Core Concepts Physiology

JoelMichael WilliamCliff
JennyMcFarland HaroldModell
AnnWright
The Core
Concepts of
Physiology
A New Paradigm for Teaching
Physiology
Published on behalf of The American
Physiological Society by Springer
The Core Concepts of Physiology
Published on behalf of The American Physiological Society

by Springer
This book is published on behalf of the American Physiological Society (APS) by
Springer. Access to APS books published with Springer is free to APS members.
APS publishes three book series in partnership with Springer: Physiology in Health
and Disease (formerly Clinical Physiology), Methods in Physiology, and Perspec-
tives in Physiology (formerly People and Ideas), as well as general titles.
Joel Michael William Cliff Jenny McFarland
Harold Modell Ann Wright
The Core Concepts

of Physiology
A New Paradigm for Teaching Physiology
Joel Michael William Cliff
Rush Medical College Niagara University
Chicago, Illinois Lewiston, New York
USA USA
Jenny McFarland Harold Modell

Edmonds Community College Physiology Educational Research Consortium
Lynnwood, Washington Seattle, Washington
USA USA
Ann Wright (deceased)

Formerly at Canisius College
Buffalo, New York
USA
ISBN 978-1-4939-6907-4 ISBN 978-1-4939-6909-8 (eBook)

DOI 10.1007/978-1-4939-6909-8
Library of Congress Control Number: 2017932318
The American Physiological Society 2017

Co-published with the American Physiological Society.
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission
or information storage and retrieval, electronic adaptation, computer software, or by similar or
dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt
from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, express or implied, with respect to the material contained
herein or for any errors or omissions that may have been made. The publisher remains neutral with
regard to jurisdictional claims in published maps and institutional affiliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature

The registered company is Springer Science+Business Media LLC
The registered company address is: 233 Spring Street, New York, NY 10013, U.S.A.
This book is dedicated to Ann Wright
(19522016), a dear friend and colleague for
many years. Ann contributed in many
different ways to the conceptual assessment
project from which this book arose. She was
always quick to lend a hand when something
needed to be done. With her typical positive
attitude, she was always certain that we could
overcome whatever the current problem was.
She made significant contributions to the
writing of this book. We will miss her
friendship and her professional contributions.
Joel Michael
William Cliff
Jenny McFarland
Harold Modell
Acknowledgements
Much of the work done by the CAB group and described in this book was supported
by National Science Foundation Grant DUE-1043443.
Mary Pat Wenderoth, PhD, Department of Biology, University of Washington,
Seattle, WA, was a collaborator on our NSF funded project and made many
important contributions to this project. Her insights and suggestions appear
throughout this book. Patricia Martinkova, PhD, Institute of Computer Science,
The Czech Academy of Sciences, Prague, Czech Republic, has been of great
assistance in helping us make sense of the data we have collected from our studies
with faculty and students.
Finally, we must acknowledge our many colleagues all over the United States
and in Europe and Canada who participated in the many surveys that have been
reported in our publications. Without their thoughtful input, our development of the
core concepts of physiology would have remained idiosyncratic.
vii
Contents
Part I Introduction
1 Reforming Science Education/Reforming Physiology Education . . . 3
1.1 The Need for Reform of American Science Education . . . . . . . 4
1.1.1 Calls for Reform in the 1980s and 1990s . . . . . . . . . . . 4
1.1.2 More Recent Calls for Reform . . . . . . . . . . . . . . . . . . 4
1.1.3 Common Features of Reform Documents . . . . . . . . . . 5
1.1.4 Reforming Both Content and Pedagogy . . . . . . . . . . . . 5
1.1.5 The Need for Reform and the Knowledge Explosion . . . 6
1.2 The Need for Reform of Physiology Education . . . . . . . . . . . . 8
1.2.1 Physiology Is Hard for Students to Learn . . . . . . . . . . 8
1.2.2 The Knowledge Explosion and Its Impact on
Physiology Teaching and Learning . . . . . . . . . . . . . . . 9
1.2.3 The Spectrum of Students Taking Physiology . . . . . . . 9
1.3 How Should We Attempt to Institute Reform in Physiology
Education? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.4 What Do We Mean by Core Concepts? . . . . . . . . . . . . . . . . . 11
1.4.1 Definitions from Psychology and Philosophy . . . . . . . . 11
1.4.2 Definitions in the Field of Education . . . . . . . . . . . . . . 12
1.4.3 Core Concepts and General Models in Physiology
Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
1.5 Defining the Core Concepts of Biology: The Conceptual
Assessment in Biology (CAB) Workshops . . . . . . . . . . . . . . . . 13
1.6 What Are the Core Concepts of Physiology and How Should
They Be Used to Teach Physiology? . . . . . . . . . . . . . . . . . . . . 14
ix
x Contents
1.7 How Can a Focus on Core Concepts Help? . . . . . . . . . . . . . . . 15

1.7.1 Selectively Reduce the Body of Knowledge to be
Acquired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1.7.2 Focus on the Generalities and that Which Is Most
Transferable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1.7.3 Provide the Scaffolding for Learning New Things
Later . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
1.8 Organization of this Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
2 What Is the New Paradigm and What Is New About It? . . . . . . . . . 19
2.1 Thomas Kuhn and the Meaning of a Paradigm . . . . . . . . . . . 19
2.1.1 What Did Kuhn Mean by the Term Paradigm? . . . . . 20
2.1.2 How and Why Have We Used the Term Paradigm
in a Book About Physiology Education? . . . . . . . . . . . 20
2.2 The Current Paradigm Shift Underway in Physiology
Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.3 The Concept-Based Paradigm . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.4 Implementing the New Paradigm in Physiology Courses . . . . . . 23
2.5 Implementing the New Paradigm in the Curriculum . . . . . . . . . 23
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Part II The Core Concepts of Physiology

3 What Are the Core Concepts of Physiology? . . . . . . . . . . . . . . . . . . 27
3.1 The Process by Which We Defined the Core Concepts of
Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.1.1 The Core Concepts of Biology Defined at the
First CAB Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.1.2 The Core Concepts of Physiology Derived from the
Biology Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.1.3 Polling our Colleagues for Their Idea About Core
Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.2 The Core Concepts of Physiology . . . . . . . . . . . . . . . . . . . . . . 30
3.2.1 The 15 Core Concepts of Physiology and a Brief
Explanation of Each . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.2.2 Faculty Feedback About the 15 Core Concepts . . . . . . 32
3.3 Characteristics of the Core Concepts . . . . . . . . . . . . . . . . . . . . 33
3.3.1 The Nature of the Core Concepts . . . . . . . . . . . . . . . . 33
3.3.2 The Intersecting Nature of the Core Concepts . . . . . . . 34
3.4 Core Concepts and General Models . . . . . . . . . . . . . . . . . . . . . 34
3.5 What Can You Do with the Core Concepts? . . . . . . . . . . . . . . . 35
3.6 Organization of the Next Four Chapters . . . . . . . . . . . . . . . . . . 35
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Contents xi
4 What Does It Mean to Unpack a Core Concept? . . . . . . . . . . . . . 37

4.1 What Does It Mean to Unpack a Core Concept? . . . . . . . . . . 37
4.1.1 Conceptual Assessment and Conceptual Frameworks
in Biology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
4.1.2 Hierarchical Levels of Our Conceptual Frameworks . . . 39
4.1.3 Conceptual Frameworks and Physiological (Causal)
Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
4.2 How Did We Construct and Validate a Conceptual
Framework? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
4.3 Why the Particular Three Core Concepts We Unpacked? . . . . . 41
4.4 What Are the Uses of Conceptual Frameworks? . . . . . . . . . . . . 42
4.4.1 Student Learning of Physiology . . . . . . . . . . . . . . . . . 42
4.4.2 Teaching Physiology . . . . . . . . . . . . . . . . . . . . . . . . . 43
4.4.3 Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
4.4.4 Curriculum Design . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
5 The Unpacked Core Concept of Homeostasis . . . . . . . . . . . . . . . 45
5.1 A Conceptual Framework for Homeostasis . . . . . . . . . . . . . . . 45
5.2 A Visual Representation of the Core Concept of Homeostasis . . . 47
5.3 Homeostasis: Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
5.4 Where Is the Core Concept of Homeostasis Applicable? . . . . . . 50
5.5 Topics that Cause Confusion for Students and Instructors:
Sticky Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
5.5.1 Everything Is Regulated . . . . . . . . . . . . . . . . . . . . . . . 52
5.5.2 Homeostasis Is an ON/OFF Switch . . . . . . . . . . . . . . . 52
5.5.3 How Constant Is Relatively Constant? . . . . . . . . . . . 52
5.5.4 The Set Point Can Change . . . . . . . . . . . . . . . . . . . . . 53
5.5.5 Not All Examples of Negative Feedback Are
Homeostatic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
5.5.6 The Hierarchy of Homeostatic Regulation . . . . . . . . . . 53
5.6 Summing Up: Homeostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
6 The Unpacked Core Concept of Flow Down Gradients . . . . . . . . 55
6.1 The Conceptual Framework for Flow Down Gradient . . . . . . . 55
6.2 Flow Down Gradients: Terminology . . . . . . . . . . . . . . . . . . . 55
6.3 A Visual Representation of the Core Concept of Flow Down
Gradients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
6.4 In What Physiological Systems Does Flow Down Gradients
Apply? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Sticky Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
6.5.1 Problems with Flow Down Gradients in the
Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
xii Contents
6.5.2 Failure to Take into Account the Presence of Multiple

Gradients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
6.5.3 Recognizing Osmosis as an Example of a Core
Concept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
6.5.4 Molecules Diffuse Independently of One Another . . . . 60
6.5.5 The Presence of a Gradient Does Not Mean that Flow
Will Occur . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
6.6 Summing Up: Flow Down Gradients . . . . . . . . . . . . . . . . . . . . 60
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
7 The Unpacked Core Concept of CellCell Communication . . . . . 63
7.1 A Conceptual Framework for CellCell Communication . . . . . 63
7.2 A Visual Representation of the Core Concept of CellCell
Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
7.3 CellCell Communication: Terminology . . . . . . . . . . . . . . . . . 67
7.4 Where Is CellCell Communication Applicable? . . . . . . . . . . . 67
Sticky Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
7.5.1 What Is Information? . . . . . . . . . . . . . . . . . . . . . . . . . 69
7.5.2 The Central Role of Enzymes . . . . . . . . . . . . . . . . . . . 69
7.5.3 What Is a Response? . . . . . . . . . . . . . . . . . . . . . . . . . 70
7.5.4 Properties of Receptors . . . . . . . . . . . . . . . . . . . . . . . 70
7.5.5 The Number of Receptors on a Target Cell Is Small
(1 to Few) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
7.5.6 The Response to a Messenger Is a Property of the
Messenger Itself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
7.5.7 Chemical Messengers Act Independently of One
Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
7.5.8 Responses to Messengers Are All-Or-None . . . . . . . . . 72
7.5.9 The Nervous System and the Endocrine System
Operate in Fundamentally Different Ways . . . . . . . . . . 72
7.6 Summing up: CellCell Communication . . . . . . . . . . . . . . . . . 73
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Part III Implementing the New Paradigm for Teaching Physiology

8 Organizing an Introductory Physiology Course Based on Core
Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
8.1 Organizing an Introductory Physiology Course . . . . . . . . . . . . . 77
8.2 Introducing the Core Concepts of Physiology . . . . . . . . . . . . . . 78
8.2.1 Introduce the Core Concepts at the Beginning of the
Course . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
8.2.2 Introduce the Core Concepts as the Students First
Encounter Them . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Contents xiii
8.3 Revisiting the Core Concepts Wherever They Apply to a

Physiology Topic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
8.3.1 Consistent Terminology . . . . . . . . . . . . . . . . . . . . . . . 79
8.3.2 Consistent Visual Representations . . . . . . . . . . . . . . . . 80
8.3.3 Requiring the Students to Actively Recognize Where
the Core Concepts Apply . . . . . . . . . . . . . . . . . . . . . . 80
8.3.4 Requiring Students to Use the Core Concepts . . . . . . . 81
8.4 Aligning Your Learning Outcomes and Learning Objectives
with the Focus on Core Concepts . . . . . . . . . . . . . . . . . . . . . . . 81
8.5 Assessing Student Mastery of the Core Concepts . . . . . . . . . . . 81
8.6 The Long-Term Goal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
8.7 How to Do It All in the Available Time and with the Existing
Constraints? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
9 Teaching Physiology Using the New Paradigm: Three Examples . . . 85
9.1 The Foundations of Our Approach to Teaching . . . . . . . . . . . . 85
9.1.1 Meaningful Learning . . . . . . . . . . . . . . . . . . . . . . . . . 86
9.1.2 Active Learning: BuildTestRefine Mental Models . . . 86
9.1.3 Learning Outcomes for this Topic . . . . . . . . . . . . . . . . 86
9.1.4 Learning Environments . . . . . . . . . . . . . . . . . . . . . . . 87
9.2 Teaching Short-Term Regulation of Blood Pressure . . . . . . . . . 88
9.2.1 Context Within the CV Block and the Course . . . . . . . 88
9.2.2 The Content of This Topic . . . . . . . . . . . . . . . . . . . . . 88
9.2.3 Learning Outcomes and Learning Objectives for
This Topic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
9.2.4 Assessing Student Mastery of the Regulation of Blood
Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
9.2.5 How We Might Help Students Master This Topic . . . . 92
9.3 Teaching Respiratory Mechanics: Generating a Tidal Volume . . . 94
9.3.1 Context Within the Respiratory Block . . . . . . . . . . . . . 95
9.3.2 Content of this Topic . . . . . . . . . . . . . . . . . . . . . . . . . 96
9.3.3 Learning Outcomes and Learning Objectives for
This Topic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
9.3.4 Assessing the Outcome (Performance) Goals:
Generating a Tidal Volume . . . . . . . . . . . . . . . . . . . . 96
9.3.5 How We Might Help Students Master This Topic . . . . 97
9.4 Teaching the Hypothalamic-Anterior Pituitary Hormones and
Their Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
9.4.1 Context Within Course . . . . . . . . . . . . . . . . . . . . . . . . 101
9.4.2 Content of Topic . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
9.4.3 Learning Outcomes and Performance Outcomes for
This Topic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
9.4.4 Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
9.4.5 How Might We Help Students Master This Topic? . . . 104
9.5 How to Use These Examples . . . . . . . . . . . . . . . . . . . . . . . . . . 105
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
xiv Contents
10 Using Core Concepts of Physiology in Designing Learning

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
10.1 What Do We Mean by Learning Resources? . . . . . . . . . . . . . . 107
10.2 Principles Guiding Development of Learning Resources . . . . . . 108
10.2.1 The Student Is Responsible for His or Her Own
Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
10.2.2 The Learning Resource Should Support Meaningful
Learning, an Active Process . . . . . . . . . . . . . . . . . . . . 109
10.2.3 The Learning Resource Should Help Students
Recognize Their Current Mental Models . . . . . . . . . . . 109
10.2.4 The Learning Resource Should Help Students Test
Their Current Mental Models . . . . . . . . . . . . . . . . . . . 109
10.2.5 The Learning Resource Should Guide Students
in Revising Their Current Mental Models . . . . . . . . . . 109
10.3 Incorporating Core Concepts in Your Learning Resources . . . . 110
10.4 Learning Resources for Introducing Core Concepts . . . . . . . . . 110
10.4.1 Introducing Students to the Core Concept of
Homeostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
10.4.2 Introducing Students to the Core Concept Flow Down
Gradients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
10.4.3 Introducing Students to the Core Concept of Mass
Balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
10.5 Learning Resources to Help Students Master Physiology . . . . . 111
10.5.1 Temperature Regulation as an Example of
Homeostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
10.5.2 The Action Potential and Flow Down Gradients . . . . . 112
10.5.3 Three Examples of the Application of Mass Balance
to Important Physiological Phenomena . . . . . . . . . . . . 112
10.6 Creating Online Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
10.6.1 An Interactive Tutorial . . . . . . . . . . . . . . . . . . . . . . . . 114
10.6.2 A Qualitative Simulation . . . . . . . . . . . . . . . . . . . . . . 115
10.7 Textbooks and the Focus on Core Concepts . . . . . . . . . . . . . . . 116
10.7.1 Challenges Posed by Textbooks . . . . . . . . . . . . . . . . . 116
10.7.2 How to Use Current Textbooks to Help Your
Students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
10.7.3 Textbooks Which Have Attempted to Incorporate
Core Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
10.7.4 How to Incorporate Core Concepts in Physiology
Textbooks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
10.8 Scaffolding Conceptual Learning with Appropriate Learning
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Contents xv
11 Conceptual Assessment of Student Learning . . . . . . . . . . . . . . . . . . 123

11.1 The Roles of Assessment in Teaching and Learning . . . . . . . . . 123
11.1.1 Formative Assessment . . . . . . . . . . . . . . . . . . . . . . . . 123
11.1.2 Summative Assessment . . . . . . . . . . . . . . . . . . . . . . . 124
11.1.3 Program Assessment . . . . . . . . . . . . . . . . . . . . . . . . . 124
11.2 Assessment Must Align with Learning Outcomes and Learning
Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
11.2.1 Assessing Knowledge Acquisition . . . . . . . . . . . . . . . 125
11.2.2 Assessing Understanding and Use of the Core
Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
11.2.3 Assessing Meaningful Learning of Physiology . . . . . . . 125
11.3 Problems of Doing Conceptual Assessment . . . . . . . . . . . . . . . 126
11.3.1 Defining the Concepts . . . . . . . . . . . . . . . . . . . . . . . . 126
11.3.2 Unpacking the Concepts: Building the Conceptual
Frameworks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
11.3.3 Writing Questions That Test Conceptual
Understanding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
11.4 Writing Concept-Based Questions . . . . . . . . . . . . . . . . . . . . . . 127
11.4.1 Questions Should Be Free of Jargon . . . . . . . . . . . . . . 127
11.4.2 Questions Should Test the Concept or Its Application
in Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
11.4.3 Distractors Should Reflect Known Student
Misconceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
11.4.4 Two Examples from the Homeostasis Concept
Inventory (HCI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
12 Core Concepts and the Physiology Curriculum . . . . . . . . . . . . . . . 133
12.1 The Undergraduate Physiology Curriculum: Varieties,
Emphases, and Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
12.1.1 Classification of Curricula by Undergraduate Programs:
Physiology Major or Concentration Versus Other
Biomedical Programs with Emphasis on Physiology . . . 134
12.1.2 Curricular Requirements for Physiology Programs
and Concentrations . . . . . . . . . . . . . . . . . . . . . . . . . . 134
12.1.3 Classification of Curricula by Student
Interest/Progression Through Physiology Courses . . . . 135
12.1.4 Sequencing of Courses and Goals . . . . . . . . . . . . . . . . 136
12.2 Sequencing of Core Concepts in the Curriculum . . . . . . . . . . . . 137
12.2.1 Homeostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
12.2.2 Flow Down Gradients . . . . . . . . . . . . . . . . . . . . . . . . 140
12.2.3 CellCell Communication . . . . . . . . . . . . . . . . . . . . . 141
12.2.4 Learning Progressions for the Core Concepts
of Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
xvi Contents
12.3 Assessing Student Mastery of Core Concepts Across the

Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
12.4 Core Concepts as a Framework for Organizing Physiology
Curricula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Part IV Concluding Thoughts

13 Extending the Paradigm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
13.1 Complete Unpacking All of the Core Concepts of Physiology . . . 148
13.2 Develop a Library of Conceptual Assessments in Physiology . . . 148
13.3 Developing Pedagogical Approaches that Support a Focus
on Core Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
13.3.1 Textbooks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
13.3.2 Learning Resources . . . . . . . . . . . . . . . . . . . . . . . . . . 149
13.4 Develop a Public Space to Facilitate Collaboration . . . . . . . . 150
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
14 Summing Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
14.1 Summary of Arguments for the Need for Reform . . . . . . . . . . . 151
14.2 Review of the Key Features of the New Paradigm We Are
Proposing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
14.3 Its a Mind-Set, Not a Prescription! . . . . . . . . . . . . . . . . . . . . . 152
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Part I
Introduction
Chapter 1
Reforming Science Education/Reforming
Physiology Education
Abstract Calls for reform of American science education go back at least to the
early twentieth century, and in recent years there has been a plethora of reports and
recommendations about how to fix the problems that have been identified. One
notable problem is the continued focus on breadth versus depth of understanding in
STEM disciplines. In part, this reflects the enormous expansion of knowledge in all
fields of science. One consequence is that more is known than can possibly be
mastered by students.
All recent reports calling for significant change in American science education
have included recommendations that learning objectives focus on the mastery of
core concepts as opposed to the mere accumulation of ever more facts.
Physiology faces the same challenges as all of the other STEM disciplines.
However, it also faces a number of additional challenges that call for changes in
the way we teach. Physiology is hard for students to learn because more is known
than they can learn. In addition, the very nature of the disciplines poses problems
for students. Physiology is hard to teach because the wide spectrum of students
taking physiology courses, the inherent nature of the discipline, and because the
goal of physiology teaching is meaningful learning, not the accumulation of facts.
A focus on core concepts of physiology can help students achieve meaningful
learning and can help teachers facilitate the acquisition of meaningful learning.
Keywords Education reform Core concepts Knowledge explosion Physiology

learning Causal reasoning Prerequisite knowledge Knowledge transfer
Student diversity
Calls for the reform of American science education have a long history. In 1910, the
noted American philosopher and educator John Dewey published a paper in the
journal Science (Dewey 1910) entitled Science as subject-matter and as method
in which he had this to say; . . .science has been taught too much as an accumu-
lation of ready-made material with which students are to be made familiar, not
enough as a method of thinking, an attitude of mind, after the pattern of which
mental habits are to be transformed. This plea for reform certainly foreshadows
more recent calls for reform and on much the same grounds, and it occurred before
the enormous post-World War II explosion of scientific research!
The American Physiological Society 2017 3

J. Michael et al., The Core Concepts of Physiology,
DOI 10.1007/978-1-4939-6909-8_1
4 1 Reforming Science Education/Reforming Physiology Education
1.1 The Need for Reform of American Science Education
Vision and Change (American Association for the Advancement of Science

2011) has captured the recurrent calls for reform in science education with capsule
summaries of 20 reform documents issued between 1986 and 2010. We will not
review each of them, but will focus on a few that most directly relate to our
proposed changes in physiology education.
1.1.1 Calls for Reform in the 1980s and 1990s
In its report A Nation at Risk, the United States National Commission on

Excellence in Education (1983) took a broad look at American primary education
(K-12) and found much to be wanting. It highlighted many failings in almost every
discipline, but it was particularly critical about what today we would call Science,
Technology, Engineering, and Mathematics (STEM) education. It called for better-
prepared teachers and higher standards for student achievement. It called for many
other reforms, but had little or nothing to say about pedagogy. Nevertheless, it did
galvanize change and at least some of these changes have persisted until today.
A year later, the GPEP reportGeneral Professional Education of Physicians
appeared (Association of American Medical Colleges 1984). This document
addressed both admission requirements for applicants to medical school (thus
reflecting undergraduate preparation in science) and basic science teaching and
learning in medical schools. Like A Nation at Risk, it too called for significant
reform in American science education.
In 1990, the National Research Council (NRC) issued a report on the state of
biology education in Americas primary (K-12) schools entitled Fulfilling the
Promise: Biology Education in the Nations Schools (NRC 1990). This report
called for reforms in curriculum, pedagogy and assessment, and the training and
institutional support for teachers. It recognized that biology education at that time
was not keeping up with changes in the science of biology and was not preparing
students to meet the needs of the country.
1.1.2 More Recent Calls for Reform
The report Vision and Change in Undergraduate Biology Education, the product
of a conference sponsored by the American Association for the Advancement of
Science (2011), contains a comprehensive critique of essentially every facet of
undergraduate biology education in the USA. Among its recommendation is one
that calls for defining learning objectives that focus student learning of core
concepts. Vision and Change also focused strongly on issues related to reforming
1.1 The Need for Reform of American Science Education 5
classroom practice to create more student-centered learning. This report has had a
strong impact on the biology education community and continues to help shape
reform efforts at all levels.
BIO2010: Transforming Undergraduate Education for Future Research Biolo-
gists is a report produced by the National Research Council (2003) which specif-
ically addressed the issue of training biology majors for future research careers in
modern biology. In spite of its focus on a seemingly small fraction of undergrad-
uates taking biology courses, its recommendations for change will impact all
students. Like Vision and Change, it recommends a curricular focus on biology
concepts. The list of 18 concepts (referred to in that document as central themes)
overlaps significantly with the list of concepts defined in Vision and Change.
The report Scientific Foundations for Future Physicians, published by the
American Association for the Advancement of Science and the Howard Hughes
Medical Institute (2009), also called attention to the need for reforms in the
undergraduate preparation of potential medical students. It recommended shifting
the focus from courses and their contents to the development of wide-ranging
competencies in the sciences.
1.1.3 Common Features of Reform Documents
These more recent calls for reform in science education have all included calls for a
focus on core concepts in science, although the lists of these concepts contain
different things (Table 1.1). In particular, concepts that physiologists would con-
sider to be central to their discipline have not been well represented in these lists
(AAAS 2011; National Research Council 2003; AAAS and HHMI 2009). In Part II
of this book, we define what we believe to be the core concepts of physiology and
expand on three of them.
Another common feature of all recent calls for reform is the recognition that the
STEM community needs to develop assessments that can measure student mastery
of the core concepts. Conventional science assessments test student knowledge of
the facts of science and, perhaps, the ability to apply these facts in solving
problems (National Research Council 2001). We will discuss the assessment of
core concepts in physiology in Chap. 11.
1.1.4 Reforming Both Content and Pedagogy
It is clear that there is a need for reform of content, what is taught and what students
are expected to learn, and pedagogy, how students are taught and how they are
expected to learn. In Part II, we will discuss how to use a core concept approach to
teaching physiology with the many approaches to student-centered teaching that
have been implemented over the past 2530 years (Michael 2006; Kay and Kibble
2016).
Table 1.1 A comparison of the core concepts defined in Vision and Change (AAAS 2011) and
BIO2010 (National Research Council 2003)
Vision and Changea BIO2010b
Evolution Evolution
Pathways and transformations of Biological systems obey the laws of chemistry and
energy and matter physics
Information flow, exchange, and Structural complexity and information content
storage
Structure and function . . .reductionist and holistic thinking. . .
Systems Living systems are far from equilibrium. . . no two
cells are alike. . .
Homeostasis
Cells are the fundamental units. . .
Living organisms have behavior. . .
DNA/RNA information coding
Role of proteins
Lipoprotein cell membrane
Cellcell communication
Gene expression and cell differentiation
Mechanisms of disease
Nature of species
Populations and ecosystems
Humans and ecosystems
a
The core concepts from Vision and Change are listed here exactly as they appear in the
document
b
The core concepts in BIO2010 listed here are summaries since the original versions are often
quite long
1.1.5 The Need for Reform and the Knowledge Explosion
The explosion of knowledge in all of the STEM disciplines exacerbates the

problems identified in all of the STEM reform documents.
The existence of this explosion in knowledge can be documented in many ways.
Bornmann and Mutz (2015) have done a detailed count of both the number of
science journals and the number of cited papers from 1600 to 2012 and found that
the rate of growth of science is currently 89% per year. This amounts to a doubling
of the knowledge base of science approximately every 8 years!
Another approach to documenting this is to count the pages in recent editions of
physiology and physiology and anatomy textbooks (Table 1.2). Textbooks have
become encyclopedic in their content, with each new edition including the most
recently established advances in the field. It is thus not surprising that textbooks get
larger and larger (and, of course, more expensive).
1.1 The Need for Reform of American Science Education 7
Table 1.2 The number of Physiology textbooks (Authors) Number of pages

pages in popular introductory
Human anatomy and physiology
and medical physiology
textbooks (Michael et al. Saladin 1248
2009) Marieb and Hoehn 1296
Martini 1110
Undergraduate physiology
Sherwood 801
Widmaier et al 738
Medical physiology
Berne et al. 978
Boron and Boulpaep 1267
Guyton and Hall 1066
An obvious consequence of the enormous length of the textbooks we ask our

students to buy is that they are confronted with more information to acquire,
memorize, and understand than is possible during a single one or two semester
course. This overabundance of information poses an additional problem; the sheer
volume of information dilutes the important messages that students should under-
stand! It also makes understanding the big picture very difficult.
The authors of the Vision and Change report (2011; page 58) made this point
quite forcefully:
As biology faculty, we need to put the depth versus breadth debate behind us. It is true
today, and will be even more so in the future, that faculty cannot pack everything known in
the life sciences into one or two survey courses. The advances and breakthroughs in the
understanding of living systems cannot be covered in a classroom or a textbook. They
cannot even be covered in the curriculum of life sciences majors. A more tenable approach
is to recast the focus of biology courses and curricula on the conceptual framework on
which the science itself is built and from which discoveries emerge. Such a focus is
increasingly interdisciplinary, demands quantitative competency, and requires the instruc-
tor to use facts judiciously as a means of illustrating concepts rather than as items to be
memorized in isolation.
Thus, another consequence of the knowledge explosion is that faculty now, more
than ever, must directly confront the difficult task of deciding what to require their
students to learn. This decision must address both the breath and the depth of their
subject; how many topics about which systems (breadth) and at what level of
organization (depth) should students be asked to understand. These decisions
must obviously be made in the context of the particular course aimed at a particular
group of students.
1.2 The Need for Reform of Physiology Education
Physiology is, of course, one of the STEM disciplines. As such it must deal with all
of the issues described above. However, physiology education also must confront a
number of additional challenges that call for new approaches to teaching
physiology.
1.2.1 Physiology Is Hard for Students to Learn
Physiology is difficult for students at any academic level to learn. As teachers we

hear this directly from at least some students. When teachers were asked directly
what made physiology hard for students to learn, they offer many reasons (Michael
2007). The survey proposed three possible factors creating the difficulties that
students report: (1) the intrinsic nature of the discipline, (2) how physiology is
taught, and (3) how students approach the learning of physiology. Faculty indicated
that the most important difficulty was the nature of the discipline, and what is thus
required for students to master physiology. It is worth noting that a survey of
students using essentially identical questions yielded a similar result (Sturges and
Maurer 2013); student difficulties learning physiology arise primarily from the
nature of the discipline.
The most important impediment to student success was identified as the need to
reason causally about physiological mechanisms. Understanding physiology
means not only having acquired an adequate knowledge base, but having the ability
to use that knowledge base to solve problems (Michael and Rovick 1999). One
mode of reasoning required to solve problems in physiology is causal reasoning, the
ability to create a chain of cause-and-effect (causal) relationships between physi-
ological entities (Michael and Rovick 1999; Evens and Michael 2006).
The second most important impediment was identified as the need to apply
knowledge of physics and chemistry to understanding physiological mechanisms.
Two problems were identified. First, students often lack the expected prerequisite
knowledge of physics and chemistry (Rovick et al. 1999), and second, students have
great difficulty transferring what they know about these subjects to the task of
learning physiology (Perkins and Salomon 1994; Bransford et al. 1999).
Students also have a problem transferring knowledge even within the domain of
physiology. For example, students learn about blood flow and the laws of hemo-
dynamics in the cardiovascular section of a physiology course. Next, they are likely
to encounter the flow of gas in the respiratory tree, which they typically approach as
a totally new topic to be learned. That is to say, they do not recognize, and faculty
often fail to point this out, that the laws are exactly the same even if the labels are
different. What we have described here is, of course, the core concept of flow down
gradients (see Chap. 6).
1.2 The Need for Reform of Physiology Education 9
1.2.2 The Knowledge Explosion and Its Impact

on Physiology Teaching and Learning
In Sect. 1.5 of this chapter, we discuss the problems caused by the knowledge
explosion that has occurred in all of the sciences including physiology. More is
known than it is possible for students to learn. Furthermore, it is difficult for
students, and faculty too, to determine what things are most important. Textbooks
often include features to aid students in determining what is important: (1) lists of
learning outcomes or objectives, (2) pages of important points, and (3) questions
related to mastery of these important facts. However, these aids are only partially
successful. On the one hand, there is so much known that such lists are themselves
daunting. On the other hand, conceiving and adequately describing learning objec-
tives is a difficult task, and students are often left quite unsure about exactly what
they are expected to learn.
It is important to acknowledge that physiology faculty, too, have similar prob-
lems coping with the amount of knowledge that is available. What are the essential
things that their students should master? Vander (1998) raised this question about a
number of topics in renal physiology, and Carroll (2001) addressed this question
with regard to pressure-flow relationships. What do their students need to under-
stand for the next physiology course they will take? What do they need to know for
their future careers in a STEM or STEM-related field? What do they need to know
to be well-informed citizens who will have to make personal and civic choices
about STEM-related issues? What all as faculty recognize is that we must make
choices about what to ask our students to learn since those students cannot learn
it all.
1.2.3 The Spectrum of Students Taking Physiology
One of the greatest challenges facing the physiology teacher is the range of students
who enroll in a physiology course. This spectrum includes differences in the reason
for taking the course, differences in prior science background, and differences in the
personal goals that students bring to the course.
The kinds of students taking physiology includes (1) lower division undergrad-
uates who are not majoring in the sciences and who take a physiology course to
fulfill a science requirement, (2) biology majors for whom physiology is a required
course or an elective, (3) physiology majors or students enrolled in physiology
related majors, (4) students who are preparing for careers in health care and
biological research, and (5) those who are already graduate or professional students.
The various kinds of students taking physiology generally come into a physiol-
ogy course with very different science backgrounds. Nonscience majors typically
have received minimal training in high school sciences and have rudimentary
quantitative and scientific thinking skills. At the other end, professional and
graduate students generally already have strong undergraduate science training

