Thinking as a learning objective

Almost 15 years ago my colleague, Jerry Robinson, and I were searching for a textbook for a new physiology course we had developed. One that would match our approach of learning the subject through an understanding of what I like to call adaptive logic. In other words, one focused on explaining how and why physiology works based upon the fact that physiological needs are met by evolutionarily honed mechanisms. Mechanisms that make perfect sense in terms of supplying the evolved requirements of multicellular organisms that rely upon a distribution of labor amongst various tissues and organs. If one can explain processes from that standpoint, then memorization, the knee-jerk response of students to content dense courses, and one the yields little to no long-term benefits, can be minimized in favor of true understanding. Unfortunately (fortunately?), we did not find a book we felt accomplished this goal…and so began our journey to produce such a pedagogical tool that we hoped would alter the trajectory of physiological education.

People have often asked me, why did it take so long to write this book? I guess my response is that doing something well takes time, apparently a whole lot of time! I wanted to develop full and clear explanations of as much of introductory physiology as I could. To do so I had to learn as much as I could, to find the details and levels at which physiology becomes intuitive. Only once I had wrapped my head around the logic of a physiological system could I even begin to attempt to explain it. One might ask, heck, didn’t you learn anything in the first 20 years you taught this stuff? Well, yeah, but most of us are truly expert in only very focal subsets of physiology that we read about and research incessantly. All that other content is largely understood at much more superficial levels, and therefore taught largely based upon how someone else has told us it should be. I just figured that wasn’t good enough. I could have simply sat down one day and started writing about what I’d been teaching for years, but I felt that would have been arrogant of me. What made me an expert on these widely varying subjects? Nothing, really….so I embarked on a whole lot of self-education to find the adaptive logic and see if I could make it clear to others. 10,000 hours later and voila, a textbook!

Certainly, our book is far from perfect, but we’re proud of the fact that we’ve managed to get a significant portion of physiology laid out from the standpoint of its functional logic. I finally had the tool to support what I tell every class I ever teach – “My job is to teach you to think - physiology is simply the subject we’ll learn while doing so”. It seems this approach was prescient as professional schools have moved more and more in this direction in the subsequent years. In 2015, the MCAT exam here in the U.S. replaced the verbal reasoning section with “Critical analysis and reasoning” section (CARS). According to the Association of American Medical Colleges (AAMC), this section is “designed to test comprehension, analysis, and reasoning skills by requiring critical analysis of information”. This is of course impossible if lacking the knowledge framework - the interrelation of facts and logical progression of actions to achieve a known goal. Very recently (right now!), the National Council Licensure Examination (NCLEX) for nursing has been updated with similar goals. In 2014, The National Council of State Boards of Nursing’s (NCSBN) Strategic Practice Analysis determined that better measurement of critical judgment was essential. This is strongly supported by the fact that medical errors are now the?third leading cause of death in the U.S.! The NCSBN also reports that clinical judgement is required in nearly half of all tasks performed by entry-level nurses. The NCSBN defines clinical judgment as “the observed outcome of critical thinking and decision-making”. It’s very clear that, from the medical world’s perspective, teaching physiology as generally an exercise in presenting facts that end up as nothing more than fodder for memorization simply doesn’t cut it any more. As my wife, a nurse manager, often exclaims to me, “Teach them to think! - the physiology is secondary”. Obviously, she is seeing the same skill deficits the NCSBN is attempting to remedy. She also notes there is anecdotal evidence that early results of the updated exam indicate poor performance on this critical thinking aspect. Boy, do we have the tools for you now, nursing.

On a final note, I recently had an encounter with an A&P colleague with 25 years’ experience who suggested our book is “too hard” for nursing and allied health students. She supported this statement by saying those particular students are “career-focused” and much less interested in the science of physiology. Ack! Well, that’s terrifying. So, because they aren’t interested, we should comply and not teach?! I argue the exact opposite, that true comprehension of physiological systems provides the critical thinking skills required, no, demanded of their future jobs if you and I want to survive a trip to the hospital. To not even attempt to convey such skills is dereliction of duty on our part. Our text contains more explanation, not more content. Sure, we’re pushing for something beyond flashcard intellects. We think that’s an endeavor worth supporting, even arguing for.

Interested in the discussion? Contact me at [email protected].