Adapting an Infectious Diseases Course for "Engaged Citizen" Themes.

This article describes philosophies and perspectives underpinning scientific citizenship-focused curricular changes implemented into a pre-existing undergraduate infectious diseases course. Impetus for the curricular changes was a novel, campus-wide, multidisciplinary "Engaged Citizen" theme for the general education curriculum. The first half of the article describes the larger contexts from which the curricular changes were borne and the resulting instructional model. The second half of the article shares both student and instructor perspectives on the curricular changes and potential application of the model to other science courses.

INTRODUCTION

Earlier deficit-based social models of scientific citizenship—where the public was seen as scientifically ignorant—have been replaced with dialogue-based models emphasizing symmetrical and mutualistic conversations between the public, scientists, and sociopolitical institutions (7, 14, 25, 35). At the individual-citizen level, scientific citizenship requires that individuals be: knowledgeable in scientific content; versant in the epistemology and nature of science (NOS); able to employ scientific literacy skills (such as the ability to critique and filter information, including self-critique); aware and concerned about social and ethical issues related to science (often termed “socioscientific issues” or SSIs); and self-actualized with respect to those issues (1, 4, 6, 17, 25). At community, national, and international levels, scientific citizenship requires a balance of public competence, participation, and democratic accountability (2, 22, 23, 29).

University classrooms are underutilized environments for developing scientific citizenship but have great potential to do so (8, 16, 28). Initiatives are needed which expose postsecondary students to, and allow them to practice using, both content and skills associated with scientific citizenship (17). SSIs provide real-world and oftentimes controversial contexts that pique student interests, allowing them to explore the issues’ multiple dimensions and practice scientific citizenship skills (18, 29, 31) and can be made accessible to both majors and nonmajors (5).

Beginning spring 2007, Drake University launched a new general education curriculum component titled the Engaged Citizen (EC) initiative. The goal of Engaged Citizen is to help students explore societal topics that span diverse disciplines (such as economics, politics, and science) and develop ways of thinking, content knowledge, and skills helpful in dialogue and democratic decision-making. Each year a different campus-wide Engaged Citizen theme is chosen on topics such as conflict (war), democracy, or poverty. All colleges and departments then have the opportunity to modify existing courses or develop new courses that fit the theme.

The Engaged Citizen initiative provided the Drake University Biology Department an impetus to examine how our curriculum addresses scientific citizenship and implement curricular changes. Two potential approaches presented themselves: create a class de novo to address the theme, or implement curricular changes in a pre-existing course. An example of the former approach has been reported elsewhere (30). This paper describes how a pre-existing course (Bio 108 Infectious Diseases, taught alternating spring semesters) was adapted to address the Engaged Citizen theme. Rather than focusing on specific lesson plans, this paper emphasizes the philosophy underpinning those curricular changes and their implementation, in the hopes that sharing our Bio 108 experience might serve as a model for other educators curious about implementing similar changes in their courses. For readers interested in the mechanics of the curricular changes, several supplementary files providing specific strategies or examples are included as appendices and referenced throughout the text.

GOALS

Prior to the Engaged Citizen initiative, Bio 108 had been a traditional, didactic course. While the primary goal was to restructure Bio 108 so that it taught scientific citizenship topics by bridging traditional course content and SSIs (via the Engaged Citizen themes), several other goals existed.

First, desirable features of the original course were identified for retention. Pedagogically, this included many of the original instructional objectives/content matter of Bio 108 taught through constructivist and active learning philosophies; since this was an infectious diseases course, instructional content encompassed basic information about each infectious agent’s taxonomy and biology, transmission, symptoms, treatment, prevention and control, and important historical or societal aspects. Pragmatically, this included “recycling” some pre-existing resources to better budget instructor time.

Second, desirable curricular modifications were identified. Knowing that the Engaged Citizen theme would change annually, it was important to develop a course structure that could be custom-tailored to each year’s theme yet have a stable structure that maintained course identity from one semester to the next (again for both pedagogical and pragmatic reasons). Cueing off the initiative’s name, it was important to involve students (“Engaged”) in exploring SSIs (“Citizen”) via scientific citizenship skill-building versus a straight lecture. Ease-of-deployment was another consideration. Finally, it was important to open the course up to a more diverse pool of majors to better capture diverse perspectives.