(chemistry, physics, biology) and seasoned analytical and scientific reasoning
abilities. There are also considerable differences in science backgrounds among
undergraduates who enroll in physiology course while majoring in the health or
biological sciences. This includes students who are pursuing bachelors degrees in
the health sciences (e.g., allied health professions, nursing, exercise science, kine-
siology, etc.), students who are preparing for doctoral programs in the health
sciences (premedical, pre-dental, pre-veterinarian, pre-pharmacy, etc.), the biolog-
ical sciences, or biomedical engineering. Students in these categories may have
widely different degrees of intellectual and scientific preparedness for undertaking
a study in physiology.
This diversity confounds an instructors assumptions about the skills and under-
standings that students bring to their study of physiology. This in turn makes it
difficult to set the foundational level of instruction required to facilitate students
mastery of the subject.
In addition to differences in preparedness for the study of physiology, students
have different degrees of interest in the subject of physiology, as well as different
motivations and expectations for taking a course in the subject. For example, some
nonscience majors may have low interest in learning about physiology and may
only be motivated to fulfill a distribution requirement. Others may be curious about
health and fitness and want to learn how these phenomena are related to physiology.
They enroll in a physiology course expecting to learn relevant aspects of how the
body works.
Students who intend to pursue careers in the health professions may have greater
interest in the life sciences but be motivated to take a physiology course primarily to
fulfill a prerequisite for a health professional degree program or to prepare to
perform well on a professional test (e.g., MCAT, DAT, PCAT, OAT, etc.). These
types of students expect to learn aspects of human physiology that are relevant to
their intended profession. This is also true of health professional students (e.g.,
medical, dental, pharmacy, veterinary) who wish to gain a scientific foundation for
their clinical practice and to acquire competency in physiology sufficient to pass
their licensing exams. Undergraduates majoring in the biological sciences may
have a broader interest in organismal biology and expect to gain both depth and
breadth in their study of the life sciences. Similarly, graduate students in the
biomedical and biological sciences may wish to enhance their understanding of
organismal biology to prepare for their thesis research and/or a career in the life
sciences.
Each category of student approaches learning physiology with a different set of
motives and expectations for successful outcome. This diverse set of reasons and
goals for enrolling in physiology poses a challenge to the physiology teacher who
wishes to engage a significant percentage of his/her students in meaningful study of
the subject.
1.4 What Do We Mean by Core Concepts? 11
1.3 How Should We Attempt to Institute Reform

in Physiology Education?
Physiology teachers are confronted by too much for their students to learn, a
discipline that poses problems for students, and a great of diversity of student.
How do we proceed?
Vision and Change and the many other reports referred to in Sect. 1.1 all
recommend that science educators focus on student learning the core concepts of
the particular STEM disciplines. As the title of this book states, teaching that is
focused on the core concepts of physiology can contribute in different ways to
meeting the challenges that we have discussed.
However, we must first deal with the question of what is meant by a core
concept.
1.4 What Do We Mean by Core Concepts?
The terms concepts, core concepts, concept learning, and foundational

concepts are all in common usage in the science education literature across all
of the STEM disciplines and in all recent STEM reform recommendations. How-
ever, it is very difficult to find explicit definitions of what is meant by a concept in
this now vast literature. Developers of concept inventories publish lists of what
they regard as the core concepts to be tested, but such a list does not constitute a
definition of a concept in that discipline. What is clear from examining these lists is
that there are obvious differences in the nature and scope of what are defined as core
concepts in different STEM disciplines.
It would be useful to have a working definition of what we mean by a concept
so that we can recognize core concepts in our own field and in other science
disciplines.
1.4.1 Definitions from Psychology and Philosophy
In both psychology (Colman 2006) and philosophy (Prinz 2005), a concept is a

category such as birds, metals, or organic compounds. Learning a concept
is then a process of learning what features of an entity must be present for that entity
to be considered a member of a particular category or concept. However, it does not
appear that this is what science educators mean when they use the term concept.
1.4.2 Definitions in the Field of Education
There is another term, big ideas, that frequently appears in the education litera-
ture. This term is used in ways that seem to us to be synonymous with the term core
concept. Descriptions of what is meant by a big idea have been provided by a
number of authors.
Duschl et al. (2007) have offered the following description:
Each [BIG IDEA] is well tested, validated, and absolutely central to the
discipline. Each integrates many different findings and has exceptionally broad
explanatory scope. Each is the source of coherence for many key concepts, princi-
ples and even other theories in the discipline.
Wiggins and McTighe (2005; page 69) have offered the following description of
a big idea.
More generally, then, big ideas can be thought of as:
Providing a focusing conceptual lens for any study
Providing breath of meaning by connecting and organizing many facts, skills,
and experiences; serving as the linchpin of understanding
Pointing to ideas at the heart of expert understanding of the subject
Requiring uncoverage because its meaning or value is rarely obvious to the
learner is counterintuitive or prone to misunderstanding
Having great transfer value; applying to many other inquires and issues over
timehorizontally (across subjects) and vertically (through the years in later
courses) in the curriculum and out of school
Finally, Harlen (2010), in a comprehensive discussion of the use of big ideas
in science education, offers the following definition.
We define big ideas as ideas that can be used to explain and make predictions about a
range of related phenomena in the natural world. However, ideas come in different sizes;
there are moderately big ideas that can be linked into bigger ideas and some of these can be
subsumed into even bigger, more encompassing ideas.
There are several features that seem common to these definitions of big ideas
(or concepts) that are relevant to our use of core concepts in physiology. Big
ideas or core concepts:
Are applicable to many sub-domains within the field (they are transferable).
Provide coherence or structure to the domain (they foster retention).
Provide tools for solving problems (thus advancing student understanding).
Have utility in the future (when the details have been forgotten).
1.5 Defining the Core Concepts of Biology: The Conceptual Assessment in. . . 13
1.4.3 Core Concepts and General Models in Physiology

Education
Modell (2000) described a set of general models that he argued could be applied
to explain and understand many different physiological phenomena. As we will see
later, there is a significant overlap between Modells general models and our
core concepts and both function in much the same way.
Feder (2005) also described a set of core ideas or concepts that he attempted to
convey to students in his course. These core ideas or concepts also overlap with our
set of core concepts, although in many ways they serve as an outline of the subject
matter he wants his students to master.
1.5 Defining the Core Concepts of Biology: The Conceptual

Assessment in Biology (CAB) Workshops
So what might be the core concepts that students in physiology courses should
learn? An approach to defining this was initiated by the National Science Founda-
tion (NSF) in 2007. NSF sponsored a workshop titled Conceptual Assessment in
the Biological Sciences which was held at the University of Colorado in Boulder,
CO (Michael 2007; Garvin-Doxas et al. 2007). A group of 2025 biologists and
biology educators was brought together to begin a conversation on how to assess
students understanding of biology concepts. There was considerable discussion
about the meaning of the term concept (see above), and the group recognized that
it must first decide what the core concepts in biology might be before attempting to
develop a means to appropriately assess students understanding.
Although the participants worked in a large number of different biology sub-
disciplines, it took very little time for the group to agree on a set of core concepts.
The list of these core concepts of biology with some explanation can be seen in
Table 1.3.
It was understood by all of the participants that the different subdisciplines of
biology emphasize different sets of these core concepts to differing degrees. It was
also recognized that these core concepts are not independent ideas; there are clear
overlaps and connections between various sets of concepts.
Having defined a set of core concepts in biology, the CAB group could then turn
to a discussion of how to develop and implement a conceptual assessment tool for
widespread use (see Chap. 11).
A comparison of the core concepts from Vision and Change (AAAS 2011) and
BIO2010 (National Research Council 2003) seen in Table 1.1 and the core
concepts from the CAB meeting seen in Table 1.3 reveals a significant overlap. It
is clear that there are STEM concepts that all biologists regard as essential for
students to understand.
Table 1.3 The core concepts (big ideas) of biology defined at the 2007 CAB workshop (Michael
2007)
Core concepts Definition
The cell is the basic The organism is made up of tissues composed of cells with specialized
unit of life structures and functions. Cells in the organism must cooperate with
one other (exchange information, exchange matter) because no indi-
vidual cell can do it all
Information flow Life requires information flow in and between cells and between the
environment and the organism. The transmission of genetic informa-
tion is a major determinant of the structure and function of each cell.
Information flow between cells (cellcell communications) is essential
to coordinate the activity of the myriad of cells making up the organ-
ism. Information flow from the environment is required so that the
organism can react appropriately to things happening in the
environment
Matter and energy Living organisms must obtain matter and energy from the external
world to continue to exist. That matter and energy must be trans-
ferred and transformed in a variety of ways in order to build the
organism and to perform work (from the cellular to the organismal
levels)
Homeostasis Homeostasis (and stability in a more general sense) maintains the
internal environment of living systems in a more or less constant state.
Important system parameters are measured and the measured value is
compared to a predetermined set-point (desired) value. The difference
is used to generate signals that alter the functions of the organism to
return the regulated variable toward its preset determined value. Sta-
bility is also a property of ecosystems (although the mechanisms are
probably quite different)
Structure and function To understand the behavior of the organism requires understanding the
relationship between the structure and the function of the organism,
since function is dependent on structure and structure must match the
functional needs of the organism
Causal mechanisms Living organisms are causal mechanisms whose functions are to be
understood by applications of the laws of physics and chemistry.
Understanding physiological systems requires the ability to think
causally
Ecosystem All life exists within an ecosystem composed of the physicochemical
world and the total biological world
Evolution Evolution provides a scientific explanation for the history of life on
Earth and the mechanisms (at the molecular level and at the level of
species, etc.) by which changes have occurred to the biota
1.6 What Are the Core Concepts of Physiology and How

Should They Be Used to Teach Physiology?
Even a cursory look at Table 1.3 makes clear that each of the core concepts of
biology has some relevance to physiology and to the teaching of physiology. Some
are ideas that are heavily represented in the usual physiology course taught at any
level, while others may appear only in advanced course (300-, 400-level courses,
1.7 How Can a Focus on Core Concepts Help? 15
Table 1.4 The core concepts Core concepts in physiology

of physiology described by
Evolution
Michael and McFarland
(2011)a Homeostasis
Causality
Energy
Structure/function
Cell theory
Levels of organization
Cell membrane
Flow down gradients
Genes to proteins
Interdependence
Mass balance
Physics/chemistry
Scientific reasoning
a
In Chap. 3 we will fully describe how we generated this list and
what each of the core concepts means.
graduate courses) or in specialized courses (e.g. comparative physiology). The

obvious applicability of these core concepts of biology to physiology led us to ask
whether we could generate a list of core concepts that would specifically address the
needs of physiology instructors. In Part II of this book, we will address this issue,
discussing how we arrived at a list of core concepts in physiology, and how we
analyzed these concepts to determine their smaller, more easily testable ideas.
For the moment, Table 1.4 lists the 15 core concepts that we have identified.
In Part III, we will present our ideas about how physiology instructors can use
these core concepts to improve student meaningful learning and understanding of
physiology.
1.7 How Can a Focus on Core Concepts Help?
In what ways can a focus on teaching physiology from a core concepts perspective
help to make physiology less difficult for students? How can this approach help
teachers do a better job of helping the learner to learn? We think that there are
several ways that a focus on core concepts can help.
1.7.1 Selectively Reduce the Body of Knowledge to be

Acquired
A focus on core concepts can help to limit the amount of knowledge students are
expected to acquire. For example, if students understand homeostasis and the
regulation of mean arterial pressure, it may be enough to require some knowledge
about the carotid baroreceptors without also requiring them to know about the aortic
arch baroreceptors. An understanding of cellcell communication as a core concept
means that not every signaling molecule (transmitter, hormone, growth factor, etc.)
needs to be memorized.
Furthermore, if the student understands the core concepts, each new system in
which those core concepts are applicable will be easier to learn because the student
is not starting from a zero base.
1.7.2 Focus on the Generalities and that Which Is Most

Transferable
One of the key points in the definition of core concepts or big ideas is that they are
applicable in many areas of the domain in question (Wiggins and McTighe 2005).
Thus, if a student understands flow down gradients, learning about hemodynamics
(blood flow in the circulation) requires only the learning of new labels for compo-
nents and ideas already understood. Once the student understands blood flow in the
circulation, understanding gas flow in the airways is not a new topic to be mastered
(Modell 2000).
Because core concepts are general in scope and apply in many different areas
within physiology, if students understand them they can be helped to learn how to
transfer this understanding as they move through the course.
This should also apply as students advance from course to course in the biology
or physiology curriculum. They will encounter new topics and be expected to
master these topics at a deeper level, but the core concepts, once mastered, will
always apply to the new systems they are learning.
1.7.3 Provide the Scaffolding for Learning New Things Later
Perhaps most importantly, an understanding of the core concepts of physiology will

provide students with a scaffold for all their future learning about physiology,
whenever and wherever that learning occurs. The frameworks are knowledge
structures on which the student can add newly acquired information so that it is
not just part of a laundry list of memorized facts but is now part of a knowledge
structure. With conceptual frameworks in place, learning about cellular or
References 17
molecular mechanisms of muscle contraction in a later course becomes easier

because of the organized framework already available. Problems involving more
complex disturbances to a system are easier to solve (predictions or explanations
about altered behavior) because runnable causal models of relevant core concepts
are available to be used in a new context.
1.8 Organization of this Book
In the next chapter (Chap. 2), we provide an overview of the new paradigm we are
proposing. In Part II (Chaps. 37), we briefly describe each of the core concepts of
physiology and then expand on three of them. In Part III (Chaps. 812), we discuss
a number of aspects of implementing the core concepts paradigm in the classroom.
Finally, in Part IV (Chaps. 13 and 14), we provide some concluding thoughts about
physiology teaching and the new paradigm.
References
American Association for the Advancement of Science (2011) Vision and change in undergrad-
uate biology education: a call to action. American Association for the Advancement of
Science, Washington, DC
Association of American Medical Colleges (1984) Physicians for the twenty-first century: the
GPEP report. Report of the panel on the general professional education of the physician and
college preparation for medicine. Association of American Medical Colleges, Washington, DC
Association of American Medical Colleges and the Howard Hughes Medical Institute (2009)
Scientific foundations for future physicians. Association of American Medical Colleges,
Washington, DC
Bornmann L, Mutz R (2015) Growth rates of modern science: a bibliometric analysis based on the
number of publications and cited references. J Assoc Info Sci Tech 66:22152222
Bransford JD, Brown AL, Cocking RR (1999) How people learn: brain, mind, experience, and
school. National Academies Press, Washington, DC
Carroll RG (2001) Cardiovascular pressure-flow relationships: what should be taught? Adv
Physiol Educ 25:8086
Colman AM (2006) A dictionary of psychology, 2nd edn. Oxford University Press, Oxford
Dewey J (1910) Science as subject-matter and as method. Science 31:121127
Duschl RA, Schweingruber HA, Shouse AW (eds) (2007) Taking science to school: learning and
teaching science in grades K-8. National Academies Press, Washington, DC
Evens M, Michael J (2006) One-on-one tutoring by humans and computers. Lawrence Erlbaum
Associates, Mahwah, NJ
Feder ME (2005) Aims of undergraduate physiology education: a view from the University of
Chicago. Adv Physiol Educ 29:310
Garvin-Doxas K, Klymkowsky M, Elrod S (2007) Building, using, and maximizing the impact of
concept inventories in the biological sciences: report on a National Science Foundation
sponsored conference on the construction of concept inventories in the biological sciences.
CBE Life Sci Educ 6:277282
Harlen W (2010) Principles and big ideas of science education. Association for Science Education,
Hatfield
Kay D, Kibble J (2016) Learning theory 101: application to everyday teaching and scholarship.
Adv Physiol Educ 40:1725
Michael J (2006) Wheres the evidence that active learning works? Adv Physiol Educ 30:159167
Michael J (2007) Conceptual assessment in the biological sciences: a National Science
Foundation-sponsored workshop. Adv Physiol Educ 31:389391
Michael J, McFarland J (2011) The core principles (big ideas) of physiology: results of faculty
surveys. Adv Physiol Educ 35:336341
Michael JA, Rovick AA (1999) Problem solving in physiology. Prentice Hall, Upper Saddle River,
NJ
Michael J, Modell H, McFarland J, Cliff W (2009) The core principles of physiology: what
should students understand? Adv Physiol Educ 33:1016
Modell HI (2000) How to help students understand physiology? Emphasize general models. Adv
National Research Council (2001) Knowing what students know: the science and design of
educational assessment. The National Academy Press, Washington, DC
National Research Council Committee on High-School Biology Education (1990) Fulfilling the
promise: biology education in the nations schools. National Academy Press, Washington, DC
National Research Council Committee on Undergraduate Biology Education to Prepare Research
Scientists for the 21st Century (2003) BIO2010: transforming undergraduate education for
future research biologists. National Academy Press, Washington, DC
Perkins DN, Salomon G (1994) Transfer of learning. In: Husen T, Postlethwaite TN (eds)
International encyclopedia of education, 2nd edn. Pergamon Press, Oxford
Prinz J (2005) Concepts. In: Borchert DM (ed) Encyclopedia of philosophy, 2nd edn. Thomson
Gale, Farmington Hills, MI
Rovick AA, Michael JA, Modell HI, Bruce DS, Horwitz B, Adamson T, Richardson DR,
Silverthorn DU, Whitescarver SA (1999) How accurate are our assumptions about our stu-
dents background knowledge? Am J Physiol 276:S93S101 (Adv Physiol Educ 21)
Sturges D, Maurer T (2013) Allied health students perception of class difficulty: the case of
undergraduate human anatomy and physiology classes. Int J Allied Health Sci Pract 11(4):
Article 9
United States National Commission on Excellence in Education (1983) A nation at risk: the
imperative for reform. National Commission on Excellence in Education, Washington, DC
Vander AJ (1998) Some difficult topics to teach (and not to teach) in renal physiology. Am J
Physiol 275 (Adv Physiol Educ 20:S148S156)
Wiggins G, McTighe J (2005) Understanding by design, expanded 2nd edn. Association for
Supervision and Curriculum Design, Arlington, VA
Chapter 2
What Is the New Paradigm and What Is New
About It?
Abstract With the publication of Thomas Kuhns The Structure of Scientific

Revolutions in 1962, the term paradigm took on several specialized meanings.
It is our contention that the changes to physiology education that we are
recommending constitute a new paradigm in the Kuhnian sense.
In this chapter, we first discuss Kuhns use of the term paradigm. We then
describe the overarching features of our new paradigm and offer an overview of the
application of this new paradigm to classroom teaching, the building of physiology
courses, and the creation of a physiology curriculum.
Keywords Paradigm Physiology education Physiology course Physiology

curriculum
The title of this book refers to a new paradigm. Before we describe our new
paradigm, we must first define the term paradigm and explain the significance of
our use of it. Merriam-Webster.com defines paradigm as a model or pattern for
something that may be copied and a theory or a group of ideas about how
something should be done, made, or thought about. Both of these definitions
describe the ideas we are advancing in this book. However, the term has acquired
a special meaning in science, and this meaning most closely reflects our use of
the term.
2.1 Thomas Kuhn and the Meaning of a Paradigm
In 1962, Thomas Kuhn introduced the notion of paradigm shifts in the history of
science (Kuhn 1962). What he meant by a paradigm was thought by many to be
unclear, and in a postscript added to the second edition, Kuhn (1970) attempted to
clarify his use of this term.

DOI 10.1007/978-1-4939-6909-8_2
20 2 What Is the New Paradigm and What Is New About It?
2.1.1 What Did Kuhn Mean by the Term Paradigm?
In one context, Kuhn used the term paradigm to mean the way a community of
scientists looks at or thinks about the domain of science in which they work. The
term encompasses, is shorthand for, the way in which this community does
science. It is how the community of scientists working in this domain behaves as
scientists.
Kuhn posited that paradigm shifts, changes in the dominant world view in a
particular field of science, occur when developments in that field result in the
accumulation of anomalies that cannot be explained by the current way of thinking
about things. Eventually, a new way of thinking appears that can accommodate not
only the old established science but also these anomalies. Although it may take
many years for it to be fully adopted, a new paradigm is said to have arisen.
However, Kuhn also uses the term paradigm in a different way to refer to
shared examples or exemplars of types of problems to be solved in a domain.
Kuhn offers an example of what he means by this. Newtons Second Law of
Motion, f ma, which relates force ( f ), mass (m), and acceleration (a), can be
used to solve problems about the motion of objects. Kuhn then shows how solving
problems in a variety of physics domains requires students to, first, recognize the
applicability of the Second Law and, second, figure out how to recast it using the
symbols, etc., appropriate to the nature of the problem. The Second Law is thus an
exemplar of a wide variety of similar relationships.
2.1.2 How and Why Have We Used the Term Paradigm

in a Book About Physiology Education?
We would argue that both meanings of Kuhns term paradigm are applicable to
what we are proposing in this book.
One use of the term paradigm by Kuhn is to describe the way in which a
particular field of science is practiced. It is a term that describes a community
that shares ideas, methods, theories, and techniques in order to advance understand-
ing in that particular field.
In this sense of the term, paradigm has a very similar meaning as the term
community of practice (Wenger 2009). In education, teachers who teach in a
certain way, or want to learn to teach in a certain way, interact with one another,
sharing ideas, theories, techniques, and information about outcomes as they attempt
to do a better job of helping their students to learn. This is one meaning of the term
community of practice. What we are proposing here is a new paradigm, a new
approach to teaching physiology that is based on a consideration of the core
concepts of physiology. We are proposing a new paradigm for the physiology
teaching community.
2.2 The Current Paradigm Shift Underway in Physiology Education 21
We would also observe that physiology education is currently going through a

protracted paradigm shift in which active learning (Michael and Modell 2003;
Michael 2006; Kay and Kibble 2016) and the pursuit of meaningful learning is
being recognized as the necessary approach to improving science education.
If we consider the term paradigm as an exemplar, we would argue that the
core concepts of physiology work in a way that is analogous to f ma. The core
concepts are each widely applicable throughout the domain of mammalian physi-
ology, and each can thus serve as a unifying construct that will help students to
integrate their knowledge of physiological mechanisms and better apply that
knowledge to solving problems.
In Part III of this book, we will be describing a new paradigm, a new mode of
practice, which is based on different assumptions than the old paradigm. Below we
will describe both the old and the new paradigms.
2.2 The Current Paradigm Shift Underway in Physiology

Education
We believe that education, and particularly science education, is in the midst of a

paradigm shift in which the teacher-centered, passive learning paradigm is being
replaced by a student-centered, active learning paradigm.
Since John Deweys call for reform of science teaching (1910), it has been
recognized that students passive accumulation of facts does not lead to the kind of
understanding of scientific phenomena that is desirable for the individual and for
society. Nevertheless, the model of students as empty vessels to be filled with as
many facts as possible continues well into the beginning of the twenty-first century.
This paradigm is fact oriented, and students are seen as passive and expected to
merely store away for later retrieval all the facts viewed as relevant.
However, in the 1990s, it became increasingly evident that this paradigm was
failing in an important way. Members of the physics education community began to
collect data that clearly demonstrated that students taking, and succeeding in,
conventional physics courses nevertheless did not understand the basic concepts
of physics (Halloun and Hestenes 1985)! Chemistry students have been found to
have many misconceptions (Ozmen 2004; Barke et al. 2009). Michael (1998) and
his colleagues (Michael et al. 1999, 2002) have found misconceptions about
respiratory and cardiovascular physiology across large, diverse groups of students.
This is the kind of anomaly that Kuhn discussed; students who are demonstrably
successful in our course nevertheless do not understand the important concepts of
the field!
At the same time, cognitive psychologists and learning scientists were
expanding on the thinking of Piaget, Dewey, Vygotsky, and Bruner to build an
approach to learning referred to as constructivism (Mintzes and Wandersee 1997;
Bransford et al. 1999). This approach to understanding learning is built on two
ideas. First, learners construct their understanding of a topic on a foundation of

what they already know (even though some of their prior knowledge is wrong).
This, of course, means that the learner is not an empty container that is being filled
by the lecturer or the textbook. Second, the notion that learning requires the learner
to build his or her own understanding means that learning with understanding is
always an active process.
The effectiveness of active learning approaches to teaching and learning science
has been well documented in STEM disciplines. Michael and Modell (2003)
described many facets of an active learning approach to teaching the sciences,
and Michael (2006) reviewed much of the literature on learning applicable to
physiology. Kay and Kibble (2016) have presented some of the findings of the
learning sciences and have discussed the application of these ideas to the classroom.
Thus, classroom practice in the middle decades of the twentieth century has been
changing from a passive and teacher-centered approach to a more active and
student-centered approach. Nevertheless, teaching has remained heavily fact
based, and in too many cases, the goal continues to be coverage of the material.
2.3 The Concept-Based Paradigm
The concept-based paradigm we will describe is predicated on the constructivist

idea that knowledge is built on existing knowledge (Michael and Modell 2003;
Mintzes and Wandersee 1997). The learner builds mental models of that which is
being learned, tests these models, and refines the models as needed (Michael and
Modell 2003). We are arguing that helping the physiology student to understand the
core concepts of physiology will provide the learner with a foundation, or perhaps it
would be better to describe it as a skeleton, on which all subsequent learning about
physiological mechanisms can be attached. This paradigm also provides a set of
tools with which students problem solving can be facilitated.
What are these core concepts? In Chap. 3, we describe in great deal what they are
and how we generated the list with the help of a large cohort of colleagues.
Table 2.1 below is a list of the 15 core concepts of physiology around which we
are proposing a new paradigm for teaching physiology.
This emphasis on core concepts is not meant to deny the importance of the
student learning the facts of physiology. Learning any discipline requires the
learning of the language with which the discipline carries out its discourse. It goes
without saying that learning any language requires the acquisition, the memoriza-
tion, of the words used in that language. Furthermore, to understand the physio-
logical mechanisms being studied requires the acquisition of a large body of
knowledge about the structures and the functions involved. Finally, it is well
recognized that while there are generic problem-solving processes, the solving of
actual problems requires both skill at employing these processes and a body of
knowledge to be used in applying these processes.
2.5 Implementing the New Paradigm in the Curriculum 23
Table 2.1 The core concepts Core concepts in physiology (Michael and McFarland 2011)
of physiology. In Chap. 3, we
Evolution
describe the process that
generate this list and what is Homeostasis
meant by each of the items Causality
Energy
Structure/function
Cell theory
Levels of organization
Cell membrane
Flow down gradients
Genes to proteins
Interdependence
Mass balance
Physics/chemistry
2.4 Implementing the New Paradigm in Physiology

Courses
In Chaps. 8, 9, and 10, we describe in detail how one might implement a physiology
course based on the core concepts. Here, let us just observe that the key to using the
core concepts to help student learn physiology is to make explicit the nature of the
core concepts and their applicability to the physiology being learned. This requires
consistency and repetition. It also requires learning outcomes and learning objec-
tives that focus on the core concepts. Finally, if the core concepts and their
application are important, if they are incorporated in the learning outcomes, then
they must be tested.
2.5 Implementing the New Paradigm in the Curriculum
A curriculum is a sequence of courses, the successful completion of which leads to

a degree in the particular field of study. It is assumed that there is a connection
between the courses that are required and that, in some sense, they build on one
another. As we describe further in Chap. 12, a focus on the core concepts of
physiology provides a structure with which to construct a physiology curriculum.
Progress through such a curriculum would involve learning to understand and use
additional core concepts. Progress would also require being able to solve more
complex problems using the core concepts and the growing knowledge base about
physiology.
References
Barke HD, Hazari A, Yirbarek S (2009) Misconceptions in chemistry: addressing perceptions in

chemical equilibrium. Springer, Berlin
Bransford JD, Brown AL, Cocking RR (eds) (1999) How people learn: brain, mind, experience,
and school. National Academy Press, Washington, DC
Dewey J (1910) Science as subject-matter and as method. Science 31:121127
Halloun IA, Hestenes D (1985) The initial knowledge state of college physics students. Am J Phys
53:10431055
Kay D, Kibble J (2016) Learning theory 101: application to everyday teaching and scholarship.
Kuhn TS (1962) The structure of scientific revolutions. University of Chicago Press, Chicago
Kuhn TS (1970) The structure of scientific revolutions, 2nd edn. University of Chicago Press,
Chicago
Michael JA (1998) Students misconceptions about perceived physiological responses. Adv
Michael JA, Modell HI (2003) Active learning in secondary and college science classrooms: a
working model for helping the learner to learn. Lawrence Erlbaum Associates, Mahwah, NJ
Michael JA, Richardson D, Rovick A, Modell H, Bruce D, Horwitz B, Hudson M, Silverthorn D,
Whitescarver S, Williams S (1999) Undergraduate students misconceptions about respiratory
physiology. Adv Physiol Educ 22:S127S135
Michael JA, Wenderoth MP, Modell HI, Cliff W, Horwitz B, McHale P, Richardson D,
Silverthorn D, Williams S, Whitescarver S (2002) Undergraduates understanding of cardio-
vascular phenomena. Adv Physiol Educ 26:7284
Mintzes JJ, Wandersee JH (1997) Reform and innovation in science teaching: a human construc-
tivist view. In: Mintzes JJ, Wandersee JH, Novak JD (eds) Teaching for understanding: a
human constructivist view. Academic Press, San Diego, CA, pp 2958
Ozmen H (2004) Some student misconceptions in chemistry: a literature review of chemical
bonding. J Sci Educ Tech 13:147159
Wenger E (2009) Communities of practice: a brief introduction. Downloaded from http://ussc.edu.
au/ussc/assets/media/docs/other/communities_of_practice.pdf. 7 Nov 2016
Part II
The Core Concepts of Physiology
Chapter 3
What Are the Core Concepts of Physiology?
Abstract What are the core concepts of physiology? Michael et al. (Adv Physiol
Educ 33:1016, 2009) defined nine core concepts in physiology. As a result of
surveying physiology faculty at a wide variety of institutions in the USA and
elsewhere, Michael and McFarland (Adv Physiol Educ 35:336341, 2011)
expanded this list to a set of 15 core concepts for physiology.
We will first describe the process by which we arrived at our list of core concepts
in physiology. Then, we will briefly describe each of the core concepts identified at
the NSF-sponsored CAB meetings, the 15 core concepts of physiology we have
developed, and their relationship to Modells general models. We will also describe
the overlap and interrelationship between the core physiology concepts.
In Chaps. 5, 6, and 7, we present our unpacking of the three most important core
concepts that physiology faculty have helped us identify.
Keywords Core concepts Physiology Big ideas
Following the CAB meetings in 2007 (Michael 2007) and 2008 (Michael et al.
2008)which we previously discussed (Sect. 1.5)a group of physiology educa-
tional researchers began working together to determine how we might take the work
of the CAB meeting and apply it to physiology teaching. Our initial goal was to
develop a concept inventory for physiology. We thought of ourselves as the
Conceptual Assessment in Physiology (CAP) group and quickly concluded that a
concept inventory could only be written if we had a definition of the core concepts
of physiology. This book is one product of our pursuit of this goal over the past
10 years.
3.1 The Process by Which We Defined the Core Concepts

of Physiology
Before listing and explaining the core concepts of physiology, it is important to

describe the process that we used to arrive at this list. It was not simply the product
of five or six of us sitting around a table and deciding what we thought was most

DOI 10.1007/978-1-4939-6909-8_3
28 3 What Are the Core Concepts of Physiology?
Table 3.1 Time line for the generation of a list of core concepts in physiology
Date Activity Described in
March, 2007 CAB workshop participants define eight big ideas in Michael (2007)
biology
20072008 CAP group defines core concepts of physiology, Michael et al.
starting with the big ideas from the CAB workshop (2009)
20082010 Physiology faculty surveyed by CAP group Michael and
November 2008 Faculty asked (free response) to define core concepts McFarland (2011)
March 2009 Faculty asked to rank order list of 15 core concepts Michael and
and to identify the three most important core concepts McFarland (2011)
January, 2010 Faculty asked for feedback about unpacking of one of Michael and
the core concepts McFarland (2011)
important, although it did start this way. Rather, after developing our first list of
concepts, we enlisted the physiology teaching community in a process of defining
and ranking the importance of these core concepts. Table 3.1 describes the time line
for this project.
3.1.1 The Core Concepts of Biology Defined at the First CAB

Meeting
As described in Chap. 1 (see Table 1.3), the participants at the first Conceptual
Assessment in Biology meeting (Michael 2007) generated a list of big ideas in
biology. This list contained five entries that would clearly appear on a list of core
concepts in physiology: (1) living systems are causal mechanisms, (2) information,
(3) matter and energy, (4) homeostasis, and (5) structure/function relationships.
3.1.2 The Core Concepts of Physiology Derived from

the Biology Concepts
Michael et al. (2009) took the list of biology big ideas and generated a list of nine
big ideas in physiology. This list was the result of discussions that the authors and
other members of the CAP team had had over the year following the first CAB
meeting. In this paper, we defined each of the core concepts, provided a description
of the context within physiology where the concept would apply, and provided an
example of such an application. This list contained the following core concepts:
(1) evolution, (2) ecosystems and environments, (3) causal mechanisms, (4) the
cell, (5) structure/function relationships, (6) levels of organization, (7) information
flow, (8) matter/energy transfer and transformation, and (9) homeostasis. Table 3.2
displays a side-by-side comparison of the core concepts of biology/physiology as
they evolved.
3.1 The Process by Which We Defined the Core Concepts of Physiology 29
Table 3.2 The evolution of identified core concepts in biology/physiology (the wording of some
entries in the table has been edited for consistency)
Core concepts in Core concepts in physiology Core concepts in physiology
biology (Michael 2007) (Michael et al. 2009) (Michael and McFarland 2011)
Ecosystems/ Ecosystems and environments
environments
Evolution Evolution Evolution
Homeostasis Homeostasis Homeostasis
Information flow Information flow
Living systems are Causal mechanisms Causality
causal mechanisms
Matter/energy transfer/ Matter/energy transfer/ Energy
transformation transformation
Structure/function Structure/function Structure/function
relationships relationships
The cell The cell Cell theory
Levels of organization Levels of organization
Cell membrane
Flow down gradients
Genes to proteins
Interdependence
Mass balance
Physics/chemistry
3.1.3 Polling our Colleagues for Their Idea About Core

Concepts
Although our group is a diverse one with members teaching at a variety of

educational institutions, we were concerned that our list might be too idiosyncratic
and that we were missing important core concepts.
Thus, in November 2008, Michael and McFarland (2011) surveyed the physiol-
ogy teaching community using four different listservs to enlist respondents. We
asked the respondents to tell us, in their own words, what they believed to be the
core principles or big ideas (both terms were defined in the survey) of physi-
ology. We received 81 responses from faculty at every level of post-second
education in the USA, Canada, and nine other foreign countries.
We received 73 useable responses (not all the respondents answered the question
we asked). Michael and McFarland individually read all the responses and extracted
all the core concepts that were described. When we compared the lists that each of
us had extracted from the surveys, they were virtually identical and contained
15 core concepts. Furthermore, the list of faculty-generated core concepts was
virtually identical to the list that we had just published (Michael et al. 2009).
In March 2009, we again surveyed the 81 individuals who had responded to our
first survey (Michael and McFarland 2011). We asked them to indicate, using a
Likert scale (1 strongly disagree to 5 strongly agree), how important it was that
their students master each of the 15 core concepts. In a separate section of the
survey, they were asked to select the three most important core concepts. Sixty-one
of the 81 responded to this survey. The results of this survey are briefly described
below.
3.2 The Core Concepts of Physiology
The result of the iterative process of consultation with our colleagues (described
above) was a list of core concepts. While they are not viewed as equally important
in all courses, all were recognized as describing much of what is important to the
teaching of physiology.
3.2.1 The 15 Core Concepts of Physiology and a Brief

