'Flipping' anatomy and physiology
Department of Biomedical Sciences Assistant Professor Amanda Haage talks ‘flipped’ classrooms and cell migration.
Amanda Haage, Ph.D., is an assistant professor in the UND School of Medicine & Health Sciences Department of Biomedical Sciences. Among other duties, she’s responsible for teaching the two-semester anatomy and physiology courses to hundreds of UND undergraduate students each year. She sat down with North Dakota Medicine recently to discuss, “flipped” classrooms, cell migration, and student engagement.
Thanks for your time, Dr. Haage. You’re relatively new to North Dakota, yes? How did you end up here?
I grew up in southeastern Iowa, south of Iowa City. I stayed in-state for my education: a bachelor’s degree in biology at Wartburg College, and a Ph.D. at Iowa State. I got my doctorate there while my husband did his [Doctor of Veterinary Medicine]. Then we went to Vancouver, British Columbia, for my postdoctoral work for five years. When I went on the job market, we wanted to come back to the Midwest for lots of reasons—cost of living, speed of life. UND had an opening and I applied and ended up really liking it here, and I guess the feeling was mutual.
And you have research interests in both the active learning environment and cellular movement?
Essentially, my task when I got hired was to revise the anatomy and physiology [A&P] courses at UND. We used to have standalone A&P courses, taught by separate people. But the best practice nationally now is a combined A&P sequence of courses—A&P 1 and 2, taught together based on organ systems. I was asked to rebuild that from scratch. It was a huge course redesign, and we launched it in fall 2020—online. It’s been good. We’ve been asked to speak on our model at the Anatomy & Physiology Society and other conferences. The courses are pretty novel in that I really try to focus on direct application of the content. It’s active learning, completely flipped courses. I have recorded lectures students can watch, but they do activities that range from drawing different anatomical structures to reading and answering questions about cases studies.
Say more about that—how might an instructor “flip” an anatomy course in an active way to get beyond the traditional memorization and lecture-test format?
We know now that just lectures and tests aren’t the best way to teach and help students retain information. Students need to do something with that information. So I ask a lot of different types of questions in different ways. Picture essays for students to consider, asking them to draw the structures and label them—the skull, or the bones in the ankle. Students diagramming out processes on paper: the mechanisms and pathophysiology. We ask students to describe how anatomy works and use the terms from a 200-level A&P course to think through how a disease process works in the body. So, they’d learn about the lungs and then we’d discuss chronic obstructive pulmonary disease—how does it work in the lungs and why? And it’s the only Science, Technology, Engineering, and Mathematics (STEM) course approved as a “diversity” course by our [General Education Committee].
Nice. What do you do in anatomy and physiology to make it about diversity?
We have a lot of “culture and med” assignments, incorporating the social determinants of health and discussing what science is and means to different groups of people, and even the biological variation in humans—actual and perceived. For example, we discuss how skin color determines the traditional “race” categories that have been used to label people even though, genetically, humans of all backgrounds of course are all extremely similar to each other. We talk about the difference between biological sex and gender. I do a lot on mobility and disability. For example, there is a lot of variability in peoples’ skeletal muscle systems that limits mobility and strength, fatigue, and so on. How our bodies differ and how they don’t.
Right—because we’re still evolving as a species in response to our environment.
Yes, and there’s definite anatomical variation too. So, when we embed the fact that there’s not a standard or “normal” in anatomy up front [with undergraduates], then it’s easier to work with medical students on questions of pathology later. We can teach them early that there are always exceptions and always variations. One of my favorite questions to ask early on is if illness is subjective or objective. And who decides what “sick” means?
Susan Sontag has that great book Illness as Metaphor that explored these questions in the 1970s.
It’s interesting. There’s a population of students that really embrace all this. Some are less excited. But the application part for the clinical pieces is a much easier sell. Everyone sees the benefit of that. It does take some more convincing with the cultural side of things. We’ve had this long division between the humanities, social sciences, and what we consider “hard” sciences. But that’s not really my philosophy [laughs]. Interestingly, at UND at least, the conversation is now around embedding our [general education courses] and broadening the vision in them. I have a list of “culture and medicine” books I give students, like [Rebecca Skloot’s] The Immortal Life of Henrietta Lacks, and others like that. It’s a good list.
These discussions were once called “medical humanities”—maybe still they still are.
Yeah, I guess that’s what I’d call it. I’m not an M.D., so I don’t come from that angle. I started as an education major and went to the sciences and decided on graduate school in the sciences quite late. It’s all about engagement and making this stuff relevant to students, instead of just straight memorization of bones, muscles, nerves. That’s stuff we need to know, but, also, we need to be able to apply it.
And how about your lab-based research?
I study how cells sense their environment and know where to move and how and how fast. Neural crest migration is one of those contexts I’ve looked at. A lot of our cells in development don’t start where they need to end up. One of those populations are the cells that make up your peripheral neurons that start in the neural tube on your dorsal side and branch out during embryonic development. Those cells travel through all these physical environments and need signaling. And they change. So, I study how our cells interpret their environment at that level. Cancer metastasis is the big clinically relevant issue here because that’s a scenario where cells decide to move throughout your body. Why? What causes them to move? I don’t view myself as a clinical-translational researcher. But I have hopes [laughs]. We have decent treatments out there for solid tumors, but with metastasis we don’t know where those cells might be—they’re too small and are hard to find. One of the potential outcomes of some of my work is determining how we can delay or prevent these cancer cells from moving, hopefully without destroying other tissues in the process.
That’s an epigenetic project, or pharmaceutical, or something else?
Hopefully at the pharmacological level—preventing changes in protein interactions and shape changes that happen in response to those “go here and metastasize” signals. If we can essentially blind the cell to the stuff telling it to move, hopefully we can prevent or stop that metastasis before it starts. But in order to do that we have to understand how the cell “reads” or “sees” it’s environment first.
Sort of like a “preventive” chemotherapy.
Hopefully! Or something that starts in combination with early diagnosis before we hit that crucial point of spread.
Interview conducted and edited by Brian James Schill