, I called previews. I called them lecture previews, because they were going to lecture class. That’s the terminology they knew. They were required to watch online preview in their learning management system. I would post it in the learning management system, and I would try to get them as short as I could. Maybe 10, 15 minutes. Some often were as long as 45 minutes, but I later broke those down into shorter units, because that is just too intimidating for a student.
Kevin Patton: Just like I like to keep these podcast episodes to around a half hour. 20 minutes to a half hour. I listen to some podcasts that go for an hour and a half, and honestly, sometimes those just get a little bit too long for straight listening.
Kevin Patton: Now, if I was doing some back flips in the middle, then maybe not. I often just break them down myself and stop listening, and start again, and students can do that with a longer preview, but I decided to help them along and do it for them. So, I would have multiple short online presentations, and these were based on a PowerPoint presentation, but I used this plug in as I mentioned, called ispring.
Kevin Patton: What that does, it allows me to put a little video of myself my little talking head in the corner. It allows me to show the slide, including any animations that I have. What I mean by animations is, an arrow coming in from the side, or different points being revealed one by one on the same slide, or maybe a little ball traveling through the cardiovascular system, or through the nephron of the urinary system, or something like that.
Kevin Patton: Not only that, but on the side, there is an outline of all the slides, arranged in logical groups, with headings. So, students could go back to a slide, and say, wait a minute, I missed something, or I was vegging out during that time, so I can just flip back, and go to this other slide, and start over again.
Kevin Patton: Another advantage is that they can click another tab, and on the side that outline of slides is replaced by notes, and in those notes, I put a transcript of what my narration is, because, we need to have universal design. The law is that we need to be prepared, for common issues that students have, including hearing impairments, and so, if I’m requiring them to listen to something online, then, I better have close captioning, or transcript. So I have think transcript for each individual slide alongside that slide. It’s far easier to do that when you are making it than have a hearing impaired student have to go suddenly back and have to fill that all in.
Kevin Patton: I say that from the heartache from having to do that, because I really wanted that student that I got, that was hearing impaired to have a great experience, and she could not have a great experience, if things weren’t ready for her. I worked really fast to do that, and nowadays there’s pretty inexpensive transcribing services where I don’t have to do it myself, and for not a very high price, and maybe you can talk your department of college in to footing that bill in the beginning, so they don’t have a massive bill, in an emergency, when they have a student that absolutely requires that.
Kevin Patton: And it not only helps students with hearing impairment. I find that ordinary students, with normal hearing, they benefit from reading alongside sometimes too.
Kevin Patton: Another neat thing about this system that I use, ispring, is that you can build in little quiz questions, so that you can go through a few slides, quiz them, then they can go back and redo those slides if they find they didn’t get the main points. Not only that, and I haven’t don’t his yet, but with ispring, and similar programs, you can link those questions to the learning management system, so any results that they get there, to that little quiz that you give them once in a while, embedded within that preview lecture, that will automatically feed back in to the learning management system, and that can become part of the grade.
Kevin Patton: Now, if I ever do that, I don’t think I’m going to make it as part of the grade. I’ll probably post it so they can see how they are doing, and so I can see how they are doing, and see if there’s any trouble spots that I’m not otherwise picking up with other ways of assessing where those trouble spots are, but I don’t really want it to be a high pressure thing. I want them to go ahead and guess, and if they get it wrong, go back to the slide, and get it right.
Kevin Patton: I don’t want this to be a high tension thing for them. There are other high tension things I give them later on in the process.
Kevin Patton: Another thing I do with this, by the way, is in the learning management system, where they are watching these online presentations, they have to watch them, and if they don’t watch them, then I can set the learning management system so that it will not open up their other activities. So they won’t be able to take the online test that they have to take. They won’t be able to get to the notes, the outline that they need to get to. They won’t be able to get to anything else they need to do the learning they need to do in the rest of the course.
Kevin Patton: So, that in itself is a motivation, but it’s not only a motivation built within the little settings of my learning management system. It’s also a motivation to come to class prepared, because when they get to class they know, that when we get to a new topic, the first thing I’m going to do is get out the clickers. Of course, there’s many different ways of doing student response systems. I use clickers, and I’ll talk more about that in a future episode of this podcast, but that’s what I use, so I’ll give them a clicker question, and then we can see at a glance, when the results show up in the graph from the clicker system, who’s been doing the previews, and who hasn’t, and I can have a nice little talk with people, and get them on board.
Kevin Patton: Honestly, it only takes a few times of students lagging behind with their online lectures outside of class, before they get the idea that, they are not going to understand anything that’s going on in the class, if they haven’t done that ahead of time.
Kevin Patton: Not only with the clicker questions, but with the other activities I do. In the episode that I released just before this one, I talked a lot about content maps, and how you can use that as a learning activity within the classroom. That would be an example of taking material that they were studying in the online previews, before class. Come to class, and say, okay, make a concept map. Get in to groups, work with peers. There’s that peer instruction thing. Work with your peers and build a concept map based on what you learned in the preview, or what you think might be going on in this other concept that we’re about to get to. It’s a different kind of preview of upcoming material.
Kevin Patton: So there’s all kinds of things that you can do in the classroom. You can have students working on case studies. You can bring in some lab activities that work well in a classroom setting. You can do all kinds of things in the classroom. What I do, is still a lot of traditional lecturing. I try to break it up with discussions, with concept maps, with case studies, done in small groups and things like that. Hence, the half flip thing.
Kevin Patton: You don’t have to fully flip your class. As a matter of fact, if it’s a really scary idea to you to do flipping, and I’ve known a lot of people that have completely flipped their classed, completely backwards, as I first described. They are still alive to tell about it, and actually, walking around with smiles on their faces, because they really like how it has affected the learning in their classroom.
Kevin Patton: I’m not trying to dissuade you from doing that, but what I’m telling us is, there is another option. There’s an in between option, where you don’t have to give up all of your lecturing, that you’re so comfortable with, and used to. Just give up some of it, and it’s an easy thing to do, especially nowadays with the kind of technology we have.
Kevin Patton: Look at my online preview and you’ll get a taste of it, and if you want some help, or need to ask some questions, go ahead, and call in. Some of the questions will probably be useful for other people to hear, so I’ll handle them, maybe in a future episode. Please do call in. Or if you just want chat with me one on one, feel free to do that to.
Aileen: The A&P professor is hosted by Kevin Patton, professor, blogger, and text book author in human anatomy and physiology.
Aileen: Go online for information, transcripts, and links relate to topics in this podcast, at theapprofessor.org.
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