Explanation of Each
Below, in alphabetical order, are the 15 core concepts of physiology (adapted from
Michael and McFarland 2011) that resulted from the process described above. The
list can also be seen in Table 3.2 where they can be compared with the earlier
version of the core concepts.
Causality: Living organisms are causal mechanisms (machines) whose
functions are explainable by a description of the cause-and-effect relationships
that are present. What we attempted to capture in this core concept is the idea that
the functions of the body arise from the interaction of atoms, ions, and molecules as
described by the law of chemistry and physics. It follows then that an explanation
for a physiological phenomenon or mechanism must be a set of statements outlining
the cause-and-effect relationships (the causal relationships) between entities.
Cellcell communication: The function of the organism requires that cells
pass information to one another to coordinate their activities. These communi-
cation processes include endocrine and neural signaling. This concept describes
the mechanism by which cells pass information to one another, thus making
possible the coordinated activity of all of the cells of the body. Modell (2000)
included this as one of the general models he described. The unpacked conceptual
framework for cellcell communication is presented in Chap. 7.
Cell membrane: Cell plasma membranes are complex structures that deter-
mine what substances enter or leave the cell. They are essential for cell signaling,
transport, and other processes. Every cell has a membrane separating the
3.2 The Core Concepts of Physiology 31
constituents of the cell from the extracellular compartment. The properties of

membranes are thus an important determinant of the functions of the cell.
Cell theory: All cells making up the organism have the same DNA. Cells have
many common functions but also many specialized functions that are required by
the organism. Cell theory is one of the oldest concepts in modern biology, and it is
often assumed that students understand it. However, it has important implications
that are not obvious to students but are, nevertheless, very important.
Energy: The life of the organism requires the constant expenditure of energy.
The acquisition, transformation, and transportation of energy are essential func-
tions of the body. While this core concept plays a major role in biochemistry,
physiological mechanisms are all ultimately dependent on the availability of bio-
logical energy.
Evolution: The mechanisms of evolution act at many levels of organization
and result in adaptive changes that have produced the extant relationships
between structure and function. This core concept occupies a somewhat strange
position in physiology; evolution is usually acknowledged but rarely invoked to
explain the functions of the body.
Flow down gradients: The transport of stuff (ions, molecules, blood, and
gas) is a central process at all levels of organization in the organism, and a simple
model describes such transport. Ions crossing a cell membrane, blood flowing in
blood vessels, gas moving in airways, and chyme moving down the gastrointestinal
tract are all processes that result from the interaction of an energy gradient and the
resistance to flow that is present. Modell (2000) also included this as a general
model. The unpacked conceptual framework for flow down gradients is presented
in Chap. 6.
Genes to proteins: The genes (DNA) of every organism code for the synthesis
of proteins (including enzymes). The genes that are expressed determine the
functions of every cell. This is the central dogma of molecular biology, and it
plays out in a large number of situations in physiological systems.
Homeostasis: The internal environment of the organism is actively maintained
constant by the function of cells, tissues, and organs organized into negative
feedback systems. The role of negative feedback in regulating the functions of the
body is a particularly powerful core concept in that it describes so much of organ
system physiology. Modell (2000) proposed negative feedback as a general model.
We present the unpacked conceptual framework for homeostasis in Chap. 5.
Interdependence: Cells, tissues, organs, and organ systems interact with one
another (are dependent on the function of one another) to sustain life. The
respondents to our first survey referred to this core concept often. However, it is
difficult to know exactly what this means since, in one sense, it is a truism. What is
probably the most important idea here is that one cannot focus on a single system in
attempting to understanding physiological phenomena or trying to solve real
problems.
Levels of organization: An understanding of physiological functions requires
understanding the behavior at every level of organization from the molecular to
the social. As the science of physiology has advanced, our understanding of
physiological phenomena has expanded to encompass many different levels of

organization. While we cannot yet explain everything at the molecular level, we
are rapidly expanding the list of phenomena understood at that level.
Mass balance: The quantity of stuff in any system, or in a compartment in a
system, is determined by the inputs to and the outputs from that system or
compartment. This is a simple general model (Modell 2000) that has wide appli-
cability in the body and explains a great many phenomena.
Physics/chemistry: The functions of living organisms are explainable by the
application of the laws of physics and chemistry. This core concept is clearly
related to the core concept of causality. Physics and chemistry are perquisite to an
understanding of all physiological phenomena, and physiologists, and students of
physiology, must be able to transfer that understanding to the living organism.
Scientific reasoning; Physiology is a science. Our understanding of the func-
tions of the body arises from the application of the scientific method; thus, our
understanding is always tentative. It is scientific reasoning, the experimental
method that has generated the information that fills our textbooks. To fully under-
stand, physiology students must understand how the results they are reading about
were generated and how future results will be generated.
Structure/function: The function of a cell, tissue, or organ is determined by its
form. Structure and function (from the molecular level to the organ system level)
are intrinsically related to each other. When applied to human designed and
constructed artifacts this is a truism. But it is equally true of biological systems.
An understanding of a physiological mechanism requires some understanding of
the structures that involved.
It is interesting to note that of the 18 Concepts of Biology: Central themes
listed in BIO2010 (NRC 2003), nine of them are essentially the same as the ones
found in our list of core concepts.
3.2.2 Faculty Feedback About the 15 Core Concepts
In the March 2009 survey (Michael and McFarland 2011), we asked the respon-
dents to indicate the importance of each of the 15 core concepts for their students.
On a separate survey page, we also asked that they indicate the three most important
core concepts. The ranking of the 15 core concepts, and the top 5, are shown in
Table 3.3. Note that the responses we received led us to expand our analysis
from the top 3 to the top 5 core concepts.
Of the five most important core concepts, one of them, Interdependence, came
from the faculty we had polled. Intense scrutiny of the written comments about this
idea has failed to clarify for us a single concept that we can work with and we have
not pursued this core concept any further. We have continued working with cell
cell communication, homeostasis, and flow down gradients, and we will have
much to say about these in the next three chapters.
3.3 Characteristics of the Core Concepts 33
Table 3.3 The ranking of the Ranking Top five

15 core concepts in
Causality 14
physiology by surveyed
faculty (Michael and Cellcell communication 3 X
McFarland 2011) Cell membrane 1 X
Cell theory 9
Energy 6
Evolution 15
Flow down gradients 5 X
Genes to proteins 11
Homeostasis 1 X
Interdependence 4 X
Levels of organization 12
Mass balance 13
Physics/chemistry 10
Scientific reasoning 8
Structure/function 7
3.3 Characteristics of the Core Concepts
On even casual inspection of the list of core concepts in physiology (Table 3.3), it is
clear that the 15 concepts differ from one another in significant ways. It is also clear
that the 15 core concepts are not isolated, independent ideas.
3.3.1 The Nature of the Core Concepts
The 15 core concepts are all big ideas according to the definitions by Wiggins and
McTighe (2005), Duschl et al. (2007), and Harlen (2010). But they seem to be big
ideas about different kinds of things.
For example, flow down gradients and mass balance are examples of concepts
that apply everywhere in the physical world, animate as well as inanimate. That is
to say, they are core concepts that are not specifically about biological organisms,
although they certainly apply to organisms.
On the other hand, homeostasis and cellcell communication are big ideas that
specifically describe biological phenomena. Interdependence, levels of organiza-
tion, and structure/function all have applications of one sort or another in the world
of man-made objects, but clearly also have very direct applications to living
organisms. However, they are core concepts which appear to be difficult to unpack
in the same way we have unpacked homeostasis, flow down gradients, and cellcell
communication (see Chaps. 4, 5, 6, and 7).
The existence of these differences should not obscure the fact that all of the core
concepts, whichever category they belong to, can serve as tools in the processes
of teaching and learning physiology.
3.3.2 The Intersecting Nature of the Core Concepts
The 15 core concepts that have been identified are related to one another or overlap
with one another in obvious and not so obvious ways; they are certainly NOT
independent ideas. This should not be surprising since, by definition, these are big
ideas with widespread application across the whole domain of physiology.
We have already mentioned the overlap between the core concept of causality
and the core concept of physics/chemistry. Although the overlap is considerable,
each of the separate concepts has different implications for student learning of
physiology. Since physiological systems are causal mechanisms, students must
learn to construct, critique, and run causal models (see Michael and Rovick
1999). The applicability of the laws of physics and chemistry to understanding
physiological phenomena means that students must be able to transfer knowledge
gained elsewhere to their learning of physiology, a task which many students find
difficult.
Another obvious overlap involves cell membrane and cellcell communication.
Cell membranes contain proteins, some on the exterior, some on the interior, and
some that span the membrane. All of these proteins play a role in the response of
one cell to chemical signals produced by other cells.
Finally, there is an obvious overlap between homeostasis and cellcell commu-
nication. Many homeostatically regulated mechanisms use hormonal signals to
alter effector function. Many others use neural signaling to communicate both
signals for neural receptors and effector control signals. Both types of mechanism
are examples of cellcell communications.
In Chap. 1, we tried to make it clear that the purpose of defining the core
concepts in physiology was to make available to teachers of physiology tools that
might help their students understand physiology. Thus, the focus is on pedagogy. In
light of this, it is important to point out that each physiology teacher deals with a
specific class and with specific course objectives. Which core concepts are empha-
sized and which overlaps between core concepts become topics for discussion will
clearly depend on the teacher and the course. In this book, we are describing tools,
NOT a course or a curriculum for physiology.
3.4 Core Concepts and General Models
In describing the 15 core concepts that were identified, we have noted that four of
them (cellcell communication, flow down gradients, homeostasis, and mass
balance) are essentially identical to four of the general models identified by Modell
(2000). Core concepts are general models in that they have wide applicability
across all areas of physiology.
References 35
3.5 What Can You Do with the Core Concepts?
Core concepts, or big ideas, are by their very nature big. They are built up from
many smaller concepts or ideas. The charge from NSF to the participants at the
three CAB meetings was to think about how to do conceptual assessment in a robust
way. The three of us who attended these meetings shared this interest, as did the
other members of our research group. We wanted to write a concept inventory to
assess students understanding of one or more of the core concepts of physiology
(see Chap. 11). However, it quickly became obvious to us that it was impossible to
assess students understanding of a complete core concept using multiple-choice
questions. The complexity of each core concept was too great to be captured in a
realistic number of multiple-choice questions.
Thus, we concluded that we needed to break a core concept into its constituent
parts and then determine whether students understood the smaller, constituent
concepts. The process of unpacking or deconstructing a core concept into its
parts yields a conceptual framework. This process is the subject of the next chapter.
The first thing we sought to do with the core concepts we identified is to begin
the process of writing a conceptual assessment instrument. However, we quickly
realized that core concepts could be used as a central theme in all physiology
teaching. We will be elaborating on these uses in Part III of this book.
3.6 Organization of the Next Four Chapters
Chapter 4 describes the process we have developed for unpacking the core concepts
into conceptual frameworks. In Chaps. 5, 6, and 7, we present the conceptual
frameworks, the unpacking, of the three core concepts that we selected for our
initial development work: homeostasis, flow down gradients, and cellcell com-
munication. For each of these core concepts, we discuss the elements of the
framework, define the key terms that are used in each framework, present a visual
representation of the concept, and, finally, discuss some of the issues that arise in
helping students understand each concept.
References
Duschl RA, Schweingruber HA, Shouse AW (eds) (2007) Taking science to school: learning and
teaching science in grades K-8. National Academies Press, Washington, DC
Harlen W (ed) (2010) Principles and big ideas of science education. Association for Science
Education, Hatfield
Michael J (2007) Conceptual assessment in the biological sciences: a national science foundation-
sponsored workshop. Adv Physiol Educ 31:389391
Michael JA, Rovick AA (1999) Problem solving in physiology. Prentice-Hall, Upper Saddle
River, NJ
Michael J, McFarland J, Wright A (2008) The second conceptual assessment in the biological
sciences workshop. Adv Physiol Educ 32:248251
National Research Council Committee on Undergraduate Biology Education to Prepare Research
Scientists for the 21st Century (2003) BIO2010: transforming undergraduate education for
future research biologists. National Academy, Washington, DC
Wiggins G, McTighe J (2005) Understanding by design, expanded 2nd edn. Association for
Supervision and Curriculum Design, Arlington, VA
Chapter 4
What Does It Mean to Unpack a Core
Concept?
Abstract Core concepts are sometimes called big ideas. As such, each core
concept is built up from a set of component ideas. Thus, understanding a core
conceptbeing able to use it to solve a problemrequires an understanding of
each of these smaller components. We have referred to the process of
deconstructing a core concept into its critical components as unpacking, and
the result of unpacking is a conceptual framework.
The process that we have used to unpack core concepts results in a set of critical
components that must be understood by physiology students at all educational
levels. The constituent ideas will vary for different educational levels (along the
novice to expert continuum) and purposes.
We will describe the process that we have used to unpacking the core concept
of homeostasis into a logical, legitimate, and useful conceptual framework. We will
also describe the process we used to validate these conceptual frameworks using a
Delphi method. Finally, we briefly mention the many ways in which conceptual
frameworks can be used in teaching and learning physiology.
Keywords Core concepts Big ideas Causal models Unpacking Conceptual

frameworks
The core concepts of physiology (Chap. 3) are all big ideas, although they clearly
vary in their size. Evolution is a larger concept than flow down gradients, but
even the smallest of the core concepts are made up of many component parts
(concepts, ideas). Understanding a core concept then requires an understanding of
these component parts.
4.1 What Does It Mean to Unpack a Core Concept?
Core concepts, or big ideas, are complex assemblages of interconnected smaller

ideas. For example, the core concept of homeostasis is made up of concepts about
sensors, effectors, set points, error signals, and controllers (see Chap. 5). Each of

DOI 10.1007/978-1-4939-6909-8_4
38 4 What Does It Mean to Unpack a Core Concept?
these subsidiary ideas may be made up of still smaller ideas. Unpacking, a core
concept, is the process of systematically deconstructing a big idea into the set of
smaller ideas needed to understand the core concept. The resulting hierarchically
structured statements make up a conceptual framework (McFarland et al. 2016).
Khodor et al. (2004) developed the Biology Concept Framework and organized
their unpacking in a hierarchical structure. Feder (2005) described a framework-
like description of essential core ideas for undergraduate physiology, and his
organization is also hierarchical.
There is no single right way to unpack a core concept and no one right way to
construct a conceptual framework. The ultimate goal of constructing a conceptual
framework is to provide students with a learning resource that will help them
achieve the learning goals for their course or curriculum. To the extent that courses
vary in their coverage of the various domains of physiology, and the breadth and
depth of understanding expected, any core concept can be usefully represented by a
number of different conceptual frameworks. As we are using the term, a conceptual
framework is not a description of the known science that makes up a discipline like
physiology (although it must never violate that understanding). Rather, it is an
organizational tool to help students learning that science.
4.1.1 Conceptual Assessment and Conceptual Frameworks

in Biology
As was noted in Chap. 1, in 2007, the National Science Foundation sponsored the
first workshop on Conceptual Assessment in Biology. CAB participants argued, we
believe convincingly, that the first step in constructing a conceptual assessment
instrument, a concept inventory, must be the definition of the concepts to be
assessed and hence the building of a conceptual framework.
At the time of this meeting, there were already a number of groups working in
different areas of biology to develop concept inventories. The literature describing
the various assessment instruments is large and growing rapidly. However, the
authors often do not define what they mean by a concept, and it is often unclear
exactly what set of concepts is being assessed. That is to say, there are conceptual
inventories for which there is no clearly defined conceptual framework.
For example, Anderson et al. (2002) have developed a concept inventory on
natural selection, but it was not based on a conceptual framework for this subject.
Knudson et al. (2003) have developed a concept inventory for biomechanics and
have defined a set of competencies but no list of concept as such. A genetics concept
inventory, which is based on a conceptual framework, has been published by
Bowling et al. (2008). Smith et al. (2008) described a genetics concept inventory
4.1 What Does It Mean to Unpack a Core Concept? 39
based on a set of course learning goals, but they do not present a conceptual
framework. Marbach et al. (2009) have developed a concept inventory for host
pathogen interactions based on a list of concepts but with no conceptual framework.
Shi et al. (2010) described a concept inventory for introductory molecular and cell
biology based on course learning goals but with no conceptual framework.
Villafane et al. (2011) have developed a concept inventory about foundational
concepts of biochemistry based on a simple list of concepts. Perez et al. (2013)
described a concept inventory on evolutionary developmental biology based on a
flat conceptual framework. Finally, Abraham et al. (2014) described a concept
inventory on genetics with a list of core concepts but without unpacking these
concepts.
4.1.2 Hierarchical Levels of Our Conceptual Frameworks
In unpacking the three core concepts described in Chaps. 5, 6, and 7 we have

created hierarchical structures of the component concepts that make up these core
concepts. The structure of one of our conceptual frameworks can be seen in the
table below (see Table 4.1 below).
Our conceptual frameworks vary in their hierarchical depth. There are four
hierarchical levels in the cellcell communication conceptual framework, two
levels for the homeostasis conceptual framework and three levels for the flow
down gradients framework. The depth of a conceptual framework depends on
two things, the complexity (which is not the same thing as the degree of difficulty)
of the physiology described by the core concept and the use to be made of it. Since
we are developing conceptual frameworks and conceptual assessments for intro-
ductory physiology students, the depth we employed is appropriate for that audi-
ence. A conceptual framework written for advanced undergraduates or graduate
students might very well have greater depth.
Table 4.1 A description of the hierarchical organization of our conceptual frameworks with an
example (Michael et al. 2016)
Level Example
Core concept (big idea) Cellcell communication (see Chap. 7)
Critical components CC4 binding of the messenger molecule to its receptor gives rise to
signal transduction
Constituent ideas CC4.3 There are two basic mechanisms for transduction, both of
which result in amplification
Elaborations CC4.3.3 The speed of the response of the two systems is different
Amplifications CC4.3.3.1 The speed of response in a second messenger system is fast
4.1.3 Conceptual Frameworks and Physiological (Causal)

Models
A conceptual framework is a text-based, hierarchically organized representation of

the ideas that taken together describe a core concept (McFarland et al. 2016). A
causal model is another device for organizing the information describing a core
concept (Michael and Rovick 1999). While these two representations clearly
overlap, they do have different purposes as learning resources.
Conceptual frameworks are compact verbal descriptions of a core concept. They
provide a structure or a scaffold that students can use to associate the facts and
details of physiological mechanisms. When used in this way, frameworks should
aid in retention and recall. They can also function as a scaffold to which attach
(associate) new knowledge as they acquire it.
Physiological (causal) models are visual representations of the critical compo-
nents of a core concept arranged in a way that illustrates the connections between
these components. A model is runnable in the sense that it can be used to make
predictions about how the system in question will respond to perturbations (Michael
and Rovick 1999; Evens and Michael 2006; Michael et al. 2008). The visual
components of the model, the boxes that make it up, can also be viewed as
folders in which all the ideas about that critical component can be stored for
retrieval and used in solving problems.
In Chaps. 5, 6 and 7, we present the conceptual frameworks and causal models
for the three core concepts that we describe.
4.2 How Did We Construct and Validate a Conceptual

Framework?
In his report about the first CAB meeting, Michael (2007) provided the first
example of an unpacking of the core concept of homeostasis. At that time, he
identified seven critical components (see Table 4.1). Michael et al. (2009), in
addition to defining nine core concepts, unpacked each of them into a hierarchical
framework.
The members of the CAP team carried out these initial attempts at identifying
and unpacking core concepts. As was the case with identifying the core concepts,
we were concerned that our attempts at unpacking did not necessarily reflect the
needs of the wider physiology teaching community. We thus went to this commu-
nity and elicited feedback from them on the unpacking of homeostasis and flow
down gradients.
As previously described, during our surveying of physiology teachers to elicit
their views of the core concepts of physiology (Michael and McFarland 2011), we
also asked our respondents for feedback on the unpacking of flow down gradients
4.3 Why the Particular Three Core Concepts We Unpacked? 41
(fully described in Chap. 5) using a Likert scale. Respondents showed strong

agreement with what we had done. Comments they provided were very supportive
and did not suggest that we had missed anything.
We pursued an even more rigorous validation process for our unpacking of
homeostasis (McFarland et al. 2016). The CAP group produced a proposed
unpacking. We then asked survey respondents to provide us with feedback on
each element of the conceptual framework. We also presented the homeostasis
conceptual framework to participants in workshops at national meetings and
elicited valuable feedback in this way. We presented the framework as a poster at
EB 2015 and received additional feedback. The conceptual frame for homeostasis
discussed in Chap. 5 is the final product of this iterative process.
4.3 Why the Particular Three Core Concepts We

Unpacked?
We have been asked why we picked flow down gradients, homeostasis, and cell
cell communication to unpack. There were two criteria that played a role in making
our choices.
We first unpacked and validated flow down gradients (Michael and McFarland
2011) because we had had experience using Modells general models (2000) in our
own teaching and because of its obvious widespread applicability. It also seemed to
us that the conceptual framework that would be created would be relatively small
(only a few items) and relatively simple (only a few hierarchical levels). In Chap. 6,
you can see what this conceptual framework looks like.
We next attempted to unpack and validate homeostasis. Michael (2007) and
Michael et al. (2009) contained simple unpackings of this core concept, but no
attempt was made to validate them. McFarland et al. (2016) generated a more
complex conceptual framework and rigorously validated it. This was the second
core concept we chose, and the reasons for selecting it were simple; homeostasis is
the most commonly cited big idea in physiology, and it was a concept whose
structure had been well established by many biomedical engineers and system
physiologists. In Chap. 5 we present this conceptual framework.
The reasons for electing to unpack cellcell communication were very similar.
In validating our selection of core concepts (Michael and McFarland 2011), our
survey respondents had told us that this was one of the top five most important
concepts. We thought we understood the pieces of this core concept and believed
that we could produce a useful conceptual framework even though it might be large
(many items) and complex (many levels in the hierarchy). The resulting conceptual
framework confirmed our predictions (Michael et al. 2016). In Chap. 7, we present
this conceptual framework.
What about the other 12 core concepts? They do need to be unpacked (see
Chap. 13), and we would urge others to begin the work of generating conceptual
frameworks for these concepts. They too will represent useful tools for helping
students learn physiology.
Finally, we must emphasize two things. There is no single, uniquely correct
conceptual framework for any of the core concepts. Although our survey respon-
dents have told us that our frameworks are correct, this does not mean that no other
correct and useful frameworks can exist. We can certainly imagine frameworks
tailored for specific courses or physiology curricula that would differ from ours.
In this book, we are attempting to provide examples of how to use the core
concepts of physiology to teach physiology. We will be using the three core
concepts that we have unpacked because we have them and because they have
been validated. Other core concepts, if unpacked, would have worked just as well.
So, what we are offering is a description of how to use a kind of tool that is available
for helping students to learn. We are not prescribing what tools must be used nor
how they must be used.
4.4 What Are the Uses of Conceptual Frameworks?
In Part III of this volume, we describe more fully the uses of core concepts and
conceptual frameworks in teaching physiology. Here, we simply mention some of
the ways in which conceptual frameworks can be used.
4.4.1 Student Learning of Physiology
Both conceptual frameworks and causal models are tools that can be used by
students to acquire an understanding of core concepts.
Conceptual frameworks can simultaneously serve two purposes. A framework
can serve to define for students what is important and therefore what needs to be
understood. At the same time, the conceptual framework makes clear the relation-
ships between the various pieces of knowledge that are encompassed by the
framework. Finally, the framework provides the student with a structure with
which to relate new knowledge as they acquire it; the framework is thus a kind of
scaffolding.
Causal models are often drawn in a way that makes them runnable. That is, if a
change is present somewhere in the system, it is possible to propagate that change
around the system to determine how the function of each system component will
change. Problem solving in physiology often involves this kind of reasoning
(Michael and Rovick 1999). In addition, such visual representations of a system
or phenomenon are compact ways of keeping track of the accumulating knowledge
References 43
about the system; the boxes become pointers to or addresses for all of the knowl-
edge about a particular component of the system.
4.4.2 Teaching Physiology
Conceptual frameworks define the essential components of a core concept. The

systematic unpacking of a core concept makes it possible for an instructor to
explicitly define what she or he expects their students to know and be able to
do. Thus, the design of courses, the preparation of learning resources, and the
planning of classroom activities can all benefit from a focus on the core concepts.
In Chaps. 8, 9, and 10, we discuss all of these at some length.
4.4.3 Assessment
If the core concepts are important, and we have certainly argued that they are, then
it is essential that we assess whether our students understand these concepts. The
first step in this process must be defining the concepts we want our students to
master. Developing conceptual frameworks is the first step in developing a con-
ceptual assessment instrument. In Chap. 11, we describe the process we have
pursued in developing a conceptual assessment for the core concept of homeostasis.
4.4.4 Curriculum Design
A curriculum (or academic major or academic minor) is a sequence of courses,

some required and other elected, that is intended to prepare students to some level
of competence in a discipline. Ideally, the courses making up a curriculum should
build on one another, with each successive course increasing the breadth and depth
of the students understanding. The core concepts and their conceptual frameworks
provide a framework with which a faculty can build a curriculum in a systematic
way. This will be discussed further in Chap. 12.
References
Abraham JK, Perez K, Price RM (2014) The dominance concept inventory: a tool for assessing
undergraduate student alternative conceptions about dominance in Mendelian and population
genetics. CBE Life Sci Educ 13(2):349358
Anderson DL, Fisher KM, Norman GJ (2002) Development and evaluation of the conceptual
inventory of natural selection. J Res Sci Teach 39:952978
Bowling BV, Acra EE, Wang L, Myers MF, Dean GE, Markle GC, Moskalik CL, Huether CA
(2008) Development and evaluation of a genetics literacy assessment instrument for under-
graduates. Genetics 178:1522
Evens M, Michael A (2006) One-on-one tutoring by human and computer tutors. Erlbaum,
Mahwah, NJ
Feder ME (2005) Aims of undergraduate physiology education: a view from the University of
Chicago. Adv Physiol Educ 29:310
Khodor J, Gould Halme D, Walker GC (2004) A hierarchical biology concept framework: a tool
for course design. Cell Biol Educ 3:111121
Knudson D, Noffal G, Bauer J, McGinnis P, Bird M, Chow J, Bahamonde R, Blackwell J,
Strohmeyer S, Anendroth-Smith J (2003) Development and evaluation of a biomechanics
concept inventory. Sports Biomech 2:265275
Marbach-Ad G, Briken V, El-Sayed NM, Frauwirth K, Fredericksen B, Hutcheson S, Gao L,
Joseph S, Lee V, McIver KS, Mosser D, Quimby BB, Shields P, Song W, Stein DC, Yuan RT,
Smith AC (2009) Assessing student understanding of host pathogen interactions using a
concept inventory. J Microbiol Biol Educ 10:4350
McFarland J, Wenderoth MP, Michael J, Cliff W, Wright A, Modell H (2016) A conceptual
framework for homeostasis: development and validation. Adv Physiol Educ 40:213222
Michael J (2007) Conceptual assessment in the biological sciences: a national science foundation-
sponsored workshop. Adv Physiol Educ 31:389391
Michael JA, Rovick AA (1999) Problem solving in physiology. Prentice-Hall, Englewood
Cliffs, NJ
Michael J, Cliff W, McFarland J, Wright A, Modell H, Martinkova P (2016) Conceptual frame-
work for the core concept of cell-cell communications. FASEB J 30:553.20. Abstract can be
downloaded from http://www.fasebj.org/content/30/1_Supplement/553.20.abstract?side8687de1-
2b4f-4cdd-ad3c-412cc2d6c7fc. Poster available at: http://physiologyconcepts.org under Publica-
tions/Abstracts
Perez KE, Hiatt A, Davis G, Trujillo C, French DP, Terry M, Price RM (2013) The EvoDevoCI: a
concept inventory for gauging students understanding of evolutionary developmental biology.
CBE Life Sci Educ 12:665675
Shi J, Wood WB, Martin JM, Guild NA, Vicens Q, Knight JK (2010) A diagnostic assessment for
introductory molecular and cell biology. CBE Life Sci Educ 9:453461
Smith MK, Wood WB, Knight JK (2008) The genetics concept assessment: a new concept
inventory for gauging student understanding of genetics. CBE Life Sci Educ 7:422430
Villafane SM, Bailey CP, Loertscher J, Minderhout V, Lewis JE (2011) Development and analysis
of an instrument to assess student understanding of foundational concepts before biochemistry
coursework. Biochem Mole Biol Educ 39:102109
Chapter 5
The Unpacked Core Concept
of Homeostasis
Abstract We define homeostasis to be the maintenance of a constant internal

environment by active functioning of cells, tissues, and organs organized into a
negative feedback system.
In this chapter, we present a conceptual framework of the core concept of
homeostasis. We provide a visual representation of the critical components that
make up homeostasis and provide definitions for all of the important terms that
appear in the unpacking. We describe specific physiological variables to which this
core concept is applied in mammals. Finally, we discuss some of the aspects of this
core concept that are known to be difficult for students to master.
Keywords Core concept Conceptual framework Homeostasis Sensor Set

point Effector Regulated variable
5.1 A Conceptual Framework for Homeostasis
In Chap. 3, we defined what we mean by the core concept of homeostasis as

follows. Homeostasis: The internal environment of the organism is actively
maintained constant by the function of cells, tissues, and organs organized into
negative feedback systems.
The conceptual framework for the core concept of homeostasis is found in
Table 5.1. It is important to note two constraints on our discussion of homeostasis.
First, although other mechanisms may contribute to homeostasis (including feed-
forward processes), this conceptual framework is limited to the concept of homeo-
stasis via negative feedback mechanisms, because these are most often encountered
in undergraduate physiology. Second, this framework specifically addresses
homeostasis at the level of the organism (e.g., an animal) and does not address
cellular or ecosystem homeostasis.

DOI 10.1007/978-1-4939-6909-8_5
46 5 The Unpacked Core Concept of Homeostasis
Table 5.1 A conceptual framework for homeostasis (From McFarland et al. 2016)
H1. The organism maintains a stable internal environment in the face of a fluctuating external
environment.
H1.1. The organisms internal environment differs from its external environment.
H1.2. The external environmental variables may change.
H1.3. A limited number of variables (i.e., regulated variables) of the internal environ-
ment are maintained stable via homeostatic processes in order to sustain cell
function (if these variables change too much, cells cannot function normally and
may die).
H1.4. Not all variables that remain within a normal range over time are homeostatically
regulated variables (e.g., blood hematocrit, testosterone).
H1.5. Depending on the particular system, the regulated variable may be kept within a
very narrow range or within a much wider range.
H1.6. Homeostatic (i.e., regulatory) mechanisms operate all the time to determine the
value of the regulated variable (they do not turn on or off; they are not like a
light switch, they are like a volume control knob).
H2. A substantial change to a regulated variable will result in a physiological response to
restore it toward its normal range.
H2.1. The regulated variable is held stable by a negative feedback system.
H2.2. Not all negative feedback systems are homeostatic.
H2.3. The process of responding to a perturbation requires an action by a sensor, a
control center, and an effector (the components of a negative feedback system).
H2.4. The sensor, control center, and effectors may be physically far from or near to
each other in the body and can even exist in the same cell.
H3. Homeostatic processes require a sensor inside the body (what cant be measured cant be
regulated).
H3.1. Sensors detect the regulated variable and respond by transducing that stimulus
into a different signal.
H3.2. Sensors respond within a limited range of stimulus values.
H3.3. Sensors generate an output whose value is proportional to the magnitude of the
input to the sensor (i.e., the stimulus).
H3.4. Sensors are constantly active (not just active when the regulated variable is not at
the set-point value).
H3.5. An organ system may employ a variety of types of sensors (e.g., chemoreceptors,
baroreceptors, mechanoreceptors, etc.) to regulate variables associated with that
organ system.
H4. Homeostatic processes require a control center (which includes an integrator).
H4.1. The control center is part of the endocrine and/or the nervous system.
H4.2. The integrator receives a signal from the sensor.
H4.3. The integrator is a component of the control center.
H4.4. Physiological systems have a normal range for a regulated variable (a so-called set
point).
H4.5. The integrator determines the difference between the signal from the sensors and
the set point (i.e., the normal range of the regulated variable).
H4.6. The value of the difference (between the signal from the sensor and the set point)
is used by the control center to calculate a change in the signals going to the
effectors (i.e., targets).
(continued)
5.3 Homeostasis: Terminology 47
Table 5.1 (continued)

H4.7. It is possible in some circumstances and in some systems for the set point to
change.
H5. Homeostatic processes require target organs or tissues, i.e., effectors.
H5.1. Physiological targets or effectors are cells, tissues, or organs (unlike effector
molecules in biochemistry).
H5.2. The action of the targets (i.e., effectors) causes physical or chemical changes that
alter the regulated variable.
H5.3. Effectors result in changes in nonregulated variables that in turn alter the regu-
lated variable (e.g., the regulated variable, blood pressure, can be changed by
altering heart rate (HR) and systemic resistance (SVR), which are not regulated).
5.2 A Visual Representation of the Core Concept

of Homeostasis
Visual representations of physiological phenomenacausal diagramscan be

useful learning resources (Weaver et al. 2002; Luckie et al. 2011). As is the case
with terminology, completeness and consistency in the use of visual representations
are essential.
We have proposed two visual representations of homeostatic mechanisms
(Modell et al. 2015) that can be seen here. Figure 5.1 depicts a generic homeostatic
mechanism. It, or figures like it, appears in at least some advanced textbooks. A
somewhat simplified version of this representation is seen in Fig. 5.2; similar
figures are found in introductory level textbooks. The labels used in any version
of a visual representation of homeostatic mechanisms should be consistent with the
terminology used in the text.
It should be noted that this figure is a visual representation of most of the
information that is found in the conceptual framework. The conceptual framework
(Table 5.1) and the causal diagram (Fig. 5.1) are thus complementary but are used
in different ways (McFarland et al. 2016). The causal diagram (Fig. 5.1) can be
run to enable predictions to be made about the consequence of various changes in
the system (Michael and Rovick 1999; Evens and Michael 2006; Michael et al.
2008).
5.3 Homeostasis: Terminology
The concept of homeostasis poses many difficulties for both instructors and stu-
dents (Modell et al. 2015). One source of some of this difficulty is the terminology
that is used to describe and explain homeostasis. The treatment of this concept in
widely used textbooks is often incomplete and inconsistent (Michael et al. 2013).
We have published (Modell et al. 2015) a set of terms that are used in discussing
Fig. 5.1 A complete representation of homeostatic mechanisms (Modell et al. 2015)
Fig. 5.2 A simplified representation of a homeostatic mechanism (from Modell et al. 2015)
homeostasis and their definitions (see Table 5.2) as a way of assisting instructors
(and textbook authors) to maintain the use of a consistent terminology.
The terminology used to describe homeostatic regulation is general; it describes
an abstract concept about how system components are arranged to carry out a
function. In learning physiology, students will encounter many physiological vari-
ables that are regulated. In each specific system, the names for the components will
differ, but the generic labels are useful as they convey the homeostatic system
function that is being described. It is, thus, important that a consistent terminology
is employed; this will help students understand the generality of the concept of
regulation.
5.3 Homeostasis: Terminology 49
Table 5.2 Definitions of terms used in the homeostasis conceptual framework (Adapted from
Modell et al. 2015)
Term Definition
Control Center The control center consists of an error detector and controller. It
(or Integrating Center) receives signals (information) from sensors, compares informa-
tion (value of regulated variable) with the set point, integrates
information from all sensors, and sends output signals (sends
instructions or commands) to increase or decrease the activity of
effectors
The control center determines and initiates the appropriate
physiological response to any change or disturbance of the
internal environment
Controller The component of the control center that receives signals
(information) from the error detector and sends output signals
(instructions or commands) to increase or decrease the activity
of effectors.
The controller initiates the appropriate physiological response to
an error signal resulting from a change or disturbance of the
regulated (sensed) variable
Effector A component whose activity or action contributes to determin-
ing the value of any variable in the system.
In this model, the effectors determine the value of the regulated
(sensed) variable.
Error detector The component in the control center that determines (calculates)
the difference between the set-point value and the actual value
of the regulated (sensed) variable.
The error detector generates the error signal that is used to
determine the output of the control center.
Error signal A signal that represents the difference between the set-point
value and the actual value of the regulated variable.
The error signal is one of the input signals to the control center.
External environment The world outside of the body and its state.
The state or conditions in the outside world can determine the
state of many internal properties of the organism.
Integrator Another term for the control center.
The integrator processes information from the sensor and those
components that determine the set point, determines any error
signal present, and sends output signals (instructions or com-
mands) to increase or decrease the activity of effectors.
Internal environment The internal environment is the extracellular fluid compartment
(ECF).
This is the environment in which the bodys cells live. It is what
Bernard meant by the internal milieu.
Homeostasis The maintenance of a relatively stable internal environment by
an organism in the face of a changing external environment and
varying internal activity using negative feedback mechanisms to
minimize an error signal.
Negative feedback A control mechanism in which the action of the effector (which
generates a response) opposes a change in the regulated variable
and returns it back toward the set-point value.
(continued)

