Why did I use a chameleon to illustrate this blog post? Chameleons have a unique ability to adapt to changes in their environment. The illustration relates to how during COVID-19 all educators and learners had to rapidly adapt and introduce some makeshift changes to teaching and learning. The lack of any face-face interactions with learners was especially mindboggling! As an educator who appreciates “connection” between teacher and learner, I endeavored to find ways to connect to my learners. During the same period Zoom emerged as a “technology” defining the time. Although technology is sometimes deemed to lose the human touch, I found that during pandemic time the use of technology emerged as a powerful way to connect to my learners. In this post, I share my practical experience with using the Zoom annotation tool in a first year medical school anatomy course. I describe why I used the Zoom annotation tool, where the tool is found, and how students used the tool? I also offer a theoretical framework to support the use of technology in teaching.

Following institutional policies and guidelines during the COVID-19 pandemic, all sessions, including anatomy, were delivered synchronously and recorded on Zoom platform. The lecture recordings were posted on the learning management system for later asynchronous viewing.

After I delivered my first Zoom lecture, I realized it was passive and unidirectional. The usual benefits of in-person sessions where I could gauge student learning by looking at their facial expressions, engage in eye contact, or observe a simple nod were missing! After consulting with an instructional designer, I learned that a number of tools are embedded in Zoom that enable participant interaction. The tools include chat, whiteboard, annotation tool and poll. I decided to start with using the Zoom annotation tool for my head and neck sessions. I was initially concerned that introducing an interactive activity might affect my ability to complete the session on time. However, with some advanced preparation I successfully integrated the Zoom annotation tool in all the eight head and neck sessions!

Anatomy is a visual subject. During the sessions, the Zoom annotation activity was introduced at the beginning to check learners recall on previously delivered content. To support development of student’s visual memory, I asked students to identify anatomical structures on an unlabeled image by using the annotate function on Zoom. For example, I showed students an unlabeled image of base of skull and asked students to label specific structures on the base of skull such as “carotid canal.” Then students usually picked different pointers from the Zoom annotation library to label the structure.

I invite you to watch this brief video (1:34 sec) which demonstrates the students using annotation tools during the Anatomy sessions. As you can see, using the annotation tool is pretty simple, and there are plenty of resources to support effective use.

The straightforward activity in which students labeled an unlabeled image on the screen turned out to be an effective method to virtually connect to my students! This activity gave an opportunity to check student recall of learning and obtain real-time feedback on student learning!  Students were “doing” - writing and drawing actively using technology to support the learning process. Although the use of Zoom annotation tool appears a very simple activity, a couple of theoretical frameworks anchor the use of annotation tools to support student learning. The first is Kolb’s Learning Cycle. Kolb’s Learning Cycle clarifies how learners learn via experiential learning. The second is an educational model called Technological Pedagogical and Content Knowledge.

Kolb’s Learning Cycle describes four quadrants. The learner begins in the first quadrant and recalls the information from the session. As an example, to identify the carotid canal on a static image (concrete experience) and use the Zoom annotation tool to label the carotid canal (reflective observation). In the second quadrant, learners think (abstract conceptualization) about the location of carotid canal beyond the static images. Learners use their observation skills to locate the carotid canal on bones, radiographs, CT scans and MRIs. In the third quadrant, learners try it out. They use the information to solve a clinical case scenario that requires them to identify the carotid canal (practical application). Finally, in the fourth quadrant, learners actively apply the new knowledge to solve real world problems. For example, in patients with issues of carotid vessels, learners can apply relevant anatomical understanding.  

The other educational model that fits the use of technology to support student learning is the Technological Pedagogical Content Knowledge (TPACK) model. The TPACK model is an educational framework that consists of three components: content knowledge (CK), pedagogical knowledge (PK) and technological knowledge (TK). CK refers to subject matter expertise as an educator or as a learner. PK stands for pedagogy used for teaching. Examples include lecture sessions, flipped classrooms, think-pair-share, and problem-based learning. TK stands for technology used for teaching. Examples include Zoom to deliver course content, Poll Everywhere to assess learner understanding, Camtasia to create brief educational videos, Twitter to stay connected with learners on social media, and email to communicate with learners. Although in theory each component appear to work separately, in reality they share a commonality in the center and named appropriately as the TPACK Model.

In the anatomy course to assess real-time student learning during the synchronous lecture sessions on head and neck, student mastery of the content on head and neck (CK) was assessed by asking them to identify and label the structures on an unlabeled image on the screen (PK applied) by using the Zoom annotate function (TK applied). In this case, all of the TPACK model components applied for a single virtual teaching session. Yet, many times we treat each component that is content, pedagogy and technology as a separate entity. The TPACK model emphasizes to effectively integrate technology to support pedagogy and content delivery to help learners learn effectively.

In summary, applying these well-established educational theories to day to day virtual teaching practice will make teaching evidence-based and fulfilling. Educators should take advantage of these virtual environment resources that effectively support our learners. How have you used educational theory in your virtual teaching? Comment below and join the conversation.

Did you know that the Harvard Macy Institute Community Blog has had more than 300 posts? Previous blog posts have explored topics including the cognitive load of COVID-19, technology in education, and creating an e-learning module.


Priti L Mishall

Priti L. Mishall, MD, MBBS, PGCertME (2.0, ’17) is a medical educator with expertise in human anatomy, embryology, histology and neuroanatomy. She is an Associate Professor in the Departments of Pathology and Ophthalmology and Visual Sciences at the Albert Einstein College of Medicine. She co-directs the Anatomy Course for the MD program and directs Anatomy course for the MSTP program. Priti’s areas of professional interest include flipped classrooms, blended and online learning, curriculum development, and anatomical variations. Priti can be followed on Twitter and LinkedIn or contacted via email