Responses to the “Scientific Foundations of Future Physicians” report: the effect on Introductory Physics for the Life Sciences Suzanne Amador Kane Physics Department Haverford College Temple University, October 2012 Catherine Crouch Swarthmore College Robert Hilborn University of Texas, Dallas Tim McKay University of Michigan Mark Reeves George Washington University

Outline  What is the Association of American Medical Colleges-Howard Hughes Medical Institute (AAMC-HHMI): Scientific Foundations for Future Physicians report?  AAMC MR5 – review and redesign of the Medical College Admissions Test  How Introductory Physics might change in response

Need for Change The approach to science education in the premedical and medical curriculum is largely unchanged for decades …. …. while biomedical sciences have changed dramatically. Readiness for medical school admission is defined by: – lists of required courses – content of the MCAT examination Both are rather static criteria, not very explicit about what students should be able to do

The Bio2010 report (NAS, published 2002) concluded: – Fixed premedical science course requirements and MCAT content constrain the undergraduate science curriculum – This applies not just in biology but across the sciences An example: Many students who would make excellent physicians identify premedical science course requirements such as Organic Chemistry as the reason they chose another career. Institutions wishing to innovate their chemistry curricula find it difficult to do so, given the externally imposed pre- med requirements Need for Change

The Scientific Foundations For Future Physicians Project Initiated and organized by – Association of American Medical Colleges (AAMC) – Howard Hughes Medical Institute (HHMI) Committee: – medical school faculty – undergraduate science and math educators. Diverse institutions MCAT leadership (a division of AAMC) closely involved

Committee members are drawn from both medical school and undergraduate institutions Robert Alpern, Co-chair Yale School of Medicine Sharon Long, Co-chair Stanford University Science faculty [grad/undergrad] Manuel Ares Cell biology U.C. Santa Cruz Karin Akerfeldt Chemistry Haverford College Julio de Paula Chemistry Lewis and Clark College Robert Hilborn Physics University of Texas at Dallas Dierdre Labat Biology Xavier University Claudia Neuhauser Math University of Minnesota Gregory Petsko Chemistry Brandeis University Dee Silverthorne Biology University of Texas at Austin

Medical School faculty Judith Bond Penn State University Medical School Jules Dienstag Harvard Medical School Andrew Fishleder Cleveland Clinic Michael Friedlander Baylor College of Medicine Gary Gibbons Morehouse School of Medicine Paul Insel U.C. San Diego Medical School Lynne Kirk U.T. Southwestern Medical Center Bruce Korf University of Alabama Medical School Vinay Kumar University of Chicago Medical School Paul Marantz Albert Einstein School of Medicine Committee members are drawn from both medical school and undergraduate institutions

Charge to the Committee What science competencies should medical students demonstrate, before receiving the M.D. degree? What science and mathematics competencies should premedical students demonstrate before entry into medical school. Emphasis should be on defined areas of knowledge, scientific concepts, and skills rather than on specific courses.

Undergraduate course requirements should be eliminated and replaced with a list of required competencies. – undergraduate schools will have flexibility to design new curricula – interdisciplinary classes may be offered – innovative educational programs may encourage students to enter medicine and the related biomedical sciences. Strategy - 1

No net increase in premed science requirements – Liberal arts are important for education of physicians – Presently, 1 year each of: physics, biology, general chemistry, organic chemistry and calculus – If we recommend new competencies, then un-needed material should be removed from overall curriculum Strategy - 2

Scientific competencies should be those required to practice medicine – includes interpretation of the scientific literature – critical and skeptical thinking, analysis These competencies are not designed to prepare for a career in biomedical research. – Some schools may design curricula to prepare students for careers in research – Choice is up to each individual institution Strategy - 3

Scientific competencies: – Reflect recent advances in the biomedical sciences – emphasize the increasingly close relationship with the physical and mathematical sciences. Examples: – Statistics is important to allow physicians to be a critical consumer of data from new clinical trials, research on genomic associations, etc. – Biochemistry is more relevant than some aspects of organic chemistry presently emphasized Strategy - 4

Structure of Recommendations Overarching Principles Competency (Medical or Entering) E1, E2, ….8 = broad statement of goal for understanding – Learning Objective 1, 2, etc competencies in various areas Examples 1, 2, etc.