Term Definition
Nonregulated variable (Con- A variable whose value changes in response to effector activity
trolled variable) but whose value is not directly sensed by the system.
Controlled variables contribute to determination of the regulated
variable. For example, heart rate and stroke volume (controlled
variables) contribute to determining cardiac output (another
controlled variable) that contributes to arterial blood pressure
(a regulated variable).
Perturbation (Disturbance) Any change in the internal or external environment that causes a
change to a homeostatically regulated variable.
Physiologically induced changes in the set point would not be
considered a perturbation.
Regulated variable (Sensed Any variable for which sensors are present in the system and the
variable) value of which is kept within limits by a negative feedback
system in the face of perturbations in the system.
A regulated variable is any property or condition of the extra-
cellular fluid that is kept relatively constant in the internal
environment in order to ensure the viability (survival) of the
organism.
Response The change in the function or action of an effector.
Sensor (Receptor) A device that measures the magnitude of some variable by
generating an output signal (neural or hormonal) that is pro-
portional to the magnitude of the stimulus.
A sensor is a measuring device. For some regulated variables,
sensors are specialized sensory cells or sensory receptors, e.g.,
thermoreceptors, baroreceptors, or osmoreceptors. For other
regulated variables, sensors are cellular components, e.g., the
calcium-sensing receptor (a G-protein coupled receptor that
senses blood calcium ion in the parathyroid gland).
Set point The range of values (range of magnitudes) of the regulated
variable that the system attempts to maintain.
Set point refers to the desired value. The set point is gen-
erally not a single value; it is a range of values.
5.4 Where Is the Core Concept of Homeostasis Applicable?
Homeostasis, the maintenance of a more or less constant internal environment, is

essential for health and the continued viability of the organism. Homeostatic
mechanisms affect the function of all of the bodys organ systems. Table 5.3 (edited
from Modell et al. 2015) contains a description of 10 homeostatically regulated
variables about which we know a great deal and the system components that are
involved in keeping them more or less constant. As can be seen, a great many
organs and organ systems are involved in maintaining homeostasis.
5.5 Topics that Cause Confusion for Students and Instructors: Sticky Points 51
Table 5.3 A list of the physiological variables that are regulated by homeostatic mechanisms
(modified from Modell et al. 2015)
Regulated variable
(normal range) Sensors (Location of control center) Effectors
Arterial PO2 Chemosensors (brain stem) Diaphragm, Respiratory
(75100 mm Hg) muscles
Arterial PCO2 Chemosensors (brain stem) Diaphragm, Respiratory
(3445 mm Hg) muscles
[K+] (3.55.0 meq/L) Chemosensors (adrenal cortex) Kidneys
[Ca2+] (4.35.3 meq/L) Chemosensors (parathyroid gland) Bone, kidneys, intestine
[H+]/pH (3545 nM; Chemosensors (brain stem, kidneys) Diaphragm, respiratory
7.357.45) muscles, kidneys
[Glucose] (70110 mg/ Fed state: chemosensors (pancreas) Liver, adipose tissue, skele-
dL fasting) Fasting state: chemosensors (hypo- tal muscle
thalamus and pancreas)
Core body temperature Thermosensors (hypothalamus) Blood vessels, sweat
(98.6 F) glands, skeletal muscle
Mean arterial pressure Mechanosensors (medulla) Heart, blood vessels
(80100 mm Hg)
Blood volume (5 L) Mechanosensors Hypothalamus, atria,
kidneys
Blood osmolality Osmoreceptors (hypothalamus) Kidneys
5.5 Topics that Cause Confusion for Students

and Instructors: Sticky Points
Modell et al. (2015), in describing our current understanding of homeostasis,

discussed several pieces of the homeostasis conceptual framework that are prob-
lematic for students and instructors. Some of these difficulties arise from the
complexity of the topic. Others are the results of apparently counterintuitive aspects
of the system under consideration. The inconsistent use of terminology or visual
representations of homeostatic mechanisms can also create a problem. Finally,
some are the consequences of faulty mental models (misconceptions). Here, we
will focus on only a few of these sticky points.
We have acquired information about student misconceptions about homeostasis
from a number of sources. In validating the questions making up our homeostasis
concept inventory (see Chap. 11), we have obtained responses from more than
600 students. An examination of the choices that students selected in taking the
inventory reveals misconceptions. Interactions with physiology faculty at Human
Anatomy and Physiology Society (HAPS) workshops have provided us with mis-
conceptions seen in the classroom. Finally, our experiences as classroom teachers
of physiology have revealed student misconceptions.
We have discussed 10 of these misconceptions with workshop participants at the
HAPS 2012 meeting (Wright et al. 2013, 2015). Here, we will focus on only three of
the most common student misconceptions about homeostasis.
In Chaps. 9 and 10, we address the creation of learning resources and the various
classroom practices that can help students correct their flawed mental models of
homeostasis and the other core concepts.
5.5.1 Everything Is Regulated
One of the more common misconceptions is that the body regulates all physiolog-
ical variables in order to keep the body in balance. This would mean that there are
sensors (receptors) for all physiological variables since a physiological variable can
only be regulated if the body has a sensor that can measure the value of that
variable.
This is, of course, not the case. To consider just one organ system, the body
cannot measure heart rate (although it can be controlled), stroke volume, or cardiac
output.
The source of this misconception is probably the very emphasis that we place on
the existence of homeostatic regulation of some physiological variables and the
natural tendency to generalize to all those variables that do not get discussed in the
course.
5.5.2 Homeostasis Is an ON/OFF Switch
Another common misconception is that homeostasis is like an ON/OFF switch that

is only turned on when the regulated variable is not at its set-point value. This
represents a serious flaw in the students mental model since the output of the
effectors that determine the value of the regulated variable are continually being
determined by the output of the controller.
This misconception is often the consequence of using the home heating system
as a model for temperature regulation; such systems almost always do operate in an
ON/OFF fashion.
5.5.3 How Constant Is Relatively Constant?
Students often find it difficult to understand exactly what we mean when we say that
homeostatic mechanisms hold the regulated variable more or less constant over
time. This difficulty is compounded when they compare a graph of a normal
subjects blood pressure over time with a similar graph for blood glucose concen-
tration. The variations in blood pressure are very small, while for a normal
individual the swings in the concentration of blood glucose over the course of a
day are very large. So, what does that relatively constant mean?
Students need to understand that homeostatic mechanisms (1) result in swings in

the regulated variable that are smaller than would occur if the homeostatic mech-
anism was not operating, and (2) even when the swings in the value of the regulated
variable seem large, the regulated variable is being held within a range consistent
with normal functioning of the body.
5.5.4 The Set Point Can Change
Having been told that the set point is the value at which the regulated variable is to
be held, students may be confused when they encounter situations in which the set
point itself changes. For example, when an individual develops a fever, the increase
in body temperature is the result of the temperature set point being increased by
some pathology that is present. Similarly, there are conditions in which the set point
for blood pressure regulation is elevated leading to hypertension.
The explanation for these phenomena and others like them is that the set point is
the product of some physiological mechanism, and such mechanisms can have their
function altered in many different ways.
5.5.5 Not All Examples of Negative Feedback Are

Homeostatic
As students learn physiology, they encounter many examples of mechanisms that

contain negative feedback. However, not all of these examples of negative feedback
represent a homeostatic mechanism. A homeostatic system must contain all of the
elements we identified earlier in this chapter. In Sect. 9.4, we discuss a system with
multiple negative feedback loops, only some of which are examples of homeostasis.
5.5.6 The Hierarchy of Homeostatic Regulation
Many effectors play a role in more than one homeostatic mechanism. For example,
the respiratory muscles (the diaphragm and the intercostal muscles) are the effec-
tors that determine alveolar ventilation (V_ A) and hence the alveolar partial pressure
of carbon dioxide (PACO2). PACO2 in turn determines arterial partial pressure of
carbon dioxide (PaCO2). PaCO2 is a regulated variable, and changes in the activity
of the respiratory muscles maintain PaCO2 within the normal set-point values.
However, arterial hydrogen ion concentration is also a homeostatically regulated
variable, one with a number of effectors. Metabolic disturbances that alter arterial
hydrogen ion concentration thus generate compensatory changes to the activity of
the respiratory effectors and cause PaCO2 to change its value outside of the normal
respiratory set-point values.
Thus, we can say that as far as the respiratory muscle effectors are concerned,
there is a hierarchy of regulation with preservation of a normal hydrogen ion
concentration taking precedence over maintaining the set-point value of PaCO2.
5.6 Summing Up: Homeostasis
Homeostasis allows complex multicellular organisms to maintain an internal envi-

ronment (the extracellular compartment) that allows normal cellular function in the
face of changes in the external environment and changes in internal function. An
understanding of the core concept of homeostasis will provide students with a tool
for understanding the many homeostatic mechanisms that they will encounter as
they learn physiology.
References
Luckie D, Harrison SH, Ebert-May D (2011) Model-based reasoning: using visual tools to reveal
student learning. Adv Physiol Educ 35:5967
NJ
Michael J, McFarland J, Cliff W, Modell H, Wenderoth MP, Wright A (2013) Homeostasis in
undergraduate physiology textbooks. FASEB J 27:739.4. Abstract can be downloaded from
http://www.fasebj.org/content/27/1_Supplement/739.4. Poster available at: http://
physiologyconcepts.org under Publications/Abstracts
Modell H, Cliff W, Michael J, McFarland J, Wenderoth MP, Wright A (2015) A physiologists
view of homeostasis. Adv Physiol Educ 39:259266
Weaver DA, Kemm RE, Petrovic T, Gilding T, Harris PJ, Delbridge L (2002) Evolution of a
student model-building program. Adv Physiol Educ 26:288298
Wright A, McFarland J, Cliff W, Michael J, Modell H, Wenderoth MP (2013) Preliminary results
on the prevalence of physiology students homeostatic misconceptions. FASEB J 27:739.5.
http://fasebj.org/content/27/1_Supplement/739.5
Wright A, McFarland J, Wenderoth MP, Michael J, Modell H, Cliff W (2015) Knowing common
misconceptions about homeostasis helps students learning. FASEB J 541.34. Abstract can be
downloaded from http://www.fasebj.org/content/29/1_Supplement/541.34
Chapter 6
The Unpacked Core Concept of Flow Down
Gradients
Abstract The core concept of flow down gradients is also a general model of how
things, whether animate or inanimate, move in the physical world.
In this chapter, we present a conceptual framework of the core concept of flow
down gradients. We provide a visual representation of the critical components that
make up flow down gradients and provide definitions for all of the important terms
that appear in the unpacking. We describe specific examples in which this core
concept is applied in physiological systems. Finally, we discuss some of the aspects
of this core concept that are known to be difficult for students to master.
Keywords Flow Pressure Resistance Gradient Core concept Conceptual

framework
6.1 The Conceptual Framework for Flow Down Gradient
The conceptual framework for the core concept of flow down gradient is found in
Table 6.1 (Michael and McFarland 2011). Note that we have described the partic-
ular physiological phenomena to which each of the component ideas applies.
6.2 Flow Down Gradients: Terminology
Flow down gradients is a core concept, but it is also what Modell (2000) called a
general model. This term perhaps best describes the very important idea that the
phenomenon being referred to is applicable to an essentially all of the transport
process that are encountered in the body. Unfortunately, in each specific area of
applicability, the student is likely to encounter different terms for ideas that she
already understands. The result is the student begins a process of learning some-
thing she already understands. For this reason, it is particularly important that great
care be given to using an appropriate terminology in discussing this core concept. In
Table 6.2 (seen below), we have provided a glossary of the terms used in the
conceptual framework for flow down gradients.

DOI 10.1007/978-1-4939-6909-8_6
56 6 The Unpacked Core Concept of Flow Down Gradients
Table 6.1 Unpacking the core concept of flow down gradients (Michael and McFarland 2011)
F1. Flow is the movement of substances from one point in the system to another point in the
system.
F1.1 Molecules and ions can diffuse through a solution.
F1.2 Fluid (blood, chyme) and gases (air) are transported through tubes.
F1.3 Heat can move through objects.
F2. Flow occurs because of the existence of an energy gradient between two points.
F2.1 Differences in concentration (concentration gradients) cause molecules and ions in
solution to move down a gradient from high to low concentration.
F2.2 Differences in electrical potential (potential gradient) cause ions in solution to
move from high to low electrical potential.
F2.3 Differences in pressure (pressure gradient) between two points in a system cause
substances to move toward a region of lower pressure.
F2.4 Differences in temperature (temperature gradients) between two points cause heat
to flow from the hotter to the cooler location.
F3. The magnitude of the flow is a direct function of the magnitude of the energy gradient that
is presentthe larger the gradient, the greater the flow.
F4. More than one gradient can determine the magnitude and direction of flow.
F4.1 Osmotic (concentration gradient for water) and hydrostatic pressure gradients
together determine flow across the capillary wall.
F4.2 Concentration gradients and electrical gradients determine ion flow through chan-
nels in cell membranes.
F5. There is resistance or opposition to flow in all systems.
F5.1 Resistance and flow are reciprocally relatedthe greater the resistance, the smaller
the flow.
F5.2 The resistance to flow is determined by the physical properties of the system.
F5.3 Some resistances can be varied and can be actively (physiologically) controlled.
F5.3.1 Ion channels in a membrane can open and close changing resistance
(decreasing and increasing, respectively).
F5.3.2 Arterioles and bronchioles can constrict (increasing resistance) and dilate
(decreasing resistance).
F5.3.3 Pilo-erection can increase the resistance to heat flow in many animals.
6.3 A Visual Representation of the Core Concept of Flow

Down Gradients
Figure 6.1 is a representation of the flow down gradients core concept. The plus
sign (+) indicates that the relationship between the energy gradient and flow is a
direct one; as the gradient increases, the flow will increase. The minus sign ( )
indicates that the relationship between resistance and flow is an inverse one; as
resistance increases, the flow decreases.
The simplicity of the model for flow down gradients (Fig. 6.1) belies the great
power of this core concept to explain many important phenomena described in
physiology. What students need to recognize as they move from the topic of cell
membranes and ion transport to the cardiovascular system and blood flow and on to
the respiratory system and air-flow is that these are all the same phenomenon
although the labels are different.
6.3 A Visual Representation of the Core Concept of Flow Down Gradients 57
Table 6.2 Definition of terms used in the flow down gradient core concept
Term Definition
Bulk flow The movement of a solution in a system driven by pressure gradient. Any
solutes in the solution are carried in the solution as it moves.
Concentration The amount of a solute in a unit volume of solution.
Changes in either amount of solute, volume of solvent, or both will change
the concentration of the solution.
Diffusion The movement of solutes through a solution driven by the random motion of
the solutes. In the presence of a gradient, there will be a net movement of the
solute down the gradient.
Electrical The result of a charge gradient (difference in charge at two points). It is a
potential measure of electrical potential energy.
Energy A measure of a systems ability to do work.
Flow The movement of substances from one point in the system to another point in
the system.
The units of flow are thus amount of substance per unit time
Gradient A difference in the magnitude of the concentration, electrical potential,
pressure, or temperature between two points in a system.
Changes in the magnitude of a gradient can occur because a change in the
upstream and/or the downstream value or both
Hydrostatic Pressure in a fluid (liquid or gas) created by a vertical column (gravity) or by
pressure a pump.
Fluid flow in tubes is driven by hydrostatic pressure gradients.
Osmosis The movement of water down its concentration gradient.
An osmotic pressure gradient is commonly defined by the gradient of solute
particles (molecules or ions) in the two compartments.
Resistance The opposition to flow in a system. The resistance that is present is always a
function of the properties of the system.
Resistances can vary as the physiological state of the system changes.
Fig. 6.1 A visual

representation of the core
concept of flow down
gradients. Note that the plus
sign indicates a direct
relationship between two
variables and the minus sign
indicates an inverse
relationship
Table 6.3 Physiological phenomena to which the flow down gradients core concepts applies
What is Nature of Source of
moving gradient resistance Quantity of flow Examples
Molecules Concentration Area available Flux: mM/min for Oxygen
(uncharged) difference for diffusion uncharged molecules or Glucose
Number of chan- mEq/min for charged Na+
nels, pores, or molecules
transporters
Ions (atoms or Electrical Number of chan- Current: A/s Na+ and
molecules with potential; nel through K+
a net charge) charge which ions can
concentration pass
Fluids Difference in The properties of Flow: Blood
hydrostatic the medium and ml/s Oxygen
pressure; the structure L/min Chyme
difference in
osmotic
pressure
Heat Temperature Thermal proper- Cal/min Heat loss
difference ties of tissues at skin
6.4 In What Physiological Systems Does Flow Down

Gradients Apply?
Essentially, every physiological system at every level of organization exhibits

phenomena that involve the movement of things down gradients. The movement
of stuff into and out of cells as well as the movement of biological fluids in tubes
and vessels can all be described by the same relationship. Table 6.3 contains a brief
list of some of the phenomena for which the core concept of flow down gradients
applies.

Michael et al. (2002) assessed undergraduate students understanding of cardiovas-

cular phenomena. They found that across a large and diverse population of students,
there were identifiable misconceptions (faulty mental models) about pressure-flow
resistance relationships (flow down gradients) in the circulation.
6.5.1 Problems with Flow Down Gradients in the Circulation
In applying flow down gradients to the circulation, students encounter a number of

difficulties.
One problem that students have is attending to ONLY the upstream pressure
(or energy) and not the pressure (or energy) gradient. By failing to recognize the
downstream pressure, they ignore the fact that it is the gradient that determines flow
and not the absolute pressure.
Another common problem is assuming that flow is an important determinant of
resistance in a blood vessel. This error arises from the assumption that increasing
flow means the vessels will get larger, and hence resistance will decrease. However,
increasing flow through a vessel does not necessarily result in a change in vessel
volume or radius. Hence, this phenomenon is not an important determinant of
resistance to flow in the arterial compartment.
Students may also fail to understand that the downstream pressure is determined
by the resistance to flow that is present. Furthermore, the likelihood of these
misconceptions about cardiovascular phenomena being present was affected by
the students ability to apply a pressure-flowresistance general model (Modell
2000) to non-physiological systems.
6.5.2 Failure to Take into Account the Presence of Multiple

Gradients
There are many situations in which the flow of something is determined by two
different gradients. These two gradients may cause flow in the same direction
(in which case the flow is greater than would be present if only one gradient was
acting) or they can promote flow in opposite directions (in which case the direction
and magnitude of the resulting flow are determined by the difference between the
gradients).
For example, the flow of ions across a membrane is always determined by both
the concentration gradient across the membrane and the electrical potential gradient
that is present (the electrochemical gradient). At the capillary, the balance between
a hydrostatic gradient and the oncotic gradient that are present determines the
direction and the magnitude of the flow of water across the wall of capillary.
Students often disregard one or the other of these gradients in thinking about
how the substance under consideration will behave.
6.5.3 Recognizing Osmosis as an Example of a Core Concept
Osmosis is the movement of water between two compartments through a semiper-

meable membrane from a region of low concentration of solutes (high concentra-
tion of water) to a region of high concentration of solutes (low concentration of
water). In osmosis, water is diffusing down its own concentration gradient. Osmosis
is thus one example of flow down gradients. However, students frequently simply
memorize a definition of osmosis without recognizing that it is simply one example
of a core concept. Thus, students may fail to recognize all of the features of flow
down gradient (see Table 6.2) that apply to osmosis.
6.5.4 Molecules Diffuse Independently of One Another
Many students believe that oxygen crosses the alveolarcapillary barrier coupled to
the movement of carbon dioxide in the opposite direction. The error has two
possible sources: (1) it is often said that there is an exchange of oxygen and carbon
dioxide which students think implies a coupling mechanism and (2) failure to
recognize that each gas is diffusing down its own concentration (partial pressure)
gradient. Molecules in solution and the gases making up air diffuse independently
of one another.
6.5.5 The Presence of a Gradient Does Not Mean that Flow

Will Occur
Movement of things into and out of cells (ions, amino acids, glucose, etc.) does not
always occur in the presence of a concentration gradient. If the cell membrane is
impermeable to the substance (equivalent to the resistance to flow being infinite),
no flow can occur. In the case of ions, flow down gradient may require the presence
of open channels; in the case of glucose or amino acids, flow requires the presence
of transporters in the membrane. Students must think about both the gradient and
the opposition to flow (resistance, permeability).
6.6 Summing Up: Flow Down Gradients
Flow down gradients is a concept that describes how things move in the world,
whether inanimate or animate. It is a core concept of physiology that applies to
every level of the organism, from transport across cell membranes to the flow of
blood in the circulation and the flow of gas in the airways. Students will encounter
References 61
this concept in systems that seem very different. If they understand the core
concept, understanding each of these seemingly disparate systems will be much
easier.
References
Silverthorn D, Williams S, Whitescarver S (2002) Undergraduates understanding of cardio-
Chapter 7
The Unpacked Core Concept of CellCell
Communication
Abstract Cellcell communication focuses on how cells generate and

receive messages from other cells. Cells do not live in isolation. Cell survival and
normal functions depend on collecting and responding to information from
other cells. Only in this way can a complex, multicellular organism carry out all of
its many functions.
In this chapter, we present a conceptual framework of the core concept of cell
cell communication. We provide a visual representation of the critical components
that make up cellcell communication and provide definitions for all of the impor-
tant terms that appear in the unpacking. We describe specific examples in which
this core concept is applied in physiological systems. Finally, we discuss some of
the aspects of this core concept that are known to be difficult for students to master.
Keywords Communications Information Receptors Cells Chemical

messengers
7.1 A Conceptual Framework for CellCell

Communication
Cellcell communication was ranked the third most important core concept in the
study reported by Michael and McFarland (2011).
Table 7.1 is the conceptual framework for cellcell communication. We pro-
pose the conceptual framework as a way to organize material to enhance teaching
and learning. This framework is hierarchical in that it places details in context and
nests related concepts. The framework can be used to help physiology students to
form their own accurate mental models (Modell 2000) and to create enduring
understanding of component ideas.

DOI 10.1007/978-1-4939-6909-8_7
64 7 The Unpacked Core Concept of CellCell Communication
Table 7.1 The conceptual framework for the core concept of cellcell communication (Michael
et al. 2016)
CC1 A cell synthesizes and releases a chemical messenger.
CC1.1 A cell synthesizes a messenger molecule.
CC1.2 Messenger molecules can be proteins (or peptides), steroids, or amines.
CC1.3 The rate of release of a messenger from a cell is determined by the sum of the
stimuli for release and the stimuli that inhibits release.
CC1.4 Chemical messengers are present at very low concentrations in the blood
compared to other biologically active molecules such as ions and nutrients.
CC1.5 The greater the net stimulus for release, the higher the rate of release of the
messenger.
CC1.6 Cells release messengers by exocytosis or diffusion across the cell membrane.
CC1.7 Cells that release messengers can be anywhere in the body.
CC2 Transport of messenger molecules is determined by the chemical nature of the messenger.
CC2.1 The solubility of the molecule determines how it is transported to its target cells.
CC2.1.1 Protein/peptide and amine messengers are generally water soluble
and are transported in solution.
CC2.1.2 Steroid messengers are lipid soluble and are transported bound to
protein carrier molecules in the blood.
CC2.1.3 Some amine messengers are transported bound to transport proteins,
and others are carried in solution.
CC2.2 The extracellular fluid concentration of a messenger molecule depends on the
balance between production/release and elimination of the messenger.
CC2.3 Only the messenger in solution and free to diffuse is biologically active.
CC3 The messenger must bind to a receptor protein in or on its target cell to produce a
response.
CC3.1 Each messenger molecule can only bind to a specific receptor molecule. Binding
of a messenger to its receptor is a probabilistic event.
CC3.2 A cell can only respond to a messenger for which it has receptors.
CC3.3 The solubility of the messenger determines the location of its receptor protein
in/on the target cell.
CC3.3.1 Water-soluble messengers have receptors that are on the target cell
membrane.
CC3.3.2 Lipid soluble messenger have receptors that are inside the target cell,
usually in the nucleus but in some cases in the cytoplasm as well.
CC3.4 The number of receptors for a particular messenger can be relatively small or
relative large and is variable.
CC3.5 There can be more than one type of receptor for the same messenger on different
target cells.
CC3.6 Thus, the same messenger can produce different responses in the same type of
target cells wherever they may be in the body.
CC3.7 Cells have a large variety of different receptors, thus enabling them to respond
to a large number of different messengers.
(continued)
7.1 A Conceptual Framework for CellCell Communication 65

CC4 Binding of the messenger molecule to its receptor gives rise to signal transduction.
CC4.1 A single messenger molecule bound to its receptor can activate or alter many
more molecules in the target cell; this is called amplification.
CC4.1.1 Because target cell response is a multistep process and amplification
occurs at each step, a single molecule can activate or alter many more
molecules; the more steps in the intracellular signaling process, the
greater the amplification can be.
CC4.1.2 Given that messenger molecules are scarce, if the signal is not
amplified, it will have little physiological effect.
CC4.1.3 Because the target cell response is a multistep process, there are
many points at which different inputs (other messengers) can modify
the outcome/response. This is referred to as integration.
CC4.2 Because the target cell response is a multistep process, a particular messenger
molecule can have more than one effect in a target cell.
CC4.3 There are two basic mechanisms for transduction, both of which result in
amplification.
CC4.3.1 Binding of a messenger molecule to its receptor can activate a
cascade of intracellular second messengers which result in altered
enzyme activity.
CC4.3.2 Binding of a messenger molecule to its receptor can alter the pro-
cesses of translation and transcription in the cell nucleus, thus alter-
ing the concentration of a specific enzyme in the cell.
CC4.3.3 The speed of the response of the two systems is different.
CC4.3.3.1 The speed of response in a second messenger system is
fast since second messenger molecules are already
present in the cell.
CC4.3.3.2 The speed of response in transcription and translation
systems is slower because new molecules have to be
synthesized.
CC4.3.4 Persistence of the response to messenger molecules also differs.
CC4.3.4.1 In second messenger systems, the half-life of the mol-
ecules that get activated is short, and the response can
be terminated quickly.
CC4.3.4.2 In translation-/transcription-based systems, the half-life
of the molecule (proteins) produced is longer, so the
responses persist longer.
CC5 Binding of the messenger molecule to its receptor alters cell function.
CC5.1 The response of the target cell is a function of the target cell and not the
messenger molecule. That is to say, the response to a given messenger is
determined by the physiology of the target cell.
CC5.2 Alteration of target cell function is always the result of altering enzyme activity,
whether caused by second messenger alteration of enzyme activity or by
changes in translation/transcription causing the appearance of more enzyme
molecules.
CC6 Termination of a messenger signal is accomplished in several ways.
CC6.1 The messenger signal goes away because the messenger molecule is no longer
released or it is broken down.
CC6.2 The messenger molecule is removed from the receptor.
CC6.3 The receptormessenger complex is internalized and ceases to generate a
signal.
(continued)

CC7 Some cells can communicate with neighboring cells electrically; they are electrically
coupled.
CC7.1 Electrically coupled cells have gap junctions that span their two membranes.
CC7.2 Current can flow from one cell, when electrically excited, to neighboring cells.
CC7.3 These currents then electrically excite the second cell.
Fig. 7.1 A visual representation of the core concept of cellcell communication
7.2 A Visual Representation of the Core Concept

of CellCell Communication
Figure 7.1, below, illustrates a model of cellcell communication. This model, like
all general models (Modell 2000), applies in a great many physiological contexts.
It makes no attempt to encompass all of the details, but it does show the relationships
between the major ideas. As with the other two models (Chaps. 5 and 6), the boxes
can serve as folders in which students can associate the new information they acquire
with the relevant components of the system. Students can also use the model to solve
problems.
7.4 Where Is CellCell Communication Applicable? 67
7.3 CellCell Communication: Terminology
Cellcell communication is a core concept in physiology (Michael and McFarland

2011). As was pointed out in Chap. 5 (homeostasis) and Chap. 6 (flow down
gradients), it is essential that a clearly defined set of terms be used in teaching
and using this core concept.
Cellcell communication describes the very important idea of how cells com-
municate with one another, which is necessary for the survival of the organism.
This topic draws on many disciplines for its foundational ideas and in turn
contributes to many disciplines. As a consequence of this, the student is likely to
encounter different terms used to describe the same idea in different contexts. Since
this is the case, instruction must include the use of the appropriate terminology in
discussing this core concept, and the same terminology must be used throughout the
course. Table 7.2 is a glossary of the terms used in the conceptual framework for
cellcell communication.
7.4 Where Is CellCell Communication Applicable?
It has been reported (Bianconi et al. 2013) that the human body is made up of 37.2
trillion cells and that there are hundreds of different types of cells (Mescher 2016).
Each of these types of cells, while they have the same DNA, expresses different
genes and carries out different functions. This myriad of functions must be coordi-
nated so that the organism is able to maintain a more or less constant internal
environment. That is to say, life can only be maintained through the coordinated
activity of all the cells of the body. This coordination takes place via the transmis-
sion of messages between cells. The cellcell communication conceptual frame-
work describes the components of this kind of information processing system.
In the human body, cellcell communication commonly occurs by the
nervous system (in which neurons release transmitters that alter the function of
adjacent cells that have receptors for those transmitters) or by the endocrine system
(in which hormones are produced and released and travel throughout the body to
bind to receptors on target cells).
Thus, the answer to the question of where the core concept of cellcell commu-
nications is applicable is EVERYWHERE!
Table 7.2 Terminology for cellcell communication core concept

Term Definition
(Chemical) A molecule produced and released by a particular cell that carries infor-
Messenger mation to target cells. The binding of the messenger molecule to a receptor
on or in the target cell causes a change in the function of that cell.
Amplification Binding of a messenger molecule to a cell receptor gives rise to a cascade of
second messengers in the cell, or the production of many enzymes, that
alters cell function. One molecule thus engages a great many molecules in
altering target function.
Biological The change in target cell function that is initiated by the receipt of the
response messenger. This may include the generation of a new function, the cessa-
tion of an existing function, or a change in the magnitude of an existing
function.
Cell function All of the myriad of processes that are ongoing in a cell. Many are general
to all cells and many represent specialized processes. Cell functions are
altered in response to chemical messengers, thus giving rise to a biological
response.
Enzyme Enzymes are biological catalysts; the activity of which is essential for the
chemical reactions that make up a cells metabolism to proceed. The
activity of an enzyme is a function of its concentration (how much is in the
cell) and the state of the enzyme molecule (which can be altered by second
messengers).
Receptor A protein molecule in the target cell membrane or nucleus to which a
particular messenger molecule can bind. When the messenger binds to a
receptor, signal transduction and amplification occur. A change in cell
function, a biological response, then occurs.
Second Molecules that relay signals received at receptors on the cell surface (the
messenger binding of messenger molecules) to other molecules in the cytosol and/or
nucleus that ultimately alter enzyme activity.
Signal The process by which incoming messages are conveyed to the target cells
transduction interior where amplification can occur.
Target (Target A cell that has receptors for a particular chemical messenger molecule and
cell) can thus respond (change its function) when the message is received.
Termination For proper control of signaling, there must be a means of terminating the
(of signal) signaling. In all cases, once the messenger molecule dissociates from the
receptor, the signal ends.
Transcription Process of building a RNA copy of a gene sequence on DNA. The copy is,
simply put, a messenger RNA (mRNA) molecule. mRNA leaves the
nucleus and in the cytoplasm is involved with assembling proteins that
function as enzymes.
Translation Process of translating the sequence of a transcribed messenger RNA
(mRNA) molecule to a sequence of amino acids during protein synthesis.
The proteins assembled are often enzymes that produce the biological
response triggered by the messenger.
Transport The chemical messenger molecules that are synthesized and released from
cells must reach their targets. In some instances, this occurs by simple
diffusion through the extracellular compartment. In other instances, the
messenger is transported around the body in the blood. Messenger mole-
cules that are lipid (not water) soluble are transported in the blood bound to
transport proteins.

