Adv Physiol Educ 42: 477–481, 2018;
doi:10.1152/advan.00097.2018.
STAYING CURRENT
Interfacing virtual and face-to-face teaching methods in an undergraduate
human physiology course for health professions students
X Angela L. Mahaffey
Marcella Neihoff School of Nursing, Loyola University Chicago, Chicago, Illinois
Submitted 14 May 2018; accepted in final form 27 June 2018
Mahaffey AL. Interfacing virtual and face-to-face teaching meth-
ods in an undergraduate human physiology course for health profes-
sions students. Adv Physiol Educ 42: 477– 481, 2018; doi:10.1152/
advan.00097.2018.—Human physiology is a core physical sciences
course for health professions students, such as nurses and exercise
science majors. The concepts of human physiology lay the foundation
for health professions courses, such as pathophysiology. The National
Council Licensing Exam for registered nurses (a timed nursing licen-
sure exam) and the American College of Sports Medicine timed
licensure exams for exercise sciences students have a framework
consisting of human physiology concepts and are computer adaptive
testing (CAT) assessments. This provides a case for electronic testing
(in the undergraduate class setting) as a preparatory measure for CAT
licensing exams. Case studies have illustrated a high information
retention rate, with students completing online homework vs. paper,
as well. Additionally, in recent years, virtual laboratories for non-
physical science majors have been described as safer and effective for
the purposes of educating students in laboratory techniques and
experimental measures. Lastly, a successful learning approach utilized
by museums has been found to be effective in younger students as
well: “touch learning” (tactile learning). It also is important to note
that student discussions and the face-to-face teaching dynamic play a
critical role in the undergraduate education process. As such, the
teaching methodology discussed here combines e-learning, virtual
laboratories, tactile learning, and face-to-face didactic instruction of
human physiology in developing a course to engage undergraduate
health professions students, increase retention of human physiology
course materials, and simultaneously prepare students for the CAT
assessments that are licensing exams.
course development; health professions; undergraduate
INTRODUCTION
The occupations often selected by health professions stu-
dents include fields such as nursing, chiropractic, medicine,
osteopathy, physical therapy, occupational therapy, physician
assistant, podiatry, and social work (24). To date, this also
includes careers in exercise sciences (1, 57). As such, college
degree programs have been developed to prepare these students
for professional certification and licensing exams [such as
National Council Licensing Exam for registered nurses
(NCLEX-RN) and American College of Sports Medicine
(ACSM) exams] (1, 10, 11, 40, 46, 45). One course within the
health professions degree programs is human physiology, a
Address for reprint requests and other correspondence: A. Mahaffey, Loyola
University Chicago, Marcella Neihoff School of Nursing, BVM 907, 1032 W.
Sheridan Rd., Chicago, IL 60660 (e-mail: amahaf1@luc.edu).
1043-4046/18 Copyright © 2018 The American Physiological Society
Downloaded from www.physiology.org/journal/advances (190.142.217.203) on June 16, 2019.
standard for nursing and exercise sciences programs accredi-
tation (10, 11, 13, 40, 48, 58, 62). A newly developed, and
implemented, integrated virtual and face-to-face teaching
method has been designed to prepare nursing and exercise
sciences students for certification and the NCLEX-RN and
ACSM exams, in addition to introducing healthcare scenarios
in which students apply critical thinking skills using human
physiology topics. This integrated teaching method consists of
multiple human physiology learning resources (including elec-
tronic textbook, animations, in-class games, and online home-
work) (6, 7, 9, 14, 22, 27, 34, 41, 50, 54), virtual laboratories
(17, 26, 41, 42), handheld physiology models (12, 23), medical
case studies with student-led discussions (21, 43, 47), external
online resources (2, 5, 15, 17, 32, 35, 56, 61), electronic
testing, and study guides (4, 60). This was done with the goal
of aiding students in retaining critical human physiology
course material. A number of these teaching styles employed
were previously done independently of each other (28, 31). In
contrast, the strategy for the undergraduate teaching method
introduced here is in the amalgamation of these multiple virtual
and face-to-face educational approaches, into developing a
single interfaced teaching method for health professions stu-
dents in an undergraduate human physiology course (Fig. 1).