Structure of Recommendations Two of the Overarching Principles: 1.Demonstrate knowledge of, and ability to use basic principles of: – Mathematics and Statistics – Physics – Chemistry – Biochemistry – Biology needed for the application of the sciences to human health and disease 2.Demonstrate observational and analytical skills and the ability to apply those skills and principles to biological situations.

1.Apply quantitative reasoning and appropriate mathematics to describe or explain phenomena in the natural world 2.Demonstrate understanding of the process of scientific inquiry, and explain how scientific information is discovered and validated. 3.Demonstrate knowledge of basic physical principles and their applications to the understanding of living systems. 4.Demonstrate knowledge of basic principles of chemistry and some of their applications to the understanding of living systems. 5.Demonstrate knowledge of how bio-molecules contribute to the structure and function of cells. 6.Apply understanding of principles of how molecular and cell assemblies, organs, and organisms develop structure and carry out function. 7.Explain how organisms sense and control their internal environment and how they respond to external change. 8.Demonstrate an understanding of how the organizing principle of evolution by natural selection explains the diversity of life on earth.

Competency E1. Apply quantitative reasoning and appropriate mathematics to describe or explain phenomena in the natural world. Learning Objectives: 5. Make inferences about natural phenomena using mathematical models. – Examples Describe the basic characteristics of models (e.g., multiplicative vs. additive). Predict short- and long-term growth of populations (e.g., bacteria in culture). Distinguish the role of indeterminacy in natural phenomena and the impact of stochastic factors (e.g., radioactive decay) from the role of deterministic processes.

Competency E3. Demonstrate knowledge of basic physical principles and their applications to the understanding of living systems Learning Objectives: 1.Demonstrate understanding of mechanics as applied to human and diagnostic systems. 2.Demonstrate knowledge of the principles of electricity and magnetism (e.g., charge, current flow, resistance, capacitance, potential, and magnetic fields). 3.Demonstrate knowledge of wave generation and propagation to the production and transmission of light and sound. 4.Demonstrate knowledge of the principles of thermodynamics and fluid motion. 5.Demonstrate knowledge of principles of quantum physics such as atomic and molecular energy levels, spin, and ionizing radiation 6.Demonstrate knowledge of principles of systems behavior, including input– output relationships and positive and negative feedback.

Competency E3. Demonstrate knowledge of basic physical principles and their applications to the understanding of living systems Learning Objectives: 3.Demonstrate knowledge of wave generation & propagation to the production and transmission of light, sound. - Examples Apply geometric optics to understand image formation in the eye. Apply wave optics to understand the limits of image resolution in the eye. Apply knowledge of sound waves to describe the use and limitations of ultrasound imaging.

Calendar Report released in June, 2009 Accompanying editorial in Science Now: coordinate work with undergraduate institutions, scientific disciplines, medical school and MCAT organizations MCAT revision MR5 approved -- preview booklet released 2011—rollout in Jan Medical schools’ response now in progress

Challenges for Physics Devise courses that helps students meet the report’s competencies Sharpen the focus of intro physics for life sciences: not everything in the standard introductory physics course is relevant to life science students Work with other STEM colleagues to streamline and focus the pre-health curriculum

Report on 2009 Workshop on Intro Physics for Life Sciences 40+ physicists, life scientists, AAMC, APS, AAPT reps AAMC message: SFFP offers a way to innovate without previous MCAT/premed requirements as constraints Do the right thing—teach what physicians/life science students need to know—don’t just teach to MCAT (old or new)

Life science perspectives Bio/Med more quantitative – students need to use (more) physics now Skill/knowledge transfer physics  biology, isn’t working Make life science connections with physics in class (not later) New content: fluids, basic stat. physics (diffusion, random walks, distributions), electrostatics in media, physical techniques, quantitative methods (data analysis, etc.)

