R3 2.4 February 20, 2024 Memorizing Anatomy & Physiology Content in Health Professions Education: Useless, Exclusionary, or Worse?
A new study takes a hard look at what future nurses actually do and do not need to know, and how missing this mark matters for diversity and inclusion.
We have a lot of new subscribers joining us this month – welcome!
In this issue, we’re going to take a close look at a new article that examines the amount and type of content covered in the courses typically required for students going into healthcare fields. Specifically, the focus is on anatomy and physiology coursework – A&P for short - and whether that content tends to be excessive, onerous, or simply not relevant to what students go on to do in their careers.
As a fervent advocate for the importance of content knowledge (in addition to, not instead of, higher-order thinking), I have to admit that this article initially gave me pause. I’ve seen many variations of a widespread and (in my opinion) incorrect claim, that building knowledge comes at the expense of developing critical thinking skills, that it turns students off of learning, and isn’t even necessary now that everything a person would ever need to know is a click away. Would this article be a repackaging of that same old set of ideas?
As it turns out, not at all, and so I’ve chosen to share it here. The article makes a meticulously argued case for rethinking how content knowledge is handled in the types of STEM courses students take on the pathway to careers in healthcare. Well-qualified healthcare workers, as you’ve probably heard, are in exceedingly high demand and poised to become even more so in the coming years. And so, successfully completing a degree in one of these disciplines offers countless students a path to economic security and rewarding careers (something I alluded in to in this article on technologies for teaching Organic Chemistry).
This is where inclusion comes in as a major concern. As the authors of the article argue, we need to keep a close eye on persistence through degree pathways in these pre-professional STEM courses, and especially, on why disparities (across ethnicities, genders, orientations, and socio-cultural backgrounds) emerge. Content coverage – the selection and scope of what students are expected to know – may be playing a bigger role than many realize, even to the point where some students are dropping out over it. That’s one big driving purpose in this work.
When I speak to faculty about issues of coverage and what students should know, I frequently emphasize our faculty role as expert selectors of content. We shouldn’t see ourselves as mere dispensers of that content, of course, but rather, as the ones best positioned to know what really is worth memorizing and what is not in a given area. It is okay to expect students to do a certain amount of memorizing, but this won’t work if we are just loading them up with anything and everything that might be good fodder for an exam question someday.
This brings me to the other reason I thought this article was a great fit for today’s R3 Newsletter, which is that it articulates well with themes in a new project I’m excited to launch, one based on my book Remembering and Forgetting in the Age of Technology: Teaching, Learning, and the Science of Memory in a Wired World. I’m working with Perusall.com to offer a four-week, structured reading group on the book as part of their new Perusall Engage program.
If you’re not familiar with Perusall, it’s a free-to-students platform designed to let readers share highlights, comments, and questions they have, while making all of that work-in-progress visible to the group leader, or in the case of a class, the instructor. I have incorporated Perusall into my courses for several years now, so I’m excited to try using it in a completely different way. The reading group officially opens on February 26, 2024; you can learn more about it here, or for more on the type of themes you’re likely to see discussed there, check out the Social Learning Amplified podcast led by Eric Mazur.
On to our article!
Citation:
Tripp, B., Cozzens, S., Hrycyk, C., Tanner, K. D., & Schinske, J. N. (2024). Content coverage as a persistent exclusionary practice: Investigating perspectives of health professionals on the influence of undergraduate coursework. CBE Life Sciences Education, 23(1), ar5.
DOI:
https://doi.org/10.1187/cbe.23-05-0074
Paywall or Open:
Open
Summary:
This study focused on the practicality of Anatomy and Physiology (A&P) course content in the day-to-day tasks of nursing, revealing a misalignment between course material and the actual knowledge needed in the nursing profession. On average, practicing nurses scored 39% on an A&P assessment, suggesting that A&P prerequisites may not effectively instill long-term knowledge useful for nursing tasks. Additionally, the intensive content coverage in A&P might act as a barrier, potentially discouraging students, especially those with minoritized and historically excluded identities, from pursuing nursing careers.
Research Questions (excerpted from the article):
1. To what extent do nursing professionals perceive A&P content as aligned with their nursing careers?
2. How do nursing professionals perform on a sample of A&P assessment questions?
3. To what extent do nursing professionals perceive A&P content as influencing who persists in their profession?
Sample:
30 practicing nurses, selected from a larger pool of 178 alumni from an accredited community college nursing program. These participants, who graduated within the past seven years, were chosen using a stratified sampling method to ensure a representative mix in terms of education level, years of experience, and demographic diversity.
