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

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.