Challenges faced by immunology educators in higher education and their responses through an adapted ecological systems framework of teaching challenges

Abstract

Introduction:

Advances in our understanding of the immune system have contributed to important progress in the medical field, however gaps in immunology education and training persist.

Methods:

We surveyed 76 immunology instructors housed in a range of institutions in the United States regarding challenges they face, as well as the solutions they employ using an adapted form of the K-12 conceptual framework of teaching challenges for higher education. Using a mixed method approach, we categorized challenges as extrinsic (outside or under instructor control) or as intrinsic (student cognitive factors).

Results:

We found that immunology instructors faced challenges that, when compounded or lacking in support, became barriers. We found that immunology was taught in varied formats and contexts, primarily to undergraduate biology majors, with class sizes ranging from under 50 to over 200 students. Interestingly, we found that a large number of instructors did not report having formal training in immunology, highlighting a critical need for professional development in the field. Patterns also emerged suggesting that instructors at smaller institutions encounter additional constraints. Despite these challenges, educators demonstrate creativity and resilience in adapting their teaching practices, which we share. Still, many noted that administrative support could further ease these barriers and assist with instructor retention. We also found that programs and courses have yet to integrate immunology curricula as a result of these challenges.

Discussion:

This study provides valuable insights for immunology education researchers and offers practical recommendations for instructors and administrators. It also highlights the potential to adapt existing resources from other biology subdisciplines to better support immunology educators—whether they are seasoned experts or new to the field. As the AAAS Vision and Change report emphasizes, evidence-based teaching practices are essential for the future of biology education, and immunology education is only beginning to develop its pedagogical foundation.

1 Introduction

In rapidly advancing fields, like immunology, it is challenging for educators to balance the influx of new information and techniques with developing engaging curricula. Educators, particularly in higher education, are faced with integrating emerging knowledge from the field into the classroom in a way that is easily understandable by the novice learners. In parallel, students continue to bring their own preconceptions about immunology to the classroom, many of which are influenced by misinformation in the media regarding immunology or misconceptions they may have (Stecula et al., 2020; Bezbaruah et al., 2024). Instructors must distill complex, interdisciplinary research into forms that are pedagogically sound and cognitively accessible to students who often rely on intuitive or nonscientific frameworks to understand scientific phenomena (Scott et al., 2019). Taken together, the landscape of challenges facing immunology instructors is dynamic and growing. Teaching challenges are prevalent in other biological fields. Faculty in medical teaching face a lack of departmental teamwork, overburdening a single faculty with multiple responsibilities, and a shortage of clinical materials during the COVID-19 pandemic (Shrivastava et al., 2022). Teaching faculty also face faith-based opposition when teaching evolution (Wiles, 2011), low budget and high regulatory concerns in education involving field studies (Fleischner et al., 2017), and emerging biological challenges (i.e., climate change) in ecology education (Cooke et al., 2021). Teaching biology subdisciplines can also have challenges in common, such as those involving student gaps in training, work-load, and lack of administrative support (Wiles, 2011; Fleischner et al., 2017; Cooke et al., 2021; Shrivastava et al., 2022). These challenges can result in attrition, particularly in early career instructors, or cause barriers like perpetuating misconceptions for educators (Leonard et al., 2014; Doherty, 2020; Beymer et al., 2022).

Immunology instructors have previously self-reported some challenges in teaching and learning immunology at the undergraduate level. For example, it is challenging to approach the interdisciplinary nature of immunology which involves complex systems that span multiple fields of biology. Immunology is also a content heavy discipline, with daunting lists of vocabulary and jargon that continue to develop and evolve (Stranford et al., 2020; Bruns et al., 2021; Pandey et al., 2022; Siani et al., 2024). Therefore, there is a need for active-learning, more support for educators teaching immunology and more intentional integration of immunology concepts across undergraduate curricula, leveraging the interdisciplinary nature of the field (Stranford et al., 2020; Mixter et al., 2023; Siani et al., 2024). Instructors teaching sub-disciplines within the life sciences, including neuroscience and bioinformatics, face similar challenges (Altimus et al., 2020). Neuroscience in particular has reported a lack of conceptual clarity and reductionism that can lead to misinformation and misconceptions (Wiles, 2011; Clement and Lovat, 2012; Cooke et al., 2021). However, when instructors have access to neuroscientific knowledge in a form they can process and understand, they apply their understanding within their curricular work to design effective pedagogical approaches (Dubinsky, 2010; Dommett et al., 2011). Recent work in developing neurobiology literacy has yielded a framework for organizing content to support educators in developing curricula through a conceptual approach (Shah et al., 2025). In bioinformatics, core competencies have been identified (Wilson Sayres et al., 2018), and linked communities of practice have been developed (Kleinschmit et al., 2023) to foster collaboration and shared learning. Addressing community-identified teaching challenges in bioinformatics (Williams et al., 2019; Drew et al., 2023) involves supporting educators through curriculum development, mentorship tailored to teaching context, and broad dissemination of adaptable resources across the educator community.