OVERALL COURSE STRUCTURE

The model that best fit all goals/components wove three elements together: a) journal article days using papers with SSI aspects, b) in-class lessons, and c) a culminating individual student concept map project. The model hinges on instructional design and not content; for example, it does not stipulate which diseases to include/exclude, how many diseases, or in what order. Each year starts with course planning as follows: 1) identify the Engaged Citizen theme; 2) identify infectious disease journal articles that fit the theme; 3) arrange articles in a logical semester sequence; 4) structure individual days (journal article days or other days) to meet Engaged Citizen, scientific citizenship, and/or content objectives; 5) interweave in-class lessons around journal article days (e.g., if a journal article on influenza is chosen, then one or more in-class lessons pertaining to influenza can be instituted before, during, or after that journal day); and 6) assessment. More details on implementation are provided in Appendix 1.

Table 1 shows four Engaged Citizen themes chosen by Drake University during semesters when Bio 108 was offered and the different diseases that best fit with each theme using the stepwise planning process described above and in Appendix 1. Serendipitously, many of the same diseases fit the Engaged Citizen theme across years—of the 22 diseases that were collectively included over the four semesters, eleven (50%) were used all four years in contrast to eight (36%) that were only used once. Specifics on the selection of journal articles and their integration are provided in Appendix 2. Diseases and associated lessons functioned as “modules” that could be assembled, broken down, and reassembled from semester to semester in a “plug-and-play” system. The modular system also allowed the course to rapidly respond to current events—a scheduled journal article day and/or in-class lesson module could be “unplugged” and a module that addresses the current event could be “plugged” in its stead without interrupting course continuity.

TABLE 1

Four Engaged Citizen themes and their respective years (columns), and infectious diseases which best fit those themes and around which each year’s curriculum was constructed (rows).

	Poverty and Ethnicity (2009)	The World and War: Conflict and Its Consequences (2011)	Sustainability and Climate Change (Human–Environment Interactions) (2013)	Human Migration and Immigration (2015)
Anthrax	X	X	X	X
Candida				X
Cholera	X	X	X	X
Clostridia		X
Dengue Fever			X
Ebola				X
Food Poisoninga	X	X	X	X
Hepatitides	X	X	X	X
HIVb				X
Influenza	X	X	X	X
Lyme Disease			X
Malaria	X	X	X	X
Plague	X	X	X	X
Polio				X
Prion Diseases	X	X	X	X
Q Fever	X	X
Smallpox	X	X	X	X
Staph/Strep	X	X	X	X
Toxic Blooms			X
Tuberculosis	X	X	X	X
Tularemia	X	X	X
West Nile Virus	X	X	X

Campylobacter, Helicobacter, Salmonella, Shigella, and/or Norovirus.

Human immunodeficiency virus is not normally discussed in this class because it’s a big focus of another class (INTD 87 and FYS).

When Bio 108 was first revamped in 2009, the scientific citizenship instructional model that best fit its needs was Ekborg and colleagues’ six-faceted socioscientific case model, contextualizing topics by starting point, subject, nature of scientific evidence, social content, use of scientific knowledge, and levels of conflict (10). Table 2 shows examples of how Ekborg and colleagues’ model was applied to Bio 108 using three different types of SSIs. Dialogue/debate (20) was a large component of the model (Appendix 3). Other models are also available and may be better suited to others’ courses (13, 17, 31–33), particularly Hodson’s six criteria for students to be successful in socioscientific issue engagement and four levels of sophistication in engaging with socioscientific issues (17).

TABLE 2

Infectious disease examples for Bio 108 using Ekborg and colleagues’ SSI model (10).

