1. Open Access Kent State
  2. American Society for Microbiology
Teaching in a Time of Crisis DOI: https://doi.org/10.1128/jmbe.v22i1.2317 Remote Conversations To Enhance Class Experience in the Time of COVID: Co-Teaching with a Wingman Model Chi-hua Chiu and Helen Piontkivska* Department of Biological Sciences, Kent State University, Kent, OH 44224 Remote delivery poses numerous challenges, particularly for discussion-based classes. Here, we describe a class management model that uses a conversational approach between instructional coleaders to introduce topics and facilitate student discussions. The conversational approach enabled us to model various aspects of the scientific process, such as asking questions and generating hypotheses, aimed at an emergent subject, such as COVID-19. Students’ feedback was positive, noting how the class enabled them to connect their existing knowledge with the daily influx of new insights about SARS-CoV-2. While our class focuses on COVID-19-related topics, this model of a conversational style class can be easily implemented for other course topics. INTRODUCTION Many of us are adept in applying active learning approaches (1) in a face-to-face (F2F) teaching environment, where one receives immediate feedback on student excitement or total confusion, facilitating course reconfiguring and scaffolding “on the fly.” Remote delivery, where synchronous class meetings occur virtually, facilitated by video platforms such as Zoom or Blackboard, has many challenges, in part because such immediate feedback is lacking (2). As many of us experienced in the spring, remote delivery not only consumes a considerable portion of our daily mental bandwidth but also requires a substantial internet bandwidth, among other technological issues, as video feeds fail and the best-practice advice is “do not require cameras on” (3). An additional challenge of remote delivery during the pandemic is that, unlike prior semesters, where students taking remote or fully asynchronous online courses were doing it by choice (and thus may have preselected themselves based on motivation and ability to engage across platforms [4, 5]), the pandemic forced everybody into virtual classrooms. As the pandemic continues, we find ourselves asking the same questions as many others—how can we emulate our lively F2F class discussions during remote delivery? How do we design and teach a 100% remote course that engages students in elements of independent research, which has been shown to be highly beneficial to student learning (6–8), *Corresponding author. Mailing address: Department of Biological Sciences, 241 Cunningham Hall, Kent State University, Kent, OH 44224. Phone: 330-672-3620. E-mail: opiontki@kent.edu. Received: 26 September 2020,  Accepted: 18 December 2020, Published: 31 March 2021 without a framework and the supportive scaffolding of a F2F class? And how can we do it with an emergent subject, where scientific insights into the matter shift almost daily? PROCEDURE To address these challenges, we designed a class around faculty co-led conversations, based in part on students’ reading of primary literature and class-wide discussions of specific topics. This course focused on increasing students’ understanding of the COVID-19 pandemic through biological, societal, and historical lenses, while simultaneously modeling diverse and inclusive ways in which scientists think and communicate about new and emergent issues. Our course has four major components (Fig. 1). First, the class design is centered around specific themes for each week, with assigned readings to prime the discussions. “Big ideas” (examples in Fig. 2) are primarily “umbrella” questions currently at the forefront of scientific and popular discussions and thus facilitate nuanced conversations about various aspects of these topics. Second, as coleaders, we generate a conversational synergy that engages the students and encourages them to participate. By seeing us asking questions of one another and working through answers and ideas using our different and complementary expertise, students gain an appreciation for how scientific discussions are structured, emphasizing that thinking through the problem step by step is more important than merely blurting out the answer. Students also learn that even scientific experts may struggle with questions and that there are no easy answers as science is unfolding before our eyes. Although students are not together in the same room, the roundtable conversation approach is an effective icebreaker, sup- ©2021 Author(s). Published by the American Society for Microbiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International license (https://creativecommons.org/licenses/by-nc-nd/4.0/ and https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode), which grants the public the nonexclusive right to copy, distribute, or display the published