Method/Design:
The study employed a qualitative design with semi-structured interviews, 45 minutes in length and conducted via Zoom, designed to explore nurses' perspectives on A&P coursework's alignment with professional practice. A stratified sampling method was used to ensure diversity and representativeness. The interview process included a preassessment, a quantitative assessment of A&P knowledge, and a postassessment, designed to measure the nurses' recall of course content and to explore their perceptions of the course's relevance and impact on their professional practice.
Key Findings:
Participants perceived a striking misalignment between content coverage in A&P courses and the practical needs of students going into the nursing profession. A majority of participants indicated that much of the course content was not directly applicable to their professional work, with over 90% deeming it irrelevant and 70% reporting they retained little of that content.
Additionally, the structure and extensive content of A&P courses were cited as potential barriers that could discourage or "weed out" students from the nursing profession, particularly those with other life obligations such as family and job commitments. Concerns were also raised about language and cultural backgrounds becoming unfair disadvantages with so much of the course hinging on the use of specific technical terms. Lastly, A&P courses do not appear to impart lasting knowledge in the area, as evidenced by the average score of 39% that nurses achieved on the test on A&P material —a score just slightly above random guessing.
Participants offered a number of suggestions for improvement, with 50% recommending a reduction in content coverage to better align the courses with the actual knowledge required for nursing practice.
These findings challenge the current approach to A&P course content in nursing education and suggest a need for reevaluation to ensure that the material taught is both relevant and retained, thus supporting the professional development of nurses and potentially affecting persistence in the field.
Choice Quote from the Article:
If growing bodies of research, and nursing professionals themselves, attribute detrimental impacts on patient care to a lack of representation among healthcare workers, and if we are teaching overwhelming amounts of content that further contributes to this lack of representation, a systemic reconsideration of content in prerequisite courses is not only recommended but essential. Given the potential consequences of excessive course content on the persistence of aspiring nurses, one may wonder why we, as a biology education research community, often overlook problems surrounding the breadth of content and detail in prerequisite courses. How can we choose content for prerequisite courses that fosters diversity in health- care fields and in the broader STEM workforce? In this light, we invite instructors and researchers to reflect on the ways course content decisions may represent a persistent exclusionary practice in undergraduate STEM education that disadvantage students based on vast amounts of content that is disconnected from professional goals.
Why it Matters:
It’s painful, but important, to hear what former students have to say about the disparity between what they learn in college and what they use in actual professional practice. Critical thinking seemed to be a point of contention in their feedback as well. While this term can mean a lot of different things depending on the discipline and setting, it’s reasonably clear from the article what these nurses meant by it, and how their educations fell short in this arena due to a perceived over-emphasis on memorization. We really do need more research on how these two things (thinking and knowledge/memory) work together in specific contexts, and what teachers should do to make them mutually reinforcing aspects of learning in a given discipline.
To hear these study participants tell it, we do have a big problem with content coverage in nursing education, with A&P content an epicenter of sorts. Nurses in the study reported what sounds to me like an indiscriminate amount of information to memorize for exams, far beyond anything that would be useful in their future careers. I’m reading in a bit here, but it also sounds to me like the study methods used to accomplish this were less than ideal, with cramming (i.e., massed rather than spaced study) being the name of the game and little meaningful or active processing. It’s no wonder that so many reported that they didn’t remember most of what they were supposed to have learned.
These reflections might be bruising for a cognitive psychologist like myself to take in, but this was balanced by the solutions offered – exactly what most of us would prescribe, beyond simply reducing the overall amount of material. Highlights included placing information in the context of problem solving, emphasizing real-world applications, making exercises more interactive - all of which fit neatly with contemporary theories of memory, and with what applied memory experts say that you should do if you want content to be learned more quickly and stick around longer.
These approaches are also reminiscent of the high-structure design advised by experts on inclusive teaching. I think to the extent that some content does need to be memorized, it would be beneficial on many levels to add more instruction on study techniques for these kinds of materials. Such an approach could support more diverse students, resulting in greater equity and ultimately, more opportunity for more people to enter healthcare fields.
This leads back to the sensitive issue of weed-out courses and the weed-out mentality generally. To the authors’ credit, they include quotes from nurses with positive views of content coverage, stating that they think that the sheer difficulty of memorizing the technical A&P content helps limit the profession to individuals who are serious, dedicated, and/or capable. This set of beliefs – that any difficult task assigned with minimal guidance, be it memorizing Latin grammar or the names of all the bones in the human hand – is diagnostic of future capability is not one I subscribe to or particularly like. But it is important to know that it does persist, not only among instructors but among students and healthcare professionals themselves.
