Institutional Collaboration in Physiology Teaching in the UK

Introduction

‘We must have a new generation of bright physiologists able to pick up from where the molecular approach runs out’.  (Peter Newmark, Nature, 2012)

rising student numbers……..loss of physiology departments as a result of their merging with schools of biological, life, health, or medical sciences……have contributed to physiology’s lamentable decline’  (Richard Naftalin, 2011)

The above two quotes set out rather starkly the perception among some UK physiologists that their discipline is in danger of dying out at a crucial time for UK bioscience. Physiology in this context is the study of the normal functioning of living organisms. It is one of the oldest of the scientific disciplines having its origins in the Hippocratic School of Medicine at around 420BC. In the modern setting physiology has been one of the fundamental scientific disciplines in the UK since the establishment of the Physiological Society in 1876. Consequently most of the pre-1992 universities have historically had long-established Departments or Schools of Physiology. Many of these units have been closely linked with medical education in the UK.

Richard Naftalin, an emeritus Professor of Physiology at King’s College London, wrote an article for The Scientist magazine entitled the ‘decline of physiology’ in which he expressed his concern for the future of physiology teaching in the UK. He suggested that practical physiology training in particular has been virtually eliminated from physiology departments in an effort to reduce cost, labour and space in a higher education (HE) environment where there are too many students and too little time to teach them. He warned however, that the omission of such skills may prove to be even more costly in the future. In particular he pointed to the situation outside the UK where the vast majority of universities in Continental Europe still actively promote the teaching of practical skills to science undergraduates. The fear is that ultimately British graduates will lose out to their competitors who have been trained in the essential skills necessary for the new bioscience industries of the future.

The discipline of physiology is not alone in experiencing such changes. Between 2006 and 2012 single subject STEM (science, technology, engineering and mathematics) degree courses fell by 14.6% (data from the University and Colleges Union, 2012). However physiology as one of the most established science disciplines studied at UK universities holds a position of some esteem in UK academic culture. Thus it has been deemed by some commentators to be part of a worrying trend that one established UK medical school halved its total number of physiology teaching hours for medical students from 128 in 1990 to just 62 in 2011. At the same time as doing this the number of students studying physiology at that institution increased from 120 to 450. At another institution in 1992 62 hours was spent in lecture time teaching physiology to medical students. This had fallen to a mere 15 hours of lecture time in 2011 (Naftalin, 2011). Similarly, practical hours constituted 34 hours of study in 1992 but by 2011 were down to 9 hours. Additionally, approximately 25% of the currently qualified physiology staff and technicians are set to retire in the next 5 years. A similar situation has been observed in the US where Silverthorn (2003) found that physiology had disappeared from the core undergraduate curriculum in 104 institutions surveyed. In Turkey a review of physiology provision in medical schools in that country concluded that there were insufficient numbers of qualified staff to adequately teach this discipline (Dicle Balkanci and Pehlivanoglu, 2008).

However, can it be assumed that the decline in physiology as a single honours degree or as a significant stand-alone component of a medical degree is necessarily a bad thing? Much medical teaching, for instance, has moved to case or problem-based learning scenarios where students are required to integrate knowledge from a range of disciplines to tackle clinically relevant problems. Equally, in the realm of the single honours physiology degree, whilst there has been undoubtedly a decline in student numbers studying this particular degree there has been a significant expansion in the numbers of students studying degrees with an appreciable physiological component such as biomedical science, pharmacy and sports science.

This study set out to establish whether the perception that there was a decline in physiology teaching on the whole in the UK had any basis in fact by auditing the current physiology departments in the UK for the number of students undertaking a single honours programme (or nearest equivalent) in physiology or a closely related discipline. This study further sought to discover if there was any collaborative teaching currently being undertaken by physiology departments in the UK and if not, if any was envisaged in the future as this has been posited as a possible means of ensuring the survival of physiology as a stand-alone discipline in the future (Freestone and Mahay 2014).

Methods

Ethical Approval

The study required data to be collected from various higher education institutions (HEIs) in the UK thus ethical approval was required. The ethical approval was received from the Faculty of Science Engineering and Computing ethics committee at Kingston University.

Questionnaire Survey

For the main part of the study, Heads of Physiology Departments were surveyed by questionnaire. As there are now only two distinct physiology departments remaining in the UK (King’s College London and University of Liverpool), it was decided to conduct the study on those institutions who were offering a physiology degree as a single subject. Through a process of data trawling and content analysis of university web-sites 16 universities were identified which still offer Physiology as a single subject. The Heads of Departments were identified for each of these departments and chosen to be participants of the study.

