Chapter 3 – Online versus live practicals: what were physiology students missing during the pandemic?

Introduction

This chapter reports preliminary findings from a research project at the University of Cambridge which explored students’ experiences of online and in-person physiology practical classes (‘practicals’). Experimental practicals have long been central to physiology teaching, but during much of the academic year 2020-2021, in-person practicals were impossible because of the SARS-CoV-2 pandemic. Therefore, ten physiology practicals within the preclinical medical/veterinary Homeostasis (HOM) module and seven animal physiology classes within the natural sciences Physiology of Organisms (POrg) module were converted to an online format, for the students to work through at home. Both HOM and POrg modules were part of first-year undergraduate courses, and there was substantial cross-over in material.

Constructing the online practicals required us to reflect on their purpose, not just in our eyes but in those of our students. HOM students took some in-person anatomy practicals in 2020-2021 and were offered one, optional, in-person physiology practical once restrictions had eased (50% of the cohort attended that live class). The HOM cohort also included a small number of graduates who may have experienced university practicals previously. In contrast, most POrg students had only ever taken in-person practicals at school. We were interested to know what students with such limited experience of experimental work felt that physiology practicals should, in principle, be for.

Methods

The online practicals began with descriptions of the experiments that would normally have been performed. The students were then given data presented either within AD Instruments’ LT system or in Microsoft Word documents with embedded spreadsheets. They were asked to make measurements from experimental recordings, analyse and interpret data, consider limitations to the experimental design and discuss the underlying physiological mechanisms. These classes were accompanied by live-streamed demonstrations performed by two academics, which were also recorded and put online. There were optional pre- and post-class formative assessments, plus Zoom-based question and answer (Q&A) sessions run by the lead academic (MJM). A debrief sheet explaining the answers to the questions posed was provided after each class.

In May 2021, we sent an online survey to all HOM and POrg students (n = 409 and 192 respectively), to assess their views of these online physiology practicals. By that point, HOM students had completed 9/10 and POrg students all 7 of their practical classes. It was made clear that survey participation was optional and responses would remain anonymous. Following several prompts, the window for responding was closed in August, after the academic year had finished. Written responses were classified using the auto-code function in NVivo software.

Results

We received 70 responses from HOM students (17% of possible respondents) and 75 from POrg students (39%).

The first question in the survey was ‘Considering what you would expect from experimental practical classes, to what extent do you feel that the online practical exercises this year, overall, were adequate replacements for the equivalent “live” practical classes?’ Five Likert-scale answers ranged from ‘The online classes were very poor replacements’ to ‘The online classes were very good replacements’. Results are shown in Figure 1. We turned the five choices into integers from 1 (‘very poor’) to 5 (‘very good’), and compared mean scores with a t-test: see Norman (2010) for a justification of this approach. The HOM mean score was 3.04 while the POrg mean score was 2.47; these values significantly differed (p = 0.002).

1. Becoming familiar with basic laboratory equipment and techniques;
2. Becoming familiar with clinical equipment and techniques (e.g. ECG, sphygmomanometry);
3. Learning about experimental design and the scientific method;
4. Having the opportunity to test your own ideas, experimentally;
5. Learning how to analyse and interpret data;
6. Gaining experience in performing calculations;
7. Discovering the difference between theory and practice;
8. Developing problem-solving skills;
9. Thinking about the ethical aspects of scientific research;
10. Working in an ‘active’ way (i.e. not just listening or reading);
11. Reinforcing lecture material (e.g. by looking at similar material in a different format);
12. Preparing you for the exam;
13. Working as a team with other students;
14. Meeting students from other colleges;
15. Discussing scientific questions with the academic staff;
16. Interacting informally with the academic staff;
17. Developing a professional identity (i.e. beginning to think and feel more like a medic/vet/scientist).

The responses for each cohort are indicated in Table 1.

Table 1: Extent to which students regarded different aspects of practicals as important, from the list of 17 choices available. Scores range from 1 (not important at all) to 5 (extremely important)

Mean scores for all 17 aspects of practicals were well above 3 (‘No strong feelings’). However, an ANOVA on the combined data (HOM plus POrg) revealed significant differences (p < 0.001). Student views were explored further in free text comments.