The authors make some stellar recommendations toward the end of the article, including the idea of regularly bringing together working professionals, students, and faculty to refine the curriculum. Imagine that! I’d also give a standing ovation to this one: Shift from a “just in case” model of including content, to putting the “burden of proof” on keeping the content in. They point out that students in an A&P course are highly likely to specialize later on, fanning out into all kinds of sub-fields ranging from dentistry to radiology. Faculty might be trying to include material geared to every one of these possible futures, when they should instead be concentrating on core materials likely to be needed by all. Regardless of where the balance lands in this particular case of A&P content, I think it’s a worthwhile reminder that content should earn its place in a course, not just end up there because someone, somewhere might conceivably need it someday. I know that’s the ideal I shoot for in my own courses.
Most Relevant For:
Faculty teaching in STEM or health professions; educators involved in designing or reviewing STEM curricula; faculty, staff, and leaders involved with inclusive course design, diversity, and equity; staff leading student success and academic persistence programs; nursing education researchers
Limitations, Caveats, and Nagging Questions:
I appreciated that the qualitative methodology was systematic, meticulously designed, and appropriate for the research questions at hand. That said, I wondered if the questions may have predisposed participants to see the down sides of the content that was covered or to have other negative interpretations of their experiences. The study is also retrospective and focused on perceptions, not measures of performance. This isn’t a limitation, per se, but it is the type of distinction that often gets lost when we talk about studies like this one. In other words, this study doesn’t say that excessive content coverage affected later performance in professional settings, or even that it directly led to disparities in persistence - but rather, that former students perceived that to be the case.
I also wondered whether the perceptions may reflect the extent to which the memory-doesn’t-matter trope has saturated the public consciousness. Are students echoing this idea, or only drawing on their own experiences as they were asked to do? It’s probably impossible to know where lived experience leaves off and expectations infused by the surrounding culture begin. None of us want to imply that students don’t know their own minds, but at the same time, most of us have pretty limited insights about how our own learning processes work.
Lastly, the authors call for increased emphasis on critical thinking in nursing education. This makes perfect sense given their findings, but designing or testing out such instruction isn’t really what the article is about. It’s also worth keeping in mind what many experts have concluded, that effectively teaching critical thinking involves a lot more than just easing up on content knowledge. There are some great ideas in the paper for what critical-thinking-oriented instruction for nurses might look like, but refining and assessing those, with an eye to long-term impacts like the ones scrutinized in this article, is another project altogether.
If you liked this article, you might also appreciate:
Allen, J. M., Muragishi, G. A., Smith, J. L., Thoman, D. B., & Brown, E. R. (2015). To grab and to hold: Cultivating communal goals to overcome cultural and structural barriers in first-generation college students’ science interest. Translational Issues in Psychological Science, 1, 331–341.
Barr, D. A., Gonzalez, M. E., & Wanat, S. F. (2008). The leaky pipeline: Factors associated with early decline in interest in premedical studies among underrepresented minority undergraduate students. Academic Medicine, 83, 503–511.
Dewsbury, B., & Brame, C. J. (2019). Inclusive teaching. CBE Life Sciences Education, 18, fe21–fe25.
Eddy, S. L., & Hogan, K. A. (2014). Getting under the hood: How and for whom does increasing course structure work? CBE—Life Sciences Education, 13, 453–468. https://doi.org/1187/cbe.14-03-0050
Miller, M.D. (2022). Remembering and Forgetting in the Age of Technology: Teaching, Learning, and the Science of Memory in a Wired World. West Virginia University Press.
Miller, M.D., Castillo, G., Medoff, N., & Hardy, A. (2021). Immersive VR for organic chemistry: Impacts on performance and grades for first-generation and continuing-generation university students. Innovative Higher Education, 46, 565–58. DOI: 10.1007/s10755-021-09551-z
Rodriguez, F., Rivas, M. J., Matsumura, L. H., Warschauer, M., & Sato, B. K. (2018). How do students study in STEM courses? Findings from a light-touch intervention and its relevance for underrepresented students. PLoS One, 13, 1–20.
Yabuno, K., Luong, E., & Shaffer, J. (2019). Comparison of traditional and gamified student response systems in an undergraduate human anatomy course. HAPS Educator, 23(1), 29–36. https://doi.org/10.21692/haps.2019.001
File under: STEM education; inclusion; equity; memory; critical thinking; health professions; nursing education; content coverage