Given that there were so few possible sources of data, a strategy was developed to try to maximise participant responses. Initially, letters were sent out to all the Heads of Department to explain the nature of the study. The letter served as an invitation to participate in the short questionnaire survey. Taylor and Lynn (1998) and several other studies of postal mail surveys have found that pre-notification by letter led to an increase in response rates for postal mail surveys than for those studies which did not pre-notify potential respondents.

Two weeks after sending out the invitation letters, the questionnaire together with a self addressed envelope was posted to all the Heads of Department bar one who had specifically declined to take part in the study on receipt of the invitation letter. The consensus among researchers is that inclusion of a stamped addressed envelope produces higher response rates in postal mail surveys (e.g. Fox et al., 1988). Each of the questionnaires was coded to allow the data to be traced back to the respondent. At the same time as posting the questionnaires a follow up letter was emailed to the academics to remind them of the nature of the study and to make them aware that the questionnaires were on their way.

Yammarino et al. (1991) suggested that follow-up mailings and repeated contact seems to have a greater effect on response rates, therefore four weeks after the questionnaires were first sent out a follow up email was sent to those participants who had not yet returned the questionnaire. The email was sent with an electronic version of the questionnaire attached giving respondents the option to email back the questionnaire electronically, thus maximising the response rate.

The questionnaires employed a Likert-type scale to elicit responses but also included a short section at the end where brief qualitative responses could be appended to the questionnaire.

Interviews

On receipt of the completed questionnaire those participants who had indicated that they were willing to undertake an interview were emailed to arrange suitable interview times. Due to time constraints and the preference of some of the participants it was decided to conduct the interviews over the telephone. As questionnaires are limited in the data that can be obtained from them i.e. they allow no flexibility for new questions to be added to enable collection of useful but unexpected data, the themes identified by the questionnaire results were discussed further in these interviews.

Semi- structured interviews were favoured over structured interviews as they allowed the collection of information that may be missed in a structured interview. It was found that semi-structured interviews allowed for fuller responses from the interviewee and also reduced interviewer bias. Questions were open and free flowing to allow the respondent to expand on a particular topic but allowed the interviewer to still retain an element of control.

The telephone interviews were recorded digitally using an Olympus recording device. In addition to the recording of the interview contemporaneous notes were taken to create a running record of what was being said that allowed the interviewer to respond using the interviewee’s choice of words and to identify questions that needed further probing and clarification. The recordings of the interviews were downloaded and transcribed manually verbatim. The transcripts were systematically analysed and broken down into sections for common themes and issues using the constant comparative method of qualitative analysis (Strauss and Corbin, 1990). This involved annotating the transcripts with numerical codes that clearly identified each theme.

Results

It was more difficult than envisaged to actually pinpoint which universities were still offering physiology as a single honours degree programme. In the end 16 institutions were identified as doing so. Table 1 below identifies these institutions.

 

University

                            

 

Department Name

 

 

Degree Title

 

University of Aberdeen School of Medical Sciences BSc Hon Physiology
University of Bristol School of Physiology & Pharmacology BSc Hon Physiological Science
University of Dundee College of Life Sciences BSc Hon Physiological Science
University of East London School of Health, Sport & Bioscience BSc Hon Medical Physiology
University of Glasgow School of Life sciences BSc Hon Physiology
University of Hertfordshire School of Life Science BSc Hon Physiology
Kings College London Department of Physiology BSc Hon Physiology
University of Liverpool Dept of cellular & Molecular Physiology BSc Hon Physiology
University of Leicester Dept of Cell Physiology & Pharmacology BSc Hon Medical Physiology
University of Leeds Faculty of Biological sciences BSc Hon Human Physiology
University of Manchester Faulty of Life Sciences BSc Hon Physiology
Manchester Metropolitan School of Healthcare Science BSc Hon Physiology
Newcastle University School of biomedical sciences BSc Hon Physiological Science
University of Portsmouth School of Health Sciences & Social Work BSc Hon Human Physiology
University of Sunderland Faculty of Applied sciences BSc Hon Physiological Sciences
University of Ulster School of Health Sciences Bsc Hon Health Physiology

Table 1: UK universities offering BSc Physiology (or nearest alternative) as a single subject

A questionnaire was completed by 10 institutions offering physiology as a single degree subject. This corresponded to a response rate of 63 %. Furthermore, five semi-structured interviews were conducted with Heads of Department or similar position.