work. Volume 22, Number 1 Journal of Microbiology & Biology Education 1 CHIU & PIONTKIVSKA: REMOTE CONVERSATIONS IN CO-TEACHING COVID FIGURE 1. Overview of “hard” and “soft” elements behind the class management design of the conversational class. Built-in (“hard”) categories include instructors, a curated list of reading materials, assessments, and scheduling elements. The resultant “soft” elements are organically created during class meetings and contribute to class success. porting and encouraging students to jump in at any point of the discussion. Third, our class structure facilitates both in-class and after-class interactions among students as they begin to practice scientific thinking on their own. Students are split into small groups of three or four; each group chooses the presentation topic depending on the interests of its members. Fourth, the course dedicates protected blocks of time (1.5 to 2 hours) for in-class presentations, group member interactions, and uninterrupted class-wide discussions. These time blocks are analogous to prescheduled “think-pair-share” activities (9, 10). On Day 1, we introduce the big ideas and potential questions (Fig. 2) and co-lead students’ discussion in a loosely supported (“free float”) mode, where we ask the first few questions to break the ice and then follow the students’ lead. Students read scientific papers in advance, are prepared for discussion, and demonstrate a mastery of concepts in short online assessments. This approach fosters the students’ ability to contribute to and participate in the discussion and to ask questions to delve more deeply into the subject. Days 2 and 3 of each week are dedicated to students’ presentations (15 slides for 15 to 20 minutes), followed by open discussion. We note that, in the few cases when different groups present on the same topic, the topic is approached from different and complementary perspectives, thus expanding the overall breadth of covered content and leading to lively discussions. Students appreciate that they are free to pursue and present topics of greatest personal interest while also contributing to the overall learning experience of the class. 2 We believe that having two instructors and a conversational atmosphere are key ingredients that enable and foster student engagement and understanding. Moreover, our daily discussions offer students many examples to emulate in their own presentations and questions. Similar outcomes may potentially be reached where one of the coleaders is a graduate teaching assistant or an advanced undergraduate student. Having faculty representing different disciplines and/ or subject areas to co-lead a conversation may offer an extra interdisciplinary dimension to the class. Furthermore, having faculty coleaders with different identities (such as race and gender) serves to model equitable discourse and diversity in STEM. The nature of the conversation will also be influenced by the individual teaching styles of coleaders, again, providing students with multiple means of understanding the topics under discussion. We do not have formal assessment data of how well this coleaders (“wingman”) approach works compared with a more traditional format with a single instructor. Such assessments may include (i) rubrics in which students evaluate their peers’ presentations on both content and delivery, (ii) pop-up quizzes that are based on concepts from student presentations and in-class discussions to evaluate whether students’ understanding of the material depends on the mode of delivery, (iii) pretest and posttest comparisons or student reflections, or (iv) contrasting students’ understanding with and without the wingman approach. An academic self-efficacy scale (11) can also be used to evaluate students’ comfort with various aspects of a scientific discussion and which elements of the class may have contributed to improvements. Journal of Microbiology & Biology Education Volume 22, Number 1 CHIU & PIONTKIVSKA: REMOTE CONVERSATIONS IN CO-TEACHING COVID FIGURE 2. Example overview of weekly class flow, including class tasks and due dates (A), and example “big idea” topics for a single week of classes (B). CONCLUSION REFERENCES We designed and implemented a 100% remote course for upper-division biology majors to increase their understanding of the biological and societal impacts of the COVID-19 pandemic. This discussion-based class of 24 students used a conversational approach with coleaders to introduce and help students expand their learning with scaffolding. Student feedback was positive, highlighting their appreciation of being able to link biological knowledge of the SARS-CoV-2 virus and societal impacts of the COVID-19 pandemic to their own experiences and perspectives in real time. As discussions of campus reopenings began, students noted that the knowledge gained in this class equips them to become “ambassadors” on campus, able to provide their peers, friends, and families accurate information on the viral biology, vaccine development, importance of physical distancing and hygiene, and placement of this current outbreak in the history of pandemics. While our class focuses on COVID-19-related topics, we envision that a similar conversational style can be easily implemented for any future course topic, whether online or F2F, as long as the scaffolding questions are provided. 