Immunology is normally taught in diverse settings, from undergraduate classrooms to medical schools, where students have varying levels of preparation. There is still a need for more immunology courses and content to be integrated throughout the undergraduate curriculum to better prepare the student pipeline that serves the healthcare professions or matriculation into graduate programs (Bruns et al., 2019). Although a major physiological system, immunology is not a topic that is deeply integrated into biological science curricula, particularly at the K-12 level (NGSS Lead States, 2013; Kafai et al., 2022). Undergraduate students may have the opportunity to take an elective or, if in certain majors, an immunology prerequisite course during their mid or late college career. Immunology modules may be included in introductory biology, microbiology, or physiology courses but not consistently. This lack of exposure can lead to student misunderstanding, oversimplification and misconceptions of basic immunological concepts and their applications (Tomasi et al., 2021; Kafai et al., 2022; Kahlon et al., 2022; Mixter et al., 2023). Furthermore, bridging interdisciplinary knowledge is challenging but is an opportunity for students to learn deeply about core biological concepts and to have a holistic understanding of biological systems and their applications in health (AAAS, 2011; Clement and Lovat, 2012; Justement and Bruns, 2020). Immunology educators are tasked with developing curricula that encourage systems thinking and mechanistic reasoning to drive students to an understanding of the immune system at the cellular level and embed concepts into a complex system (Siani et al., 2024). Even in academic programs where immunological concepts are extensively integrated (e.g., medical training), helping students appreciate the relevance and application of this knowledge can still be challenging. In medicine, immunology has a long history of being a difficult subject to understand (Bansal, 1997). Lee and Malau-Aduli (2013) found that medical students often perceive immunology as abstract, describing it as “very complex and difficult to relate to…” (Lee and Malau-Aduli, 2013). Research suggests that active learning strategies may help address these challenges by making content more accessible and engaging (Karim, 2020).

Navigating these challenges requires more than content expertise from instructors. Instructor self-efficacy, or the belief in one’s ability to overcome teaching challenges and succeed in specific instructional contexts, is an understudied yet critical aspect of teaching immunology. Rooted in Bandura’s theory of behavioral change, self-efficacy connects personal belief with motivation and persistence, especially when navigating complex or unfamiliar tasks (Bandura, 1993). Teachers with higher self-efficacy are more likely to use novel approaches like inquiry-based and student-centered pedagogy (Czerniak, 1990). Importantly, self-efficacy reflects belief in one’s capabilities (i.e., growth mindset) and has been identified as a key driver of behavior and resilience in the face of obstacles, which is directly linked to success in the field (Swackhamer et al., 2009; Gordon et al., 2023; Golubtchik, 2024).

In this study, we examined how diverse instructors’ experiences teaching immunology vary across the United States. We aimed to identify challenges faced by instructors teaching immunology across a range of institutional and instructional contexts. We developed a survey tool designed to assess not only the types of challenges instructors encounter but also how they are adapting and responding to them. Using an embedded mixed-methods approach, we were able to tease out nuances in responses and unpack the current landscape of challenges instructors face in hopes of focusing efforts to overcome these through a survey tool we developed (Harvard Catalyst, 2025). Importantly, this study represents the first systematic analysis of undergraduate immunology instructor challenges, differentiating our contribution from others cited earlier in the introduction and enhancing the ongoing conversation around Science, Technology, Engineering, and Mathematics (STEM) instruction and faculty development.