Questionnaire Results

90% of the respondents said that they envisaged that they would continue to teach physiology in their departments in the future. However, 40 % of the respondents said that despite this fact they thought that there had already been a decline in physiology teaching at other institutions. Furthermore, 70 % of the respondents thought that physiology teaching would decline in the UK in the future. When asked whether, in an effort to protect physiology teaching into the future, their institutions had entered into a collaboration with another HEI to share resources and expertise 80 % of the respondents replied in the negative. A follow up question then asked whether the respondents thought that such a strategy might be effective at safeguarding physiology teaching across the sector. 60 % agreed that this might be a good idea. However, when asked if their own institution had any plans to collaborate in the future 70 % of the respondents said no.

Qualitative questionnaire responses

Wordle

Figure 1: Wordle analysis of qualitative questionnaire responses

Figure 1 shows the frequency with which certain terms occurred in the responses of the Physiology Heads of Department. Whilst this gives no insight into whether a particular topic or concept was positively or negatively viewed it does give and insight into the main topics of concern. From this analysis it can be seen that the terms ‘staff’, ’location’ and ‘competition’ turned up very frequently.

Semi-structured Interview Responses

To obtain a fuller insight into the themes and concepts identified by the questionnaire and Wordle analysis, transcripts of semi-structured interviews were analysed. A number of themes were identified. The most pertinent of these are as follows.

Fewer students want to study physiology

‘Yes, I think that’s true……we had a physiology and pharmacology programme which I withdrew because we only got a few students.’

The response above was elicited from a Head of Department at an HEI that had recently closed its physiology course due to lack of take-up by prospective students. This was not an isolated case.

Yes I am aware of a decline in physiology. We have taken first year students on to a physiology degree this year but we won’t next year…..we do get a lot of students but we have too many options. For instance, with an intake of 250 students only 5 want to do a physiology named degree’

The above quote reflects another theme that emerged from the data.

Students like the flexibility of being able to choose their own modules

The reason for it is manifold. One is the rise in biomedical science degrees…..the thing about biomedical science degrees, particularly here, is that they are very flexible and students like the flexibility of being able to choose their own modules’

There is a rise in Biomedical Science and other degrees

I am sure that it’s the case that the number of physiology courses that exist in this country have gone down. After all we don’t have a physiological science course any more. We have a course called biomedical sciences.’

‘..but I don’t think that that means that necessarily the amount of physiology teaching is diminishing. I think it’s just no longer headlined as a degree course. That’s certainly what has happened at this university. In fact we have gone up…we actually have more students studying biomedical sciences…all the physiology that’s in there…than we had when we had a straightforward physiological sciences course’

Sports science degrees are increasingly popular and students can now do that degree which includes human physiology, nutrition which all used to be part of a physiology degree. This is an attractive degree for students as it is good for their employment prospects’

These quotes fed in to the view that students were increasingly focused on their employment prospects upon graduating and were uncertain as to what specific job a single honours degree in physiology would qualify them for. Thus respondents were of the view that students were being strategic in their choice of courses and modules with the aim of undertaking programmes that would be of benefit to their future employment prospects and careers. It appears from these quotes in addition, that there it isn’t obvious that there is a general decline in the amount of physiology teaching being undertaken in at least a number of the institutions audited as physiology as a discipline was being subsumed into other degree programmes like biomedical and sports science.

Physiology teaching is resource intensive

It’s been happening over the last 10 years basically and it’s going to accelerate probably. Because the new funding regime…if we did a full economic cost of how much it costs to train a science student that requires laboratory work and this is the same for biochemistry, physiology whatever, it’s going to be like 12,500 pounds per student….it’s always going to lose money….it’s very difficult to argue that we can afford such things’

I’ve been teaching in xxxxx for 20 years. There definitely has been a reduction in that time. At least half and maybe a bit more than that actually in terms of the exposure. There are 2 things, there is funding and then there is the space requirement. Both are an issue for us. So in terms of equipment availability and somewhere to put it in order to run the types of practical we are talking about you need dedicated laboratory space. So it has gone down but we try hard to maintain what we’ve got’

In terms of current or future teaching collaborations a number of other themes emerged from the data analysis.