The study of cellcell communication occurs in many different biological disci-

plines, such as developmental biology, neurobiology, endocrinology, and physio-
logy. Students will learn many component ideas (see Table 4.1) of cellcell
communication in a number of different courses. It is thus important that instruc-
tion about this core concept is accurate and consistent across the curriculum. We
will have more to say about the use of core concepts in building the curriculum in
Chap. 12.
7.5.1 What Is Information?
Both the endocrine and the nervous systems are information processing systems.
Information is a term with a precise scientific meaning and a much looser
meaning in everyday conversation. As a consequence, students are often confused
by what is meant by information in the organism.
The signals that pass from cell to cell are examples of information. The
presence of the messenger molecule attached to a receptor means something to
the target cell. For example, when a molecule of insulin binds to the receptor on the
membrane of a skeletal muscle cell, it means that blood glucose is higher than it
ought to be (higher than the set point). That information directs the cell to incorpo-
rate glucose transporters into its membrane metabolism, increasing the influx of
glucose into the cell, thereby causing blood glucose concentration to decrease.
The insulin molecule does not itself alter cell metabolism, it does not provide a
substrate used by the cells metabolism, and it does not itself provide metabolic
energy for use by the cell. Insulin simply tells the cell that something has happened.
As with many of the other difficult topics we have discussed here, teachers can
help students by explicitly addressing this issue and clarifying the issues that arise.
We will discuss in later chapters how teachers can accomplish this in the classroom.
7.5.2 The Central Role of Enzymes
The final common pathway for most cellcell communications systems is the alter-
ation or modulation of the activity of intracellular enzymes. When enzyme activity
changes, metabolism changes in some way, and these changes in metabolism con-
stitute the biological response that the target cell generates when stimulated by the
messenger.
Thus, it is essential that students have some understanding (perhaps only a
limited one) of enzymes, what they are, how they work, and why they are important.
Enzymes are molecules that speed up a specific chemical reaction. Some mole-
cule called the substrate undergoes a change (a chemical reaction) because of the
presence of an enzyme. The resulting molecule is called the product. Second
messengers are enzymes that can alter other enzymes. These changes then cause
the metabolic pathways in the target cells to change. These changes are the response
of the target cell to the messenger molecule.
Because enzymes are usually protein molecules whose complex shape deter-
mines their function, very small structural changes to an enzyme will change their
function.
7.5.3 What Is a Response?
Students are likely to see the contraction of a muscle, the lowering of blood glucose
after a meal, increased activity of osteoblasts, and the secretion of gastric acid as
categorically different events. However, they share two things: (1) the occurrence
of each is the result of the communications of information via some kind of cell
cell interaction, and (2) each is the result of changes in enzyme activity in the target
(responding) cell.
Teachers, like all people, tend to assume that what they know everyone else
knows. That is to say, teachers often assume that students see the common features
of things just as they see them. Here too, then, the key is for teachers to be as
explicit as possible in order to help students see the commonalities where they exist
and to help students look at these commonalities on their own.
7.5.4 Properties of Receptors
Students are often confused when they encounter the term receptor because that
word is used to describe two fundamentally different kinds of structures. In
studying functions of the nervous system, they learn about several different kinds
of cells that function to convert some physical stimulus into a neural signal
(depolarization or action potential): mechanoreceptors, stretch receptors, touch
receptors, etc. Each of these is a discrete cell.On the other hand, the term receptor
also is used to refer to protein molecules in cell membrane or in the nucleus that
bind specific chemical messengers and thereby trigger a response from the target
cell. These two kinds of receptors are functionally quite different, and they have
very different properties.
In talking about cellcell communications, we are, of course, talking about
receptors as proteins that bind specific messenger molecules. These receptors
have some important properties that must be understood. First, their function is
dependent on their shape, and this can be altered in a variety of ways so that the
receptor does not function normally.
In addition, there are many receptor molecules of a particular kind on every

target cell, and the strength of a response depends on the number of receptors
available that bind a messenger molecule. But receptor expression is usually
dynamicchronic stimulation of receptors often results in decreased numbers of
receptors (downregulation), while under-stimulation causes an increase in the
number of receptors (upregulation). There are many practical examples of this
process, for example, long-term stimulation of beta-1 and beta-2 adrenergic recep-
tors causes their numbers to decrease (with profound effects on asthmatics and
people in heart failure), while denervation of some structures may cause upregu-
lation and modification of receptors to a point where even mild stimuli cause
substantial responses (e.g., in achalasia and also in spinal cord injury).
7.5.5 The Number of Receptors on a Target Cell Is Small

(1 to Few)
Students commonly respond to questions or problem as if they believe that cells

have small number of receptors, in some cases implying that there is a single
receptor for each chemical messenger. This misconception probably arises from
the fact that few textbooks explicitly discuss the binding of a messenger molecule to
a receptor is a probabilistic event, and that number of receptors that are present for
any system, even when they describe processes of up- and downregulation that can
change that number.
7.5.6 The Response to a Messenger Is a Property

of the Messenger Itself
In spite of the fact that teachers and textbooks list the many different responses that
can be elicited by a particular autonomic transmitter (acetylcholine) or hormone
(cortisol), students often retain the misconception that it is only the nature of the
messenger molecule that determines the response that will be generated. A conse-
quence of this misconception is that students then find it difficult to understand the
varied responses to insulin that are involved in the regulation of blood glucose
concentration.
7.5.7 Chemical Messengers Act Independently of One

Another
Students may believe that each chemical messenger generates a unique response in
each of its target cells. They think that if a tissue is innervated by sympathetic and
the parasympathetic neurons, then each type of input produces a unique response.
They might also believe that if a cell responds to many hormones (has receptors for
many hormones), then each hormone produces a distinctive response in the
target cell.
What students fail to understand is that each postsynaptic cell is a device that
adds up the inputs it receives from multiple messengers, and the net result deter-
mines whether the postsynaptic cell fires an action potential or not. Similarly, a
skeletal muscle cell has receptors for many hormones that alter the cells metabo-
lism, and hence the results of stimulation depend on a summing up of all of the
inputs it is receiving.
7.5.8 Responses to Messengers Are All-Or-None
Perhaps because students know that the action potential is all-or-nor, they assume
that the responses to all chemical messengers are all-or-none. This is, of course,
incorrect even for neurons. While action potentials are all-or-none, the response of
neurons to synaptic inputs is graded; spatial and temporal summation of synaptic
inputs is required to excite a neuron. Similarly, the responses generated by hor-
mones acting on their target cells are graded; the more the receptors occupied
(which usually means the higher the concentration of hormone reaching the target),
the bigger the response.
7.5.9 The Nervous System and the Endocrine System Operate

in Fundamentally Different Ways
For many students, the obvious differences, anatomical, histological, and func-
tional, between neural systems and endocrine systems obscure the similarities in
function between the two systems. This is, of course, the message that is meant to be
conveyed by the core concept of cellcell communications. Both systems
operate by sending out chemical messenger molecules that, if they bind to a
specific receptor, trigger a response in the target cell.
References 73
7.6 Summing up: CellCell Communication
The many cells making up the body must coordinate their functions in order to
maintain the life of the organism. Cellcell communication is a core concept of
physiology that describes the complex processes that underlie this interaction
between cells. Whatever physiologic topic the students attempt to understand,
their understanding of this core concept will provide a tool to facilitate their
learning.
References
Bianconi E, Piovesan A, Facchin F, Beraudi A, Casadei R, Frabetti F, Vitale L, Pelleri MC,

Tassani S, Piva F, Perez-Amodio S, Strippoli P, Canaider S (2013) An estimation of the
number of cells in the human body. Ann Hum Biol 40:463471
Mescher A (2016) Junqueiras basic histology, 14th edn. McGraw-Hill Education, New York
Michael J, McFarland J (2011) The core principles (big ideas) of physiology: results of
faculty surveys. Adv Physiol Educ 35:336341
Michael J, Cliff W, McFarland J, Wright A, Modell H, Martinkova P (2016) Conceptual framework
for the core concept of cell-cell communications. FASEB J 30:553.20. Abstract can be down-
loaded from http://www.fasebj.org/content/30/1_Supplement/553.20.abstract?side8687de1-
2b4f-4cdd-ad3c-412cc2d6c7fc. Poster available at http://physiologyconcepts.org. Under Publi-
cations/Abstracts
Modell HI (2000) How to help students understand physiology? Emphasize general models.
Part III
Implementing the New Paradigm for
Teaching Physiology
Chapter 8
Organizing an Introductory Physiology
Course Based on Core Concepts
Abstract We begin by defining a typical sequence of topics that make up an

introductory physiology course. We then describe how one might introduce stu-
dents in the course to the core concepts and general models. We then discuss how to
revisit the core concepts as they occur in the physiology being learned. What is
essential is the use of consistent terminology and visual representations of the core
concepts. It is also essential that the learning objectives (the definition of what is
required for student mastery) include the recognition and use of the core concepts.
We end with a discussion of the time constraints that are associated with every
course while at the same time adding an emphasis on the core concepts.
Keywords Physiology course Core concepts
Whether you teach a first-year introductory anatomy and physiology course, a

medical physiology course for first-year medical students, or a course somewhere
in the middle, focusing your course on the core concepts of physiology will require
changes be made to the way you think about your current course.
The issue is not about the physiology content of the course, although we will
address this below. It is about building into your course the consistent use of the
core concepts as learning tools for your students. The steps to be taken may not
directly change your course content, but they will result in changes to the way in
students learn (master) the content you expect them to master.
8.1 Organizing an Introductory Physiology Course
It will perhaps be most useful to illustrate the processes we are talking about by
describing how an introductory physiology course can be organized in order to
incorporate a focus on the core concepts of physiology (see Chap. 3).
Typical courses of this kind, and the textbooks that are assigned, follow a more
or less common sequence of topics: chemistry of the body, cells and their functions,
the nervous system, muscle, cardiovascular physiology, respiratory system, the
kidneys, digestive system, endocrine system, regulation of metabolism, and repro-
ductions. Not every textbook or course is organized in exactly this way; topics such

DOI 10.1007/978-1-4939-6909-8_8
78 8 Organizing an Introductory Physiology Course Based on Core Concepts
as the endocrine may come early or late in the sequence or there may be other
deviations from the pattern we are assuming. However, for our purposes, the
sequence defined here will provide us the structure we need to discuss how to
incorporate the core concepts of physiology.
8.2 Introducing the Core Concepts of Physiology
We, and a cohort of physiology teachers, identified 15 core concepts of physiology

(see Chap. 3). While it is clear that all of the core concepts are of some importance,
this same cohort told us that homeostasis (Chap. 5), flow down gradients (Chap. 6),
and cellcell communication (Chap. 7) were the three most important ones. Thus,
we will be describing how we would incorporate these three core concepts into a
physiology course.
It is unlikely that you will want to incorporate all of the 15 core concepts in your
course. Thus, the first task is to select which of the core concepts (in addition to the
first three) you will introduce in your course. It is worth noting that the three
identified as being most important appear, in one way or another, in essentially
every physiology textbook and course. If others are to be introduced as well, they
will have to be selected to meet the learning needs of your students in your course.
The next issue is how to introduce your students to the set of core concepts you
have selected. There are two ways in which one might do this.
8.2.1 Introduce the Core Concepts at the Beginning

of the Course
It is not uncommon for physiology textbooks and courses to begin with an intro-
ductory unit that focuses on broad biological topics. Homeostasis is one such topic
that is likely to be included in such a section. The issue, though, is how to introduce
this and the other core concepts in a way that will help students gain an under-
standing of them.
There are two answers to this question. First, the core concepts, like everything
else you want your students to master, must be taught in an active learning
environment. Second, if you expect students to achieve some particular level of
mastery of the core concepts (whichever ones you select), this must be clearly
communicated in your learning objectives/learning outcomes. It follows, then, that
you must assess students mastery of whatever you have included in your learning
outcomes.
Below, we will discuss how you can build on this initial exposure to the core
concepts as the course moves from topic to topic.
8.3 Revisiting the Core Concepts Wherever They Apply to a Physiology Topic 79
8.2.2 Introduce the Core Concepts as the Students First

Encounter Them
An alternative approach to introducing the core concepts is to focus on each one as

they first become applicable to the physiology being studied. Since most courses
begin with a consideration of basic cell function, flow down gradients is probably
the first core concept that students will encounter. The passive movement of
molecules into and out cells is driven by a concentration gradient (energy gradient).
The passive movement of ions is driven by the electrochemical gradient that is
present. In either case, the opposition to flow, the permeability or resistance,
determines the flux that will result for any given gradient. As this core concept is
developed, it is essential to point out that exactly the same relationship describes the
movement of blood in the circulation and the movement of gas in the airways. It is
also important to help students recognize that many core concepts (e.g., flow down
gradients) are encountered in everyday life.
Where you choose to introduce each of the core concepts you have selected for
incorporation in your course will clearly depend on the sequence of topics you
present in your course and where you think it will be didactically most useful to
your students.
8.3 Revisiting the Core Concepts Wherever They Apply

to a Physiology Topic
Perhaps the most important tactic in helping students develop an understanding of,
and the ability to apply, the core concepts is explicit and consistent repetition of
their use.
8.3.1 Consistent Terminology
One problem that students encounter in every textbook is the lack of consistency in
the terminology that they encounter as they move from organ system to organ
system. Some of this simply reflects the fact that different domains in physiology
use different terms to describe the different systems being studied, and some
differences reflect historical conventions that have arisen. Take the core concept
of homeostasis as an example. After the initial development of the concept and the
introduction of terms such as sensor and error signal (see Chap. 5), later discussions
of specific homeostatic mechanisms (i.e., regulation of blood pressure, regulation of
blood glucose) generally present students with different terminologies. In talking
about blood pressure regulation, students do not necessarily recognize that the
carotid baroreceptor is the sensor in a homeostatic mechanism. Thus, it is not
hard to understand why students usually do not see the connection between the core
concept of homeostasis that they learned earlier in the course and the phenomenon
of blood pressure regulation.
It is therefore important that the teacher uses a consistent terminology in
discussing phenomena where one or more of the core concepts are applicable. It
is also essential that the teacher explicitly relate new, system-specific terms to the
more generic terminology used in discussing core concepts.
8.3.2 Consistent Visual Representations
A similar problem arises when we think about the visual representations that are
used in describing different systems. Each of the core concepts we have discussed
can be represented visually (see Chaps. 5, 6 and 7), and for many students such
visual representations are powerful learning tools.
But as with terminology, the visual representations the students are likely to see
as they study the various organ systems are different from the canonical represen-
tations they saw initially. Thus, it is hard for the students to see that the system they
are now studying is like the system they saw several weeks ago.
Thus, it is important for the teacher to either generate visual representations that
make clear the connection between the physiology being described and the canon-
ical version or at least call to the students attention that the systems are essentially
identical.
Michael et al. (2013) and Wright et al. (2014) have discussed the visual repre-
sentations of homeostasis that are found in common textbook (and presumably used
by faculty) and discussed the problems that these representations create. In Chap. 5,
you can see the representations created by Modell et al. (2015) that we believe are
more correct and more useful.
8.3.3 Requiring the Students to Actively Recognize Where

the Core Concepts Apply
The learning phenomenon we have been discussing is referred to as the transfer

problem in the learning sciences (Perkins and Salomon 1992; Bransford et al. 1999;
Wiggin and McTighe 2005). It is a general problem in teaching and learning at all
educational levels and in all disciplines.
How does one facilitate students learning to transfer what they have learned in
one context into a second, different context? One answer is practice (with appro-
priate feedback)! We need to create learning resources (see Chap. 10) with which
students are required to practice recognizing core concepts or general models and
then using them to solve a problem. We also need to be sure that our learning
8.6 The Long-Term Goal 81
outcomes include requiring a demonstration of this skill and that we then assess
whether our students have achieved the level of competence that we define.
8.3.4 Requiring Students to Use the Core Concepts
If students are to develop the ability to use core concepts as an aid to learning and
understanding physiology, we have to explicitly expect them to learn to recognize
where they are applicable and learn to use them. This means that we must provide
them with opportunities to practice these skills. In Chap. 10, we discuss how to go
about writing such resources and present some examples of exercises that help
students accomplish this.
8.4 Aligning Your Learning Outcomes and Learning

Objectives with the Focus on Core Concepts
If you want your students to become proficient at using core concepts to understand
physiology, it is essential that your learning objectives (what students need to
know) and learning outcomes (what students can do) clear descriptions of which
core concepts are to be mastered and how the students are expected to use them.
It is also essential that your learning objectives and outcomes incorporate the use
of the core concepts into their mastering of the physiology content of your course.
8.5 Assessing Student Mastery of the Core Concepts
Having established your learning objectives and learning outcomes, it is essential

that your assessments, whether formative or summative, determine whether stu-
dents have mastered the core concepts and their application in physiology. We will
have more to say about assessment in Chap. 11.
8.6 The Long-Term Goal
In Chap. 1, we discussed what we mean by core concepts or big ideas. One point
that we made is that mastery of the core concepts can be expected to have a benefit
long after the students have completed your course. This should be evident in
subsequent physiology courses where students should be able to apply what they
have learned in your course to the new and more complex material they are being
asked to master in more advanced courses (see Chap. 12 on core concepts and the
physiology curriculum).
If students truly master the core concepts of physiology, we can hope that in
5 years or more, long after they have forgotten the details of many physiological
mechanisms, they will still be able to think about physiology and use that
understanding.
8.7 How to Do It All in the Available Time and with

the Existing Constraints?
We recognize that the above recommendations, and those to be found in the next
chapter, would seem to require additional course time, when you already are facing
the task of accomplishing everything that needs to be accomplished in too
little time.
However, the power of the core concepts as learning tools lies in their general-
izability, the fact that they apply to a great many of the physiological phenomena
that you are asking your students to learn. Having learned about flow down
gradients in the section on cells and their properties, learning about the flow of
blood down a pressure gradient should be easier and quicker. And when they have
to learn about the flow of gas down a pressure gradient in the airways this should be
easier still. There will be new structures to learn about and perhaps some additional
wrinkles that are relevant, but the basic idea is the same in all three instances.
Similarly, if your students understand homeostasis as a core concept, then learning
about the regulation of [K+] or [Ca2+] does not require them to learn a totally new
set of mechanisms.
Similarly, your students will be able to learn to solve physiological problems
quicker since the core concepts provide a set of tools for approaching even difficult
problems. With a greater command of the facts and a greater facility at using the
facts to solve problems, students will be able to advance toward mastery of your
learning goals and outcomes more quickly.
In short, we are proposing that an approach to teaching physiology that is
focused on the core concepts your students will become more effective and more
efficient learners.
References
Bransford JD, Brown A, Cocking RR (eds) (1999) How people learn: brain, mind, experience, and
school. National Academy Press, Washington, DC
undergraduate physiology textbooks. FASEB J 27:739.4. http://www.fasebj.org/cgi/content/
References 83
meeting_abstract/27/1_MeetingAbstracts/739.4. Poster homeostasis-textbook-poster-eb2013.

pdf. Additional materials textbooks_used_in_study.pdf
Modell H, Cliff W, Michael J, McFarland J, Wenderoth MP, Wright A (2015) A physiologists
view of homeostasis. Adv Physiol Educ 39:259266
Perkins DN, Salomon G (1992) Transfer of learning. In: International encyclopedia of education,
Pergamon Press, Oxford
Wiggin G, McTighe J (2005) Understanding by design, expanded, 2nd edn. Association for
Supervision and Curriculum Development, Alexandria, VA
Wright A, Michael J, McFarland J, Modell H, Cliff W, Wenderoth MP (2014) What visual
representations of homeostasis do faculty use? FASEB J 28:531.14. Abstract can be
downloaded from http://www.fasebj.org/content/28/1_Supplement/531.14
Chapter 9
Teaching Physiology Using the New
Paradigm: Three Examples
Abstract In this chapter, we illustrate how three important topics included in

every introductory course can be taught using the new paradigm. The three topics
are (1) short-term regulation of blood pressure, (2) generating a tidal volume, and
(3) the hypothalamic-anterior pituitary axis.
For each of these topics, we will (1) describe the context within the course of this
topic, (2) describe the content of this topic, (3) define the learning objectives or
learning outcomes, (4) discuss how one can assess student understanding of the
material, and (5) discuss how to help students master this topic.
Keywords Conceptual framework Blood pressure Tidal volume

Hypothalamic-pituitary axis
In this chapter, we illustrate the core concepts paradigm by showing how it can be
used to teach three topics found in every introductory physiology course. We will
do this by first defining a topic and then providing a description of how one can
teach this topic using core concepts as the organizing scaffolding.
Our examples will be structured according to the backwards design paradigm
(Wiggins and McTighe 2005). We will explain the context in which it might occur
in a typical course. Next, we will describe the content of the topic. We will then
describe the learning outcomes and learning objectives for the topic and what the
students are expected to know and be able to do at the conclusion of the topic.
Then we will discuss how to assess whether students have mastered the described
learning outcomes. Finally, we will describe some learning activities to help
students build the required mental models based on the application of core
concepts.
9.1 The Foundations of Our Approach to Teaching
How we teach is informed by our beliefour mind-setthat the goal in our class-
rooms must be meaningful learning, that students must learn in a setting that allows
them to build, test, and refine their mental models, and all this must occur in an
active learning environment (Michael and Modell 2003).

DOI 10.1007/978-1-4939-6909-8_9
86 9 Teaching Physiology Using the New Paradigm: Three Examples
9.1.1 Meaningful Learning
Meaningful learning (Michael 2001; Simon 2001)learning with understanding

has occurred when the learner can use what they have learned to do something. In a
physiology course, this typically means solving problems (Michael and Rovick
1999). Meaningful learning requires both the acquisition of knowledge and the
development of the skills needed to use that knowledge. Memorization and the
ability to recognize or recall acquired knowledge is an important component of
learning physiology, but it is not per se the desired learning goal.
9.1.2 Active Learning: BuildTestRefine Mental Models
Meaningful learning is most likely to occur in an active learning environment

(Michael and Modell 2003). In such an environment, students are challenged to
build mental models of the phenomena being learned, test their models by solving
problems, and then refine or correct their models. An active learning environment is
one in which students engage the content while interacting with one another and
with the instructor. It is a student-centered environment. Such learning environ-
ments have been repeatedly demonstrated to facilitate student learning (Michael
2006).
9.1.3 Learning Outcomes for this Topic
What exactly do we mean by learning outcomes and learning objectives?

The Teaching & Learning Laboratory of MIT provides a useful definition on their
website (tll.mit.edu):
It may be best to start with what intended learning outcomes arent. They arent simply a
list of the topics to be covered in the course. Certainly, there will be a body of knowledge
that students should know and understand by the time the course is complete. But if the
goals for what students should achieve stops there, there may be many missed opportunities
for providing them with a more productive learning experience.
An intended learning outcome should describe what students should know or be able to
do at the end of the course that they couldnt do before. Intended learning outcomes should
be about student performance. Good intended learning outcomes shouldnt be too abstract
(the students will understand what good literature is); too narrow (the students will
know what a ground is); or be restricted to lower-level cognitive skills (the students will
be able to name the countries in Africa.).
Each individual intended learning outcome should support the overarching goal of the
course, that is, the thread that unites all the topics that will be covered and all the skills
students should have mastered by the end of the semester. Best practice dictates that
intended learning outcomes be kept to no more than half a dozen. [Emphasis in the original
text]
9.1 The Foundations of Our Approach to Teaching 87
Learning outcomes, then, define both knowledge to be acquired and the skills
needed to accomplish certain tasks. We will be using the term learning objectives
for the cataloging of the facts that students are expected to acquire and the term
learning outcomes to describe what students should be able to do with what they
have learned. As an example, Table 9.1 describes a possible set of learning objec-
tives and learning outcomes for the topic of short-term regulation of blood pressure.
We must emphasize that our lists is NOT intended to be a universal prescription for
what all students ought to know and be able to do. Each instructor must establish
learning objectives and outcomes for his or her students.
9.1.4 Learning Environments
Any teaching space can be an active learning environment, and in every space,
we can maintain a focus on the core concepts of physiology.
If you deliver conventional lectures, they should be organized around the core
concepts (or ask the students to do this for you). It is important that in doing this
you, and the students, use the standard terminology and visual representations
consistently (Chaps. 5, 6, and 7). This is essential if students are to come to under-
stand the transferability of these concepts to many different physiological
phenomena.
For example, in describing the autonomic innervation of the heart and blood
vessels, it is important that you remind the students that these systems are examples
of cellcell communication and that they will be seeing similar systems elsewhere
in the body. In describing the baroreceptor reflex, it is important to use
visual representations that map onto the standard representation of a homeostatic
mechanism.
If you use clicker questions (or do think-pair-share exercises) in your lectures, it
is essential that you not only ask questions about the baroreceptor reflex but that you
ask students to demonstrate their understanding of the core concept of homeostasis
that is involved. This is one way to determine how well your students are doing in
acquiring the content of the lessons and whether they are acquiring the skills to use
the core concepts.
You can ask a question about the core concept of homeostasis (What happens to
the error signal when the output of the sensor is interrupted?) and then ask how the
blood pressure will change if the nerve from the baroreceptors to the medulla is cut.
The students answers to these questions will help them assess their knowledge
about the system and will help you gauge the extent to which your efforts are
helping your students to learn.
If you implement a flipped classroom, the same considerations apply. In addi-
tion, you should incorporate core concept-based exercises into the classroom activ-
ities that occur after your students have viewed the online material.
Workshops should offer opportunities for the students to practice applying core
concepts to the physiological mechanisms being studied and to practice using
their understanding of the physiological mechanisms to solve problems. As with
every activity that makes up the course, standard terminology and visual represen-
tations should be used consistently.
An example of the kind of exercise that can be used in a workshop is to present a
brief scenario of a patient with a myocardial infarction and then ask the students to
predict how cardiovascular function will change and how blood pressure will
change (Michael and Rovick 1999).
Laboratories, whether actual (human or animal models) or virtual, should
present the students with problems that can be solved through application of the
core concepts and their understanding of the physiology involved.
As we describe our approach to teaching of the three topics we have selected,
we will describe some active learning exercises that address the physiology
involved and the underlying core concepts.
9.2 Teaching Short-Term Regulation of Blood Pressure
This is a topic that occurs in every introductory physiology textbook and in

every course. It occurs in the context of the cardiovascular system block. The
essential core concept that this topic illustrates is homeostasis, although cellcell
communication and flow down gradients also play major roles.
9.2.1 Context Within the CV Block and the Course
As we discussed in Chap. 8, the cardiovascular block typically follows units on the

core concepts of physiology, the autonomic nervous system, and sensory receptors
(and possibly other topics). Within the CV block, students will have studied
pressure-flow and resistance in the cardiovascular system, the heart and cardiac
muscle, the heart as a pump, and the properties of the circulation. All of these are
topics that the students are expected to have mastered before dealing with the
regulation of blood pressure
9.2.2 The Content of This Topic
What follows is NOT intended to be a prescription for what should be taught about
the regulation of blood pressure. It is one example of how core concepts can be used
to succinctly tell the story of why regulation of blood pressure is important and how
this is brought about. You may feel that some parts of this story can be omitted or
9.2 Teaching Short-Term Regulation of Blood Pressure 89
minimized for your students. You may choose to deliver this story in a different
sequence than the one found here, and your assumptions about what your students
already know when they come to this topic may differ from our assumptions.
One central feature of the new paradigm is its attention to the core concepts
while at the same time attending to those details that are required for the students to
master your intended learning outcomes.
The cardiovascular system transports to every cell in the body those substances
necessary for their health and function. It must do this in the face of varying levels
of activity in the cells, tissues, and organs and, hence, varying needs for perfusion.
To accomplish this task, mean arterial pressure, the driving force for tissue perfu-
sion, is maintained relatively constant over time in the face of changes in the state of
the organism (disturbances), both internal and external. With blood pressure more
or less constant, appropriate distribution of blood flow (cardiac output) can be
accomplished by varying the resistance to flow in the many circuits of the body.
Thus, to accomplish its fundamental task, the cardiovascular system uses a mech-
anism that is one example of the core concept of homeostasis.
An elevated pressure in the arterial compartment, blood pressure or mean arterial
pressure, can be thought about as arising in two different ways. The heart is a pump
whose activity causes a flow of blood out of the heart, the cardiac output. Flow
through the circulation is opposed by the systemic vascular resistance (SVR), often
referred to as the total peripheral resistance. Thus, the pressure in the arterial
compartment, the mean arterial pressure, is determined by the cardiac output
(CO) pumped by the heart and the SVR. The central core concept here is clearly
flow down gradients.
The pressure in the arterial compartment can also be viewed as being the result
of the volume of blood in the arterial compartment (determined by flow inflow
out) and the compliance of the arterial compartment. Here, the relevant core
concept (and a general modelModell 2000) is mass balance in elastic structures
(another general model).
Cardiac output is, by definition, determined by heart rate and stroke volume
(the volume of blood ejected from the left ventricle each beat).
Both heart rate and stroke volume are controlled, in part, by the autonomic
nervous system. The SA node, which establishes the intrinsic heart rate, is inner-
vated by both the sympathetic (increases HR) and the parasympathetic (decreases
HR) nervous systems. The ventricles are innervated by the sympathetic nervous
system that determines the inotropic state (contractility) of the heart (note that
stroke volume is also determined by the lengthtension relationship of cardiac
muscle, an intrinsic, not neutrally controlled, property). Thus, the heart, which
comprises two different effectors, is controlled by the ANS. Here, the core concept
of cellcell communication is applicable.
The resistance to flow of the arterioles (the major component of the SVR) is
determined, in part, by the sympathetic nervous system. Here too cellcell com-
munication is the applicable core concept.
Regulation of a physiological variable requires a sensor to measure that variable.
Blood pressure is measured by the baroreceptors located in the carotid sinus and in
the arch of the aorta. At normal blood pressure, these receptors have a tonic firing
rate. As pressure increases, these receptors increase their firing rate, and as pressure
decreases they decrease their firing rate. The applicability of the homeostasis core
concept is obvious here.
The baroreceptor reflex (a homeostatic mechanism) maintains blood pressure
more or less constant over time (see Fig. 9.1). The baroreceptors are the sensors in
the control system. The SA node, the ventricular myocardium, and arteriolar
smooth muscle are the effectors whose outputs determine blood pressure. The
mechanism defining a set point and control centers is located in the medulla.
Fig. 9.1 This diagram is a visual representation of the baroreceptor reflex, an example of
homeostasis. The minus signs () indicate an inverse or inhibitory relationship between the
connected variables. The dotted connections represent neural signals and the solid connections
represent physical relationships. Such a model is useful to students in solving problems about the
regulation of blood pressure. BV blood volume, CVP central venous pressure, IS inotropic state, SV
stroke volume, HR heart rate, CO cardiac output, TPR total peripheral resistance (also known as
systemic vascular resistance), MAP mean arterial pressure, BR baroreceptors, NS nervous system
9.2.3 Learning Outcomes and Learning Objectives for This

Topic
Given the overarching goal of meaningful learning, it is essential that the learning
outcomes defined for this topic define what kinds of problems the student will be
expected to be able to solve at the conclusion of this particular topic. In Table 9.1,
two different kinds of problems are described and the nature of the expected solu-
tion is described. To accomplish these learning outcomes, the student will need to
have mastered the learning objectives defined in the table.
Table 9.1 Learning outcomes for the topic of short-term regulation of blood pressure
Learning outcome (performance goal) Relevant core
concepts
1. Predict the consequence of perturbations to the organism on blood Homeostasis
pressure and the response of the components that make up the baroreceptor Flow down gradi-
reflex to the perturbation. ents
Cellcell
communication
2. Given a description of the signs and symptoms of a patient, explain the Homeostasis
physiological mechanisms that gave rise to them. Flow down gradi-
ents
Cellcell
communication
Learning objectives for regulation of blood pressure Relevant core
concept
1. List the two parameters that determine mean arterial pressure and write Flow down
the equation that relates them. gradients
2. State the two parameters that determine cardiac output and write the Flow down
equation that relates these parameters. gradients
3. Name the receptors that measure blood pressure and state their Homeostasis
locations.
4. Describe the relationship between baroreceptor firing rate and blood Homeostasis
pressure.
5. Describe the neural controls of heart rate, cardiac contractility, and Cellcell
arteriolar resistance. communication
6. Draw a causal diagram of the baroreceptor reflex and identify the Homeostasis
location in the body of each component.
7. Describe the function of each component of the baroreceptor reflex as Homeostasis
an example of the core concept of homeostasis.
8. Describe the ANS control of the heart and blood vessels and relate the Cellcell
mechanisms to the core concept of cellcell communication. communication
9.2.4 Assessing Student Mastery of the Regulation of Blood

Pressure
Assessment of students mastery of this topic must follow from whatever learning
outcomes and objectives you have set for your students. These outcomes and
objectives should encompass knowledge acquisition, the ability (the skill) to inte-
grate the information acquired, and finally the ability to use the knowledge and
skills acquired to solve problems.
It is important to remember that the outcomes and objectives define mastery of
the topic, regulation of blood pressure, as well as evidence of the ability to use the
core concepts that are relevant here.
We will have more to say about assessment in Chap. 11, but let us note here that
assessing the students understanding of the core concepts and the mechanisms of
blood pressure regulation as defined in the learning outcomes is an essential step.
In a large class setting in which grading written work is problematic, there are
multiple choice questions that can be used to test the performance goals defined
here. Rovick and Michael (1992) described a type of problem format, the prediction
table, that tests students ability to carry out causal reasoning to solve a problem
about the regulation of blood pressure, and Michael and Rovick (1999) provide
many examples of the sorts of perturbations that can be used in assessing this
learning outcome.
Below are two examples of questions that can be machine scored. An important
feature of the question is that it describes a situation novel to the students. That is, it
is a situation that they have not previously encountered in class. Thus, the answer is
not likely to have been memorized, and the student must engage in causal reasoning
to arrive at an answer. Another feature of this question format is that the distractors
(incorrect answers) can be selected to represent common student misconceptions.
We will have to say about writing assessment items in Chap. 11.
The question seen in Table 9.2 illustrates a prediction table question about the
behavior of the baroreceptor reflex. To correctly answer this question, the student
must understand the core concept of homeostasis and know the homeostatic mech-
anism that regulates blood pressure.
Question 1 (Table 9.2) requires students to apply an understanding of the
core concept of homeostasis to a specific homeostatic mechanism, the baroreceptor
reflex. It is equally important to determine student understanding of core concept
itself. The questions in Table 9.3 do this in a different format.
9.2.5 How We Might Help Students Master This Topic
Here, we suggest an approach to teaching about the regulation of blood pressure

using core concepts. The focus is on the pedagogy to be employed, not on the
content that you decide your students need to master.
Table 9.2 An example of a multiple-choice question to test students ability to reason causally
about the baroreceptor reflex
Question 1: An Iron-Man triathlon is being conducted under conditions of high temperature and
high humidity. One of the competitors becomes extremely dehydrated. Predict the effects of this
condition on the state of his cardiovascular system.
A B* C D E
Inotropic state (IS) NC I I I NC
Central Venous Pressure (CVP) D D D D NC
Stroke Volume (SV) D D D I NC
Heart Rate (HR) NC I I I NC
Cardiac Output (CO) D D I I NC
Total Peripheral Resistance (TPR) NC I I I NC
Mean Arterial Pressure (MAP) D D I I NC
I increase, D decrease, NC no change
*The correct answer
Table 9.3 The questions here test student understanding of the core concept of homeostasis in a
format that is easily scored by a computer
You are driving down the highway with the cruise control set to 65 miles/hour. One cylinder in
your engine stops working. Predict the changes that will occur to the following components of
cruise control system.
Question 1
The output of the sensor will:
a. increase
b. decrease*
c. not change
Question 2
The value of the set-point will:
a. increase
b. decrease
c. not change*
Question 3
The signal to the effector will:
a. increase*
b. decrease
c. not change
*
The correct answers
As Wiggins and McTigue (2005) have reminded us, we must start with defining
what it is we expect our students to be able to do with what they learn. We have
proposed a set of learning outcomes and objectives above, but you will have to
determine what learning outcomes and objectives are appropriate for your students
and your course. It is also essential to determine what specific learning objectives
your students will have been expected to learn in previous portions of the course.
The question, then, is how can I best help my students to learn (Michael and
Modell 2003); how can I help them build a mental model of the topic with which
they can solve whatever problems you expect them to solve.
Our answer to this question is to scaffold everything that occurs in the course
around the core concepts of physiology. The mechanisms involved here can be
scaffolded by considerations of the core concepts of (1) homeostasis, (2) cellcell
communication, (3) flow down gradients, (4) mass balance, and (5) the general
model of elastic structures.
How does one do this?
It must start with a mind-set that recognizes the importance of the core concepts
as learning tools. This must be followed by a diligent effort to incorporate the
relevant core concepts into everything that you do in your course.
The single most important thing that you can do is to assist your students in
incorporating the core concepts into their understanding and mental models of the
physiology they are learning. Thus, you must use the core concepts in what you do,
and the student must be asked to use the core concepts in what they do. Students
must learn to recognize where core concepts are relevant and useful and learn to use
core concepts to advance their learning and to solve problems.
Several examples of the kinds of challenges to students understanding of the
regulation of blood pressure and the relevant core concepts are presented in
Table 9.4. These problems can be used in any kind of classroom activity or as
homework problems.
Each of these exercises provides opportunities for students to cooperatively
solve problems, thus learning from one another. These problems also offer the
faculty opportunities to determine what aspects of the physiology are causing
student difficulties. The first step in helping students repair their mental model is
to determine what problems are present in the students models.
Exercises like these can be combined into problem sets in which students in
small groups solve the first problem, discuss the solution, and then go on to the
next problem (Michael and Rovick 1999). At each step, the instructor can intervene
as needed to help students correct their mental models or solution algorithms.
9.3 Teaching Respiratory Mechanics: Generating a Tidal