These interfaced teaching practices were utilized in three
lectures and nine virtual laboratory human physiology for
health professions courses. The overall purpose of this meth-
odology was to help nursing and exercise sciences students
create a connection between human physiology and healthcare,
as they prepare for certification.
METHODS
Learning methods. As with most current textbook publishers, an
online textbook (or “eText”) is available for students to access via
laptops, personal computers, and mobile devices. This has made the
applications of reading assignments easier for student access (41, 50).
In this undergraduate pedagogical approach for the human physiology
course, an attempt to peak student interest in completing human
physiology course assignments and exam preparation was made via
the use of animations, games, and assigning online homework (where
students could utilize mobile devices and complete assignments on the
go) (Fig. 1). Research of recent years indicates that videos and
animations used in the collegiate educational process were successful
pedagogical tools in engaging students in learning (7, 15, 17, 34).
Therefore, videos (and animations) provided from the textbook pub-
lisher library of animations (chapters entitled “IP Animations,” “A&P
Flix,” and “BioFlix”; Ref. 41) and YouTube anatomy, physiology,
and pathology educational videos (36, 44, 52) were integrated during
the development of this health professions undergraduate course. The
topic of “e-learning” for nursing students has been explored and found
477
478 INTERFACING VIRTUAL AND FACE-TO-FACE TEACHING METHODS
Fig. 1. Diagram of the human physiology course for health professions
development model. HW, homework.
to be useful here in “supplementing” face-to-face teaching method
(Fig. 1) (29, 37). This speaks to the validity of integrating online
homework assignments in a human physiology course for nursing and
exercise science majors. In fact, previously published research con-
cluded that students completing online homework assignments were
able to retain information review for up to 5 days in two sampled
physiology courses (9). The use of games (trivia or deductive reason-
ing) in a classroom or laboratory learning environment has been
observed in both chemistry and health professions classrooms (6, 14,
22, 27, 30, 59). A “quiz show (human physiology)” game was utilized
on a weekly basis. Three independent groups (sections) of students
were separated into two parts (a total of 6 groups), and each pair
would compete against each other as a weekly review of chapter
context. Students used the quiz show game as a self-assessment
resource in preparation for upcoming human physiology exams.
Virtual laboratory: PhysioEx 9.1. Virtual laboratories, virtual sim-
ulations, and virtual learning spaces have been incorporated into
courses for nurses and other health professions curricula in previous
years (18 –20, 25, 26, 33, 39, 55). Eleven virtual human physiology
laboratories were integrated into the course development process for
the nine virtual laboratory courses created, by selecting and creating
assignments using the Pearson Education Inc. PhysioEx 9.1 physiol-
ogy virtual laboratory modules (41, 42). The PhysioEx 9.1 offers a
selection of laboratories, including “Cell Transport Mechanisms and
Permeability,” “Renal System Physiology,” “Serological Testing,”
“Blood Analysis,” and more. One caveat to this library of virtual
laboratories is that a course curriculum has to be designed that makes
a connection between laboratory topics, lecture (via eText) (41, 50),
and healthcare. External resources used during prelaboratory lectures
helped to resolve this concern. Case in point, for the “Serological
Testing” and “Blood Analysis” (Fig. 2) PhysioEx 9.1 laboratories,
there was no sufficient reference found in the Stanfield human phys-
iology eText that could substantially explain the role of these two
laboratory experiments in healthcare (41, 42, 50). To remedy this
issue, external resources, such as animations, educational videos, and
match games, were added to the teaching plan. This proved to be an
effective way to create a bridge between virtual laboratory topics and
healthcare (2, 3, 6, 7, 15, 29, 34, 49). A number of assignments
outside of the library of PhysioEx 9.1 laboratory modules were
designed to promote student teaching (21) and group discussions.
