How to fit it all in

A professor sent me the following email:

I’m an A&P instructor and subscriber to your newsletter.
I have a very serious question.
Many of the activities that you suggest are very creative, and they seem like wonderful learning tools.  But I never use them.
I have so much material to cover in class that as it is I’m barely able to cover the material in the time allotted. In fact, most semesters I have to end up cutting material that I had planned to cover. There just isn’t time to get to everything I planned to cover.  How on earth do you find time for all of the activities you suggest?
Since you’re an RN, I thought perhaps you would have some insight into a basic dilemma that I face every semester. At one end of the spectrum, I can be very “encyclopedic” and try to cover as much material as possible.  At the other end, I can really concentrate on some of the fundamental concepts, use the tools you provide, but at the expense of omitting even more topics than I now omit.
How important is it for students headed for nursing school to get one end of the spectrum versus the other? Since the nursing schools which my students will attend don’t teach A&P per se, are students going to suffer more if they don’t have mastery of fundamentals, or will they
suffer more if they master fundamentals at the expense of omitting many of the details?
I REALLY want my students to succeed, and I’m REALLY puzzled as to how I can accomplish this goal in the relatively short amount of class time that I have.

My answer:
The basic problem in question is lots of material and not enough class time to cover it.  This is true even without considering using time intensive activities.  This dilemma raises basic questions about the responsibilities of both professors and students.   Professors face a choice.  As the writer states, should a professor be encyclopedic in his or her coverage or more in-depth including creative activities on some topics at the expense of other material?  I am sure that you all already do this to a degree.  I’m guessing you devote more time to renal function and the renin-angiotensin system than you do to skeletal nomenclature.
However, it strikes me that part of the problem is that colleges expect you to pass most of your students.  Is that not true?  Are you not questioned if above a certain percentage of your students fail?  This obviously affects your decisions about how to spend class time.  There are students who do not read (some don’t even buy) the textbook.  A certain amount of spoon feeding is necessary to boost some of these students into the passing column.  If the majority of students came to class having read the chapter(s) to be covered that day, would that change your decisions for how and what to cover in class?
Furthermore, is it possible that a more interested and challenged student body would rise to the occasion and put in more independent study time?  I believe that would be true of some students, but there are students who will not rise to the challenge and who would fail as a result of not hearing about certain things in class.  Does it help those students in the long run to help them pass a class?  There probably are not easy, definite answers to these questions, but it might be worth investigating administrative and professorial expectations within your departments.
I think the second part of the professor’s question sheds some light on the dilemma in the case of teaching future nurses.  The email wanted to know which end of the teaching spectrum (rote vs. creative & student taking responsibility vs. prof. taking responsibility) is more helpful to nursing students and ultimately nurses.
The NCLEX does not ask many simple questions.  Many of the questions have more than one right answer, with one correct ‘right’ answer being better.  Facts alone will not help a student much on the NCLEX.  In fact, many students, myself included, are fairly flummoxed by NCLEX style questions when first encountered.  They require some flexibility of thought.  Creativity is flexibility of thought.
Nurses spend a large portion of their day prioritizing tasks and monitoring physiology.  They may not feel that they are monitoring physiology, they may think they are taking vitals, auscultating body sounds and deciding whether or not to give medications, but in order to keep patients safe and encourage healing, a good nurse must understand physiological systems and the ramifications of changes in system players.  Students who understand processes and the ramifications of change in physiological systems will better understand why they are doing what they are doing, as well as the importance of the parameters that they monitor.  Then, pursuant to their judgments, the nurse will know when it is appropriate or necessary to seek out help from a doctor or other staff.  When bringing in other team members is done in a timely fashion, nurses can prevent patients from declining beyond reclamation into sepsis, CHF, internal bleeding, arrhythmia, diabetic ketoacidosis, diabetic coma, or respiratory failure.  Understanding homeostasis and balance in every body system makes a good nurse who can certainly double check any facts that she has forgotten or didn’t get in the first place.
Nurses also spend time coming up with creative solutions for bandaging, moving, consoling, helping, informing and teaching.  Not every case requires creativity, but many do.  The variety of people and illnesses that come through your basic emergency department or med-surg floor is staggering.  Nursing school does not prepare anyone for everything they will see.  Therefore a nurse must be able to gather information she needs, ask questions and creatively problem solve.  If you can help your students learn how to do those things, they will do better in nursing school, on the NCLEX, and as nurses.
My recommendations are as follows, with the reminder that these recommendations come from an RN, musician and former special education teacher, not an A&P professor.
1) Make time for creative teaching techniques by forcing more students to come to class prepared.  Forewarn students that they will be responsible for knowing the basic facts from a section or chapter before coming to class.  Give a short quiz at the beginning of class on the material that was assigned.  Then field any questions from the chapter.  At this point some creative teaching techniques or exercises can be used to cement their understanding without feeling like you’ve cheated them.   You may choose to do this several times a semester, or many times a semester, but if they are forewarned, then hopefully, more of them will be prepared and you can help them get beyond the first layer of the material.
I am sure that most of you already encourage your students to read the text before coming to class.  Most of them do not.  Some of them never read it.  And if you didn’t cover it in class, they would fail.  However, if they become interested in and begin to truly understand the complex intermingling of simple physical and chemical realities that are the basis of the human body, perhaps they will be motivated to contribute more to their own learning and their own future.
2)  Encourage an atmosphere that is open to creativity.  Share your own strange connections with your students.  One of my A&P professors told us that he found adipose tissue to be the most beautiful tissue in the body under the microscope.  If you include a few questions like, “Which tissue do you think is the most beautiful, or looks most alive, or reminds you of a food?” on lab activities, quizzes, etc. you will be encouraging your students to see A&P in a different light.  Help them see that there is still some room for personal interpretation and impression in science.  Encourage your students to make connections and ask questions.  Have them turn in a question that came to them, or that they can think of at the end of class, related to the days’ material – but not limited to A&P.  In other words, it’s okay for a student to ask, “What is the psi limit of fibrocartilage?”  They don’t need to know that for your class but they will remember more about fibrocartilage simply by asking the question.
Many creative teaching techniques can be used as separate assignments that don’t use class time.
3) I encourage you to broach the topic of student vs. professor responsibility at your school.  More responsibility will help students.  Especially students who are growing up in a culture where their personal actions do not have much impact on their well being until they are adults.  Responsibility contributes to being a self-motivated student and nurse.  This is especially true for nurses.  If a nurse is to be successful and not hurt anyone, she must be somewhat autonomous and willing to seek out information and solutions.  Responsible people who accept their part of the bargain (i.e. preparing for class) make better students, better nurses and probably happier people.  There are lots of opportunities for nurses to do more harm than good and many opportunities for good nurses to have a positive impact on healthcare outcomes.
I hope this is a helpful answer and I hope you will forgive my presumption in offering these thoughts.  I would love to hear your thoughts and am posting this on our website where there is the opportunity to respond and discuss.  I do believe that our early educational system seldom brings out the best in students.  You, as college educators, are left with students who are ill prepared for college or to solve problems in general.  I hope that together we can make a difference in some students’ lives.