Answer 10, (‘Working in an “active” way’), scored highest for both cohorts, and experience with techniques, answers 1 and 2, also scored highly. The open-ended question ‘What do you feel are the most important things practical classes should contribute to your education, beyond what you would gain from the lecture course?’ yielded 60 written responses from HOM students and 63 from POrg students. 37 responses indicated that practicals support the development of ‘skills’ and ‘practical’ experience, which some students linked to their future professional needs:

I mean in future careers, a lot of us will be handling these things, be it as doctors, vets or natural scientists. So practical classes are a good way for us to hone these skills and make mistakes without serious consequences.

Students generally valued developing problem-solving skills (answer 8). The following comment compares making electrocardiogram (ECG) recordings in the single in-person HOM practical at the end of the year to looking at ECG recordings online, earlier in the course:

Primarily it was appreciation of the true nuance of the procedures described. For example, while I understood the principles of ECGs well from our lectures, understanding how the leads attached, seeing actual cases of anatomical variation and errors of method and generally having the opportunity to try, perhaps not succeed straight away, but still eventually manage to complete the task far outstripped the purely theoretical consideration I gave to the online exercise in Michaelmas [term 1].

Although exam preparation (answer 12) ranked lower, HOM students wanted practical classes to reinforce lectures (answer 11). Active learning evidently helped understanding of the theoretical material:

[Practical classes should] allow us to gain practical experience with equipment and generally build on practical skills. The practical course also allows us to apply things we have learnt in lectures to the real-world – I think this also makes lecture content easier to learn if we are able to apply it to a real situation that we have witnessed and not just read about online.

POrg students in particular were keen to use the opportunity to meet students from other colleges (answer 14), while discussing questions with the academic staff was generally valued relatively highly (answer 15). For some, such interactions were important in fostering a sense of connection, as well as fulfilling deeper social needs:

Feeling like you’re a student who interacts with the department which teaches you rather than feeling disconnected all year.

…missed time meeting fellow students, poor mental health from so much time alone.

Students saw testing their own ideas (answer 4), calculation practice (answer 6) and consideration of ethical aspects of scientific research (answer 9) as the least important of the possible options.

Discussion

The HOM and POrg practical classes considered here were moved to an online format as an emergency measure, in response to the SARS-CoV-2 pandemic. If more time had been available for consideration and planning, the classes could have been improved: our ‘Recommendations’ section below suggests what, in retrospect, we might have done differently. Our student respondents did recognise the constraints that the course developers were under at the time but in response to the direct question we asked, most did not see the online practicals that we had been able to produce as good replacements for live classes. The responses from the HOM students, who had some in-person practical experience, seemed to follow a bimodal distribution (Fig. 1). Their higher mean score may have reflected a more realistic view of what in-person university practicals are like compared to the POrg students, who had little or no such experience.

It is important to recognise that positive student perceptions of a teaching method do not always translate into better marks, and vice versa (e.g. Deslauriers et al., 2019). We did not attempt to compare the summative examination performance of our students with that of previous cohorts: the enormous changes to all aspects of teaching, learning and examining associated with the pandemic would have made the results impossible to interpret. Nevertheless, one would expect the views of the students expressed here to have a significant impact on their satisfaction with their course as a whole, as well as their confidence in applying practical skills in future years.

Differences in how students valued the 17 aspects of practical classes were small, but some trends were apparent. It was no surprise that the medical and veterinary students taking HOM valued learning clinical techniques (answer 2), while natural scientists taking POrg favoured basic laboratory techniques (answer 1). Both cohorts valued the development of problem-solving skills (answer 8), echoing Sella’s (2017) drive towards designing practical classes that do not ask students simply to follow instructions towards a pre-defined outcome. Ethical considerations seldom arise in most first-year physiology practicals, and students may have become inured to performing calculations on pre-recorded data, perhaps explaining why these aspects were relatively little valued.

Although HOM and POrg students scored ‘Working in an “active” way’ (answer 10) highest of all 17 options, the online practicals, which involved making measurements, plotting graphs, performing calculations and answering questions, were generally not regarded as good replacements for in-person classes. We suspect that for most students, ‘working in an active way’ means hands-on familiarisation with equipment and experimental techniques, rather than the opportunity for interactive learning through a computer. This requires confirmation through further study.