The theoretical framework of conceptual framework of teaching challenges (CFTC) was originally developed for K–12 education based on Bronfenbrenner’s Ecological Systems Theory of Human Development, also referred to as Bronfenbrenner’s Ecological Systems Theory (Bronfenbrenner, 1979, 2000; Akuma and Callaghan, 2019). The CFTC framework outlines hierarchical levels of challenges for K-12 teachers. The intrinsic level (the individual-level or teacher-level) includes challenges intrinsic to the instructor such as instructor lack of motivation, insufficient practical skills and gaps in content knowledge. These teacher intrinsic challenges can be grouped into phases of instruction (i.e., preparation-phase, implementation-phase, and assessment-phase) (Akuma and Callaghan, 2016, 2019).

The next level of challenges for K-12 instructors arise from contextual factors, which are extrinsic to the instructor. K-12 teachers face constraints on curriculum, time, supplies and facilities as well as challenges associated with large classes, school culture, appropriate resources, professional support, and gaps in student training and experience (National Research Council et al., 2005; Ramnarain, 2014, 2016; Akuma and Callaghan, 2019). These extrinsic challenges can be material-related (e.g., resources) or social and cultural factors (e.g., professional support), which are non-material-related, extrinsic challenges. These K-12 extrinsic challenges can be divided into two levels: the institutional-level and the system-level (Akuma and Callaghan, 2019).

In this study, we also apply Bronfenbrenner’s Ecological Systems Theory to assess challenges within the higher education context (Figure 1). At the broadest level is the Extrinsic Macrosystem, which encompasses challenges beyond an instructor’s direct control, such as disciplinary norms, institutional policies, and interactions with colleagues or administrators. Secondly, the Extrinsic Microsystem represents challenges within the instructor’s control, including course design and interactions with students. Finally, the Student Intrinsic level captures challenges rooted in student characteristics, such as prior knowledge, attitudes, and expectations. These extrinsic and intrinsic themes are measured as nested levels within the framework.

Figure 1

2 Materials and methods

2.1 Survey tool development

We designed a survey tool (see Appendix) to explore the challenges faced by immunology educators across a range of higher education institution types in the United States. The survey was administered in February 2025 through Qualtrics. The first section of the survey included 5 demographic questions about the respondent institution, career stage, teaching experience, and disciplinary training, adapted from (Pandey et al., 2024). To better understand their instructional approaches, we asked 7 questions related to the modalities used to teach immunology (e.g., lectures, labs, approaches), the strategies employed (e.g., active learning vs. traditional lecture), and the context in which immunology is taught (e.g., as a standalone course or as a module within a broader course such as microbiology).

The second section of the survey was modeled after an intervention teacher satisfaction tool focused on the K-12 level, which asks respondents to rank their level of agreement with statements illustrating distinct challenges (Riggs and Enochs, 1990). We took an exploratory sequential design approach to develop these statements that captured the nuances of challenges instructors encounter while teaching immunology. This method has been established to develop instruments in their early stages, to maximize clarity and capture potential wide range and variety in responses (National Research Council et al., 2001; Márquez and Delgado, 2017; Scott et al., 2019). Survey questions in this section were informed by short preliminary interviews conducted in August–October 2021, with eight undergraduate faculty housed in different institutions. In these interviews, we asked faculty one question: “What challenges do you encounter while teaching immunology related concepts/topics?,” followed by thematically analyzing interview responses to identify emerging challenges commonly experienced across the interviewees. We situated emerging challenges within one of the three dimensions of the CFTC based on Bronfenbrenner’s Ecological Systems Theory Ecological Systems Theory (Bronfenbrenner, 1979, 2000; Akuma and Callaghan, 2019) adapted to a higher education infrastructure (Figure 1). Intrinsic cognitive factors are also emphasized in Social Cognitive Theory, which helped us define the “intrinsic” factors of the CFTC framework and adapt them to an undergraduate teaching context (Bandura, 1977). This section included 35 Likert-scale items and two open-ended questions. Likert-scale questions followed a 1–5 rating scale (strongly disagree to strongly agree) and included positive (i.e.,“I feel confident teaching immunology.”) and reverse rewording (i.e., “I feel unprepared to teach immunology”). We also included two open-ended questions to allow respondents the opportunity to share (1) challenges they face in the classroom and (2) ways they addressed (or attempted to address) challenges.