Advances in Physiology Education • doi:10.1152/advan.00097.2018 • http://advan.physiology.org
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Fig. 2. A screenshot view of the PhysioEx 9.1 Blood Analysis Laboratory,
“Activity 1: Hematocrit Determination” (41, 42).
Here, students were separated into groups and asked to present on the
correlations of the physiological virtual laboratory topics and health-
care. Laboratory reports were submitted online into the collaboration
and learning environment (CLE) Sakai software (4), both promoting
use of electronic submission (less use of paper) and integrating the
electronic reporting process into the course curriculum, as health
professionals are currently mandated to complete electronic medical
reporting (8, 51). A student attendance requirement for the human
physiology virtual laboratory courses ensured students were physi-
cally present in the virtual learning laboratory classes, and working
with a partner, a synchronous activity per laboratory pair.
Using handheld models for tactile learning. Tactile learning is a
concept often encouraged in museums as an educational resource for
multiple exhibit visitors of all ages (38, 63). Handheld physiology
models purchased from the AnatomyWarehouse.com (Evanston, IL)
allowed students to exercise the touch sensory (tactile) learning
process during lecture (Fig. 3). Such models are a useful addition to
the undergraduate studies classroom (12, 23). This provides students
with a three-dimensional representation of the subject matter. More
importantly, in human physiology courses for health professions
students, this provides students with a visual perspective on the effects
of pathologies in the human body. A human physiology course serves
as a curriculum bridge to pathophysiology (1, 10, 11). Handheld
models illustrate the physiological functions of organs and systems
and their pathologies, providing a physical surface on which students
can make observations (using senses other than sight and sound) while
formulating critical thinking decisions.
Case studies in lecture and discussions. Case studies show the
correlation between physiology and disease in healthcare. Reviewing
Fig. 3. Handheld physiology/pathology models. A: pathologies of the arteries,
veins, bronchioles, osteoporosis of the bone, chronic obstructive pulmonary
disease model with bronchus and aveoli, and neuron cell body model. B:
pathologies of the liver, lungs, stomach (cancer), uterus, and hypertension
model (eye: glaucoma; arteries: atherosclerosis; arterial plaque; kidney: kidney
failure; and brain: stroke). Models were purchased from AnatomyWare-
house.com (Evanston, IL).
 INTERFACING VIRTUAL AND FACE-TO-FACE TEACHING METHODS
case studies promotes student discussion and participation. Table 1 is
a case study presented to health professions students, in the three
human physiology courses reviewed, during the lecture on renal
physiology. While lecture students learned details of the glomerular
filtration process and the role of the kidney and bone marrow in
erythrocyte production, they were presented with a case study. A
patient (as seen in Table 1) diagnosed with ESRD (end-stage renal
failure) would not only exhibit low blood filtration of waste (as seen
with high blood urea nitrogen, creatinine, and potassium counts; Table
1), but also exhibit anemia, without pharmaceutical aide. Students
discussed renal physiology as pertaining to ESRD. This case study
engages health professions students in the details of renal physiology
and creates a bridge between physiology and healthcare.
External resources in physiology lecture and discussions. In 2018,
a new organ was introduced to the public: the interstitium (5). As this
was a novel discovery, the physiological characteristics of the inter-
stitium had not yet been published in a textbook. Students learned
what classifies matter as an “organ” from these resources. Here
external resources (journal articles) were used to educate students on
the interstitium organ in human tissues (5, 35).