	Anthrax	Influenza	Enteroviruses/Polio
Starting Point	Television programming (watched in this order) a:http://www.youtube.com/watch?v=92Syc1agCBkhttp://www.youtube.com/watch?v=JH7Y0j0rjwkhttp://www.youtube.com/watch?v=uX_yoRxsuEUhttp://www.youtube.com/watch?v=mi3sYzDsSGI	Unexpected current event (2009 swine influenza or 2015 avian influenza outbreaks)	Popular media and scientific sources on EV-D68 cases in North America (and subsequent discussions on the status of enteroviruses—and polio specifically—in current global contexts)
Science Subjects	Bioterrorism; epidemiology; genetics; public health	Agriculture; epidemiology; public health	Epidemiology; genetics; neurology; public health
Nature of Scientific Evidence	Categories II and III (scientific knowledge is available but with gaps, and decision-making may be based on nonscientific knowledge)	Category II (scientific knowledge is fairly well-established, and decision-making may be based on nonscientific knowledge)	Categories I and III (scientific knowledge is available but may be misreported or misinterpreted, and decision-making requires weighing different sources)
Social Content	Criminal systems; ethics; government; law; politics	Economics; transportation infrastructure	Civics; ethics; immigration; international relations; politics
Use of Scientific Knowledge	Critical thinking; risk assessment; strengths and weaknesses of current scientific technology (and applications)	Critical thinking; problem solving; risk assessment; scientific literacy	Critical thinking; scientific literacy
Primary Conflict Level(s)	Structural	Societal	Individual, Societal, Structural

All videos were available as of May 2015

Outside of class, students prepared a posterboard-sized concept map which focused on a specific infectious disease of their choosing in terms of “scientific” and “social” dimensions (the latter always in relation to the Engaged Citizen theme). Projects were presented at an in-class “Concept Map Convention” later in the semester. Some years, depending on schedules, students also presented posters outside of class at a campus-wide “Engaged Citizen Showcase” where they could share their projects with students and faculty from other Engaged Citizen courses. Specifics on the concept map project, its relation to the course, and examples of student work are provided in Appendix 4. More information on use of concept maps may be found elsewhere (3, 15, 26, 27).

STUDENT PERSPECTIVES

Students completed course evaluations at the end of the each semester. “Scientific citizenship” was not specifically queried because this manuscript was not foreseen at the time the courses were given. However, student responses often contained unprompted references to scientific citizenship– associated course elements and may serve as a proxy for assessing students’ perceptions of those elements. The Drake University Institutional Review Board approved the analyses of past course evaluations for this manuscript (IRB ID#2014-15075). End-of-course evaluations were completely anonymous and did not identify students by major or demographic. Most students were science majors studying medicine-associated fields. Nonscience majors included business, education, mathematics, open-enrolled, and political science majors.

Five questions that might contain relevant responses were identified from all previous course surveys. Only those responses that specifically referenced some aspect of scientific citizenship (the Engaged Citizen theme or other social/political/economic/etc. dimension of the course, journal article days, in-class activities, concept map, or class discussion) were included for analysis. Example student responses are presented in Appendix 5.

One question asked whether students felt the learning modalities (journal article days, in-class activities including discussions, and concept map) paired well with the scientific citizenship goals of the course: “How did the instructional materials (notes, in-class activities, journal article days) integrate with the course and its objectives?” This question elicited a mix of favorable (good integration), unfavorable (poor integration), or neutral (giving examples of both good and poor integration) responses. Most were favorable (Table 3, Appendix 5) with the exception of 2013, which will be discussed in “Instructor Perspectives” below.

TABLE 3

Student responses to two course evaluation questions.

Survey Item	2009	2011	2013	2015
1. How did the instructional materials integrate with the course and its objectives?	n = 27	n = 27	n = 50	n = 19
	Favorable (10/16)	Favorable (10/12)	Favorable (10/27)	Favorable (11/14)
	Neutral (4/16)	Neutral (2/12)	Neutral (14/27)	Neutral (2/14)
	Unfavorable (2/16)	Unfavorable (0/12)	Unfavorable (3/27)	Unfavorable (1/14)
2. Please comment on the blend of social/science aspects of the course.	n = 26	n = 23	NA	NA
	Favorable (20/26)	Favorable (23/23)
	Neutral (3/26)	Neutral (0/23)
	Unfavorable (3/26)	Unfavorable (0/23)

n = the total number of responses to the question overall (regardless of whether or not they met inclusion criteria); the numbers in parentheses indicate the number of responses that specifically addressed scientific citizenship components. As an example: for question #1 2009, 27 students responded but only 16 of those responses met inclusion criteria. Of the 16 responses, 10 were favorable, 4 were neutral, and 2 were unfavorable. NA = not available.