Collaboration may be of benefit for other HEIs but a respondent’s individual institution had sufficient in-house expertise and resource

there is no advantage to collaboration unless the other place can give you something that you haven’t got’

I am sure that there are gains to be had from sharing resources in this way but as I said I think you will find a slightly cautious approach to it’

‘We have a very large number of staff and research areas so it’s not that we wouldn’t necessarily benefit from collaborations it’s just that there is no need to’

These quotes above illustrated the fact that many institutions thought that they still had sufficient resource in terms of personnel and expertise to deliver single honours physiology courses. This didn’t take into account the fact previously mentioned that there is a significant aging of the pool of qualified personnel available to teach these courses. It may be that in the future institutions will have to more consciously revisit this aspect of their provision.

Geography and communication would be a barrier to collaboration

Distance is a consideration, because if a student can’t go and find a lecturer easily or get in contact with them, that can be a problem. I mean that can happen within a single institution of course but generally they can find someone they know. So I think it would be difficult if you had for example, one institution that had no cardiovascular physiology at all and was relying on another to provide that aspect because where the students are based they would not be able to go to anyone to talk to them about it if they had a problem’

There are concerns about this because that person is not in the department on the ground and they can’t come to a meeting, they can’t really discuss the course very well, they don’t know the students well and they can’t give supervisions

There are lots of disadvantages, ie distance, so if it’s something that you haven’t got then clearly this is a good idea but a better solution would be to get it yourself’

There are certain issues that come in – geographical constraints. I mean from our point of view we are talking about being miles away from other institutions. In London you obviously have lots of places on your doorstep’

These quotes highlight some of the practical difficulties envisaged by institutions in engaging with the subject of institutional collaboration. Respondents were also asked to comment upon the widely advertised teaching collaboration between Queen Mary, University of London and Warwick University in the disciplines of English, History and Computer Science despite them being geographically separated by a distance of approximately 80 miles. Most of the respondents were unaware of this specific development.

Tension between collaboration and competition

Successful collaboration would need to strike a fine balance between collaboration and competition’

There is always potential for collaboration where there isn’t direct competition

One university was in talks with another HEI to share some teaching resource but even here the respondent felt the need to emphasise the risks of competing institutions collaborating with each other.

‘…in some respects we don’t compete with each other. We are in different niches…..at the moment it’s very small scale’

Discussion

This study has found evidence for the anecdotal observation of a decline in the provision of physiology single honours degrees in the UK. Whether this relates to a decline in overall physiology teaching, given the rise of biomedical science and other degree programmes that include a large physiological component, is a moot point. Nevertheless, this study has found that at least one provider has recently withdrawn a purely physiology degree whilst another is in the process of winding down its programme, taking on no more first year enrolments in the future. One of the criticisms that might be levelled at this study is the small number of respondents involved in the study. However, as the respondents were almost exclusively at Head of Department level, the data obtained from these individuals is unusually well informed and insightful and thus very valuable.

This study has further found that the concept of teaching collaborations between HEIs was generally well received by institutions. However, it was found that very little collaboration was actually being undertaken at the present time and little was being planned for the immediate future. There were consistent reasons put forward for why this was the case. These included a tension between competition and collaboration (which may only be heightened now that the cap on student numbers has been removed and institutions will be more actively chasing each individual qualified student), geographical constraints and the perception that sufficient expertise and resource was available in-house. A number of respondents suggested that their institutions would be too proud to collaborate with another HEI given their history, traditions, number (and quality?) of staff, coverage of research areas and expertise.

There were a few inconsistencies in the participant responses. Primary amongst these was the belief that whilst physiology would continue to be taught within the respondent’s own institution (90 % agreement with this suggestion) a majority of the participants also thought that physiology student numbers (60 %) and physiology teaching (70 %) had declined across the sector. Another inconsistency was evident in the data obtained with regard to possible collaborations. Here 60 % of the respondents thought that collaboration was a viable way to ensure the future stability of physiology teaching in the UK but 80 % of the institutions canvassed were not in any collaborative ventures and 70 % had no future plans for any such collaborations. In this regard it was illuminating to find that one of the themes that emerged was that many institutions did not know how current collaborative teaching ventures in the sector actually worked.