1. Bonwell CC, Eison JA. 1991. Active learning: creating excitement in the classroom. ASH#-ERIC Higher Education Report No. 1. The George Washington University, School of Education and Human Development, Washington, DC. 2. Gares SL, Kariuki JK, Rempel BP. 2020. Community matters: student–instructor relationships foster student motivation and engagement in an emergency remote teaching environment. J Chem Educ 97(9):3332–3335. 3. Stanford University Center for Teaching and Learning. 2020. 10 strategies for creating inclusive and equitable online learning environments. https://drive.google.com/file/d/14EkhW4W MS1RTGKFRSd5TRC42dzmYzEPe/view 4. Murphy CA, Stewart JC. 2017. On-campus students taking online courses: factors associated with unsuccessful course completion. Internet Higher Educ 34:1–9. 5. Dunnagan CL, Gallardo-Williams MT. 2020. Overcoming physical separation during COVID-19 using virtual reality in organic chemistry laboratories. J Chem Educ 97(9):3060–3063. 6. Bangera G, Brownell SE. 2014. Course-based undergraduate research experiences can make scientific research more inclusive. CBE Life Sci Educ 13(4):602–606. 7. Shortlidge EE, Bangera G, Brownell SE. 2016. Faculty perspectives on developing and teaching course-based undergraduate research experiences. BioScience 66(1):54–62. 8. Bennett J, Dunlop L, Knox KJ, Reiss MJ, Torrance Jenkins R. 2018. Practical independent research projects in science: a synthesis and evaluation of the evidence of impact on high school students. Int J Sci Educ 40(14):1755–1773. 9. Wilke RR, Straits WJ. 2005. Practical advice for teaching ACKNOWLEDGMENTS We thank Jenny Marcinkiewicz, Bradley Morris, and three anonymous reviewers for their useful feedback on the manuscript. The authors have no conflicts of interest to declare. Volume 22, Number 1 Journal of Microbiology & Biology Education 3 CHIU & PIONTKIVSKA: REMOTE CONVERSATIONS IN CO-TEACHING COVID inquiry-based science process skills in the biological sciences. Am Biol Teach 67(9):534–540. 10. Kaddoura M. 2013. Think pair share: a teaching learning strategy to enhance students’ critical thinking. Educ Res Q 36(4):3–24. 4 11. Honicke T, Broadbent J. 2016. The influence of academic self-efficacy on academic performance: a systematic review. Educ Res Rev 17:63–84. Journal of Microbiology & Biology Education Volume 22, Number 1
Photograph
Photograph
GUEST EDITORIAL crossm Robin Patel,a President, American Society for Microbiology, Esther Babady,b Elitza S. Theel,a Gregory A. Storch,c Benjamin A. Pinsky,d Kirsten St. George,e Tara C. Smith,f Stefano Bertuzzi,g Chief Executive Officer, American Society for Microbiology a Mayo Clinic, Rochester, Minnesota, USA b Memorial Sloan Kettering Cancer Center, New York, New York, USA c Washington University, Saint Louis, Missouri, USA d Stanford University School of Medicine, Palo Alto, California, USA e Wadsworth Center, New York State Department of Health, Albany, New York, USA f Kent State University, Kent, Ohio, USA g American Society for Microbiology, Washington, DC, USA A s we enter the second quarter of the COVID-19 pandemic, with testing for severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2) increasingly available (though still limited and/or slow in some areas), we are faced with new questions and challenges regarding this novel virus. When to test? Whom to test? What to test? How often to test? And, what to do with test results? Since SARS–CoV-2 is a new virus, there is little evidence to fall back on for test utilization and diagnostic stewardship (1). Several points need to be considered to begin answering of these questions; specifically, what types of tests are available and under which circumstances are they useful? This understanding can help guide the use of testing at the local, regional, state, and national levels and inform those assessing the supply chain to ensure that needed testing is and continues to be available. Here, we explain the types of tests available and how they might be useful in the face of a rapidly changing and never-beforeexperienced situation. There are two broad categories of SARS–CoV-2 tests: those that detect the virus itself and those that detect the host’s response to the virus. Each will be considered separately. We must recognize that we are dealing with (i) a new virus, (ii) an unprecedented pandemic in modern times, and (iii) uncharted territory. With this in mind, in the absence of