If I am confused by this course, then how must my students feel? I have worked extensively to fix that.

A Personal Anecdote

Where were you the day the world changed?

I'm looking over the sea of student faces, 209 are enrolled in the class. It's been a good term; the students are engaged. At the beginning of every class, we've been checking in on the progress of an emerging infectious disease. This year, I picked one that tied into a case study we use in the course on the SARS outbreak from 2003, a coronavirus that emerged from Wuhan, China. 

We've learned how to use words like pandemic and epidemic in the class. We've reviewed virus structures and immunology. We've developed an understanding of epidemiology, how to track diseases and vaccine development. 

Today's class feels a little bit different. It's March 11, 2020. 

I tell my students, "The WHO has just announced that SARS-CoV-2 is a pandemic. "

It was the last time I saw them in person.

Course Context and Evolution

This course is one of several perspectives courses Health Sciences (HSCI) students require for their degree. Depending on their program, they must take 2-4 of these courses. These courses provide fundamental principles and breadth on different disciplinary areas of health sciences and are essential to our programs. Although many HSCI students take this course, we also teach students from across the university. This course examines infectious diseases through different disciplinary perspectives. Over 200 students will be enrolled in this course at one time. 

I have taught this course ten times between 2011 and 2021. The last time I taught, it was fully remote instruction. The first time I taught the class, I had inherited the course from other instructors. I did not have a clear vision of the course goals, was overwhelmed by the number of guest lecturers, and did not see the connection between lecture topics. This resulted in several issues. First, asking rigorous exam questions based on guest lecture content was challenging. Second, the course lacked focus, making it difficult to identify a common theme. Student feedback reinforced my observations. They said they enjoyed the class and the topics but had difficulty identifying the key content, particularly from guest lectures. Furthermore, students requested that I teach more classes as they found my teaching style accessible and didn't have to adjust to the multiple teaching styles of guest instructors. 

Ways I Have Improved the Course Since 2011

• A course redesign workshop helped develop an overarching vision and learning objectives that embraced a multi-disciplinary viewpoint (see below).

• I created a team project that integrated the course's themes and connections between the different content modules. Eventually, the format was adjusted to write case studies (see assignment description below).

• I created consistent tutorial plans for the TAs (see sample below).

• I wrote weekly study guides that provided learning objectives, study questions and resources; these have now been migrated to online course modules (see sample below).

• I taught more lectures to create consistency in the course teaching style. 

• I started to use case studies in teaching.

• I worked more closely with guest lecturers to develop learning objectives and exam questions.

• I wrote and published a case study for the epidemiology module after receiving feedback that the content was dull and uninteresting. (See Gastronomic Gastroenteritis). 

• More recently, I instituted a quiz and pre-reading for every content module.

• I used TopHat as a classroom feedback system and learning management system, but students didn't like switching between platforms, so in 2020, I migrated all of the content to Canvas.

• I brought a decolonial perspective to the course, exploring the impact of residential schools on TB dissemination. I also have a plan to introduce anti-viral drugs, with inspiration drawn from Indigenous Medicines. 

• In 2020, this class was the focus of one of my inquiry projects. They were the first ones to be tested and provide feedback on the 5-step reading method that I described in the scholarship section (see below).

• In 2021, I developed a remote learning course. The course content was more organized and included quizzes for formative assessments on the reading and recorded lectures. To help students navigate through the course, I created weekly checklists and recorded lectures.

These changes have made the course more cohesive and the learning goals more explicit, providing opportunities for formative assessment.

How I Express My Teaching Values

Mindset Transformation - This course has included many modules that get students to think differently about issues about which they have preconceived biases. For example, destigmatizing HIV-1 infection and looking at the role of the Canadian government in spreading tuberculosis in the residential school system.

Connecting to our Shared Humanity - This course has cases that are based on the human experience with disease.

Student Experience and Emotional Growth - I work to create an interesting and interactive classroom environment and have students develop compassion in areas where they may have had biases.

Integration of Technology - I use classroom response systems regularly to enhance in-class interaction.

Importance of Reflection and Critical Thinking - Students have to make connections between modules and apply knowledge.

Systems Thinking - This course investigates infectious diseases through a series of disciplinary lenses, then we consistently work to bring those pieces together.

Course Redesign

In 2012, I took a 4-day workshop called "Rethinking Teaching" (now called Rethinking Course Design). It uses backwards design principles and taught me the importance of course-level learning outcomes and alignment with assessment. 

I applied the approaches in the workshop to this class. This was a course I inherited from other instructors, and I felt there was an overemphasis on guest lectures and a lack of connection across the course. Due to the various teaching styles, students found the content difficult to connect with and didn't know how to study for exams. This workshop helped me refocus disconnected course content and create more cohesion and consistency. I developed a novel "Disease Busters" assessment to combine course content. My work on this course via this workshop made some substantive improvements and enhanced the student experience. 