Volume
Respiratory physiology is covered in most courses as three broad topics, respiratory

mechanics, gas exchange between the atmosphere and tissues, and regulation of
ventilation. Students find respiratory mechanics especially challenging for a num-
ber of reasons including system-specific terminology, the quantitative nature of the
topic, and the application of simple physics concepts to the system. However, if we
examine the lung and chest wall in terms of a simple everyday model and applying
several core concepts and general models, the challenges may be minimized.
9.3 Teaching Respiratory Mechanics: Generating a Tidal Volume 95
Table 9.4 Exercises to help students build mental models of short-term regulation of blood
pressure using the related core concepts
Exercise Core concepts/General models
The arterial compartment can be considered an elastic Elastic structures
structure. Briefly describe the factors that contribute to the
pressure in this compartment.
Pressure receptors (sensors) are essentially stretch receptors. Homeostasis
Predict how the pressure receptors in arterial walls will
respond to changes in arterial blood pressure. Explain the
basis for your prediction.
Based on your model of the cardiovascular system, predict Homeostasis
the location(s) where you expect to find the receptors mea-
suring arterial blood pressure that send signals to the control
center. Explain the basis for your predictions.
Based on your study of the heart and the concept of mass Mass balance, elastic structures
balance (reservoir model), predict how changes in cardiac
function can change the pressure in the arterial compart-
ment. Explain the basis for your predictions.
Based on the flow model and elastic structure model, predict Flow down gradients, elastic
how changes in arteriolar resistance can change the pressure structure, mass balance
in the arterial compartment. Explain the basis for your
prediction.
Based on your model of cardiac function, predict how Homeostasis
changes in venomotor tone of the great veins will lead to Flow down gradients
changes in pressure in the arterial compartment. Explain the Elastic structures
basis for your predictions.
Draw a causal diagram that shows how your homeostatic Homeostasis
control model will respond in the face of blood loss. Elastic structures, mass balance
Draw a causal diagram that shows how your homeostatic Homeostasis
control model will respond to an increase in sympathetic Cellcell communication
nervous system activity. Flow down gradients
Predict response of the components of the baroreceptor
reflex to various perturbations of MAP or of the system itself
(computer lab or paper and pencil workshop).
Predict changes to cardiovascular function and MAP as a
result of alterations of ANS function; i.e., administration of
agonists or antagonists.
9.3.1 Context Within the Respiratory Block
Examining the mechanical properties of the lung and chest wall generally occurs at
the beginning of the respiratory block, but some instructors choose to deal with this
topic later in the sequence. Whichever is the case, we will assume that the student
has not had prior experience with respiratory physiology topics. However, we will
assume that the student is familiar with the core concepts of flow down gradients
and the general model of and elastic structures. We will also assume that the student
is familiar with the universal gas law (PV nRT).
9.3.2 Content of this Topic
The role that the respiratory apparatus (lungs and chest wall) plays in gas exchange
between the atmosphere and tissues is that of moving air from the atmosphere to the
alveoli and moving alveolar gas from the lungs to the atmosphere. This is accom-
plished through the interaction of forces generated by the respiratory muscles and
elastic components of the lungs and the chest wall.
When, during a resting tidal volume, the muscular force is greater than the
elastic recoil force, air moves from the atmosphere to the alveoli. When these
forces are balanced, airflow ceases marking the end of inspiration. Relaxation of the
respiratory muscles results in the recoil forces becoming greater than the muscular
force, and gas flows from the alveoli to the atmosphere (expiration). The end of
expiration occurs when the muscular force is zero, and the internal elastic forces of
the respiratory system (lung and chest wall) are balanced. A simple analysis of this
process may be achieved by applying the flow down gradients core concept and the
general model of elastic structures to the respiratory apparatus (see Sect. 9.3.5).
9.3.3 Learning Outcomes and Learning Objectives for This

Topic
Several learning outcomes (performance goals) can be stated for this topic depend-
ing on the level of the student. For the beginning student, the performance goal is to
predict how changes in the mechanical properties of the respiratory system com-
ponents (lung and chest wall) will alter overall respiratory system function. At a
more advanced level, the performance goal is similar but focused on changes in
regional mechanics and their effect on distribution of ventilation. In this case, the
goal would be to predict how changes in the regional mechanical properties of the
lung (compliance and airway resistance) will alter the distribution of ventilation in
the lung. At both levels, the student should also be able to explain the reasoning
behind his/her prediction.
The learning objectives define for the student the scope of information
required to complete the topic. Table 9.5 presents both the learning outcome and
the learning objectives for this topic along with the relevant core concept/general
model.
9.3.4 Assessing the Outcome (Performance) Goals:

Generating a Tidal Volume
The performance goal for this topic is to predict how changes in the elastic proper-
ties of the respiratory system components (lung and chest wall) will alter overall
respiratory system function. The easiest way to assess this performance goal is to
Table 9.5 Learning objectives for unit on generating a tidal volume

Learning outcomes Course level Relevant core con-
cept or general
model
Be able to predict how changes in the mechanical Introductory Elastic structures
properties of the respiratory system components (lung Flow down gradients
and chest wall) will alter overall respiratory system Universal gas law
function.
Learning Objectives
1. Define the characteristics of an elastic structure. Introductory Elastic structures
and advanced
2. Explain why the intrapleural pressure is Introductory Elastic structures
sub-atmospheric when the respiratory system is at its and advanced
unstressed volume.
3. Explain how the lung and chest wall interact during Introductory Elastic structures,
a breath. and advanced flow down gradients,
universal gas law
4. Describe the forces that cause gas flow into and out Introductory Flow down gradients
of the respiratory system. and advanced
5. Describe how surfactant and alveolar Advanced Elastic structures
interdependence affect lung function.
6. Describe the factors that contribute to airway Advanced Elastic structures,
resistance. Flow down gradients
7. Describe the determinants of gas flow during a Advanced Elastic structures,
forced expiration. Flow down gradients
8. Define the Forced Expiratory Volume in 1 second Advanced Elastic structures,
(FEV1.0), and explain its clinical significance. Flow down gradients
provide the student with a problem in which alterations in lung or chest wall mech-
anics have occurred and ask him or her to predict how these changes will affect
function. An important feature of the assessment is to have the student explain the
basis for the prediction.
The complexity of the problem should match the complexity of understanding of
the system by the student. The examples shown in Table 9.6 illustrate the type of
problem that might be presented to an introductory student and the type of problem
that might be presented to an advanced student. The problem may be stated as a
theoretical change in mechanics or in the context of a clinical situation.
9.3.5 How We Might Help Students Master This Topic
A simple model that is often used at the introductory level to examine the inter-
action between the lung and chest wall consists of a balloon within a second balloon
(see Fig. 9.2). The inner balloon represents the lung that communicates with the
Table 9.6 Below are some examples of questions that test students understanding of both the
core concepts and the physiological mechanisms underlying the process of generating a tidal
volume
Example 1 (Introductory): A normal subject develops a cold with a productive cough. The cold
has not affected the elastic properties of the lung but has increased the resistance to gas flow.
Assume the measurements are made in the subject before and during the cold. Also assume that
the breathing frequency and tidal volume remain the same for both measurement periods.
Predict how the intrapleural pressure changes occurring during the cold will compare to
those when the subject was normal. Be sure to explain the basis of your prediction.
Example 2 (Introductory): Over a period of time, a normal subject is exposed to an irritant and, as
a consequence, develops interstitial fibrosis. As a result, the lung recoil of the subject increases.
Data obtained before the onset of the disease are compared to those obtained after the lung recoil
is increased. Predict how the intrapleural pressure changes occurring after development of
the disease will compare to those when the patient was normal. (Assume that breathing
frequency and tidal volume were same in both the cases.) Be sure to explain the basis for your
prediction.
Example 3 (Advanced): Consider a 2-compartment lung that is exposed to the same changes in
intrapleural pressure. Compartment 1 of this lung has twice the airway resistance as that found in
compartment 2. Predict how the ventilation arriving at compartment 1 will compare to the
ventilation arriving at compartment 2. Be sure to explain the basis for your prediction.
Example 4 (Advanced): Pulmonary function tests in which the time course of changes in
intrapleural pressure and lung volume is conducted on a series of patients. The volume changes
observed in patients A and B are the same, but the intrapleural pressure change in Patient B is
much larger than that recorded in Patient A. Predict how the elastic properties of the two
patients lungs compare to each other. Be sure to explain the basis for the prediction.
Fig. 9.2 The model

representing the interaction
of the chest wall (the outer
balloon) with the lungs (the
inner balloon)
atmosphere. The outer balloon is connected to the inner balloon by a thin liquid
film. The outer balloon does not communicate with the outside world.
Before dealing with a model further, it is helpful to review briefly the charac-
teristics of an elastic structure. If the elastic structure contains a volume, then that
structure has a resting or unstressed volume that occurs when no outside forces are
applied to the wall. When the structure is displaced from its resting or unstressed
volume (i.e., a transmural pressure is applied), the structure exhibits recoil that
opposes the applied force and tends to return the structure to its resting or unstressed
volume. The degree to which structure recoils toward its resting volume is often
referred to in terms of compliance. The greater the compliance of the structure, the
smaller the recoil generated by the structure.
Returning to the model, the inner balloon has a low resting volume, and the
outer balloon has a much higher resting volume. Hence, when the two structures are
connected by the thin liquid film between them, the outer balloon exerts a dis-
tending force on the inner balloon, and the inner balloon exerts a force in the oppo-
site direction on the outer balloon. As a result, a positive transmural pressure
develops across the inner balloon, and a negative intrapleural pressure develops
across the outer balloon. Because the inside of the inner balloon communicates with
the atmospheric, the pressure inside the inner balloon is atmospheric or zero. The
volume of the inner balloon is greater than its resting volume and so the transmural
pressure is positive. If the pressure inside the balloon is atmospheric, the pressure
outside the balloon in the liquid film must be subatmospheric.
By applying the core concept/general models of elastic structures, pressureflow
relationships, and the universal gas law to this model, the introductory student can
easily examine the mechanisms responsible for generating a tidal volume. At an
advanced level, the model can be extended by adding more inner balloons having
different compliances and/or adding resistances between the airways and the atmo-
sphere. With this model, the student can study how a distribution of ventilation
occurs within the lung.
The following exercise is intended to show one approach to helping students use
the core concepts and general models to explain the mechanisms involved in gener-
ating a tidal volume. The exercise can be run in the classroom as an individual or
group exercise. It can be run as an independent study exercise. It can also be con-
ducted as a role-play in which the students generate the forces and act as elements
of the model.
The purpose of the exercise, which can be seen in Table 9.7, is to have the
students work through the mechanisms generating inspiration and expiration in a
step-by-step fashion. At the completion of the exercise, students should be able to
draw a causal diagram of the steps involved and use this diagram to predict
what will happen if the lung compliance changes or if the airway resistance changes.
The model illustrated in Fig. 9.2 serves as the reference for this exercise.
Table 9.7 Examples of an exercise that facilitate student mastery of the learning outcomes and
the learning objectives
Part 1: The exercise begins with the volume of the system at the end of expiration. At this
volume, the muscles of the chest wall are relaxed, and alveolar pressure is atmospheric.
Question 1: How does the volume of the lung (inner balloon) compare to its resting volume
when the system is at this beginning volume?
Question 2: How does the volume of the chest wall (outer balloon) compare to its resting
volume when the system is at this beginning volume? At this point, is the pressure between the
two balloons greater than atmospheric pressure, equal to atmospheric pressure, or less than
atmospheric pressure? Explain the basis for your prediction.
Part 2: Consider what happens if the respiratory muscles now exert a force tending to pull on the
outer balloon. Assume that this change occurs before any volume can enter the system.
Remember, the liquid film connecting the inner and outer balloon still contains the same number
of molecules.
Question 3: If the outer balloon pulls on this liquid film, what will happen to the volume of the
liquid film? Will this change be a micro-change or a macro-change?
Question 4: According to the universal gas law (PV nRT), what will happen to the pressure in
the liquid film? How will this pressure change act on the inner balloon? If we again assume that
the time frame of this change is such that no volume has entered the lung (inner balloon), what
will happen to the volume of air in the lung (inner balloon)? Will this change be a micro-change
or a macro-change? Again, think about the universal gas law and the fact that the number of gas
molecules has not yet changed. What will happen to the pressure inside the lungs (alveolar
pressure, pressure in the inner balloon)? What will happen to the flow through the airways as a
result of this pressure change? (Hint: think about the pressure-flow-resistance model.) Now, what
will happen to the number of gas molecules in the inner balloon? Will the ensuing volume
change be a micro-change or a macro-change? What determines how fast gas flows into the
balloon? When will gas stop flowing into the balloon? At this point, what force is opposing the
force in the intrapleural space (in the liquid film) acting on the lung (inner balloon)?
Part 3: Think about a quiet, resting, inspiration. The muscles of inspiration continue to act on the
elastic elements of the chest wall, developing more force until the respiratory center stops
stimulating the inspiratory muscles. Repeat steps Part 2 until you think a tidal volume has entered
the lung. On the axes provided, plot the intrapleural pressure, gas flow, and lung volume as
functions of time for one inspiration.
Part 4: Now consider quiet expiration from the end-inspiratory volume that you chose. In this
case, assume that the respiratory muscles begin to relax. Using your model, the core concepts of
elastic structures, pressureresistance-flow, and the universal gas law predict the changes that
will occur in intrapleural pressure, alveolar pressure, and gas flow as expiration continues. What
causes the observed changes in alveolar pressure? What happens to the volume of the chest wall
as expiration continues? When will flow out of the lung stop? Explain why alveolar pressure is
atmospheric at this point? At this point, how do the volumes of the lung, chest wall, and
respiratory system compare to their resting (unstressed) volumes? On the axes provided, plot, for
one expiration, the intrapleural pressure, gas flow, and lung volume as functions of time.
Part 5: Draw a causal diagram of the mechanism responsible for one tidal volume.
9.4 Teaching the Hypothalamic-Anterior Pituitary Hormones and Their Control 101
9.4 Teaching the Hypothalamic-Anterior Pituitary

Hormones and Their Control
The hypothalamus and anterior pituitary together constitute an endocrine system

that determines the concentrations of many different hormones. The system con-
tains many negative feedback loops, although these do not constitute a homeostatic
system per se. This is an important distinction that will be considered below.
9.4.1 Context Within Course
A major topic within the endocrine physiology block is the role of the hypo-
thalamic-anterior pituitary-target endocrine gland axis in regulating various physio-
logical parameters. In some cases, this axis represents the effectors in the
homeostatically regulated system. As a result, many students find the relationships
within this axis confusing, and they interpret the control of hormone secretion
within this axis to be an example of homeostatic regulation. Examining these rela-
tionships within the context of the cellcell communication core concept can
provide clarity to these mechanisms.
9.4.2 Content of Topic
The hypothalamic-pituitary axis (HPA) controls secretion of multiple peripheral

endocrine glands. This is accomplished through a cascade of secretions arising from
various groups of cells within the hypothalamus and anterior pituitary. Fig. 9.3
provides a general scheme for the hormonal systems involving the hypothalamus
and anterior pituitary. In this scheme, there are several possible mechanisms for
feedback loops that act on different elements in the pathway.
As this diagram indicates, one feedback loop is integral to the homeostatic regu-
latory mechanisms that involve the HPA. However, there are negative feedback
loops that are part of the effector systems that lead to changes in the regulated
variables. Because many students believe that all mechanisms that include negative
feedback loops are homeostatic, they mistakenly believe that hormone levels that
act on the final target tissues (e.g., thyroid hormone, cortisol) are homeostatically
regulated.
Using the core concept of cellcell communication to view this model can help
students recognize the role that these feedback loops play in this effector system.
Fig. 9.3 The figure below is a general scheme for the hormonal systems involving the hypo-
thalamus and anterior pituitary
9.4.3 Learning Outcomes and Performance Outcomes

for This Topic
The learning outcomes and learning objectives for this topic will depend on
exactly where in the course the topic appears. Endocrine physiology is a one of
those systems that can appear early in a course in conjunction with some discussion
of the nervous system. It can also appear much later in the course when the
target organs for hormones have already been discussed. Table 9.8 contains learn-
ing outcomes and objectives for this subject matter presented early in the course.
9.4.4 Assessment
Assessment of the performance goals for this general model of the Hypothalamic-
Anterior Pituitary axis can be achieved by providing the students with a case
problem of hypo- or hyperfunction involving a specific hormone (e.g., thyroid
hormone, cortisol). Along with the signs and symptoms, laboratory data related to
9.4 Teaching the Hypothalamic-Anterior Pituitary Hormones and Their Control 103
Table 9.8 Learning outcomes (performance goals) for the hypothalamic-anterior pituitary axis
Learning outcomes (Performance goals)
1. Predict the physiological consequences of alterations in the hypothalamic-anterior pituitary
axis and explain the rationale behind the prediction(s).
2. Predict the site of dysfunction in the hypothalamic-anterior pituitary axis given a set of
pathophysiological signs and symptoms and explain the rationale behind the prediction(s).
3. Predict how the range of variables values homeostatically regulated by the hypothalamic-
anterior pituitary system will change (increase, decrease, no change) if the hormonal feedback
loops are blocked. Explain the basis for your predictions.
Learning objectives
1. Describe the functionalanatomical relationship between the hypothalamus and the anterior
pituitary.
2. Describe the nature, action, and control of the hormones secreted by the anterior pituitary.
Table 9.9 An example of a scenario-based assessment of student understanding of the HPA

Assessing student understanding of the HPA
A 34-year-old woman has a 3-month history of nervousness, tremor, palpitations, increased
sweating, and discomfort with heat. She has lost 15 pounds despite increased food intake. She
also noted muscle weakness and easy fatigability with exercise to which she was ordinarily
accustomed.
A. What do these data suggest about thyroid hormone levels?
B. Explain how you used your model to arrive at your prediction?
On physical examination, pulse was 110 beats/min at rest and increased to 150 beats/min with
30 s of rapid stair climbing. Blood pressure was 150/60 and respirations were 20/min. Her skin
was warm and moist, and her speech was rapid. She exhibited a tremor and very rapid reflexes
(e.g., knee-jerk reflex), and she was unable to rise without assistance from a squatting position.
The thyroid gland was diffusely enlarged.
A. Do the additional physical findings support your initial hypothesis? Explain.
B. Based on your model of thyroid hormone secretion, what are the possible sites of
pathophysiology that could produce this endocrine abnormality? How would you distinguish
between these possible sites?
Laboratory studies: Total serum T4 level: 26 g/dl (normal: 512 g/dl), free T4 level: 4.1 ng/dl
(normal: 0.82.4 ng/dl), serum TSH: 0.01 mIU/ml (normal: 0.55 mIU/ml), and 24-h radioactive
iodine uptake (what does this measure?): 70% (normal: 20%30%)
C. What is the difference between total serum T4 and free T4?
D. What does the low serum TSH concentration suggest?
E. How do the lab results support your hypothesis?
F. What is the most likely site of pathophysiology in this patient?
Note: This case also assesses the students model of thyroid function
plasma concentrations of the trophic hormone (e.g. TSH, ACTH) and final target
tissue hormone (e.g., T3, T4, cortisol) are provided (see Table 9.9). The task for the
student is to determine the most likely site of the pathophysiology and explain the
basis for the prediction.
9.4.5 How Might We Help Students Master This Topic?
Table 9.10 below contains an example of an exercise that can be used to help
students recognize the impact of negative feedback loops within the Hypothalamic-
Anterior Pituitary-target endocrine gland axis on the control of target endocrine
gland hormone (e.g., thyroid hormones, cortisol) secretion. The exercise can be
used as an independent study exercise (individual, group) as a preview for an inter-
active classroom discussion, a small group exercise in a classroom setting, or a
series of think-pair-share activities in a large group (classroom) setting. It is
assumed that the student is familiar with the core concepts of homeostasis and
cellcell communication including the graphic representations of the homeostasis
(Modell et al. 2015) and the HPA axis (Fig. 9.3 above) model. In addition, it is
assumed that the student has studied a homeostatic mechanism (e.g., the baro-
receptor reflex) previously.
Table 9.10 Exercises to help students understand the Hypothalamic-Anterior Pituitary Axis
Purpose of the exercise: To examine the impact of negative feedback loops within the HPA
effector system on the control of final hormone secretion.
Step 1: Review of homeostasis
Recall the mechanisms involved in the baroreceptor reflex. Answer the following questions:
What is the regulated variable? What is the set point (reference value)? What is the error
signal? What role does the error signal play in the integrators control of the actions of the
effectors? How does this action of the effectors influence the regulated variable? Over time, what
happens to the error signal? What happens to the activity of the effectors as the error signal
changes?
Step 2: Applying the homeostasis model to the HPA axis
Examine the general figure representing the hormonal control by the hypothalamic-anterior
pituitary axis. In this figure, how are the regulated variables represented? In which box would
you locate the integrator (control center)? For this step, ignore the negative feedback loops that
involve hormones. Which boxes represent the effectors in this model? In the diagram, what
determines release of hormones from the hypothalamus? What determines release of hormone
from the anterior pituitary? What determines release of hormone from the target endocrine
gland? Based on the core concept of cellcell communication, how would you explain the
increase in hormone concentration secreted by glands later in the cascade? What determines
which tissues are affected by the target gland hormone? What determines the actions that these
hormones will have on these target tissues? When will the CNS decrease stimulation of
Releasing Hormone from the hypothalamus?
Step 3: Comparing the two models.
Continue to ignore the endocrine feedback loops for this step.
The communication in the effector components of the baroreceptor reflex is neuronal. Those in
the HPA system are hormonal. In view of this, in which system would you expect the fastest
response to a perturbation? Explain the basis for your expectation. How do you think the time
course of the response to a perturbation in the two systems would compare? Now consider the
nature of the hormones involved in the HPA effector system. The Releasing Hormones in this
system (e.g., TRH, CRH) are water soluble. The trophic hormones in this system (e.g., TSH,
ACTH) are also water soluble. Based on this information, what would you predict about the time
course of the target cell (e.g., anterior pituitary cells, thyroid cells, adrenal cortex cells) response
to stimulation by these hormones? How long do you think the response would last? The
(continued)
9.5 How to Use These Examples 105

hormones released by the target endocrine gland in this system (e.g., thyroid hormone, cortisol)
are lipid soluble. Based on this information, how do you think the response time of the target
endocrine gland to stimulation will compare to the response of the anterior pituitary cells? How
quickly do you think the actions of the hormonal action on the final target tissue will become
evident? Explain the basis for your prediction. When a decrease in the levels of the trophic
hormone to basal levels occurs, will there continue to be circulating hormone affecting the final
target tissues? As a result, how do you think the regulated variable value will compare to the
reference value (set point) at this time? As a consequence of the continued action of the final
target gland hormone, the homeostatic regulatory system will exhibit oscillation. That is, the
regulated variable value will overshoot the set point causing an error signal in the direction
opposite direction from the original perturbation.
Step 4: Examining the influence of the negative feedback loops on the effector system
For this step, consider the entire model including the endocrine feedback loops.
In this step, we will compare the predictions from Step 3 (without feedback loops) with pre-
dictions resulting from the system with functioning feedback loops.
In this model, hormone-secreting cells in the hypothalamus and anterior pituitary have receptors
for the final target tissue hormone (e.g., thyroid hormones, cortisol). In this model, what
determines the secretion rate of the hormone from the hypothalamus (e.g., TRH, CRH) and the
hormone secretion rate of the hormone from the anterior pituitary (e.g., TSH, ACTH)? How will
these secretion rates compare with those in Step 3 (without feedback loops)? How will the
release rate of the final target tissue hormone (thyroid hormones, cortisol) compare to that in Step
3 (without feedback loops)? What factors determine the level of circulating final target tissue
hormone? (Hint: think about the mass balance core concept.) In this model, as the regulated
variable value approaches the reference (set point) value, how does the level of circulating
final target tissue hormone compare with that you predicted in Step 3? To what extent would you
expect this model to exhibit oscillation compared to the model in Step 3? Explain the basis for
your prediction.
Problem:
Consider a situation in which an antibody is produced in an autoimmune response that binds to
receptors on the cell surface of the target endocrine gland (e.g., thyroid gland). As a result, the
gland is stimulated to release hormone. Describe what you would measure and what results
expect to distinguish between this condition and one in which a tumor in the anterior pituitary
secretes trophic hormone (e.g., TSH).
9.5 How to Use These Examples
Each of the three examples we have presented is merely one way to incorporate the
core concepts of physiology into a consideration of an important physiology topic.
Our goal here is to stimulate your thinking about your particular physiology course.
To the extent that your course is different than the ones we have imagined here,
your solutions to how to incorporate core concepts will differ from our examples.
Your learning objectives and learning outcomes will differ, your assessments will
look for different things, and the learning environments you create will aim at
facilitating student construction of different models and the development of differ-
ent problem solving skills.
Hopefully, these examples will serve to stimulate your imagination about how to
begin implementing the new paradigm into your approach to teaching physiology.
References
Michael J (2001) In pursuit of meaningful learning. Adv Physiol Educ 25:145158

Michael JA, Rovick AA (1999) Problem solving in physiology. Prentice Hall, Englewood Cliffs,
NJ
Modell HI (2000) How to help students understand physiology? Emphasize general models.
Modell H, Cliff W, Michael J, McFarland J, Wright A (2015) A physiologists view of homeo-
stasis. Adv Physiol Educ 39:259266
Rovick AA, Michael JA (1992) The prediction table: a tool for assessing students knowledge.
Am J Physiol 263 (Adv Physiol Educ 8):S33S36
Simon HA (2001) Learning to research about learning. In: Carver SM, Klahr D (eds) Cognition
and instruction: twenty-five years of progress. Erlbaum, Mahwah, NJ, pp 205226
Teaching and Learning Laboratory, Massachusetts Institute of Technology (2016) Intended learn-
ing outcomes. Downloaded from tll.mit.edu (Course design and delivery, teaching materials,
intended learning outcomes)
Wiggins G, McTighe J (2005) Understanding by design, expanded, 2nd edn. Association for
Chapter 10
Using Core Concepts of Physiology
in Designing Learning Resources
Abstract Learning resources are materials used by students to assist in mastering

the learning objectives and learning outcomes assigned by the instructor. There are
many different kinds of learning resources. Most learning resources can be used in a
variety of learning environments.
All of the learning resources to be used in a course should focus on the core
concepts of physiology, whatever learning context they will be used in.
Keywords Core concepts Learning resources
Learning resources are materials that student use to assist in meeting the learning
outcomes or learning goals of the course. Some learning resources are produced by
the instructor, and some are produced by others and recommended or assigned for
student use by the instructor.
In this chapter, we discuss some of the issues that arise in developing and
implementing learning resources to help students (1) understand the core concepts
of physiology and (2) maintain a focus on the core concepts as they learn the
assigned physiology.
10.1 What Do We Mean by Learning Resources?
All teachers make use of some sort of learning resources, and many teachers make
use of a great many different kinds of resources. Table 10.1 contains a list of some
of the commonly used resources in physiology courses and the context in which
they are most often used.
It is important to note that we are distinguishing the learning resource, an
object, from the context or setting in which it is used. For example, a clinical
problem (a brief scenario, physical exam results, or laboratory results) can be used
in a problem-based learning session, in a team-based learning session, in small
group discussion setting, and in a think-pair-share exercise in the lecture hall. In
each of these settings, the task assigned to the students and/or the protocol for
using the resource will differ, but the students will be using the same learning
resource.

DOI 10.1007/978-1-4939-6909-8_10
108 10 Using Core Concepts of Physiology in Designing Learning Resources
Table 10.1 A partial list of learning resources used in physiology courses

Learning resource Context in which it is typically used
Animations Lecture hall, laboratories, online
Computer simulations Laboratories, online
Problems to be solved Lecture hall, discussion groups, online
Laboratories (wet or human) Laboratory
Laboratories (simulated) Laboratory, online
Textbooks Anywhere
Journal articles Discussion groups, individually, online
Role-play games Lecture hall, discussion groups, laboratories
10.2 Principles Guiding Development of Learning

Resources
The overarching goal for any course is that students engage in meaningful learning
(Michael 2001; Michael and Modell 2003). This requires the student to acquire the
information needed to solve problems (use the information) and the skills to
successfully do so.
Given the goals described above, we can describe the general principles that
should govern the development of learning resources.
10.2.1 The Student Is Responsible for His or Her Own

Learning
Herbert Simon (2001) cogently observed that The long-established first principle,
the foundation stone of the entire enterprise [the learning sciences/cognitive sci-
ence], is that learning takes place inside the learner and only inside the learner.
The helping the learner to learn mind-set (Michael and Modell 2003) follows
directly from that observation; all that we as teachers can do is help.
An equally direct conclusion is that students are ultimately responsible for their
own learning. One of the jobs of the teacher is to help the learner accept this
responsibility. Equally important is making clear and explicit what it is that the
students are expected to learn and be able to do.
10.2 Principles Guiding Development of Learning Resources 109
10.2.2 The Learning Resource Should Support Meaningful

Learning, an Active Process
Meaningful learning, or learning with understanding, is achieved when a student

can use the knowledge that has been acquired from all sources to do something. In
physiology, this means solving a problem.
10.2.3 The Learning Resource Should Help Students

Recognize Their Current Mental Models
When anyone acquires new knowledge, they form a mental model from that
information or they modify an existing mental model. While this process is essen-
tially automatic, students need help to become aware of the exact nature of their
models. The learning resources that we make available to students should provide
opportunities to do just that.
10.2.4 The Learning Resource Should Help Students Test

Their Current Mental Models
Once students have become aware of their mental models about some physiological
phenomenon, they need to be given opportunities to test the validity of those
models. To do this, students need to use their mental models to solve some sort
of problem. A correct solution suggests that their model is correct, while errors
suggest that their models need to be repaired.
10.2.5 The Learning Resource Should Guide Students

in Revising Their Current Mental Models
A faulty mental model cannot be fixed by telling a student that it is faulty or by

giving him or her the correct model (McDermott 1993). Repairing a mental model
first requires that the learner recognize that use of his or her model has yielded an
incorrect answer. Then they must examine their model to identify missing elements
or elements that need to be revised.
10.3 Incorporating Core Concepts in Your Learning

Resources
We are advocating for teachers to focus on the core concepts of physiology in all
aspects of their courses. Thus, all learning resources that are developed for a course
should contribute to the students understanding of and use of the core concepts as
tools for learning.
Students can be introduced to core concepts by learning resources developed for
that purpose (see the examples described in Sect. 10.3). Appropriate learning
resources can reinforce the use of core concepts to understand physiological
mechanisms as students learn about physiology (see Sect. 10.4).
10.4 Learning Resources for Introducing Core Concepts
In Chap. 8, we described two approaches to introducing the core concepts to be

emphasized in your course: (1) explore the core concepts at the beginning of the
course or (2) introduce each core concept when it is first relevant to understanding a
physiological phenomenon.
We will describe three different kinds of learning resources to introduce students
to core concepts. Each of these makes use of an everyday model or analogy for the
core concept being discussed. Not all of the core concepts lend themselves to this
approach.
10.4.1 Introducing Students to the Core Concept

of Homeostasis
Although physiology textbooks routinely use a heating system as a model (analogy)

for a homeostatic mechanism, a better model is an automobile cruise control
system. (As we discussed in Sect. 5.5.2, home heating systems almost always
work in an ON/OFF fashion although this is NOT how homeostatic mechanisms
work.)
The cruise control mechanism found in most automobiles is a much more
appropriate analogy. There are many ways to introduce students to a cruise control
system. One is to use the role-playing game described here.
One student is selected to determine the desired speed (thus acting like the set
point), one student measures the speed (acting like the sensor, a speedometer), one
person decides whether the actual speed is too high or too low (the error detector),
and one person operates the gas pedal (controlling the effector).
Other students are asked to suggest possible perturbations (the automobile
begins to climb a hill), and other students are then asked to decide how the actors
10.5 Learning Resources to Help Students Master Physiology 111
are to behave. Playing this game with several perturbations will give students the
opportunity to begin building a mental model of the core concept of homeostasis.
10.4.2 Introducing Students to the Core Concept Flow Down

Gradients
Here is a simple exercise that will introduce students to the core concept of flow
down gradients. Small groups of students are presented with a number of scenarios
describing seemingly unrelated events from everyday life. Their task is to explain
the mechanisms underlying the observations described.
A set of observations illustrating flow down gradients may include water flowing
through a garden hose, diffusion of an ink drop in a glass of water, the heating of a
pair of tongs placed on a barbeque, airflow through a heating/air conditioner vent,
watching a river flow, and flow through a bathroom shower before and after a flow
restrictor is placed in the shower head. In each case, the answer to the question
What causes the flow? is the same regardless of what is flowing (water, air, heat).
10.4.3 Introducing Students to the Core Concept of Mass

Balance
A bathtub is a simple, everyday model of the core concept of mass balance. The
level of water in the tub (or the amount of water) is determined by the rate at which
water enters from the faucet and the rate at which it leaves via the drain. Students
can be presented with various scenarios and asked to predict what will happen to the
level of the water.
10.5 Learning Resources to Help Students Master