either proven effective therapy or a vaccine, diagnostic testing, which we have, becomes an especially important tool, informing patient management and potentially helping to save lives by limiting the spread of SARS–CoV-2. What is the most appropriate test, and for whom and when? Hypothetically, if the entire world’s population could be tested all at once, with a test providing 100% specificity and sensitivity (unrealistic, obviously), we might be able to identify all infected individuals and sort people into those who at that moment in time were asymptomatic, minimally/moderately symptomatic, and severely symptomatic. The asymptomatic and minimally/moderately symptomatic could be quarantined to avoid the spread of the virus, with the severely symptomatic managed and isolated in health care settings. Contract tracing could be carried out to find those at risk of being in the incubation period by virtue of their exposure. Alternatively, testing for a host response, if, again, the test were hypothetically 100% sensitive and specific, could identify those previously exposed to the virus and (if we knew this to be true, which we do not) label those who are immune to the virus, who could be tapped to work in March/April 2020 Volume 11 Issue 2 e00722-20 Citation Patel R, Babady E, Theel ES, Storch GA, Pinsky BA, St. George K, Smith TC, Bertuzzi S. 2020. Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of diagnostic testing for SARS–CoV-2/COVID-19. mBio 11:e00722-20. https://doi.org/10.1128/mBio.00722-20. Copyright © 2020 Patel et al. This is an openaccess article distributed under the terms of the Creative Commons Attribution 4.0 International license. Address correspondence to Robin Patel, patel.robin@mayo.edu. Published 26 March 2020 ® mbio.asm.org 1 Downloaded from http://mbio.asm.org/ on November 19, 2020 at KENT STATE UNIV LIBRARY Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of Diagnostic Testing for SARS–CoV-2/COVID-19 Guest Editorial ® Downloaded from http://mbio.asm.org/ on November 19, 2020 at KENT STATE UNIV LIBRARY settings where potentially infected individuals (e.g., sick patients in hospitals) might otherwise pose a risk. Unfortunately, these hypothetical scenarios are not reality. However, with this ideal situation as a guide, what we do have available as tests today should be carefully considered in terms of how they can be leveraged to move the current crisis closer to the ideal situation, especially in the absence of therapeutics or vaccines. Although the virus can be cultured, this is dangerous and not routinely done in clinical laboratories. While detection of viral antigens is theoretically possible, this approach has not, to date, been a primary one, but one that those participating in the summit considered to deserve further research. TEST 1. TESTS FOR VIRAL RNA Most tests currently used for direct detection of SARS–CoV-2 identify viral RNA through nucleic acid amplification, usually using PCR. An important consideration is exactly what gets tested for viral RNA. Tests that detect viral RNA are contingent on viral RNA being present in the sample collected. The most common sample types being tested are swabs taken from the nasopharynx and/or oropharynx, with the former considered somewhat more sensitive than the latter (2); if both are collected, the two swabs may be combined and tested simultaneously in a single reaction to conserve reagents. Today, health care professionals collect these swabs; however, evidence suggests that patients or parents (in the case of young children) might be able to collect their own swabs (3, 4). Following collection, swabs are placed into a liquid to release virus/viral RNA from the swabs into solution. Then, viral RNA is extracted from that solution and subsequently amplified (e.g., by reverse transcription-PCR). For patients with pneumonia, in addition to nasopharyngeal and oral secretions, lower respiratory tract secretions, such as sputum and bronchoalveolar lavage fluid, are tested. It should not be assumed that each of these (e.g., nasopharyngeal swab specimen, sputum, bronchoalveolar lavage fluid) will have the same chance of detecting SARS–CoV-2; detection rates in each sample type vary from patient to patient and may change over the course of individual patients’ illnesses. Some patients with pneumonia may have negative nasal or oropharyngeal samples but positive lower airway samples (5), for example. Accordingly, the true clinical sensitivity of any of these tests is unknown (and is certainly not 100%, as in the hypothetical scenario); a negative test does not therefore negate the possibility that an individual is infected. If the test is positive though, the result is most likely correct, although stray viral RNA that makes its way into the testing process (for example, as the specimen is being collected or as a result of specimen cross-contamination or testing