Arthur C. Guyton 
Physiology Educator of the Year
Robert Carroll

Robert Carroll

“Those of us that dabble in science, we don’t have beards.” 
Arthur C. Guyton, January 1981.

I am excited for many reasons to be selected the 2004 Arthur C. Guyton Physiology Educator of the year. First, it reflects the excellent mentorship and guidance I received during my training from David F. Opdyke and Walter N. Duran while a graduate student at UMDNJ-Newark, and Thomas E. Lohmeier and Arthur C. Guyton while a postdoc at the University of Mississippi. In addition, my friends and colleagues in the education communities of the APS and the IUPS continue to develop my awareness and appreciation of education. Thank you all.

Setting Expectations to Enhance Learning
Setting clear expectations enhances learning. This is not merely a hypothesis but, rather, a proven educational maxim. As curricula and curricular goals increase in complexity and number, making sure that the learner has a firm idea of the material she/he is expected to master is essential. The need for clear communication becomes even more critical as we achieve our goal of diversifying the biomedical research community, to assure that students from diverse racial/ethnic groups, nationalities, and even regions of the US clearly understand what constitutes “success” in their training or studies. 

The important connection between expectations and achievement was not always a cornerstone of my approach to learning and teaching. Interestingly, the time and impetus to reflect on my training provided by this award led me to recognize that some of my most important educational lessons occurred in practice, rather than by overt “teaching.” My first understanding of the relationship between expectations and learning was provided by mentors who set high expectations and communicated them clearly. Allow me to expand on two incidents that shaped my educational approach.

Learning the Lesson #1
While a second-year graduate student I was asked to develop a catecholamine assay for Dr. Opdyke. Even in pre-Medline 1977, conducting the literature search was a straight-forward task and I completed it quickly. Unfortunately, I never found time to do the preliminary lab work that was needed. During my third “update” meeting, Dr. Opdyke noted the lack of progress with the terse statement, “If you can’t complete the project, other arrangements will have to be made.” (David F. Opdyke, April 1977).

The fact that I had other demands on my time was an explanation, but it didn’t change the fact that Dr. Opdyke needed the results, and I was responsible for producing them. My explanation did not excuse my lack of performance. With renewed motivation, I completed the necessary work over the next month. This encounter led me to select Dr. Opdyke as my dissertation advisor, and began an association that grew into a friendship. I did not realize it at the time, but I felt comfortable with the clear (and sometimes pointed) communication of expectations that he provided. I knew what I had done correctly…and what I had not accomplished yet. 

Learning the lesson #2
I arrived in Jackson, Mississippi in June of 1981 with all of the pride of a newly minted PhD. I used the Christmas break to grow a beard. In early January, I was in the departmental office when Dr. Guyton came in and, after appreciating my new facial hair, said in a clear voice, “I see you are finally becoming a scientist.” I was fairly sure I was not going to like the conversation, but I eloquently responded, “Yes?” Dr. Guyton turned to the few people in the departmental office and announced, “You can tell when a young man becomes a scientist. He grows a beard. Those of us who just dabble in science—we don’t have beards.” My youthful pride demanded that I not shave my beard. And I didn’t – for an entire week. Dr. Guyton had high expectations, clearly communicated his expectation, and then stepped aside. Again, I was not aware of it, but I re-learned something that day. The first step in shaping student performance is to clearly communicate your expectations. 

Applying the Lessons Learned
Two recent projects completed by the APS Education Committee and Education Office illustrate the principles of setting and clearly communicating expectations. The APS is fortunate to have an exceptional and talented group supporting the educational activities of the Society, and I and many others owe a special gratitude to Marsha Matyas and Melinda Lowy for their friendship and diligence. 

Medical Physiology Learning Objectives
One of the more ambitious projects was the Medical Physiology Learning Objectives project. The idea resulted from a discussion with Gabby Navar (Tulane) in 1997, and took shape over the next three years. This joint project of the APS and the Association of Chairs of Departments of Physiology (ACDP) provides a detailed description of the physiology concepts that should be mastered by students while completing their pre-clinical training. More than 50 physiologists were involved in constructing the objectives, which were then evaluated at 31 different medical schools. 