Online testing (face-to-face) and licensure exams, social media,
and study groups. There is a common saying, “You have to meet
people where they are,” and this approach is along the same vein of
reasoning. In fact, publications note that using Facebook as an
instructional tool has been useful in encouraging students to form a
collaborative group for studying, sharing knowledge, and exercising
critical thinking skills (32, 37, 56, 61). During the progression of this
human physiology course, students created a Facebook group for
studying and created group sessions for exam review. Study guides
designed by the lecturer outlined the following: 1) exam topics, 2)
related figures, 3) tables, and 4) helpful animations. The correlations
between these four categories of study were based on the meticulous
selection of each category to formulate a more focused approach in
studying for the students enrolled. The exams were timed electronic
assessments. These online exams were administered using the CLE
Sakai program (4) to ensure that students enrolled in the course had
access to each exam, and the CLE Sakai testing algorithm included a
timing mechanism, which had been set for each exam. The timed
online exams helped to mimic the CAT licensure exam settings to
prepare students for those critical future exams and to provide stu-
dents with an opportunity to cultivate stress-management skills during
important CAT test-taking scenarios. The overall goal for having an
electronic exam in a face-to-face setting was to prepare health pro-
fessions students for the computer-based licensure and graduate ad-
missions exams (1, 16, 40, 46). Students were anonymously polled as
to whether they would prefer the online (electronic) testing format in
a face-to-face class vs. the traditional paper, in preparation for elec-
tronic licensure and graduate admissions exams, and, of the 136
students polled, 104 preferred the online format (Fig. 4). The anony-
mous poll was administered using the CLE Sakai software to ensure
students polled were enrolled in the human physiology course (4).
Table 1. Female ESRD patient case study: review of renal
physiology and ESRD
Course Patient X Normal Range
Hemoglobin, g/dl 7.8 12.0–15.5
BUN (predialysis), mg/dl 66 7–20
BUN (postdialysis), mg/dl 18 7–20
Creatinine (predialysis), mg/dl 9.7 0.5–1.1
Creatinine (postdialysis), mg/dl 3.6 0.5–1.1
Potassium, meq/l 6.7 3.5–5.0
Renal laboratory analysis results were voluntarily submitted by end stage renal
failure (ESRD) patient for educational purposes. BUN, blood urea nitrogen.
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479
Fig. 4. Using the collaboration and learning environment (CLE) software
(Sakai) (4), an anonymous student poll asking, “Considering the online
(in-class) testing format serves to prepare students for online licensing exams,
would you prefer the online testing format or paper?” was designed, and three
independent student groups were polled. Of the 136 health professions students
polled, an overall 76% preferred online (in-class) testing. Students were not
required to complete the anonymous poll; as such, only 136 of 152 students
elected to complete the anonymous poll. n, No. of responses.
RESULTS
As this was an examination of an extensively interfaced
teaching method, much of the results can be observed in
student performance. Of the three lecture human physiology
courses developed using this combined teaching mechanism,
there were a total of 152 students enrolled. Each student was
also enrolled in one of the nine virtual laboratory courses. A
99% passing rate (with a required minimum passing grade of
75%; C⫺) was observed for students successfully completing
this course, which was developed on the methodology of an
interfaced virtual and face-to-face pedagogy. Many of the
students expressed gratitude for the approaches incorporated in
the lectures and laboratories and confidence in preparedness for
the next advanced physiology course and electronic testing
skills for certification exams, from using this teaching mecha-
nism.
DISCUSSION AND CONCLUSIONS
To conclude, this interfaced approach of virtual and face-to-
face teaching methods was developed to prepare students for
the technologically advanced health professions workforce.
The use of models, animations, virtual laboratories, and exter-
nal resources help to create a multisensory approach to learning
that included touch (tactile learning), which would further
integrate course details into student perception. Case studies
promoted the necessary discussions to keep students engaged.
One point of interest may be to investigate the psychological
aspect (such as anxiety) of students taking electronic vs. paper
exams. Although, as noted previously, there are advantages for
student testing to switch to electronic vs. paper, for the pur-
poses of preparation for computerized adaptive testing (40).
Suffice it to note that this novel undergraduate pedagogy (the
union of e-learning and face-to-face into a single course) has
interesting concepts that may be applicable in future human
physiology courses.
DISCLOSURES
No conflicts of interest, financial or otherwise, are declared by the author.
480 INTERFACING VIRTUAL AND FACE-TO-FACE TEACHING METHODS
AUTHOR CONTRIBUTIONS
A.L.M. conceived and designed research; analyzed data; prepared figures;
drafted manuscript; edited and revised manuscript; approved final version of
manuscript.
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