2.2 Data collection

Instructors (a total of 76) were recruited from a variety of national institutions, academic backgrounds, and subject-matter expertise who teach immunology at the post-secondary, graduate, and professional levels (Table 1). Faculty were recruited by either reaching out to biology, immunology, and/or microbiology departments via colleagues and educator groups (e.g., ImmunoReach), or via professional society listservs (e.g., ASMCUE and SABER). This study was reviewed and approved by the Institutional Review Board (IRB) at Colorado State University (IRB # Protocol 6,504). All participants provided informed consent prior to participation in accordance with the Colorado State University’s IRB guidelines and participation was volunteer-based. Interviews were used to identify a framework and assist with survey development, and this preliminary work was approved through the Minnesota State University Moorhead (IRB Protocol #1561719–3).

2.3 Data analysis

We analyzed the survey results using an embedded mixed-methods approach, in which demographic and Likert-scale questions were examined using descriptive and statistical analyses, while qualitative open-ended responses underwent thematic coding to provide additional context, confirm identified themes, and uncover any additional themes not included in the Likert-scale questions (Gibbs, 2018; Naeem et al., 2023). This approach allowed us to contextualize the quantitative findings around challenges, such as instructors’ backgrounds in teaching immunology and teaching demands, with deeper insights from open-ended responses, offering a more comprehensive view of challenges instructors face.

2.3.1 Qualitative analysis

Initial themes were identified from the 8 pilot interviews and further refined through an analysis of respondent survey data. Responses were thematically analyzed individually by 9 co-authors and then the group collectively met to discuss and resolve finalized response themes (Naeem et al., 2023). We identified 10 themes grouped into 3 categories (A) Field/content and materials accessibility (B) Students’ pre-existing knowledge / training, and (C) Course curriculum design. These categories fit well within the CFTC framework (Supplementary Table 1).

Thematic analysis of responses left by 50 participants within the subsequent survey open-response items was iterated to confirm themes previously established and to identify distinctly novel themes. We applied a well-established qualitative analysis method to increase the rigor of our analysis and refine our understanding of underlying challenges (National Research Council et al., 2001; Gibbs, 2018; Naeem et al., 2023). Emerging themes were identified and categorized into one of the three dimensions of the adapted framework. Thematically analyzed responses were used to contextualize quantitative results and as an opportunity for us to identify additional novel challenges not presented in the quantitative section of the survey.

2.3.2 Quantitative analysis

We examined demographic responses (Q4–Q8) for the respondents who fully completed the Likert-Scale items (66 of 76 total respondents; Table 1). In questions where respondents could select multiple options to best describe their background (Q7-8) and pedagogy (Q9-13 and 15), each selected response was counted. Ordinal data from the Likert-scale questions were first summarized as percentages, with “strongly agree” and “somewhat agree” grouped into an agreement category, and “strongly disagree” and “somewhat disagree” grouped into a disagreement category. We then subsetted Likert responses by demographic variables (e.g., comparing responses from instructors who reported teaching high- vs. low-lecture-intensity courses). Given the unequal group sizes, we used the Mann–Whitney U test (W Statistic) to compare response distributions between groups in R.

3 Results

3.1 Instructors from diverse academic backgrounds report on challenges they face in teaching immunology

A total of 76 instructors participated in the survey, representing a broad range of career stages, institutional types, and disciplinary backgrounds. A subset, 66 respondents, fully completed the Likert-scale items assessing their agreement with various statements, and 50 participants responded to the open-ended items regarding the challenges that prevented them from teaching the way they would like followed by how they addressed their listed challenge(s). A majority of respondents (n = 58; 76.3%) had over 10 years of teaching experience, and nearly all reported holding (n = 73; 96%) doctoral degrees in fields within the life sciences. Among instructor types, tenured faculty represented the largest group (n = 40; 52.6%), followed by teaching-track instructors (n = 19; 25%), pre-tenure faculty (n = 8; 10.5%), and other instructional roles, like instructors at a 2-year college (n = 8; 10.5%). Participants were affiliated with a variety of institution types, most commonly R1 and R2 universities (n = 38; 50%), but also Primarily Undergraduate Institutions (PUIs), Minority-Serving Institutions (MSIs), Liberal Arts Colleges, and Community Colleges (participants could select more than one) (Table 1). Areas of disciplinary expertise were diverse, with the most common being immunology (n = 40; 31.3%), microbiology or virology (n = 34; 26.5%), and biological sciences (n = 33, 25.8%). Respondents also represented fields such as neuroscience, ecology, and science education (Figure 2, Supplementary Table 2).

