**3. Teaching-learning approaches**

It is not new and has been assumed since the Bologna treaty that the teaching and learning processes should be student centered, and a shift from an "instruction paradigm" towards a "learning paradigm" should be followed. Therefore, students must build their own understanding of concepts, relationships and procedures, and teachers can encourage this process by carefully considering the type and organization of information, as well as instructional strategies. Specifically, teachers should reduce the total amount of factual information students are expected to memorize, reduce passive lecture format, and devote much more effort to helping students to become active, independent learners and problem solvers. Collaborative learning

activities, interactive models, educational games, and establishing a culture of inquiry/scholarship are critical for achieving these goals [22]. In this context, the teacher assumes the role of facilitator of learning experiences, designing structured classroom environments to maximize student learning, and promote at the same time "classrooms equity" [34, 35].

### **3.1 Active learning methodologies**

Active learning strategies meet perceptual preferences of all types of learners [22, 36, 37]. The implementation of evidence-based active learning interventions, physiology-specific, particularly in large-enrolment class environments can be a challenge [35, 38]. However, active learning strategies range in scale from simple, "low risk" to more complex, "higher risk" activities.

### *3.1.1 From "simple" to more "complex" active learning activities*

Simple activities require little planning from the instructor and little involvement from the students (did not require verbal feedback to the teacher) and are easy to implement. They include pause procedure, minute papers, think pair-share activities, and classroom assessment techniques. More complex activities require more interaction and commitment of the students and more planning by the teacher. Students can work in informal, cooperative learning groups to solve problems, answer inquiry-type questions, analyze case studies and discuss articles among themselves and with the class. These active learning activities can be interspersed between lecture periods (basic active-learning lecture) [39] or replace completely lecturing. In this case, content can be transmitted before class, asking students to watch videos, or read certain material and then lecturing time can be exclusively used for active learning [35].

## *3.1.2 Game-based learning*

The use of games for teaching and learning purposes is not new. Games although fun and entertainment provides engaging experiences, interactive learning environments and collaborative learning activities [40].

Game-based learning (GBL) is an active learning approach that uses different types of game with defined learning outcomes [41–43]. It includes the so-called serious games, when its main goal is teaching and learning, besides entertainment [36, 44]. GBL is useful whether we are addressing basic disciplines or more specific ones. Physiology is considered difficult by many students from different courses in the area of veterinary health, namely veterinary medicine and nursing. They attribute the difficulty to the need to memorize content, an excessive quantity of information, difficulty in understanding the relations between the morphology and function of organs and systems, and the perception of some topics as being too abstract [45]. GBL creates a beneficial learning environment, requiring the interaction of the students in questions and answers that assist in retaining information and improving performance. In addition to the positive impacts on student learning, the use of educational games can increase involvement with activities related to the content of the course, as well as promote greater perception of improved learning by the students [45, 46]. On the other hand, games bring an element of pleasure and can reduce anxiety; students are promoted as participants and share their knowledge and engage in teaching each other; and students can combine theory and practice [47, 48].