performed by a laboratory worker who is infected with SARS–CoV-2 [these are just some examples]) could conceivably result in a falsely positive result. Also, we note that viral RNA does not equate to live virus, and therefore, detection of viral RNA does not necessarily mean that the virus can be transmitted from that patient. That said, viral RNA-based tests are the best tests that we have in the setting of an acute illness. It is important to recognize that the accuracy of the test is affected by the quality of the sample, and thus it is critical that the sample be obtained in a proper (and safe) manner. Testing patients for SARS–CoV-2 helps identify those who are infected, which is useful for individual patient management, as well as for implementation of mitigation strategies to prevent spread in health care facilities and in the community alike (Fig. 1). There are numerous unanswered questions, challenges, and controversies surrounding testing for viral RNA. RNA may degrade over time. There are concerns that specimen collection for testing is exhausting the supply of critical personal protective equipment needed to care for infected patients. Alternative strategies for specimen collection, including home collection, should therefore be considered either by a health care provider or patients themselves (or a parent in the case of young children); the use of alternative specimen types, such as oral fluid or nasal swabs (if they are shown to provide results equivalent to those from nasopharyngeal swabs) should also be considered. Spread to health care workers and within health care and long-term-care March/April 2020 Volume 11 Issue 2 e00722-20 mbio.asm.org 2 ® Guest Editorial Downloaded from http://mbio.asm.org/ on November 19, 2020 at KENT STATE UNIV LIBRARY FIG 1 Tests for SARS–CoV-2/COVID-19 and potential uses. facilities is a primary consideration for prioritization of testing; testing of patients likely to have SARS–CoV-2 who are in health care facilities or long-term-care facilities, alongside potentially ill workers critical to the pandemic response, including health care workers, public health officials, and other essential leaders, is a priority. That said, testing anyone who has symptoms compatible with COVID-19 should be considered, since broad testing will help define who has this infection, allowing control of its spread. Given that SARS–CoV-2 can infect anyone and result in transmission prior to the onset of symptoms or even possibly without individuals ever developing symptoms, testing asymptomatic patients could even be considered. Unfortunately, little is known at this time about viral RNA detection in asymptomatic patients, and such testing strategies may stretch available resources beyond realistic limits. Some future therapeutics may work best if given early, which will demand early testing for SARS–CoV-2 to realize maximal efficacy. The questions of how many tests are needed and what kind should be performed on individual patients (for primary diagnosis if results of initial testing are negative and subsequently to document clearance of the virus to release patients from isolation) remain open. As the number of tests available for SARS–CoV-2 increases, new challenges, including the needs to (i) better understand variability in the performance characteristics of the various tests (e.g., sensitivity and specificity), including on different samples types, (ii) optimize assays from their original design (e.g., multiple targets to a single target) to improve reagent utilization while maintaining performance characteristics, and (iii) monitor test performance given the potential for the virus to mutate, are emerging. The last can be addressed by periodically sequencing the evolved virus to look for changes in primer and probe binding regions that might affect the performance of tests based on the detection of viral RNA; periodic sequencing can also aid in tracking viral evolution. Additionally, as testing increases, decreasing the time to results of testing will continue to be crucial to better manage both patients and health care workers. Development of rapid, point-of-care diagnostics is a gap and should be a priority. March/April 2020 Volume 11 Issue 2 e00722-20 mbio.asm.org 3 ® Guest Editorial Downloaded from http://mbio.asm.org/ on November 19, 2020 at KENT STATE UNIV LIBRARY Measurement of viral levels may also be useful to monitor recovery, response to therapy, and/or level of infectivity. Current RNA-based diagnostic tests are primarily qualitative, and although they could be calibrated to provide viral loads, a standardized process does not currently exist. Of note, there is no established threshold for interpretation of viral loads, which may vary in different hosts. Although tests have become available, the huge demand for them has created supply chain challenges, compromising their very availability; this