Figure 2

Instructors reported a wide range of teaching contexts for immunology education. While most taught immunology as a standalone course (n = 50; 65.8%), many incorporated immunology as a module within broader courses such as microbiology (n = 21; 40.4%) or introductory biology (n = 11; 21.1%) (Figure 3, Supplementary Table 2). Some reported teaching immunology in a laboratory format solely or in addition to lecture (n = 15; 19.7%) (Table 1). Most respondents taught undergraduate students, with 66 (86.8%) instructing biology majors and 25 (34%) teaching non-majors either alone or in addition to biology majors. Additionally, some taught graduate students (n = 14; 18.4%) and/or students in allied health programs (n = 16; 21%), while five participants taught exclusively at the post-secondary level (i.e., graduate and/or allied health). Class sizes varied across institutions: the majority (n = 65; 85.5%) taught courses with fewer than 50 students, while 30 (39.5%) taught classes with more than 50 students, including seven instructors who reported class sizes exceeding 200 students (Supplementary Table 3).

Figure 3

To address challenges in teaching immunology, we adapted the CFTC framework of K-12 instructor challenges, based on Bronfenbrenner’s Ecological Systems Theory, to higher education. We base this on the data presented below which we organized into three levels of challenges: (1) Extrinsic Macrosystem encompassing challenges at the field, institutional, and programmatic levels, (2) Extrinsic Microsystem encompassing challenges under the instructor’s control, and (3) Intrinsic Student encompassing student’s cognitive factors (Bandura, 1977; Bronfenbrenner, 1979, 2000; Akuma and Callaghan, 2016) (Figure 1).

3.2 Extrinsic Macrosystem challenges: barriers within field and institutional dimension

Instructors across institution types described numerous barriers to effective immunology instruction, many of which extended beyond their direct control, or at the Extrinsic Macrosystem scale (Figure 1). Between 34 and 70% of participants reported experiencing barriers at the macrosystem-scale including limited access to instructional laboratories and equipment (course infrastructure), inadequate teaching resources (discussed below), and challenges associated with a rapidly evolving field of immunology. Instructors described the inherent complexity and density of immunology concepts as a challenge for both them and their students. We identified five additional distinct themes from open-ended responses: (1) lack of institutional or disciplinary support (ie., experts in immunology), (2) programmatic curricula challenges, (3) restrictions on course content, (4) constraints on in-class time, and (5) classroom infrastructure limitations. These challenges often intersect, revealing that many challenges can create a web of constraints that influence the ability of instructors to engage students and teach immunology effectively. In the following sections, we summarize some of the most common Extrinsic Macrosystem challenges facing immunology instructors.

3.2.1 Resource limitations

Missing or inaccessible resources in the form of budgetary restrictions and course materials appropriate for the student level were another source of challenges reported by instructors. Budget limitations were particularly relevant for students to gain access to instructional laboratories and essential equipment. Nearly half of respondents (44%) reported limited access to well-equipped immunology labs, and 70% specifically cited flow cytometers as missing or inaccessible. These challenges were especially pronounced at PUIs, Liberal Arts Colleges, Community Colleges, and Master’s-granting institutions, where 60–82% of participants reported such issues. In contrast, instructors at R1or doctoral-granting institutions reported fewer barriers (26 and 60%, respectively). Resource limitations also affected classroom instruction, with 42–56% of participants noting difficulty in accessing appropriate instructional materials and engaging activities. This issue was more prevalent at PUIs and Liberal Arts Colleges (54–55%) than at Doctoral, Master’s-granting, or Minority-Serving Institutions (34–43%).