2010 American Association of Medical Physicists meeting Residents: Med students tend to regard physics as something they take to pass their boards Physicists tend to teach physics in the abstract without telling them how it connects Only later do they realize how important it is Medical physicists: emphasized need for more medical physicists for retirement replacements and how much physics MD’s need to understand now

Audience Challenges IPLS students don’t understand course goals Many feel they “can’t do physics” Fixed ideas about “plug-and-chug” Learning other approaches in other courses “I went into the life sciences to avoid math and physics” Diverse student preparation, background Diverse student majors, careers

Physics content in SFFP Report Most topics sound familiar New bio/med emphases What physics to omit/de-emphasize? Swap engineering  Life science examples New curricular materials needed: textbooks, good problems (relevant life science content)

The rub… Bottom-down approach: teach physics  later see an application ? “These students see biology in other courses; this is their only chance to learn physics. Teach foundations, the rest will follow.” Top-down approach: Bio problem  motivates physics tools ? “We know transfer isn’t happening with this approach; teach them what they need to know/use. The extra motivation results in their learning more physics.”

The No-Pain, No Physics-Loss IPLS Solution! TEACH THIS NOT THAT!

Less time on… Kinematics & friction-free trajectories Constant force, acceleration Friction Hookean mass-spring systems Kepler’s Laws Gravitation

More time on… Actual trajectories Acceleration from rest to a constant velocity Energy Dissipative systems (drag, etc.) Thermodynamics at constant T, Pressure Elasticity (simple continuum mechanics, fracture, non-Hookean systems) Fluids

About the same on… Waves & oscillations Electricity & magnetism (most) Modern / quantum physics But with attention to applications in life sciences

Physics “process skills” Keep physics approach to math modeling Simplifying problems, finding essential features Quantitative model-building Empirical testing, limitations Experimental design, critiquing, refinement. Some ideas and approaches to be included: the possibility for open systems teach momentum conservation, but from the point of view of interactions and impulse discuss energy realistically, that is include all forms of ingoing and outcoming energy accounting for dissipative energy introduction of statistical principles discussing complexity, the idea of hidden models in thermodynamics, but showing that statistical approaches connect these to fundamental interactions. ideas of scale using circuits as an analogy for energy input and output of a system. and others to be excluded: equations that do not have conceptual meaning discussions of steam engines discussions of entropy and disorder or of entropy as a hidden cause of not being able to convert all heat to work a focus on mechanical energy thermal expansion A major goal of teaching about energy will be to demonstrate its universality so that studnets do not emerge from their science classes, as they often do now, with the sense that there is physics energy, chemistry energy, and biology energy. == Dynamics: particle motion, fluids, diffusion == The general feeling was that kinematics in the sense of trajectory motion problems has little usefulness to the life science curriculum. These are problems that are endured, sometimes mastered, but rather quickly forgotten. Ideas from kinematics such as rate and acceleration do have application to problems in epidemiology, evolution, and population growth. What should be included? Motion influenced by dissipation diffusion osmosis modeling on conservation principles to illustrate and use the Bernouli equation What should be excluded trajectory motion a heavy emphasis on inertial motion rotational kinematics, conservation of angular momentum == Forces and torques == Forces and torques as drivers of kinematics, that is Newtonian mechanics, forms the heart of current introductory physics classes. This approach assumes that the students will be later thinking about problems that arise in inertial reference frames. Is this the correct approach when trying to solve problems in which dissipation plays a major role? Certainly one moves from accelerated motion to constant velocity when the dissipative force equals the driving force, and this comes straight from Newton's Laws of Motion. However, as traditionally taught, the three laws of motion are applied over and over to problems in which dissipation is ignored. Thus, our discussion centered on placing in the introductory course problems from fluid motion, fluids at low Reynolds numbers, and other examples where once the external force is removed, then then object ceases its motion. What should be included Free body diagrams and resolution of forces and torques motivating ideas from biomechanics: strength of materials, muscle action, thresholds for damage drag forces What should be excluded gravitation Kepler's Laws == Summary == In the end, it is worth repeating that we are looking to teach an easily identifiable physics course that is enriched by life-science contents. Relevance is important as a motivating tool to inspire students to learn, and also that the material presented in the course will be useful to our students in subsequent classes. Thus it is important to also teach where the students will see these ideas in their biology and chemistry courses - a point made by the group who reported the life sciences perspective. We teach that Physics is the foundational science - the point is made more convincingly when we show our students the explicit connections to other sciences. Finally, we have a unique opportunity to teach a knowledge and understanding of physics that will allow our students to be better scientists and medical professionals.