A separate question read: “Please comment on the blend of social/science aspects of the course.” This question was only found in the 2009 and 2011 evaluations. Student responses were analyzed similarly to the previous question, and again were mostly favorable (Table 3, Appendix 5).

Two questions asked students broadly about “what worked well” and “what could be improved.” Of the 121 responses to “What aspects of this course were most beneficial to you?” 57 (47%) contained a reference to a scientific citizenship aspect of the course. Within those 57 responses, 29 students (51%) mentioned the in-class activities, including the discussion; 26 (46%) mentioned the social theme; 8 (14%) mentioned the journal club; and 3 (5%) mentioned the concept map. The number of mentions is greater than the total number of responses because some students discussed more than one element (this was true for subsequent questions also). Of the 112 responses to “What do you suggest to improve this course?” 35 (31%) contained a reference to a scientific citizenship aspect of the course. Within those 35 responses, 17 (49%) mentioned journal article days; 15 (43%) mentioned the in-class activities, including the discussion; and 3 (9%) each mentioned the social theme or the concept map. These responses revealed an interesting juxtaposition regarding journal article days: in the first question, students cited journal article days most frequently as integrating with the scientific citizenship theme, yet in the fourth question, they indicate journal article days were what they would improve (Appendix 5, Table 3).

The final question was, “please comment on what (if anything) you feel you accomplished in this course.” Of the 121 responses, 41 (34%) contained a reference to scientific citizenship. Within those 41 responses, the overwhelming majority of students (32, 78%) mentioned obtaining a better understanding of the interplay between science and social/political/economic factors, 7 (17%) mentioned heightened awareness of SSIs, 3 (7%) mentioned using course skills to engage with the world around them, and 2 (5%) each mentioned applying content to their future careers and better scientific literacy skills (Appendix 5).

Since none of the questions specifically asked about “scientific citizenship,” and the questions are largely “satisfaction” questions, results should be interpreted conservatively. Although scoring of the open-response questions was standardized as best as possible into favorable, unfavorable, and neutral categories, such classification (and any subsequent interpretation) is inherently subjective; similarly, a different instructor may have picked out different representations of student responses for Appendix 5. The final question represents students’ self-perceptions of their own learning, so none of these questions can demonstrate whether “deep learning” occurred in the course. The response rate is lower than what might be expected if students were specifically prompted to consider the scientific citizenship components. Even with these shortcomings, responses suggest students received the curricular changes favorably and felt the pedagogical strategies supported the teaching of scientific citizenship.

INSTRUCTOR PERSPECTIVES

Infusing scientific citizenship content into a traditional (wholly scientific content–based) course initially presented some challenges. When I first offered the modified course in 2009, there was scant literature on scientific citizenship instruction for the college level specifically, resulting in much trial and error in lesson construction and implementation. Thankfully, and as evidenced by the earlier literature review, the scientific citizenship instructional literature has mushroomed in recent years. On a more personal level, one large obstacle was my own tendency to fall back on traditional science content or teaching strategies, likely because the traditional content was more familiar to me.

For every course I teach, I complete a qualitative “teaching reflection” in two parts. Before the first day of class, I identify two to three goals and anticipate hurdles or idiosyncratic factors for the upcoming semester. After final grades are submitted, I write what worked well and what could be improved, composing some responses prior to receiving the students’ course evaluations and then adding to or modifying those responses subsequent to reading students’ course evaluations. Two factors appear to be the most critical for successful scientific citizenship integration with Bio 108—selection of appropriate journal articles, plus proactive and specific construction of each day’s lesson prior to the start of the semester.