Physiology
In Chap. 9, we described some learning resources incorporating core concepts that

could be used to help students master three important topics in physiology. Here,
we will present additional examples of a variety of different kinds of learning
resources to help students build useful, appropriate mental models of physiological
systems.
Table 10.2 An exercise about temperature regulation as an example of homeostasis

A hospitalized patient comes down with a fever of unknown origin. Consider the period during
which the patients temperature is still rising.
Identify the physiological components of the temperature regulating system and the role they
play as a component in a homeostatic mechanism. Indicate how the function of each of the
components has changed relative to the period before the fever began.
How does this system differ in it operation from the simple thermostat-furnace system in a
house?
10.5.1 Temperature Regulation as an Example

of Homeostasis
Temperature regulation is often presented as the introductory example of homeo-

static mechanism. Disturbances to temperature regulation occur naturally (exposure
to a cold ambient environment) and when pathology is present. Table 10.2 contains
an example of an exercise that requires students to explore temperature regulation
during the onset of a fever. It also requires students to think about how the
physiological system differs from the simple heating system found in most homes.
10.5.2 The Action Potential and Flow Down Gradients
One of the earliest examples of the application of flow down gradients is present in
any consideration of the action potential (whether in nerve, skeletal muscle, or
cardiac muscle). The distribution of ions across the membrane at rest (the resting
potential) and the movement of ions during the action potential both result from
movement down gradients (concentration and electrical). In Sect. 10.8, we describe
exercises that can be used to help students understand the core concept and relate it
to important physiological mechanisms.
10.5.3 Three Examples of the Application of Mass Balance

to Important Physiological Phenomena
After a core concept has been introduced with a simple analogy as described above,
a set of questions/problems can be presented applying the analogy to physiological
situations. A brief explanation may be necessary to introduce the physiology if the
student has not studied the particular system previously. However, this introduction
need not be any more complex than necessary to relate it to the analogy.
For example, the following three problems (Table 10.3) illustrate mass balance
in three different systems. The goal of the exercise is to help students recognize that
the vocabulary may be system specific, but the underlying concept is the same.
10.6 Creating Online Resources 113
Table 10.3 Three examples of problems using the core concept of mass balance to facilitate
students learning of important physiological mechanisms
Example from the respiratory system
Carbon dioxide enters the alveoli from the blood as blood passes through the pulmonary
capillaries. Carbon dioxide leaves the alveoli when exhalation causes alveolar gas to leave the
lung. (Note: atmospheric air contains essentially no carbon dioxide [0.03%]). What will happen
to the concentration of carbon dioxide in the alveoli if the breathing rate doubles and the carbon
dioxide production rate remains constant?
Example from renal physiology:
Creatinine is a metabolic waste product that is eliminated from the body by being filtered at the
kidney. It is produced at a fairly constant rate by muscle metabolism. Plasma creatinine
concentration is used clinically as an indicator of glomerular filtration rate. Use the mass balance
core concept to explain the basis for using plasma creatinine concentration as an indicator of
glomerular filtration rate. Predict what will happen to plasma creatinine concentration if glo-
merular filtration decreases. Explain the basis for your predictions.
Example from cardiovascular physiology:
Blood flows through a metabolizing tissue bed. Using the core concept of mass balance, explain
what measurements you would make, and how would you use the results to determine how much
oxygen the tissue is consuming in one minute.
Hence, as presented, the problems might be included in an introductory discussion

of the mass balance core concept. These problems can, of course, be used in a
variety of different settings.
10.6 Creating Online Resources
As technology has progressed, a growing number of instructors are putting learn-

ing resources online. Frequently, these take the form of video presentations or
demonstrations, voice-over PowerPoint presentations, research papers, or problem
sets. Unfortunately, these formats do not require that the learner test his/her mental
model and, hence, do not promote active or meaningful learning.
To promote active or meaningful learning, online resources should follow the
governing principles that were discussed above. To accomplish this, the resource
must help students address their current state of understanding (mental model),
make a prediction on the basis of that model, evaluate the prediction, and provide
feedback to help the student revise the current model, if necessary.
Many institutions use learning management systems (e.g., Moodle, Blackboard)
that include features that allow development of interactive lessons. Website design
software can also be used for the purpose. However, it is not necessary to learn these
systems to develop effective resources.
Interactive lessons can be developed using readily available software. For
example, narrative frames (screens) with embedded graphics can be created with
a word processor (e.g., MS Word) or with desktop publishing software (e.g.,
InDesign) that can convert the document to PDF format. Navigation links, video
Fig. 10.1 A screen illustrating the use of a graphic as a basis for programstudent interaction
clips, or audio clips can then be inserted using Acrobat Pro. With this approach, a
variety of interactive activities can be produced (Modell and Michael 2013).
The following examples provide a sampling of strategies used in online
resources that follow the governing principle for promoting meaningful learning.
10.6.1 An Interactive Tutorial
This example, drawn from an introductory homeostasis tutorial (Modell and

Michael 2013), illustrates studentprogram dialogue based on a graphic represen-
tation of a model. The program moves from defining homeostasis to helping the
student build a simple model of a homeostatic mechanism from everyday life.
The mechanism is a cruise control feature in an automobile. Figure 10.1 presents
the resulting model and asks the student to apply it to a simple problem.
In this interaction, the student is asked to predict, by clicking on it, which
element in the model will exhibit a change when a perturbation is applied. The
ensuing dialogue is based on the choice made by the student. The dialogue provides
more feedback than a simple yes/no. It discusses the role of the chosen element and
why, in that context, the response is either correct or incorrect. The student is then
either redirected to this screen in the event that she or he has made an incorrect
choice, directed to the next screen in the conversation.
The range of images that can be used with this type of interaction is consider-
able, from that of an actual picture to a cartoon-type illustration to a causal diagram,
10.6 Creating Online Resources 115
Fig. 10.2 The model of the baroreceptor reflex from which the predictions requested by
CIRCSIM are derived. The dotted line is meant to represent neural signals. The solid lines are
physical interactions. (Adapted from Evens and Michael 2006). BV blood volume, CVP central
venous pressure, IS inotropic state, SV stroke volume, HR heart rate, CO cardiac output, TPR total
peripheral resistance (also known as systemic vascular resistance), MAP mean arterial pressure,
BR baroreceptors, NS nervous system
etc. Use of an image in this way can provide more insight into the students mental
models than a set of words.
10.6.2 A Qualitative Simulation
CIRCSIM (Evens and Michael 2006) is a qualitative simulation of the baroreceptor

reflex, the mechanism that provides short-term regulation of blood pressure. The
model on which it is based can be seen in Fig. 10.2.
Students using CIRCSIM are presented with a set of problems, each describing a
perturbation to the subject that will alter blood pressure in some way. The students
task is to predict the changes that will occur to eight physiological parameters
presented in an interface called the prediction table (Rovick and Michael 1992).
The prediction table can be seen in Table 10.4.
The program detects student errors and patterns of errors that reflect common
misconceptions. These errors trigger explanations that assist students to refine their
mental model about blood pressure regulation. The effect of using CIRCSIM has
been investigated, and it has been determined that CIRCSIM does help students to
better understand the baroreceptor reflex (Rovick and Michael 1992; Evens and
Michael 2006).
Table 10.4 The prediction table used in CIRCSIM

Parameter DR RR SS
Inotropic State (IS)contractility
Central venous pressure (CVP)
Stroke volume (SV)
Heart rate (HR)
Cardiac output (CO)
Total peripheral resistance (TPR)
Mena arterial pressure (MAP)
DR is the direct response to the perturbation (with no reflexes operating), RR is the reflex response,
and SS is the new steady state. Students are asked to predict whether the parameter increases,
decreases, or shows no change.
10.7 Textbooks and the Focus on Core Concepts
Textbooks continue to be one of the most commonly used learning resources by

students in higher education. However, textbooks pose certain problems in a
learning environment that focuses on achieving meaningful learning and on the
use of core concepts. We will address some of these issues in this section.
10.7.1 Challenges Posed by Textbooks
Our new paradigm emphasizes meaningful learning and the building of mental
models of physiological mechanisms that are applicable to a spectrum of physio-
logical systems. A focus on the core concepts of physiology should provide students
with tools that will help them achieve the breadth and depth of understanding we
are seeking.
To reach this goal, it is important that all resources begin with models to which
students can readily relate and use those models as scaffolding when more com-
plexity is added during students study of specific systems.
Unfortunately, current textbooks do not promote this approach. Although many
texts begin with describing core concepts or general models in the introductory
chapter, they do not refer the student back to these descriptions as specific physi-
ological systems are discussed. In addition, there seems to be no attempt to adopt a
consistent terminology that helps students make appropriate connections to the core
concepts/general models. Another inconsistency of current texts exists in the choice
of pictorial representations of mechanisms. Rather than adopting a common set of
design criteria that help students make conceptual connections among mechanisms,
illustrations appear to show relationships as situationally specific (e.g., specific to
cardiovascular physiology, specific to digestive physiology, specific to renal phys-
iology, etc). Michael et al. (2013) have described some of these problems with
textbook descriptions of homeostasis.
10.7 Textbooks and the Focus on Core Concepts 117
In addition to not providing a framework of core concepts or general models,

textbooks also fail to offer opportunities for readers to challenge their mental
models. In the absence of such challenges, students initial, nave mental models
(their misconceptions) usually fail to be corrected. The intrinsic difficulties of
achieving meaningful learning (conceptual learning) of physiology (Michael
2007) can be compounded by reliance on a learning resourcethe textbookthat
does not offer the supports needed for success.
The deficiencies in current physiology (and anatomy and physiology) textbooks
lead to the question of how we can best help students use the existing textbooks we
assign.
10.7.2 How to Use Current Textbooks to Help Your Students
Textbooks are a source for the facts that represent our current understanding of
physiology. To the extent that your learning objectives (see Chap. 9) include some
set of these facts, textbooks can serve to make these available to your students.
In the buildtestrefine paradigm described by Michael and Modell (2003), the
test of a students mental model always requires that the student compare his or her
predictions of how the model will behave with the known responses of the system.
The textbook can be an important reference for that comparison.
The deficiencies of textbooks can only be overcome by the instructors consis-
tent reference to and use of the core concepts wherever they are applicable.
Consistent terminology needs to be used, even when it is different than the
terminology encountered in the textbook; it is, of course, incumbent on the instruc-
tor to help the students with the translation problem. Consistent visual represen-
tations of the core concepts should also be used; here too it is important that
instructors explain the differences between the figures students will see in the
textbooks and the representations being used by the instructor.
10.7.3 Textbooks Which Have Attempted to Incorporate Core

Concepts
Rhoades and Pflanzer (2003) attempted to address this challenge in the fourth
edition of their text. A section of chapter one of the text was devoted to explaining
the general models proposed by Modell (2000). An icon was presented to represent
each of the general models. The intent was to place these icons within the text
whenever the narrative described a mechanism to which the general model applied.
However, due to a publishers error, the icons were only placed in one chapter.
Consequently, it was not possible to assess the impact of adding the icon to the text.
A second feature added to this text attempted to help students approach their
reading as an active learner. Immediately following a heading in the text, a question
was presented to help students examine their current understanding of the topic
discussed in the ensuing narrative. The question also helped students look for
answers to specific questions rather than passively reading the narrative. For
example, the narrative describing the chemistry of hormones includes the heading
Most Hormones Can Be Characterized as Belonging to One of Three Chemical
Classification. Before the narrative begins, the following question is proposed.
What characteristics do various hormones have in common?
Michael (2011) employed a similar approach. Eight general models were
described, and wherever a general model was applicable, an inset box identifying
and discussing the application of that general model was presented. Repeated
explicit invocation of these general models wherever they appear should help
students generalize these models.
In addition, each section of the book (essentially each organ system) was started
with a clinical scenario and questions related to the case were present in each
chapter. These questions served as a vehicle for getting students to think about their
mental models, the core concepts that are related to it, and how both can be used to
explain the case.
10.7.4 How to Incorporate Core Concepts in Physiology

Textbooks
One solution to the challenges of current textbook design extends the approach
attempted by Rhoades and Pflanzer (2003) and Michael (2011) to include the
following features:
(1) Include a general graphic representation for each core concept/general model
early in the text. These general representations would then be used as a first step
throughout the text whenever a specific model of the core concept/general
model is presented.
(2) Define a set of terminology early in the text and used consistently throughout
the text.
(3) Use uniform diagrams when applying core concepts/general models to specific
physiological systems.
(4) Provide exercises within the text similar to those illustrated in the learning
guide examples above to help students examine their current mental models.
The physiology education community needs to ask textbook authors and pub-
lishers to make their products a better learning resource for students.
10.8 Scaffolding Conceptual Learning with Appropriate Learning Resources 119
10.8 Scaffolding Conceptual Learning with Appropriate

Learning Resources
One strategy for using core concepts to reinforce understanding of physiological

mechanisms is to present a model of the mechanism and ask students what core
concepts apply to the mechanism under study. Once the students have identified the
applicable core concepts, they can be presented with problems related to the
physiology being studied that can be solved using those core concepts.
However, conceptual learning is difficult (Sinatra and Pintrich 2003), and the
provision of scaffolding as students progress to that end point can be very helpful
(Bransford et al. 2000). A structured series of exercises to guide student learning,
beginning with the relevant core concepts, and providing opportunities for the
students to test and refine their mental models can help students achieve the
meaningful learning we expect. Exercises may take a variety of approaches.
Some may be interactive computer exercises. Some exercises may pose questions
for students to think about and provide resources to help them articulate what they
are thinking. Some exercises are designed to prepare students to engage in discus-
sions that will take place in subsequent workshops. This approach is based on a
constructivist model of learning that recognizes that learning is built on prior
knowledge (Bransford et al. 2000).
This approach to scaffolding conceptual learning can yield a learning guide
(Modell and Modell 2004). Such learning guides focus on the process of testing and
refining mental models that is essential to meaningful learning. The exercises first
help students make their current mental models visible. They then present
situations or problems in which students use those models to predict how the system
will respond to the situation. The sequence of problems provides a scaffolding to
incrementally build a more comprehensive model of the mechanism. Finally, the
guide provides information for the students to determine if their predictions are
correct. This information often takes the form of selected reference reading in
standard textbooks. Note that, in this design, the reference reading is identified
after the exercises are performed. It is assumed that students will generate questions
for themselves while going through the exercises. Thus, when approaching the
reference reading, they will be seeking answers to questions raised and, therefore,
approach the reading in a more active learning mode than if they used the reading as
an introduction to the topic.
An example of this approach can be seen in the sequence of exercises that deal
with membrane potentials in a variety of cell types shown in Table 10.5. The
exercises presented are distributed among a number of content areas that include
nerve and skeletal muscle, cardiac pacemaker cells, and ventricular muscle cells.
However, the list could be extended to include smooth muscle and other situations
that involve ion movement across cell membranes. These topics might be taught in
a single block in an academic term or might occur at different times in a multi-term
course.
Table 10.5 A sequence of learning guide exercises dealing with membrane potentials in a variety
of cell types. The primary core concept being dealt with is flow down gradients
Course topic Exercise Description
Introduction Determinants of flow Interactive computer tutorial focused
to core on flow down gradients core concept.
concepts
Introduction Membrane transport Interactive computer tutorial focused
to core on membrane transport mechanisms.
concepts
Excitable Membrane potentials Interactive computer tutorial focused
cells on factors contributing to the mem-
brane potential and applying flow
down gradients core concept to deter-
mine membrane potential.
NerveSkel- Prediction of membrane potential Students use computer simulation of
etal muscle changes resulting from ion concentra- squid giant axon to predict changes in
tion changes or relative permeability membrane potential resulting from
changes changes in extracellular ion concen-
trations or changes in relative mem-
brane ion permeability resulting from
opening or closing specific ion chan-
nels. Students generate a membrane
potential pattern consistent with an
action potential in the neuron. Refer-
ence reading allows students to relate
results with the mechanism of action
potential generation in an axon or
skeletal muscle.
Nerveskel- Problem set for group discussion Predict how changing experimental
etal muscle conditions in a squid giant axon prep-
aration will affect characteristics of an
action potential.
Nerveskel- Propagation of an action potential Apply the flow down gradients core
etal muscle along the axon or sarcolemma concept to examine propagation of the
action potential using the view from
the inside approach (Modell 2007).
Nerve Initiation of an action potential in the Apply the flow down gradients core
neuron concept to examine ion movement in
the neuronal cell soma. Students
examine summation and membrane
length constant contributions to depo-
larization of the axon hillock.
Nerveskel- SynapseNeuromuscular junction Interactive computer tutorial focused
etal muscle on core concept of conservation of
mass followed by application of this
concept and flow down gradient to
events at the synapse/neuromuscular
junction.
(continued)
References 121

Course topic Exercise Description
Cardiac Excitation of cardiac pacemaker cells Given the relative permeability
muscle changes for K+, Na+, and Ca++ over
time, students use the flow down gra-
dients core concept to predict the
changes that occur in the membrane
potential of SA node cells. Reference
reading allows students to relate
results with the mechanism of action
potential generation in a pacemaker
cell in the SA node.
Cardiac Excitation of cardiac contractile Given the relative permeability
muscle (ventricular muscle) cells changes for K+, Na+, and Ca++ over
time, students use the flow down gra-
dients core concept to predict the
changes that occur in the membrane
potential of cardiac contractile (ven-
tricle muscle) cells. Reference reading
allows students to relate results with
the mechanism of action potential
generation in a ventricular muscle cell.
References
Bransford JD, Brown AL, Cocking RR (eds) (2000) How people learn. National Academy Press,
Washington DC
McDermott LC (1993) How we teach and how students learn. Ann NY Acad Sci 701:920
Michael J (2007) What makes physiology hard for students to learn? Results of a faculty survey.
Michael J (ed) (2011) Fundamentals of medical physiology (based on a work by Sircar S). Thieme
Medical Publishers, New York
http://www.fasebj.org/content/27/1_Supplement/739.4. Poster available at: http://
physiologyconcepts.org under Publications/Abstracts
Modell HI (2007) Helping students make sense of physiological mechanisms: the view from the
inside.. Adv Physiol Educ 31:186192
Modell HI, Michael JA (2013) Interactive computer tutorials illustrating a pedagogy promoting
conceptual change. FASEB J 27:740.10. Abstract can be downloaded from http://fasebj.org/
content/27/1_Supplement/740.10
Modell TW, Modell HI (2004) Strategies for promoting meaningful learning in physiology.
FASEB J 18:300.4
Rhoades RA, Pflanzer RG (2003) Human physiology, 4th edn. Brooks-Cole, Pacific Grove, CA
Rovick AA, Michael JA (1992) The prediction table: a tool for assessing students knowledge. Am
J Physiol 263(Adv Physiol Educ 8):S33S36
and instruction: twenty-five years of progress. Erlbaum, Mahwah, NJ, pp 205226
Sinatra GM, Pintrich PR (eds) (2003) Intentional conceptual change. Lawrence Erlbaum Associ-
ates, Mahwah, NJ
Chapter 11
Conceptual Assessment of Student Learning
Abstract In this chapter, we first discuss the roles that assessment plays in any
learning environment. We then discuss the problem of aligning assessment with
learning objectives. We then turn to the particular problem of assessing conceptual
understanding as opposed to assessing information acquisition. We conclude with a
discussion of the special characteristics of concept-based questions.
Keywords Formative assessment Summative assessment Conceptual

assessment
Teachers, educators, and educational researchers frequently say assessment drives

learning. While this saying has many different implications, all point to the
important, even essential, role of assessment in teaching and learning.
11.1 The Roles of Assessment in Teaching and Learning
Assessment has many roles to play in helping to enhance the learning environment.
Assessments of any kind can provide information about the teaching and the
learning that is occurring. It can also provide information for program evaluation.
11.1.1 Formative Assessment
Formative assessment is an idea in widespread use, although its definition is often

rather elastic. Chappuis (2014) offers the following definition: Formative assess-
ment are formal and informal processes teachers and students use to gather evi-
dence for the purpose of improving learning. Thus, by definition, formative
assessment is not intended to measure students achievement or to generate a grade.
Formative assessment provides feedback to both the teacher and the student.
This information is then used by the teacher to appropriately alter what happens in
the classroom and by the student to change what he has been doing to improve his
learning. Research has shown that under the right conditions, formative assessment

DOI 10.1007/978-1-4939-6909-8_11
124 11 Conceptual Assessment of Student Learning
with appropriate feedback to the student can significantly increase learning (Kibble
2007; Marden et al. 2013). To be effective, feedback has to be immediate and has to
engage the students working mental models; in this way, having had their mental
model challenged and finding it wanting, the student can repair their model.
Note that the definition of formative assessment does not in any way define the
nature of the instrument used to provide feedback to teacher and/or students.
Formative assessment is a matter of the use that is being made of the evidence
generated, not the nature of the instrument being used.
11.1.2 Summative Assessment
Summative assessment is probably a more familiar process. Chappuis (2014)

defines it as assessment that provides evidence of student achievement for the
purpose of making a judgment about student competence or program effective-
ness. Certainly, assessment to enable the awarding of grades has long been a
responsibility of the classroom teacher. End of term final exams, SAT and ACT
exams, and the MCAT exams are all different examples of summative assessments.
11.1.3 Program Assessment
Program assessment is a process in which evidence is gathered to determine how

well a programa course or the curriculumis succeeding in achieving its stated
goals. Program assessments may be internally generated or it may use externally
generated instruments.
11.2 Assessment Must Align with Learning Outcomes

and Learning Goals
We believe that the overarching learning goal should be student meaningful

learning (Michael 2001). We want our students to not only accumulate information
but to be able to use that information to solve problems of varying kinds (Michael
and Rovick 1999). Finally, we want our students to understand the core concepts of
physiology and be able to use them in learning the physiology content for which
they are being held accountable. It is therefore essential that in defining our learning
outcomes (or learning objectives), we clearly define what it is we expect the
students to know and what we expect them to be able to do.
It is equally critical that there is an alignment between what you have told
students they should know and be able to do and what you ask them to demonstrate
11.2 Assessment Must Align with Learning Outcomes and Learning Goals 125
in the assessment you use (Wiggin and McTighe 2005). If your objectives include
items requiring students to be able to solve certain problems but your exams only
test the recall of information, students will not attempt to accomplish these higher-
level goals since you do not seem to actually value them.
11.2.1 Assessing Knowledge Acquisition
Students learning any STEM discipline need to acquire some body of information
about that discipline. This includes learning the language of the discipline (both the
vocabulary and the syntax, how you say things in the language), the names of
variables, and the causal links\ages that make up mechanisms, etc. Depending on
the course, it may be important that students learn the normal values for important
physiological variables.
Assessing students acquisition of this information can employ any and all of the
standard question formats; Michael and Modell (2003) have discussed many of the
questions types that can be used. Which ones to use with your students will depend
on what you want to accomplish, the number of students in your class, and the
resources that are available for scoring assessments.
11.2.2 Assessing Understanding and Use of the Core

Concepts
We have advocated that physiology teaching focuses on a set of core concepts as a

way to help students master physiology. This, of course, means that the students
must be able to demonstrate an understanding of the assigned core concepts and
demonstrate an ability to use those concepts to understand physiological
phenomena.
Assessing understanding of the core concepts usually requires writing new types
of questions with important properties; the usual exam questions that you have
employed in the past will not generally be suitable. In Sect. 11.3 (below), we will
discuss our approach to writing conceptual assessment questions.
11.2.3 Assessing Meaningful Learning of Physiology
Meaningful learning involves the acquisition of information and the ability to use
that information to do something, typically to solve a problem (Mintzes and
Wandersee 1997; Michael and Rovick 1999; Michael 2001). Meaningful learning
is usually equated with learning with understanding. Simon (2001, p. 214) has
offered this definition: . . . a person understands some information to the extent that
he or she can use it in performing the tasks for which it is relevant.
Assessing whether students has achieved meaningful learning thus requires that
you assess whether the student can solve relevant problems.
11.3 Problems of Doing Conceptual Assessment
Assessing whether students understand the concepts of a STEM discipline is

difficult. McCloskey et al. (1980) determined that college students, even those
who had completed a physics course, exhibited significant misconceptions about
the laws of motion. Hestenes et al. (1992) developed the Force Concept Inventory
(FCI) to assess whether students understood the concepts of force and motion
independently of their ability to solve quantitative problems (the usual classroom
or course assessment). To the surprise of many physics teachers, a high percentage
of students successfully completing college physics course nevertheless made many
errors on the FCI.
This points to the difficulty of determining whether your students do, in fact,
understand the core concepts of physiology. The ordinary questions you write,
whether formative or summative, usually do not allow you to assess conceptual
understanding. That being the case, how do we determine whether our students
understand and can use the core concepts of physiology?
11.3.1 Defining the Concepts
If you want to assess students understanding of a set of core concepts, you have to
first define which of these concepts you want your students to master. Our list
contains 15 core concepts (see Chap. 3), although they are not all equally important.
We also acknowledge that there may be other core concepts not on our list that
nevertheless can serve important pedagogic purposes.
Selecting which core concepts to emphasize in a particular course or selecting
core concepts to be incorporated in a curriculum or academic major will depend on
the overall goals of the course or the curriculum. Thus, these choices are one that
only you and your colleagues can make.
11.4 Writing Concept-Based Questions 127
11.3.2 Unpacking the Concepts: Building the Conceptual

Frameworks
In Chap. 4, we described the process of unpacking a core concept to generate a

conceptual framework. In Chaps. 5, 6, and 7, we presented and discussed concep-
tual frameworks for three of core concepts: homeostasis, flow down gradients, and
cellcell communication. While they vary considerably in size and complexity, all
three contain those component ideas that students must understand if they are to be
said to understand the particular core concept.
11.3.3 Writing Questions That Test Conceptual

Understanding
All of the question types that are available for use in the classroom (multiple choice,
true/false, short answer, essay, concept maps, etc.) can be employed to assess
students conceptual understanding. However, when class size is large or when
resources are scarce, questions that can be objectively scored may be the only
viable approach to testing conceptual understanding.
11.4 Writing Concept-Based Questions
Questions to assess students understanding of concepts, regardless of their format,

are different in some important ways from the usual multiple-choice questions used
to assess knowledge acquisition. These differences include the avoidance of (sci-
entific) jargon as much as possible, a focus on the big picture not individual
knowledge elements, and the deliberate construction of distractors (wrong answers)
that reflect known student misconceptions or misunderstandings.
11.4.1 Questions Should Be Free of Jargon
Physiology, like all disciplines, has a language that students must learn and be able
to use with at least some minimal correctness. This language contains many
specialized technical terms, some jargon, and some terms that are in common
usage, but also have specialized meaning in physiology. If the purpose of a question
is to determine whether a student understands a particular concept, it would not be
useful if the student answers incorrectly due to a misunderstanding of a specialized
piece of jargon.
This should not be interpreted to mean that questions must be written at an 8th
grade reading level! Some technical language must be used to even ask the question
and students would, of course, be expected to know those terms. Nevertheless, an
effort should be made to eliminate, as much as possible, terminology, the meaning
of which does not matter. The threshold for including technical language in concept
questions obviously depends on the students and the course; more advanced
students in advanced courses should be expected to deal with more technical
language.
11.4.2 Questions Should Test the Concept or Its Application

in Physiology
The usual multiple-choice questions used in classroom exams test whether students
have acquired a particular piece of information. If the purpose of a question is to
determine if the students understand a core concept or its application in physiology,
then the question has to focus on the concept and not on the recall of a collection of
facts.
For example, a question about the core concept of homeostasis as applied to the
regulation of blood pressure should not require students to know the different
properties of the carotid and the aortic baroreceptors; what the student needs to
demonstrate is that they understand the need for, or the role of, a baroreceptor in the
blood pressure regulating system.
11.4.3 Distractors Should Reflect Known Student

Misconceptions
In assessing whether students understand the core concepts, it is particularly useful

to write distractors that represent the misconceptions you have observed in your
students thinking or those described in the physiology education literature
(Michael et al. 1999, 2002; Wright et al. 2015). When student select these
distractors as correct answers, it provides you with useful insight into how they
are thinking and thus how you might better help the learner to learn.
11.4.4 Two Examples from the Homeostasis Concept

Inventory (HCI)
According to Smith and Tanner (2010) Concept inventories are research-based

instruments that measure students conceptual understanding of topics for which
11.4 Writing Concept-Based Questions 129
Table 11.1 Two sample questions from the Homeostasis Concept Inventory with the distribution
of student responses (N 244) from a pilot study. (McFarland et al. 2014)
% of Responses
Question (N 244)
4. A homeostatic control mechanism functions to maintain the concen-
tration of X at a relatively constant level. This mechanism is functioning
A. when the concentration of X gets too high 0.8
B. when the concentration of X gets too low 0.8
C. when the concentration of X gets too high or too low 46.5
D. at all concentrations of X. CORRECT 51.0
9. Baroreceptors detect blood pressure. Blood pressure is maintained
relatively constant even when the internal or external environment
changes. Under what conditions do the baroreceptors send signals to the
brain?
A. when blood pressure is not at its normal value 34.2
B. when blood pressure is increasing 5.3
C. when blood pressure is constant 1.2
D. at all levels of blood pressure CORRECT 58.0
students share common alternative conceptions (also called misconceptions) and

faulty reasoning (Smith and Tanner 2010).
We have developed a concept inventory for homeostasis that is based on our
conceptual framework for this core concept (see Chap. 5). The process by which
this inventory was generated has been described (McFarland et al. 2014; McFarland
et al. in preparation). The HCI has been extensively tested with a large diverse
population of students, and its questions have demonstrated a lack of bias toward
native English speakers, gender neutrality, and an appropriate level of difficulty.
Table 11.1 contains two sample questions from the HCI that we are developing
(McFarland et al. 2014). The two questions selected from the HCI were adminis-
tered to 244 undergraduate students at seven colleges and universities across the
country. The correct answer is marked and the distribution of answers can be seen.
Several things about these two examples are worth noting. Both questions are
testing students understanding of the idea that homeostatic mechanisms are active
all the time, not just when the regulated variable is different than the set point (item
H1.6 in Table 5.1). Question 4 poses an abstract question about homeostatic
mechanisms containing no reference to any actual physiological system. Question
9 tests exactly the same idea in the context of a specific physiological mechanism,
the baroreceptor reflex.
The distractors (the incorrect choices) represent known misconceptions about
this aspect of homeostatic mechanisms (Wright et al. 2015). Distractors 4C and 9A
say essentially the same thing and both were collected from interactions with
physiology teachers.
Note also the simple language used and the fact that Question 9 asks about a
generic baroreceptor without regard to where it might be located (carotid or arch
of the aorta) as this distinction is not relevant to the students understanding of the
homeostatic mechanism.
The process of writing questions like these and of then validating them is a
complex one and we have developed only one concept inventory, the HCI. Concept
inventories for the remaining core concepts need to be created.
But it is important to note that the type of questions we have illustrated here can
be written and used in formative and summative assessments without formal
research basis needed to establish their validity for use in a concept inventory.
You will, of course, have to analyze these questions and the responses of your
students as would do for any examination that you write.
References
Chappuis J (2014) Seven strategies of assessment for learning, 2nd edn. Pearson Education, Upper
Saddle River, NJ
DAvanzo C (2008) Biology concept inventories: overview, status, and next steps. BioScience
58:17
Hestenes D, Wells M, Swackhamer G (1992) Force concept inventory. Phys Teach 30:141158
Kibble J (2007) Use of unsupervised online quizzes as formative assessment in a medical
physiology course: effects of incentives in student participation. Adv Physiol Educ 31:253260
McCloskey M, Caramazza A, Green B (1980) Curvilinear motion in the absence of external
forces: nave beliefs about the motion of objects. Science 210:11391141
McFarland J, Michael J, Wenderoth MP, Modell H, Wright A, Cliff W (2014) Conceptual
assessment of physiology: development of a concept inventory for homeostasis. FASEB J
28:531.13. Abstract can be downloaded from http://www.fasebj.org/content/28/1_Supplement/
531.13. Poster avail at http://physiologyconcepts.org/workspace/uploads/ebposter2014-v4-.
pdf
McFarland JL, Price RM, Wenderoth MP, Martinkova P, Cliff W, Michael J, Modell H, Wright A
(accepted for publication with revisions) Development and validation of the homeostasis
concept inventory. CBE-Life Sci Educ
Marden NY, Ulman LG, Wilson FS, Velan GM (2013) Online feedback assessments in physiol-
ogy: effects on students learning experiences and outcomes. Adv Pysiol Educ 37:192200
NJ
Michael JA, Richardson D, Rovick A, Modell H, Bruce D, Horwitz B, Hudson M, Silverthorn D,
Whitescarver S, Williams S (1999) Undergraduate students misconceptions about respiratory
physiology. Am J Physiol 277 (Adv Physiol Educ 22):S127S135
Silverthorn D, Williams S, Whitescarver S (2002) Undergradutes understanding of cardio-
Mintzes JJ, Wandersee JH (1997) Reform and innovation in science teaching: a human construc-
tivist view. In: Mintzes JJ, Wandersee JH, Novak JD (eds) Teaching science for understanding.
Academic Press, San Diego, CA
and instruction: twenty-five years of progress. Lawrence Erlbaum Associates, Mahwah, NJ
References 131
Smith JI, Tanner K (2010) The problem of revealing how students think: concept inventories and
beyond. CBE Life Sci Educ 9:15
Wiggin G, McTighe J (2005) Understanding by design, expanded, 2nd edn. Association for
Wright A, McFarland J, Wenderoth MP, Michael J, Modell H, Cliff W (2015) Knowing common
misconceptions about homeostasis helps students learning. FASEB J 29:541.34. Abstract can
be downloaded from http://www.fasebj.org/content/29/1_Supplement/541.34
Chapter 12
Core Concepts and the Physiology
Curriculum
Abstract We begin by defining what we mean by a curriculum and describing

the critical features of a curriculum. We next describe the enormous diversity of
students and programs in physiology and how the curricula reflect this diversity. We
then propose how each of the three core concepts we have detailed can be
sequenced through the courses that make up a curriculum. Finally, we consider
how to assess student mastery of the core concepts across the courses that make up
the curriculum.
Keywords Core concepts Physiology curriculum
A curriculum is a set or sequence of required courses that, if successfully

completed, results in the awarding of a degree in a particular discipline
(Merriam-webster.com). As commonly used, the term is synonymous with a
major. In this chapter, we discuss how attention to the core concepts of physiol-
ogy can help in the planning or organizing of a curriculum in which mastery of
physiology is the goal.
12.1 The Undergraduate Physiology Curriculum:

Varieties, Emphases, and Goals
Physiology is one of many biological sciences. There are relatively few undergrad-
uate physiology departments, and physiology majors are often offered in Biology
departments. There are also many other departments which may offer physiology
majors or majors with a predominantly physiology content.