‘Discussing scientific questions with the academic staff’ (answer 15) scored relatively highly among both cohorts. Paradoxically, attendance at Zoom-based Q&A sessions where students had this opportunity was in single figures throughout 2020-2021, with many sessions attracting no students at all. This suggests that there was a high threshold to log into an online Q&A session, and some students might not have received the support they needed. Perhaps students felt that logging in to ask a ‘small’ question would be a waste of a professor’s time, while asking a ‘big’ question might embarrass them by revealing their ignorance.

Some aspects of practicals which were evidently valued by our students are not typically covered in formal learning objectives. Unlike the HOM students, the POrg students had no live practicals at all, which might explain why they particularly valued the social aspects of the classes (answer 14). Students were encouraged to work through our online classes in groups, but this may have been difficult for first-years to organise if they lacked pre-established social networks at university. Interestingly, the POrg students rated ‘developing a professional identity’ more highly than the HOM students, perhaps for the same reasons, although the difference was not statistically significant (p = 0.347). Although the problems of social isolation were doubtless exacerbated by the entire course being online in 2020-2021, not just the practicals, the results of this study support some previous research (Hodgson et al. 2014; Colthorpe & Ainscough, 2021) in suggesting that the social and collaborative aspects of ‘live’ practical classes should not be overlooked.

Recommendations for educational developers

Given improvements in efficiency, it is unsurprising that senior academic leaders are keen to draw on what was learned in 2020-2021, and continue some aspects of online teaching into the future. The findings of this study invite us to reflect further on the purposes of practicals, and consider how to improve online methods of teaching and learning beyond the pandemic. Based on the three most obvious shortcomings of our own classes from the point of view of the students, we make the following recommendations for those developing online practical classes in the future:

1. Introduce a hands-on practical element to the classes which can safely be performed at home with minimal equipment. For example, smartphone technology can be utilised to record electrocardiograms (Thoms et al., 2019).
2. If students are unfamiliar with others in their cohort, assign them centrally into small groups for the purposes of collaborative work. This could be through the use of online breakout rooms, with students assigned to the same groups throughout the semester. Previous research on online practicals has suggested that this helps to build team cohesion (Fong & Hammond, 2021).
3. The lack of participation in online Q&A sessions was concerning, given that students told us that they valued opportunities to discuss scientific questions with academics. Using junior members of staff as facilitators in breakout rooms might have a ‘bridging’ effect, ultimately giving students more confidence to approach the professors. In addition, collaborative tools which can be used anonymously could be employed, such as online discussion boards. A discussion board created during a breakout session could be used initially for synchronous peer-learning, but the academic in overall charge of the class could later leave answers to any questions posted there.

Going forward, we hope that our study can be used to initiate and/or support dialogue between educational developers, academic colleagues and students, regarding the design and delivery of practical classes at module and course levels. The resource efficiencies of online practical classes must be considered in the light of student voices, which have helped us to identify areas that clearly need strengthening within our own courses.

References

Colthorpe, K., & Ainscough, L. (2021). Do-it-yourself physiology labs: Can hands-on laboratory classes be effectively replicated online? Advances in Physiology Education, 45(1), 95-102. https://doi.org/10.1152/advan.00205.2020

Deslauriers, L., McCarty, L. S., Miller, K., Callaghan, K., & Kestin, G. (2019). Measuring actual learning versus feeling of learning in response to being actively engaged in the classroom. Proceedings of the National Academy of Sciences, 116(39), 19251-19257. https://doi.org/10.1073/pnas.1821936116

Fong, A., & Hammond, A. (2021). Student experience with online Physiology practical laboratory during COVID: What worked? What didn’t work? The FASEB Journal, 35(S1). https://doi.org/10.1096%2Ffasebj.2021.35.S1.04769

Hodgson, Y., Varsavsky, C., & Matthews, K.E. (2014). Assessment and teaching of science skills: whole of programme perceptions of graduating students. Assessment & Evaluation in Higher Education, 39(5), 515-530. https://doi.org/10.1080/02602938.2013.842539

Norman, G. (2010). Likert scales, levels of measurement and the “laws” of statistics. Advances in Health Sciences Education, 15, 625-632. https://doi.org/10.1007/s10459-010-9222-y

Sella, A. (2017). Rethinking practical classes. Nature Reviews Chemistry, 1, Article 0090. https://doi.org/10.1038/s41570-017-0090

Thoms, L.-J., Colicchia, G., Watzka, B., & Girwidz, R. (2019). Electrocardiography with a smartphone. The Physics Teacher, 57(9), 586-589. https://doi.org/10.1119/1.5135782