Regarding journal article selection, I found that SSI-based journal articles provided an ideal foundation for the course, but could backfire if they a) did not represent the theme well, b) were repetitive in the type of SSIs they presented, or c) were too technical. A combination of these factors may have led to the relatively tepid student reactions towards the journal articles in 2013 compared with other years (Table 3, Appendix 5). One adjustment I made in 2015 was to expressly ask students to identify the connections between each journal article, its SSI (when applicable), and the Engaged Citizen theme at the start of each journal article day, before beginning any discussion or activity. Alternatively, the lower student satisfaction responses in 2013 may simply reflect the fact that some Engaged Citizen themes worked better in this model than others, or they might be related to students’ preconceived notions about the theme.

Regarding course planning, I found that I had to go beyond standard course mapping (e.g., solely writing down which diseases or articles will go with which class days, and worrying about the specifics of what we will do each day later) at the start of the semester and instead expressly identify scientific citizenship or scientific content goals for each day in advance. The strategy for course sequencing given in the first paragraph of the “Overall Course Structure” section is the product of trial and error from teaching the course multiple times, each with different Engaged Citizen themes. I was overwhelmed with the number and complexity of “moving parts” when I tried this strategy in 2009; in fact, when the course was initially modified in 2009 it was called “Emerging Infectious Diseases” and all selected diseases had to appear on the National Institutes of Allergy and Infectious Diseases’ (NAIAD’s) list of “Emerging and Re-Emerging Infectious Diseases.” The additional criterion proved to be too difficult to juggle with other curricular elements and the ever-shifting Engaged Citizen themes (and frequently excluded historical diseases that fit themes well) and was dropped in 2014.

Each year, as my comfort with teaching scientific citizenship skills grows, I am able to layer in more scientific citizenship elements and balance them better with traditional science content. One strategy that helped me to identify opportunities to expand scientific citizenship content (and concomitantly helped me organize and sequence the different elements of the class overall) was to use a notecard for each class day and different colored markers for scientific citizenship goals and traditional content goals, and also for the different class modalities (journal article days, in-class activities, lecture, etc.). Laying out the notecards in front of me allowed me to gauge the “balance” of the class by color comparisons.

Expectedly, teaching this course has become easier with each course offering, especially once an arsenal of structured discussion and in-class activities was built up, because many could be used interchangeably for different infectious agents or class modalities within or across semesters. The “plug-and-play” system worked well; for example, there were bird and swine flu outbreaks in 2009 and 2015, respectively, and I was easily able to remove the planned lessons and swap in discussions and activities that could capture those current events without disrupting the general flow of the course. Being aware of the course sequence at finer resolution in advance of the course gave me the added benefit of forewarning and subsequently reminding students about connections between different days or topics, emphasizing the undergirding scientific citizenship themes of the class.

EXTENDING THE MODEL TO OTHER COURSES

This paper has shared one example of how scientific citizenship–driven curricular changes were applied to a traditional course on infectious diseases, emphasizing the thought processes and philosophies of the curricular changes rather than the specific lessons themselves to underscore generalizable aspects of the process and resultant model. There is nothing “mythical” about the exact model developed for Bio 108, and instructors should take liberty in picking and choosing elements or variations they feel would work best for their classes.

For readers from different scientific disciplines, other writers have shown potential applications (29) of scientific citizenship curricula in biotechnology (6), business and economics (21), ethics (12), food origins and safety (14), genetics (11, 12), nanotechnology (9), medicine (34), philosophy (19), politics (14), risk regulation (24), sustainability (31), synthetic biology (33), and water fluoridation (20). Regardless of an instructor’s specific field, it is hoped this article will inspire others to begin infusing scientific citizenship curricular changes into science courses across the scientific spectrum, so that students experience multiple exposures in a variety of contexts.

Appendix 1: Implementation

Appendix 2: Journal article selection and integration

Appendix 3: Student debate/dialogue

Appendix 4: Concept map convention: design, rubric, and examples

Appendix 5: Example student responses