DOI 10.1007/978-1-4939-6909-8_12
134 12 Core Concepts and the Physiology Curriculum
12.1.1 Classification of Curricula by Undergraduate

Programs: Physiology Major or Concentration Versus
Other Biomedical Programs with Emphasis
on Physiology
To speak of the impact of core concepts in physiology on the physiology curriculum

presupposes that curricula exist whose specific purpose is to help students think and
function as physiologists. In the USA, a relatively small percentage of colleges and
universities offer an undergraduate program that emphasizes physiology as a major
subject or concentration and that involves a defined series of physiology courses.
According to Wehrwein et al. (2014), there are about 25 B.S. programs in the USA
that afford an undergraduate curriculum that contains a course sequence in human
physiology. Of these, 19 programs offer a degree in physiology (such as physiol-
ogy, integrative physiology, human physiology) and six offer a degree in biology
with a track or concentration that stresses physiology (Wehrwein et al. 2014). Our
discussion of the relationship between core concepts and physiology curricula is
mainly addressed to programs like these.
However, a variety of physiology courses also reside within the curricula of a
much larger number of programs in exercise physiology, kinesiology, and general
biomedical/health sciences. In this broader collection of undergraduate programs,
physiology can be a core subject, and a specified sequence of physiology courses
may be required. Even though a mastery of physiology is not the ultimate focus of
teaching and learning in these programs, physiology instruction here would benefit
from a deliberate effort to integrate the core concepts of physiology into the
sequence of courses that are offered.
12.1.2 Curricular Requirements for Physiology Programs

and Concentrations
In theory, the number of required physiology courses in a program or major sets the
number of opportunities in which core concepts in physiology can be introduced
and revisited in the curriculum. Wehrwein et al. (2014) determined that most
physiology programs mandated a core of three semesters of physiology courses to
fulfill degree requirements. This requirement was in addition to any instruction in
physiology that might have been included in the introductory or general biology
course sequence. The three-course core varied from three specified physiology
courses, a single-semester anatomy and physiology course and two additional
specified physiology courses, or a two-semester anatomy and physiology sequence
and an additional specified course (Wehrwein et al. 2014). However, this core
requirement does not include any required electives in physiology that may also
have been stipulated by the program. At a minimum, such a core course
12.1 The Undergraduate Physiology Curriculum: Varieties, Emphases, and Goals 135
requirement offers four opportunities (including general biology) to expose stu-

dents to the core concepts of physiology. Moreover, the requirement presumably
enables students to engage the core concepts at different levels of conceptual rigor
and complexity (see below)
12.1.3 Classification of Curricula by Student Interest/

Progression Through Physiology Courses
The findings of Wehrwein et al. (2014) indicate that most general biology programs
do not offer a specific track or concentration in physiology and therefore do not
spell out a specified physiology curriculum. (This makes physiology different from
physics and chemistry where there are standard curricula that have been pre-
scribed.) Nevertheless, it is not uncommon to find that students take definite
pathways through the physiology-related course offerings even in a general biology
program. These pathways, when viewed from the perspective of students interest
in physiology, sort themselves out into at least three distinct curricula and can be
recognized in the different sequences of courses that students select to fulfill their
degree requirements. These curricula or pathways can be identified as: (1) biomed-
ical/human, (2) animal/comparative/environmental/ecological, and (3) exercise.
Given the significant interest in the health professions (Wehrwein 2016), the first
track is undoubtedly the most popular. Students who follow this pathway see their
progression through a series of courses in physiology and other basic and biomed-
ical sciences as a means to prepare for professional training. As a result, the
physiology curricula of this population of students is dominated by systems-
based, human or mammalian, physiology and is rounded out by electives in
specialty topics (e.g., endocrinology, physiology of nutrition, cardiorespiratory
physiology, physiology of aging) and subjects related to human health and disease
(e.g., pathophysiology, pharmacology, toxicology).
The second track is not so narrowly defined by the target goals of the students.
Many students who follow this sequence are interested in animal biologywhether
for professional reasons (e.g., to become animal scientists or veterinarians) or
because of a personal interest in learning how different animals function and how
this function is influenced by the animals environment. These students will seek
out courses in comparative or animal physiology and related courses in the animal
sciences (e.g., animal behavior, animal nutrition). Others pursuing this pathway
have an interest in environmental biology or ecology and wish to combine it with an
understanding of organismal biology. These students will also take courses in
comparative or animal physiology. In addition, they will gravitate to course offer-
ings in environmental physiology or ecophysiology (or physiological ecology).
Given the diversity of interests in students following this pathway, it is not
surprising that the only common thread that runs through the curricula is animal
physiology.
Students in the third group, if they are not enrolled in a school that has a program
in exercise science, will follow a curriculum that begins with systems-based human
physiology. From here, students will choose among different electives and specialty
courses (e.g., musculoskeletal physiology) that best suit their interests in exercise
physiology, biomechanics, or kinesiology.
Even though these pathways through the general biology curriculum are self-
selected and do not have the cohesion (breadth, depth, sequencing) of true curric-
ulum, they nevertheless constitute a progression through a sequence of physiology-
related courses. As such they represent an opportunity to progressively engage a
considerable number of students with the core concepts of physiology.
12.1.4 Sequencing of Courses and Goals
Most undergraduate biology programs offer an introductory course that broadly

surveys the biological sciences and is required of students from a variety of majors
in the life sciences. In such a survey course, the introductory sequence typically
features an instructional block or module that focuses on organismal biology and/or
human physiology. This module or course component usually presents an overview
of the major body systems and often emphasizes aspects of human physiology. Here
is where the opportunity presents itself to introduce students to the core concepts of
physiology and expose them to some of the critical components and fundamental
constituent ideas.
Intermediate level courses in physiology are required by the physiology major or
concentration and are often required electives in the general biology curriculum.
These courses typically provide a general survey of physiological processes at the
organizational level of the cell or the body systems. In this setting, system specific
examples illustrating the core concepts occur repeatedly and the critical compo-
nents and constituent ideas underlying the core concepts can be examined and
reexamined in greater detail.
A variety of advanced courses in physiology are typically offered to satisfy
diverse interests of students and to explore specialized topics in greater detail. For
students who have progressed to this point in the curriculum, these courses offer an
opportunity where advanced ideas and theories relevant to the core concepts can be
addressed, exceptions to the general principles analyzed, and more specialized
applications of the core concepts investigated. Table 12.1 outlines a hypothetical
physiology major (sequence of courses).
As students pursue such a curriculum, they should be expected to develop
increasingly complex mental model of the core concepts (see below). They would
be expected to develop the skills needed to solve increasingly complex problems.
12.2 Sequencing of Core Concepts in the Curriculum 137
Table 12.1 Sequence of courses across three levels of subject rigor and complexity in a physi-
ology curriculum
Introductory (Required) Intermediate (Required) Advanced (Elective)
Introductory Biology Cellular Biology/ Endocrinology
Physiology
Organismal Biology/Physiology block or Systems Physiology Neurophysiology
component (Anatomy & Physiology)
Animal Physiology Reproductive
Physiology
Mammalian
Physiology
Ecophysiology
Integrative
Physiology
Immunology
Etc.
12.2 Sequencing of Core Concepts in the Curriculum
Even with the variation between different course sequences in physiology and
notwithstanding the diverse interests of students (and faculty) in physiology, it is
reasonable to propose a sequence for how core concepts ought to be unfolded within
different physiology curricula. Core concepts are by definition widely applicable,
and the mental models that underlie them are uniform regardless of the particular
curricular context in which they are learned. Moreover, core concepts have wide-
spread applicability and therefore do not depend on the particular stress or emphasis
that is placed on the physiology being learned.
Our proposal for sequencing the core concepts of physiology across the curric-
ulum is grounded on the construct of science learning progressions (Duncan and
Rivet 2013). Put simply, science learning progressions are cognitive models of
how learning of scientific concepts and practices unfolds over time (Duncan and
Rivet 2013). They purport to describe the paths by which students might develop
more sophisticated ways of reasoning over extended periods of time (Duncan and
Rivet 2013). As a way of approaching teaching and learning, learning progressions
are distinguished by at least four characteristic properties (Duncan and Hmelo-
Silver 2009). First, learning is focused on the big ideas or core concepts of the
discipline. Second, the scope of a learning progression is delimited by the prior
knowledge and skills of the incoming students at the onset and by the outcome goals
expected of students at the end. Third, intermediate levels of achievement within
the progression are derived from existing research on student learning as well as
from empirical studies of the progression itself. Fourth, learning progressions are
accomplished by targeted instruction that scaffolds student learning with appropri-
ate learning activities and resources.
For a number of reasons, this approach to mapping the progress students ought to
make as they advance through a scientific discipline is helpful for proposing how
different core concepts ought to be learned as students move through the physiology
curricula. Most obviously, the construct of science learning progressions focuses on
the big ideas of a domain. Furthermore, learning progressions place an emphasis on
defining both the input and output states of student understanding that bound the
progression.
It should be emphasized that progress in learning of the core concepts of
physiology ought to occur in parallel. Since each core concept is foundational to
achieving a meaningful understanding of the discipline, it would be counterpro-
ductive for students to learn the core concepts of physiology in seriese.g.,
homeostasis first, flow down gradients second, cellcell commuunication third,
etc. Thus, progression through the core concepts of physiology will occur as set of
parallel, intertwining learning pathways whereby students gain more sophisticated
understanding of each of the concept over the course of their studies.
At the outset, we admit the limitations facing the construction of legitimate
learning progressions around the core concepts in physiology. Very little is known
about the prior knowledge and skills that undergraduates bring to their learning of
the core concepts of physiology and even experienced teachers are not very
accurate in their predictions about this (Rovick et al. 1999). Furthermore, while
output goals have been defined for individual courses of instruction, there is no
widespread consensus (in the form of standards) about what constitutes satisfactory
achievement of the learning outcomes associated with the core concepts. Therefore,
much more needs to be uncovered about the prior knowledge that students bring to
their college-level learning of physiology before we can satisfactorily define our
input state. Further delineation of the expected outcomes with regard to under-
standing each of the core concepts need to be made. Thirdly, the existing literature
relevant to instruction in the core concepts of physiology needs to be called upon to
determine suitable levels of intermediate achievement for progression through the
core concepts. Finally, appropriate instructional strategies need to be identified that
will enable students to develop more sophisticated ways of reasoning about the core
concepts over the course of their undergraduate education.
Despite these limitations, we think it worthwhile to attempt to create a frame-
work for meaningful learning progressions about core concepts in physiology.
Following Duncan et al. (2009), we will ground our learning progressions on
(1) the limited research literature that exists about student thinking and learning
of the core concepts in physiology, (2) an analysis of physiology as a knowledge
domain itself, and (3) some of the expectations set by relevant national science
standards (AAAS 2011; AAMC 2009). Admittedly, much of our efforts here will be
conjectural since empirical validation of student understanding of the big ideas of
physiology is rudimentary.
In this process, we are assisted by the unpacking of the core concepts into
conceptual frameworks (Chaps. 5, 6, 7) and guided by the experience and expertise
of the instructors who have helped students to learn physiology at different levels of
the discipline. We are also informed by the preliminary identification of miscon-
ceptions about the core concepts (Wright et al. 2013). This unpacking, together with
our experience in helping students learn core concepts, helps us begin to determine
12.2 Sequencing of Core Concepts in the Curriculum 139
the foundational ideas within each core concept and to distinguish them from more
advanced or complex ideas. From here, calling upon the expertise of experienced
instructors, we can arrange the foundation and advanced ideas into a reasonable
sequence for learning. Recognition of the student misconceptions enables us to
identify where and when in the sequence of learning, special attention needs to be
applied to helping students overcome misconceptions and therefore continue to
progress satisfactorily in their learning of the core concepts.
In this chapter, we restrict our development of learning progressions to those
core concepts that have been most thoroughly unpacked into conceptual frame-
works (Chaps. 5, 6, 7). Each core concept was deconstructed into a series of
statements that describe features, requirements, and behaviors of the necessary
processes that underlie the core concept (McFarland et al. 2016). These so-called
critical components (see Table 4.1) are essential for the specification of the
complete mental model of each concept (McFarland et al. 2016). Each critical
component was in turn deconstructed into a set of constituent ideas. These ideas are
necessary to develop a working understanding of each critical component
(McFarland et al. 2016). Being essential for building an accurate model of the
core concept, an understanding of the critical components is vital at all stages of the
learning progression. However, constituent ideas can be assigned to different levels
of the progression based on their perceived contribution to building increasingly
sophisticated models of the core concept. It should be noted that the original scope
of the conceptual frameworks was fashioned to reflect the understanding of the core
concepts that second and third year undergraduates in the life sciences would be
expected to understand. Therefore, it is not surprising that most of the constituent
ideas have been assigned to the intermediate level within the learning progressions.
12.2.1 Homeostasis
The learning progression for homeostasis is founded on the conception of internal

stability (Table 5.1, Component H1). At the introductory level, the constituent ideas
that must accompany this critical component are (1) an organisms internal envi-
ronment differs from its external environment and (2) homeostatic processes work
to maintain stability in the internal environment. As students move into intermedi-
ate levels of understanding about homeostasis, they gain more detailed pictures of
which variables that are homeostatically regulated and the operational parameters
of the systems involved. Advanced ideas related to the component of stability
include the consideration of differences in the homeostatic ranges observed, the
limitations of homeostatic mechanisms, and the extension of the idea of physiolog-
ical stability into more complex conceptions of feedforward and allostasis.
The second critical component of homeostasis is the notion of negative feedback
(Table 5.1, Component H2). Since this conception is foundational to meaningful
understanding of homeostasis, it is not surprising that most of its constituent ideas
are required at the introductory level of the learning progression. This includes the
idea that a negative feedback system of any sort, including a physiologic homeo-
static system, consists fundamentally of a sensor, control center, and effector. More
complex ideas concerning the anatomical arrangement of these components and the
functional hierarchy of negative feedback systems are assigned to higher levels of
the learning progression (Table 5.1).
Critical components H3, H4, and H5 (Table 5.1) emphasize that homeostatic
processes require the operation of three essential components of a regulatory
system (sensor, control center, effector). Introductory learning begins with a basic
understanding of how each component works. Intermediate learning develops this
basic functional understanding to include more detailed conceptions of component
operation, and how each component contributes to the maintenance of homeostasis.
Advanced learning of homeostatic system requirements extends the understanding
of the mechanisms to include environmentally induced alterations in the perfor-
mance of the system.
12.2.2 Flow Down Gradients
At the introductory level, the learning progression for flow down gradients is
grounded in a fundamental understanding of flowthat particular substances
(individual molecules, volumes of fluid and bulk gas) and heat move from one
point in a system to another (Component F1, Table 6.1). This corresponds to the
notion of flow as expressed in the general model of mass and heat flow (Modell
2000). Critical components F2 and F3 describe the second significant element of
mass and heat flowthe relationship between flow and an energy gradient. At the
introductory level, students should understand that the driving force for flow is the
existing energy gradient for any particular substance or heat and that the magnitude
of the flow (flow rate) is directly proportional to the magnitude of the energy
gradient (Table 6.1). The notion that more than one type of energy gradient acting
together can drive the flow of ions and water (Critical Component F4) is then
addressed at the intermediate level and builds on the understanding of how a single
gradient can drive flow. Learning that multiple gradients can influence the move-
ment of ions and water across membranes is important for the application of these
conceptions to the intermediate level understanding of the mechanism of the action
potential and of fluid movement across the capillary wall. The third significant
element of the mass and heat flow model is the notion of resistance or opposition to
flow. At the introductory level, it is enough that students understand that resistance
and flow are reciprocally related (Table 6.1, Critical Component F5). The physical
determinants of resistance and the specific mechanisms for controlling resistance in
different physiological systems can then be explored when system-specific physi-
ology is addressed at the intermediate level.
12.3 Assessing Student Mastery of Core Concepts Across the Curriculum 141
12.2.3 CellCell Communication
The learning progression for cellcell communication builds on the fundamental

understanding of the general model of a control system (Modell 2000) or a stimulus
response pathway. At the introductory level, students are expected to develop a
basic understanding of cellcell communication that involves the release of a
messenger molecule, binding to a receptor protein, intracellular signal transduction
and amplification, and the target cell response (Table 7.1, Critical Components
CC1, CC3, CC4, CC5, Introductory Level). Beginning with these understandings,
students continue to build their mental models at the intermediate level to include
mechanisms of transport of the message molecule and termination of the message
signal (Table 7.1, Critical Components CC2, CC6, Intermediate Level). Students
further refine their mental models of how messenger molecules are released, how
message molecules are transported, how message molecules bind to receptors, how
amplification and integration occur, and the mechanisms of message termination
(Table 7.1, Critical Components CC1, CC2, CC3, CC4, Intermediate Level).
12.2.4 Learning Progressions for the Core Concepts

of Physiology
Table 12.2 describes possible learning progressions for the core concepts of
homeostasis, flow down gradients, and cellcell communication across courses
at three different levels in a curriculum. It should be obvious that as students
advance from one course to the next, they should be held accountable for all of
the previous component ideas they have already mastered. These progressions are
meant to illustrate how one might build into the curriculum (the sequence of
courses) a gradual unfolding of the core concepts.
The details of how a learning progression might occur in any particular program,
and even the sequence of the components of the core concepts, will obviously
depend on many local factors.
12.3 Assessing Student Mastery of Core Concepts Across

the Curriculum
The planned learning progressions described in the previous section should be

reflected in the learning outcomes and learning objectives for the courses making
the sequence of courses. It follows, then, that assessment in each of these successive
courses must look for a mastery of more complex mechanisms and more complex
mental models. One way of accomplishing this is to use novel scenarios (stems of
questions) of increasing depth and complexity.
Table 12.2 Suggested learning progressions for three different levels of courses. The topics listed
make up those pieces of the core concepts. These topics do not correspond exactly to the items in
the conceptual frameworks, but where they do correspond the item number has been listed.
Students are expected to understand and be able to use component ideas already mastered in
subsequent courses. Tables 5.1 (homeostasis), 6.1 (flow down gradients), and 7.1 (cellcell
communication) contain the full conceptual frameworks
Core Concept Introductory Intermediate Advanced
Homeostasis Sensor (H3) Regulation vs Control Variables Feedforward
Control Center (H5.3) Allostasis
(H4) Integrator (H4.2,4.3,4.5) Acclimatization
Effector (H5) Error Signal (H4.6)
Negative Feed- Controller (H4)
back (H2.1) Changing Set Points (H4.7)
Hierarchy of Controls
Flow Down Flow (F1) Determinants of Flow 2 Active Trans-
Gradients Energy Gradient Multiple Energy Gradients (F4) port
(F2) Determinants of Resistance Solvent Drag
Resistance (F5) (F5.3) Ion Selectivity
Control of Resistance (F5.3) Gating Behavior
(F5.3.1)
Poiseuilles Law
Starling
Equation
CellCell Messenger Mole- Determinants of Cell Release
Communication cule (CC1) (CC1.3)
Biochemistry Transport of Messenger Mole-
(CC1.1) cule (CC2)
Cell Release Determinants of Receptor Bind-
(CC1.3) ing (CC3.1)
Target Cell (CC3) Determinants of Signal Amplifi-
Receptor Binding cation (CC4.1)
(CC3.1) Signal Integration (CC4.1.3)
Signal Transduc- Determinants of Cell Response
tion (CC4) (CC5.1, CC5.2)
Cell Response Mechanisms of Signal Termina-
(CC5) tion (CC6)
12.4 Core Concepts as a Framework for Organizing

Physiology Curricula
An effective curriculum is based on a clearly defined sequence of learning out-

comes and learning experiences embodies in some required sequence of courses. A
curriculum is not simply an amalgamation of idiosyncratically selected courses.
What kind of curriculum (courses in some sequence) would we build if the
organization of the curriculum were driven by learning progressions for the core
concepts?
It is likely that it would not look much different than existing curricula; there
would still be introductory, intermediate, and advanced courses. What would be
different is emphases across the curriculum on helping students build increasingly
References 143
complex mental models by recurring application and deepening of core (Duncan

and Rivet 2013). There would also be less emphasis on mere accumulation of facts
and more emphasis on learning to use the facts to solve problems.
In other words, what we would see is a focus on deepening students under-
standing, even if there is a potential for less depth. This is, after all, what the
recommendations in Vision and Change call for (AAAS 2011).
References
American Association for the Advancement of Science (2011) Vision and change in undergrad-
uate biology education: a call to action. American Association for the Advancement of
Association of American Medical Colleges and the Howard Hughes Medical Institute (2009)
Scientific foundations for future physicians. Association of American Medical Colleges,
Washington, DC
Duncan RG, Hmelo-Silver CE (2009) Learning progressions: aligning curriculum, instruction, and
assessment. J Res Sci Teach 46(6):606609
Duncan RG, Rivet AE (2013) Science learning progressions. Science 339:396397
Duncan RG, Rogat AD, Yarden A (2009) A learning progression for deepening students under-
standings of modern genetics across the 5th10th grades. J Res Sci Teach 46(6):655674
Rovick AA, Michael JA, Modell HI, Bruce DS, Horwitz B, Adamsoon T, Richardson DR,
Silverthorn DU, Whitescarver SA (1999) How accurate are our assumptions about our stu-
dents background knowledge? Adv Physiol Educ 21:S93S101
Wehrwein EA (2016) Physiology is alive and well. Just ask the undergraduate student. Physiol-
ogist 59(6):285290
Wehrwein EA, Poteracki JM, McCann DJ, Henriksen EJ, Matyas ML, Halliwill JR (2014) A
nationwide assessment and comparison of curriculum requirements in undergraduate physiol-
ogy programs. Physiologist 57(6):353 (A25.4)
Wright A, McFarland J, Cliff W, Michael J, Modell H, Wenderoth MP (2013) Preliminary results
on the prevalence of physiology students homeostatic misconceptions. FASEB J 27:739.5
http://fasebj.org/content/27/1_Supplement/739.5
Part IV
Concluding Thoughts
Chapter 13
Extending the Paradigm
Abstract In this chapter, we discuss the additional work that needs to be done to
fully implement the core concepts paradigm in teaching physiology. One necessary
step is the unpacking of more of the core concepts and validating the conceptual
frameworks that result. We also need to better understand the relationships between
the core concepts and how to utilize them to enrich the paradigm. We need to
develop a library of conceptual assessment instruments that can be used by physio-
logy teachers. We also need to continue developing and refining the pedagogical
approaches, including the learning resources, that focus on core concepts. Finally,
we need to develop means for collaborative work on all of these tasks.
Keywords Unpacking core concepts Conceptual assessment Learning

resources Physiology textbooks
The physiology teaching community has only just begun the process of reforming
physiology education in the ways recommended in the Vision and Change report
(AAAS 2011). That said, it is clear that much progress has been made. Active
learning has begun to replace passive learning (Michael and Modell 2003; Michael
2006) and anyone reading Advances in Physiology Education can follow the
evolving movement to experiment with and implement active learning experiences
in the classroom. A search for active learning on the Advances in Physiology
Education webpage yields over 300 articles published between 2006 and the
present (July, 2016). However, there is clearly much still to be done.
In this book, we have proposed a new paradigm for teaching physiology that
focuses on the core concepts of physiology. We recognize that what we have
described is only a first step and much remains to be done. In this chapter,
we explore the direction in which we believe continued development of this
new paradigm needs to go.

DOI 10.1007/978-1-4939-6909-8_13
148 13 Extending the Paradigm
13.1 Complete Unpacking All of the Core Concepts

of Physiology
We have unpacked and validated only three of the 15 core concepts that we have
identified (see Chaps. 5, 6, and 7). To the extent that the other core concepts are
important, and we firmly believe that they are, they too need to be unpacked. This is
an enterprise that ought to involve the entire physiology teaching community.
Which of the other core concepts should be unpacked next?
We began our project by focusing on the three core concepts that we felt were
most central to any level of physiology: homeostasis, flow down gradients, and
cellcell communication. Each of these concepts is relevant to essentially every
section of physiology and is applicable at every level of study. This is not to say that
every item making up their concept frameworks is equally important at every level,
but the main ideas certainly are.
Which of the remaining 12 core concepts should be unpacked next? There is no
right answer to this question. As physiology teachers begin to implement a concept-
based approach, they will determine what additional core concepts their students
need for a particular course. These will then be the next core concepts to be
unpacked. As additional conceptual frameworks are created, and eventually vali-
dated, they can be used as springboards to the development of additional concept
inventories. This process, however, should be a community-wide one and we will
have to say about this aspect below.
13.2 Develop a Library of Conceptual Assessments

in Physiology
We have developed and validated only one conceptual assessment instrument,

the HCI, that assesses students understanding of homeostasis (McFarland,
in preparation). If physiology teaching is to focus on all the core concepts, it is
imperative that we should be able to assess whether students understand all of the
core concepts.
As we have pointed out in Chap. 11, a concept inventory for a particular core
concept can only be written when a conceptual framework has been developed.
Thus, as additional core concepts are developed, it will be possible to write asso-
ciated concept inventories.
The work involved in validating a concept inventory is great (see Chap. 11), and
the entire teaching community must participate in the process. We will have to say
about how to share the work involved in doing this below.
13.3 Developing Pedagogical Approaches that Support a Focus on Core Concepts 149
13.3 Developing Pedagogical Approaches that Support

a Focus on Core Concepts
As the physiology education community acknowledges the validity of a focus on

core concepts, there is a need to develop learning resources that will promote both
deeper understanding of the core concepts while at the same time fostering a
deeper understanding of physiology.
13.3.1 Textbooks
Regardless of the active learning modalities that may be implemented in class-

rooms, textbooks continue to be important resources for helping students learn
physiology. However, we have already noted (see Table 1.1 in Chap. 1) that current
physiology textbooks have become encyclopedic in their coverage of the discipline,
even at the introductory level. In addition, there is rarely any attempt made to
point out the commonalities, the core concepts, which span multiple organ systems.
Finally, topics that are explicitly represented in multiple systems, homeostasis
being one example, are not presented to the students in a correct and consistent
way (Michael et al. 2013; Modell et al. 2015).
Thus, there is a real need for textbooks that will support the core concepts para-
digm we have described here. Making this happen will require input from
many physiology teachers to the textbook publishers.
13.3.2 Learning Resources
Physiology teachers use a variety of resources to help their students master the
learning outcomes that have been defined for the course. When used in a classroom
with a focus on the core concepts of physiology, such resources must facilitate the
students mastery of both the particular core concepts and the physiology being
mastered.
Table 10.1 listed eight types of resources, each of them useable in a variety of
settings. This list is clearly incomplete; there are many other resources that could be
added to the list. Scanning through any issue of Advances in Physiology Education
will reveal other possible resources that can be used.
It is unlikely to find all of these types of exercises used in a single course, but it is
not at all uncommon to find a number of them used by any particular instructor.
Whenever and wherever these exercises are employed, the goal is to encourage
students to build, test, and refine their mental models (Michael and Modell 2003).
What is needed is the development of learning resources that focus on
core concepts as well as on specific physiological mechanisms. We have provided
150 13 Extending the Paradigm
brief description of such exercise in Chap. 11 but clearly the physiology teaching
community needs to develop many more and more varied kinds of exercises.
There is also a need for the community to begin asking a new set of questions
about active learning, concept-focused exercises. Are one or more types of exer-
cises more effective than others at promoting meaningful learning? Do different
groups of students (by levels or nature of program) benefit more from one type of
exercise? And finally, we need to start asking questions about how, exactly, to get
the greatest learning gains from the learning exercises we use.
13.4 Develop a Public Space to Facilitate Collaboration
Comprehensive implementation of the care concepts approach to teaching and

learning physiology will be a major undertaking. Conceptual frameworks need to
be developed and validated; concept inventories must be written and validated; and
learning resources, including new textbooks, need to be developed and tested. This
work will only be possible if as many members of the physiology teaching com-
munity as possible contribute to the work.
What is needed is a public space in which materials can be shared and criti-
qued; several such sites exist today, and the community needs to begin to use
such sites to continue the development of the core concepts approach to teaching
physiology.
References
American Association for the Advancement of Science (AAAS) (2011) Vision and change in under-
graduate biology education: a call to action. American Association for the Advancement of
McFarland JL, Price RM, Wenderoth MP, Martinkova P, Cliff W, Michael J, Modell H, Wright A
(accepted with revisions) Development and validation of the homeostasis concept inventory.
CBE-Life Sci Educ
Michael JA, Model HI (2003) Active learning in secondary and college science classrooms:
a working model of helping the learner to learn. Lawrence Erlbaum Associates, Mahwah, NJ
http://www.fasebj.org/content/27/1_Supplement/739.4. Poster available at http://physiology
concepts.org. Under Publications/Abstracts
Modell H, Cliff W, Michael J, McFarland J, Wenderoth MP, Wright A (2015) A physiologists view of
homeostasis. Adv Physiol Educ 39:259266
Chapter 14
Summing Up
Abstract In this final chapter, we review the arguments for reform of science
education in general and physiology education in particular. We then summarize
the key features of the new paradigm that we have described. Finally, we suggest
that what is needed to realize the changes we have proposed is a change in the
teachers mind-set.
Keywords Physiology education Core concepts
14.1 Summary of Arguments for the Need for Reform
In Chap. 1, we reviewed just a few of the many calls for reform of American
education and particularly science education. Every level of education from kin-
dergarten through graduate and medical school has been asked to make changes in a
way that students learn science.
Among the problems identified is the fact that there is much more known than
students can possibly learn. Students do not have the opportunity to develop an
understanding of the big picture because so much time and effort are spent
learning the facts. Finally, there is too little emphasis on students developing the
ability to use the knowledge being accumulated to solve problems.
One result is that too few individuals in our society are equipped to deal with the
myriad of issues having a biological component. Another easily identified conse-
quence is that students in the healthcare professions are less prepared than they
ought to be to deal with the additional learning that will occur throughout their
careers. Lastly, graduate students in all the sciences, and particularly the biological
sciences, are being trained in narrower and narrower domains, with consequences
for both research and teaching.
We have proposed a new paradigm for teaching physiology that we believe will
increase student learning, deepen their understanding, and improve long-term
retention of this subject.

DOI 10.1007/978-1-4939-6909-8_14
152 14 Summing Up
14.2 Review of the Key Features of the New Paradigm We

Are Proposing
Learning must be student centered and active if students are to develop the
appropriate mental models and develop the skills to use these models to apply
their knowledge to solving problems.
Teaching and learning should focus on core concepts and deep learning, not the
accumulation of ever more facts.
Assessments, formative and summative, must focus on students attainment of
meaningful learning about concepts and mechanisms, not just the ability to
remember facts.
We must build courses and curricula that focus on core concepts.
The physiology teaching community must develop learning resources that
actively engage students while focusing on core concepts.
Physiology needs new textbooks that focus more on presenting and using core
concepts and less on enumerating every longer list of facts.
14.3 Its a Mind-Set, Not a Prescription!
In the Preface to Michael and Modell (2003) the authors have this to say:
This book is about helping the learner to learn. While this phrase seems to
merely describe all good teachers strive to do, it really describes something more
than that. This phrase should be understood as a short-hand description of a mind-
set that directs all aspects of a teachers behavior. Michael and Modell then
proceed to explain the implications of this mind-set for all the various tasks and
challenges that a teacher must face. However, the active learning mind-set pro-
posed by Michael and Modell addressed pedagogy or classroom practice, not the
content of what students are asked to learn.
In this book, we have added an additional dimension to this mind-set, one that
asks the teacher to help the learner to learn the concepts of physiology and not just
a collection of facts about physiology.
To help make this change, we have proposed a way to systematically think about
what students in a physiology course need to understand, how to determine whether
the student do understand, and how to build a course and a curriculum that will
facilitate student understanding of physiology.
But remember, it is a mind-set, not a prescription!
Reference 153
Reference

Core Concepts Physiology

Uploaded by

Copyright:

Available Formats

Core Concepts Physiology

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Core Concepts Physiology

Uploaded by

Copyright:

Available Formats

JoelMichael WilliamCliff

Published on behalf of The American Physiological Society

The Core Concepts

Jenny McFarland Harold Modell

Ann Wright (deceased)

ISBN 978-1-4939-6907-4 ISBN 978-1-4939-6909-8 (eBook)

Library of Congress Control Number: 2017932318

The American Physiological Society 2017

Printed on acid-free paper

This Springer imprint is published by Springer Nature

1.7 How Can a Focus on Core Concepts Help? . . . . . . . . . . . . . . . 15

Part II The Core Concepts of Physiology

4 What Does It Mean to Unpack a Core Concept? . . . . . . . . . . . . . 37

6.5.2 Failure to Take into Account the Presence of Multiple

Part III Implementing the New Paradigm for Teaching Physiology

8.3 Revisiting the Core Concepts Wherever They Apply to a

10 Using Core Concepts of Physiology in Designing Learning

11 Conceptual Assessment of Student Learning . . . . . . . . . . . . . . . . . . 123

12.3 Assessing Student Mastery of Core Concepts Across the

Part IV Concluding Thoughts

Keywords Education reform Core concepts Knowledge explosion Physiology

The American Physiological Society 2017 3

1.1 The Need for Reform of American Science Education

Vision and Change (American Association for the Advancement of Science

1.1.1 Calls for Reform in the 1980s and 1990s

In its report A Nation at Risk, the United States National Commission on

1.1.2 More Recent Calls for Reform

1.1.3 Common Features of Reform Documents

1.1.4 Reforming Both Content and Pedagogy

1.1.5 The Need for Reform and the Knowledge Explosion

The explosion of knowledge in all of the STEM disciplines exacerbates the

Table 1.2 The number of Physiology textbooks (Authors) Number of pages

An obvious consequence of the enormous length of the textbooks we ask our

1.2 The Need for Reform of Physiology Education

1.2.1 Physiology Is Hard for Students to Learn

Physiology is difficult for students at any academic level to learn. As teachers we

1.2.2 The Knowledge Explosion and Its Impact

1.2.3 The Spectrum of Students Taking Physiology

graduate students generally already have strong undergraduate science training

1.3 How Should We Attempt to Institute Reform

1.4 What Do We Mean by Core Concepts?

The terms concepts, core concepts, concept learning, and foundational

1.4.1 Definitions from Psychology and Philosophy

In both psychology (Colman 2006) and philosophy (Prinz 2005), a concept is a

1.4.2 Definitions in the Field of Education

1.4.3 Core Concepts and General Models in Physiology

1.5 Defining the Core Concepts of Biology: The Conceptual

1.6 What Are the Core Concepts of Physiology and How

Table 1.4 The core concepts Core concepts in physiology

graduate courses) or in specialized courses (e.g. comparative physiology). The

1.7 How Can a Focus on Core Concepts Help?

1.7.1 Selectively Reduce the Body of Knowledge to be

1.7.2 Focus on the Generalities and that Which Is Most

1.7.3 Provide the Scaffolding for Learning New Things Later

Perhaps most importantly, an understanding of the core concepts of physiology will

molecular mechanisms of muscle contraction in a later course becomes easier

1.8 Organization of this Book

Abstract With the publication of Thomas Kuhns The Structure of Scientific

Keywords Paradigm Physiology education Physiology course Physiology

2.1 Thomas Kuhn and the Meaning of a Paradigm