Open-ended responses highlighted budget constraints and a lack of content-specific materials as critical barriers, particularly at PUIs and MSIs. Of the six participants who cited budget limitations, five connected these directly to instructional labs, citing costs related to kits, reagents, and specialized equipment. Beyond equipment and space, instructors also cited challenges in finding appropriate instructional materials for their students. Some participants specifically mentioned barriers such as the lack of textbooks written at an appropriate level for their student audience (n = 3), limited availability of immunology-related and customizable teaching resources (n = 2), and the inaccessibility of complex primary literature for students without an immunology background. Others pointed to a broader training gap in the field: the lack of published, evidence-based instructional strategies tailored to immunology education. These limitations hindered efforts to design inclusive, engaging, and pedagogically sound curricula for diverse student populations (Table 2A, Figure 4A, and Supplementary Figure 1).

Figure 4

3.2.2 Physical and logistical barriers

In addition to missing resources, instructors frequently described physical and logistical barriers within the classroom environment in their open-ended responses. Twelve participants identified challenges related to large class sizes, absence of lab components, and limitations in physical or digital teaching spaces. Large classes, especially those exceeding 100 students, were commonly cited as barriers to implementing active learning and managing course time effectively. As one instructor shared, “my class is generally >100 students, which limits the effectiveness of active learning strategies without additional resources.” Several instructors also emphasized the value of lab components in fostering hands-on learning and deeper student engagement. Five respondents, from PUIs, Master’s-granting, and research-intensive institutions, noted that the lack of a lab component hindered instruction, even when budget constraints were not a factor. Additional logistical barriers included technical issues in online environments (e.g., bandwidth problems) and restrictive classroom layouts, such as fixed seating that prevented collaborative work: “Lack of space to allow breakout groups. Seat[s] are packed in and bolted to the floor.”

3.2.3 Programmatic challenges and constraints on class time

Instructors reported that programmatic curricula—structured course sequences determined by faculty committees or administrators—can create challenges that contribute to gaps in students’ foundational knowledge. Although these curricula are designed to guide students through a logical progression of courses within a degree plan, in practice, students often take varied paths. Courses intended to serve as prerequisites may be optional or interchangeable within a category, resulting in inconsistent preparation among students entering an upper-level immunology course. As one instructor explained, “Because students can take any one of these (required 200-level cell biology, genetics, microbiology, or biochemistry courses) to enroll in the (300-level immunology) course, many times they have substantial gaps in their knowledge in foundational cellular and molecular biology.” Instructors noted limited control over prerequisites or course sequencing, which made it difficult to address these gaps systematically. In response, many adapted by reducing immunological content coverage, slowing the pace of instruction, implementing active-learning strategies (e.g., concept mapping), or providing Supplementary materials to help students review foundational concepts. Program-imposed restrictions on immunology course content was noted by two participants teaching medical students or biology-majoring and pre-nursing students. These participants either stopped teaching or made no adjustments in response (Table 2A).

A related and frequently cited challenge was a limited amount of in-class time available to cover the breadth and complexity of immunology. Sixteen participants described struggling to balance foundational content, complex immunological pathways, and applied topics within the time constraints of their courses. This issue was particularly salient for two groups: (1) instructors teaching immunology as a module within broader courses and (2) those teaching in medical education contexts. Five participants who taught immunology modules, such as in introductory biology or physiology, reported having as few as 2–4 lectures to cover the subject domain. As one noted, “Since it’s one module in an intro course (and a module in which I also cover basics of viruses, vaccines, and pandemics), it’s hard to give them sufficient background to understand important societal issues without getting too deep.” Time constraints also hindered the use of active-learning strategies for some, especially when instructors were unable to reduce or adjust the immunology content to be covered. Instructors teaching in medical schools similarly reported inadequate time for immunology instruction, often limited to just a few lectures. One participant stated, “Time constraints. We have about 2–3 lectures in the course that I can use.” These constraints were further complicated by the need to align content with accreditation requirements and board exam objectives, limiting instructors’ flexibility to revise or restructure course material (Table 2A).

3.2.4 Field-level challenges

Field-level challenges, including excessive jargon and heavy memorization demands, were reported by 34(58%) of participants (Figure 4A). Additionally, 10 instructors explicitly described the complexity and density of immunological information as a significant barrier to effective teaching with open responses. Many noted that the complexity of the subject negatively affected student engagement and content retention, making it difficult to prioritize material and prevent students from becoming overwhelmed. As one instructor explained, “The course material is very dense, and students have a new immunology vocabulary to learn.” Another echoed this concern, stating, “The density of the field can deter students from wanting to learn more than a few lectures’ worth of material before dropping the class” (Table 2A).

