Rethinking Physiology Teaching: Evidence and Theory-Informed Strategies for Interactive Physiology Education

Traditional physiology lectures often result in passive learning, fragmented knowledge, and difficulty transferring concepts to new contexts. Although interactive strategies are increasingly recommended, educators question their feasibility for complex topics and large class teaching. Following PRISMA 2020 guidelines, we conducted a systematic evidence informed narrative review of interactive teaching in physiology. The review question used the PICOS framework: undergraduate/graduate students (Population); interactive teaching (Intervention); compared with traditional lectures (Comparison); outcomes of comprehension, retention, reasoning, engagement, and perceptions (Outcomes); limited to empirical quantitative, qualitative, mixed-methods studies, and theoretical insights (Study design). Searches of PubMed, Scopus, and Web of Science (1990–Aug 2025) were supplemented by hand-searching, citation tracking, and key sources. Two reviewers independently screened, extracted data, and appraised quality (MERSQI for quantitative; MMAT for qualitative/mixed methods). Thematic synthesis mapped findings to challenges. From 3,266 records, 49 studies were included. Six recurring challenges emerged: (1) maintaining engagement in large classes; (2) clarifying abstract/paired concepts; (3) integrating fragmented knowledge; (4) explaining system-level complexity; (5) encouraging pre-class preparation; and (6) providing formative feedback. Effective strategies included interactive lecturing with polling, peer-instruction, scaffolded problem-solving, pattern recognition, system-based frameworks, flipped classroom elements, and embedded low stakes assessments. Across studies, these approaches improved comprehension, reduced misconceptions, and strengthened reasoning. Median MERSQI was 12.0/18 (IQR 10.5–13.5), and MMAT ratings indicated moderate-to-high quality. Interactive teaching in physiology consistently improves comprehension, reduces misconceptions, and enhances higher-order reasoning. Findings show that even small, structured interventions can enhance learning, while highlighting the need for further large-scale, high-quality studies.