Traditionally collaboration between institutions has concentrated on research projects, however the prospect of bringing together teaching resources is beginning to gain some interest and in March 2012 a conference held in London entitled “Collaboration in the Higher Education Landscape” discussed the viability of collaboration between HEIs. The Higher Education Funding Council for England (HEFCE) has recognised that in a fiscally constrained future, institutions will need to take a particularly rigorous approach to costing and financing their offer. HEFCE noted institutions might have to consider partnerships with other institutions as they adapted to change. HEFCE consider that Collaborations, Alliances and Mergers (CAM) will continue to be part of the HE sector’s response to change. HEFCE is further of the belief that at the core of all CAM projects should be a strong focus on students, the academic community and wider society.

The pace of change in the HE sector is gathering speed in many countries owing to numerous related factors such as globalisation, increasing use of international rankings of institutions, continuing constraints on public funding, governance reforms and greater institutional autonomy, the increased role of the private sector, inequalities in access, increasing student mobility, increasing demand for higher education and rising participation rates along with changing student needs and expectations. Institutions therefore need to become more adaptive to serve these evolving influences and drivers. They will need to continue reviewing how they function internally and engage externally with other institutions and organisations, thus raising the likelihood of collaborations, alliances and mergers as part of an institution’s reaction to change.

In various European countries there have been major CAM developments which have been actively supported by governments to strengthen institutions and improve their performance. In some instances, collaboration can bring many of the benefits of a merger without the same cost or level of disruption, however some may argue that compared with mergers, collaborations will involve less commitment from the parties while mergers may accomplish a deeper and more extensive change. Collaboration activities are, by and large, relatively small in relation to the overall size of the HEI hence generally there is a modest impact at the institutional level. A collaboration can enable HEI’s to strengthen research and improve their position in the rankings, institutions with a strong dedication to widening access might become useful partners for other institutions who have less experience in these areas. Research by McCord (2002) has found how institutions can benefit from facilities and resource sharing and HEFCE consider that future CAM activities are likely to provide opportunities for greater efficiency and effectiveness.

In conclusion then, while it may not currently be the case that HEIs in the UK have engaged with the subject of collaborative teaching as a means of increasing their efficiency and effectiveness this may become a necessity in the future. This is especially true in the case of specialist departments such as physiology, where a lack of students, named degree programmes and ultimately resource may force the disappearance of physiology as a separate subject in the UK HE landscape.

References

Dicle Balkanci, Z. and Pehlivanoglu, B. (2008) An overview of undergraduate physiology education in Turkish medical faculties. Advances in Physiology Education 32:322-28

Fox, R., Crask, M. R., Kim, J. (1988) Mail Survey Response Rates: a Meta-Analysis of Selected Techniques for Inducing Response. Public Opinion Quarterly 52467-491

Freestone, N. and Mahay, N. (2014) Physiology Teaching in the UK: Is it in decline? Physiological Society meeting C78

McCord, R. (2002) Breaking the School District Boundaries: Collaboration and Cooperation for Success. Education, 123: 386-89.

Naftalin, R. J. (2011) The decline of physiology. The Scientist, 25:4

Silverthorn, D. (2003) Restoring physiology to the undergraduate biology curriculum: a call for action. Advances in Physiology Education, 27:91-96

Strauss, A. and Corbin, J. (1990) Basics of qualitative research: Grounded theory procedures and techniques. Sage Publications Inc.

Taylor, S. and Lynn, P. (1998) The effect of a preliminary notification letter on response to a postal survey of young people. Journal of the Market Research Society, 40:165-78

Yammarino, F. J., Skinner, S., Childers, T. L. (1991) Understanding mail survey response behaviour. Public Opinion Quarterly, 55:613-39

Nicholas Freestone

Nick Freestone is an Associate Professor of Physiology and Subject Area Leader for the Physiology/Pharmacology teaching in the Department of Pharmacy at Kingston University. Before taking up his lecturing position at Kingston he undertook post-doctoral research at the Babraham Institute in Cambridge and the Charité Medical Faculty of the Humboldt University in Berlin. His scientific research involves looking at calcium handling in cardiac muscle cells. His pedagogic research focuses on institutional collaboration and individualised learning and assessment. He was the winner of the UK HE Bioscience Teacher of the Year Prize in 2014/15 and was Kingston University’s “Most Engaging Lecturer” in 2013. Nicholas Simon Freestone Kingston University Faculty of Science, Engineering and Computing Penrhyn Road 0208 4172551 n.freestone@kingston.ac.uk

Nazia Mahay

Nazia Mahay undertook this study as part of her final year project work in her degree of MPharm. Nazia graduated from this programme in 2013 with a First Class Honours degree and is now a practising pharmacist.

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