The compiled objectives, available through the APS website (http://www.
the-aps.org/education/MedPhysObj/medcor.htm), provide a useful guide for both new and experienced faculty. New faculty gain insight into the balance between depth and breadth of coverage when organizing their teaching. Experienced teachers find the objectives to be a valuable reinforcement of their teaching decisions, and a rare opportunity to see what topics are emphasized at other institutions. 

The objectives have proven useful for physiologists participating in curriculum “renewal.” Medical schools appropriately seek to improve the educational experience and the quality of their graduates. The pre-clinical years are often charged with simultaneously decreasing the amount of classroom time to allow learner-directed activities, and to increase clinical exposure. The development of a nationally accepted description of medical physiology content helps insure that physiology remains a significant component of the pre-clinical curriculum.
Apart from use in individual institutions, this approach has two additional benefits:

1) Control of “Medical Physiology:” The objectives allow for review and revision of the physiology curriculum. There are a number of topics, such as gender differences, and changes across the life-span, which are only briefly touched on in most medical physiology courses. Revising the objectives to include these or other topics will speed their appearance as a common component of physiology.

2) Control of the internal and external evaluation (USMLE Step 1). Whether they agree with it or not, experienced teachers accept the reality that testing drives learning. Management books deal with a similar theme—assessment determines behavior. Most teachers can confirm that the most common question asked in a lecture setting is, “Is this on the test?” The objectives need to be provided to new members of the USMLE physiology item writing committee. If item writers use the objectives to guide their content expectations, much of the mystery and confusion surrounding the examination content can be diminished. There should be a clear link between what is taught as medical physiology and what is tested on the USMLE as medical physiology. The objectives can be used to establish this link. Again, clearly identifying and communicating your expectations, and incorporating those expectations into the assessment of learning, will allow more effective direction of student learning. 

Professional Skills for Physiologists and Trainees
The second project focuses on graduate training in physiology. Our expectation of graduate students is sharply different from medical students, but faculty often have difficulty in expressing that difference. In my mind, I have a content expectation for medical students, but I expect graduate students to go past content acquisition to the development of analytical and critical thinking skills, writing and presentation skills, etc. The APS and ACDP have made it easier for graduate students and postdoctoral fellows to comprehend those expectations by providing a template, the “APS/ACDP List of Professional Skills for Physiologists and Trainees.” 

The APS Council initiated this project in July of 2002 by jointly charging the chairs of the Education Committee (me), Career Opportunities in Physiology Committee (Frank Belloni, New York Medical College), and Women in Physiology Committee (Carole Leidtke, Case Western Reserve University) to participate in the development of a listing of professional skills critical for physiologists and trainees. A proposal was presented to the ACDP at their annual meeting. The ACDP endorsed it and designated Bill Dantzler (University of Arizona), Vernon Bishop (University of Texas Health Science Center, San Antonio) and Bill Spielman (Michigan State University) to develop and shape the project. As with the Medical Physiology Learning Objectives project, the APS Education Office ended up doing most of the work. 

This project built on a variety of similar efforts from other organizations. The working committee compiled and reviewed published documents with similar themes, and evaluated how relevant the components were to physiologists. A draft was circulated through the APS and the ACDP for comments, and the revised document is now available through the APS website (http://www.the-aps.org/education/skills.htm). Table 1 indicates the major headings for the final document. Interestingly, core biomedical science knowledge, which was the major focus of the Medical Physiology Learning Objectives project, is only one of the nine headings, demonstrating the diverse nature of skills we expect trainees to develop during graduate and postdoctoral studies and in early career development.

I had the opportunity to “field test” the draft objectives on our graduate students. The reactions were interesting, and clearly split along seniority. The first-year students found the list intimidating. The second and third year students found the list useful and the more senior graduate students were frustrated that they did not have the list available to them earlier. One interpretation of their response is that that list is close to being “on target.” Again, student performance can be enhanced by clearly communicating expectations. 

In summary, in my teaching and mentoring, I try to do unto others as I was lucky enough to have done unto me: hold high expectations of students, tell them exactly what is expected of them, and help them achieve the goals. Let them accomplish it. And be sure to celebrate their accomplishments. Oh yes—Hi, Mom. 

Arthur C. Guyton Physiology Educator of the Year Award

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