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Large classes taught with didactic lectures and assessed with multiple-choice tests are commonly reported to promote lower order (LO) thinking and a surface approach (SA) to learning. Using a case study design, we hypothesized that incorporating instructional scaffolding of core physiology principles and assessing students exclusively with long-answer written tests would encourage higher order (HO) thinking and promote a deep approach (DA) to learning in a two-course physiology sequence (Phys I and II), despite their large size. Test questions were categorized as LO or HO according to the Blooming Biology Tool, and students’ LO and HO performance was determined for each of six tests across the two courses. The validated Revised Two-Factor Study Process Questionnaire survey tool was administered at the beginning and end of each course to measure student approach to learning. HO performance was maintained across Phys I (72.9 ± 19.4 vs. 74.8 ± 20.7%, P = 0.37) and significantly improved across Phys II (69.9 ± 18.4 vs. 79.4 ± 14.8%, P &lt; 0.001). Unexpectedly, students’ LO performance declined from the beginning to end of Phys I (78.5 ± 20.6 vs. 69.4 ± 17.9%, P &lt; 0.001) and Phys II (80.5 ± 19.6 vs. 72.2 ± 24.3%, P &lt; 0.001). Students’ approach to learning did not change throughout Phys I or II, but at each time point students preferred a DA over a SA. Taken together, these results indicate that an intentionally designed large lecture class can support a DA to learning and suggests that this teaching and assessment structure may be particularly well suited to promote HO thinking, albeit possibly at the expense of LO thinking.

Incorporating higher order thinking and deep learning in a large, lecture-based human physiology course: can we do it?