Case Studies

Case studies are an effective way to showcase interdisciplinary problem-solving methods and provide students with practical context (Herreid, 2005). They can pique students' interest by presenting engaging narratives that content alone cannot match. To ensure the validity of the content, I use case studies that have been peer-reviewed and classroom-tested by the National Science Teaching Association. Students appreciate using case studies as it allows them to interact with course concepts. In this course, I have written two case studies.

Reference

Herreid, C. The Interrupted Case Method. Journal of College Science Teaching, 2005 35, 4-5. Available from: https://static.nsta.org/case_study_docs/resources/Interrupted_Case_Method.pdf

Gastronomic Gastroenteritis 

This is a case study based on a norovirus outbreak at a high-end restaurant. I wrote the case to introduce infectious disease epidemiology. It has been published by the National Center for Case Study Teaching in Science (now National Science Teaching Associateion). The case body and slides are available below. 

Link to download full case: https://www.nsta.org/ncss-case-study/gastronomic-gastroenteritis-fat-duck

Abstract

This interrupted case study was inspired by and uses data from one of the largest commercial restaurant associated outbreaks of norovirus reported in the literature. It applies basic principles of epidemiology and outbreak investigation to a shellfish-linked norovirus outbreak at a Michelin star restaurant in the UK in 2009. The details of the case are taken directly from the report that was produced by the health protection agency and publications that followed. Students take on the role of an infection control team (ICT) that is responsible for identifying the extent and source of the outbreak. They are taken through different stages of the outbreak investigation and at each stage asked what their team would do in response to given pieces of information. Specifically, students uncover the scope and source of the outbreak using descriptive and basic analytical epidemiology methods. The case is suitable for first or second year introductory courses in microbiology, epidemiology, or other infectious disease related topics.

Objectives

• Review steps of an outbreak investigation in the context of a food-borne disease investigation.

• Understand the role of descriptive epidemiology in the context of an outbreak, and the importance of defining a case.

• Interpret an epidemic curve and calculate incubation period from a graph produced from outbreak data.

• Identify transmission mode and predict the impact on the spread of the outbreak and explain what is meant by secondary transmission.

• Distinguish between case-control and cohort study and determine which study type is appropriate for this outbreak investigation.

Course Feedback

I have provided data from the course experience surveys for Spring 2021 (conducted remotely) and Spring 2019 (conducted in-person). I implemented many changes to make the course's online version more organized. There is a significant shift in how students remarked on course organization between those two sets of feedback. In 2019, students faced difficulties while navigating between Canvas and TopHat. However, in 2021, the organization was substantially improved. Unfortunately, no course experience surveys were conducted for Spring 2020 due to the pandemic and the pivoting of remote instruction midway through the term. 

Next time I teach the class, I plan to maintain the same organization and structure for the online version of the course and incorporate case studies into the in-person teaching as well. However, the challenge will be to create a sense of community and add value to attending the class in a large classroom setting. I aim to encourage second-year students to read primary literature by introducing another case study that will reinforce this skill through repetition.

Unsolicited Correspondence From Students 

Hi Nienke, 

Hope this email finds you well. I'm an FHS graduate of 2019, you wrote me a reference for a service award in my last year at SFU. I started medical school this year at UBC's Prince George program. We're doing a unit on immunology and allergy. My classmate (also an SFU FHS grad) and I were just reflecting on how amazed we were by how much we could remember from your HSCI 212 class. Just wanted to send a quick note to say thanks for doing such an excellent job with teaching that, and how thoughtful you are in the teaching process. 

All the best, *Student*

Hello Dr. N, 

I was in your spring 2019 HSCI 212 class. 

I just wanted to say that I have just finished my last semester at SFU and to date, it has been one of my favourite courses. You taught it incredibly well so I was not only engaged in the class at the time but so the information stuck with me. 

The sections on the immune system, HIV, and vaccines all have information that stood out and I've retained and have helped me in later courses, as well as to generally better understand health and our world. I keep notes from past courses, and rarely reference them, however, I have had the notes from your class out recently and referenced information on vaccines. 

I also found the section on how to talk to people with vaccine hesitancy a critical life skill. Teaching us how to meet someone where they are, validate their feelings, and then gently correct misconceptions and provide them with the information that they need is an incredibly valuable life skill. I had to use that last Christmas with a friend of my mother's and over the course of an hour, I saw him go from very defensive to actually having a calm conversation and seeing eye to eye with me on many points.  

I just wanted to thank you for your teaching, both your method of delivery and your course content were amazing. 

I hope you are healthy, and doing well, despite the ongoing pandemic. 

Thank you again and all the best, 

*Student*

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