includes issues with the availability of nasopharyngeal swabs, RNA extraction reagents and instruments, and PCR reagents and instruments. Even with now-FDA-approved/cleared commercial tests, there are delays with the installation of instruments and supply of reagents/kits to meet the demand at many sites. At the moment, extensive efforts are being made on multiple fronts to address the numerous supply challenges surrounding testing and a secure continuity of testing services. TEST 2. SEROLOGY The other broad category of tests is those that detect IgM, IgA, IgG, or total antibodies (typically in blood). Development of an antibody response to infection can be host dependent and take time; in the case of SARS–CoV-2, early studies suggest that the majority of patients seroconvert between 7 and 11 days postexposure to the virus, although some patients may develop antibodies sooner. As a result of this natural delay, antibody testing is not useful in the setting of an acute illness. We do not know for certain whether individuals infected with SARS–CoV-2 who subsequently recover will be protected, either fully or partially, from future infection with SARS–CoV-2 or how long protective immunity may last; recent evidence from a rhesus macaque study does suggest protective immunity after resolution of a primary infection (https://doi.org/10 .1101/2020.03.13.990226); however, further studies are needed to confirm this. Antibody tests for SARS–CoV-2 may facilitate (i) contact tracing—RNA-based tests can help with this as well; (ii) serologic surveillance at the local, regional, state, and national levels; and (iii) identification of those who have already had the virus and thus may (if there is protective immunity) be immune. Assuming there is protective immunity, serologic information may be used to guide return-to-work decisions, including for individuals who work in environments where they can potentially be reexposed to SARS–CoV-2 (e.g., healthcare workers). Serologic testing may also be useful to identify individuals who may be a source for (currently experimental) therapeutic or prophylactic neutralizing antibodies. In addition, antibody testing can be used in research studies to determine the sensitivity of PCR assays for detecting infection and be employed retrospectively to determine the true scope of the pandemic and assist in the calculation of statistics, including the case fatality rate. Finally, serologic testing can possibly be used diagnostically to test viral RNA-negative individuals presenting late in their illness. Summit participants noted that testing for host markers might be needed to fully understand which patients are at risk of developing severe disease from their infection. In summary, both of the two categories of tests for SARS–CoV-2 should be useful in this outbreak. We are fortunate to have the technologies we do that have allowed diagnostics to be made rapidly available. There is likely to be a direct connection between understanding the level of virus/disease in individual communities and acceptance of control measures that require individual action, such as social distancing. Now, we need to ensure systematic and coordinated efforts between the public, clinical, commercial, and industry sectors to ensure robust supply lines in the midst of the pandemic so that we can leverage the power of testing to address the pandemic confronting us. REFERENCES 1. Patel R, Fang FC. 2018. Diagnostic stewardship: opportunity for a laboratory-infectious diseases partnership. Clin Infect Dis 67:799 – 801. https://doi.org/10.1093/cid/ciy077. 2. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, Yu J, Kang M, Song March/April 2020 Volume 11 Issue 2 e00722-20 Y, Xia J, Guo Q, Song T, He J, Yen H-L, Peiris M, Wu J. 2020. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 382:1177–1179. https://doi.org/10.1056/NEJMc2001737. 3. Dhiman N, Miller RM, Finley JL, Sztajnkrycer MD, Nestler DM, Boggust AJ, mbio.asm.org 4 ® Guest Editorial Jenkins SM, Smith TF, Wilson JW, Cockerill FR, Pritt BS. 2012. Effectiveness of patient-collected swabs for influenza testing. Mayo Clin Proc 87: 548 –554. https://doi.org/10.1016/j.mayocp.2012.02.011. 4. Murray MA, Schulz LA, Furst JW, Homme JH, Jenkins SM, Uhl JR, Patel R, Cockerill FC, Myers JF, Pritt BS. 2015. Equal performance of self-collected and health care worker-collected pharyngeal swabs for group a strepto- coccus testing by PCR. J Clin Microbiol 53:573–578. https://doi.org/10 .1128/JCM.02500-14. 5. Winichakoon P, Chaiwarith R, Liwsrisakun C, Salee P, Goonna A, Limsukon A, Kaewpoowat Q. 26 February 2020. Negative nasopharyngeal and oropharyngeal swab does not rule out COVID-19. J Clin Microbiol. https:// doi.org/10.1128/JCM.00297-20. Downloaded from http://mbio.asm.org/ on November 19, 2020 at KENT STATE UNIV LIBRARY March/April 2020 Volume 11 Issue 2 e00722-20 mbio.asm.org 5
Photograph