How to (better) teach “Process Skills” How to harness student’s motivation to succeed in our courses? Learn about their other courses – connect explicitly to their chosen fields. Tell students these skills are a course goal Relate to their future career goals Test & grade based on these skills

How to (better) teach “Process Skills” Know students’ “initial knowledge state” Scientific skills develop over the long-term— coordinate with other departments? Reference their other science course content? Integrated courses? (integrated Princeton? Harvard’s chem/physics intro course?) Improve lab & integrate into lecture

Assessment What do we want to assess? (what mix of content, skills, and attitudes) What existing assessment tools are useful? What new tools are needed and how can they be developed? Can we test retention and/or transfer of skills into later (non-physics) courses? Many existing tools, but not aimed at this task

Education Research Challenges How do IPLS students differ from other physic s populations? How to use lessons from Physics Education Research ? What new work can be done / needs to be done? Existing resources include: HHMI-funded NEXUS group (U. Md., others) Teaching problem-solving skills, U.Minnesota cooperative group problem-solving (CGPS) Hypothesis generation and testing: Rutgers group’s Investigative Science Learning Environment (ISLE) Explicit focus on reading and interpreting graphs (such as with Real-Time Physics) SCALE-UP and Arizona State -- modeling

Institutional support Blue ribbon panel—identify & publicize best practices Funding initiatives to support curricular development and institutional changes AAMC: Clarity on timing, logistics of implementation & assessment AAMC: More specifics on the new MCAT

Laboratories How do we meet the goals of competencies E1 & E2, while including more life science content into the physics laboratory curriculum? Many institutions have such labs New emphases: imaging, diffusion, random walks, medical applications of circuits, optics. How to incorporate lessons from physics education research (SCALE UP) to make students learn desired competencies from these experiences?

Bone scaling & rubber elasticity Geometrical optics & the human eye Electrocardiography lab Our Lab Examples

DNA crystallography with visible light (Institute for Chemical Education) Fluids mechanics Ultrasound Imaging Animal trajectories Spectroscopy & Quantum Dots Our Lab Examples

Ultrasound Imaging Physics Students use pulse-echo imaging to detect the presence of objects within medical “phantoms” (test samples) Both M-mode and B-mode imaging is supported The labs explore attenuation, spatial resolution and Time-Gain- Compensation. Final project involves imaging a medical model of breast tumors and a kidney “phantom” using an actual scanner Doppler and therapeutic units are also available for inexpensive purchase and lab use now Images: 3B Scientific & GE

Lab Examples from elsewhere Imaging & bacterial motility (George Washington University) Brownian Motion (Centre College, U. Md., Johns Hopkins) Fluids & microfluidics (Johns Hopkins)

Process skills in the lab Enhance transfer—show how physics leads into applications (Waves & Sound  ultrasound imaging) Hypothesis testing: Bone Scaling  simple Galilean theory does not work! Interpretation skills & data analysis Teamwork Reading (simple, basic) in the scientific literature

Google: “ intro physics life sciences” “AAMC-HHMI physics” astro/Amador/links/IPLSResources.php astro/Amador/links/IPLSResources.php AAMC-HHMI report: htm htm New MCAT MR5: ortoverview.pdf ortoverview.pdf