Rethinking physiology teaching: evidence and theory-informed strategies for interactive physiology education

<b>NEW & NOTEWORTHY</b> Unlike broad, older "active learning" overviews, this review applies a physiology-specific, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020-guided approach [protocol registered on Open Science Framework (OSF)] that integrates empirical evidence with theory to produce actionable guidance. It updates the field through an exhaustive 1990 to Aug 2025 search and quality appraisal [Medical Education Research Study Quality Instrument (MERSQI)/Mixed Methods Appraisal Tool (MMAT)] and then maps findings onto six persistent, discipline-relevant challenges (large-class engagement; abstract/paired concepts; fragmented knowledge; system-level complexity; preclass preparation; and formative feedback). Beyond cataloging strategies, it links each challenge to concrete, small-step interventions (interactive lecturing with polling, peer instruction, scaffolded problem-solving, pattern recognition, system-based frameworks for acid-base, flipped elements, and low-stakes assessment) explicitly grounded in learning theory (constructivism, cognitive load, dual coding, and retrieval practice). Sensitivity analyses demonstrate thematic robustness. The result is a practical, evidence-and-theory-informed toolkit that shows educators how to incrementally transform physiology teaching without curricular overhaul.