Interestingly, a lack of immunology-specific expertise by the instructor also emerged as a barrier. Five participants indicated that they either lacked formal training in immunology or were the sole instructor in their department with any relevant background. These limitations affected their confidence and capacity to teach the subject effectively (Table 2A). This is consistent with broader survey findings: only about half of respondents identified immunology as their primary area of expertise. When asked directly, just 50% agreed with the statement “I consider myself an immunologist,” while 35% strongly disagreed. One instructor shared, “It is difficult for me as an instructor to stay current with understanding techniques. (…) I do not really have time to learn, given the demands of my job.” (Table 2A).

3.3 Extrinsic Microsystem challenges: barriers within instructor-controlled dimension

Instructors face several challenges within the Extrinsic Microsystem dimension, including curriculum management, varying levels of instructor experience teaching immunology, and sourcing appropriate instructional materials for their students (Figure 4B). These challenges often intersect with both Student Intrinsic and Extrinsic Macrosystem factors. For example, instructors reported difficulties in managing the content of a dense and rapidly evolving field, where new discoveries frequently redefine core concepts. These issues are influenced not only by students’ foundational knowledge (Student Intrinsic) but also by the broader disciplinary context (Extrinsic Macrosystem). Instructors cited struggles with sourcing appropriate materials for their students and navigating their own expertise in immunology, which we noted as distinct new themes uncovered from participants’ open responses.

3.3.1 Curriculum management and sourcing materials

As participants discussed struggles with curriculum management, time constraints and gaps in student background understanding, they expressed a need for more teaching experience (n = 3) or a lack of immunology expertise (n = 2). We assume that these responses are based on ‘traditional’ training (i.e., doctoral or postdoctoral) but can be addressed through professional development, which is why we include these challenges within the Extrinsic Macrosystem. We found that about half of participants were non-immunology experts (Figure 2). As an example, a participant describes the content they discuss within their immunology curriculum and includes “Cytokines? I’m a neuroscientist; I do not even have all of those straight” (Table 2B).

Within curriculum management, most (68%) participants agreed that they did not have time to cover everything needed for their students to get a full understanding of immunology during a semester/quarter/module of immunology. This challenge was particularly relevant for those teaching an immunology module within another course, with 90% of participants in agreement (Figure 4B). Many comments also reflected this challenge. For example: “Not enough time in the semester to cover basics in depth and then cover applications to build on those fundamentals” and “Immunology is a complex topic, and it can be difficult to teach the content accurately when students do not have a strong background in the subject matter, and there is only a week in the course schedule to cover the topic.” (Table 2B) Challenges in identifying, addressing (sensitively) and correcting student misconceptions were noted by 28–32% of participants; more so among participants teaching immunology modules (36–47%) and less so among laboratory instructors (9–18%) (Figure 4B).

A second theme we uncovered from the open responses was challenges associated with the creation of materials adequate for the instructor’s curriculum and student audience. Instructors shared that they created their own materials in an attempt to address the needs of their students and the complexities associated with immunology content, however these efforts presented another challenge of carving out time as indicated by respondent: “I create my own resources where possible but this is often time consuming and is still a struggle” (Table 2B).

3.3.2 Teaching approaches

To gain insights into how instructors’ teaching approaches influenced the challenges they faced, we used lecturing intensity as an indicator of active versus passive learning (Theobald et al., 2020). We parsed the data based on the proportion of class time spent lecturing: instructors who spent 50% or more of class time lecturing were classified as High Lecture Intensity (HLI), while those who spent less than 50% of class time lecturing were classified as Low Lecture Intensity (LLI). LLI instructors struggled significantly more with finding materials appropriate for their students relative to their HLI counterparts (W statistic = 528, p-value = 6.805e-7). Instructors who harnessed LLI approaches reported greater challenges keeping up with the latest findings in immunology, with 10% more of these instructors facing this issue compared to those using HLI approaches (Figure 4B, Supplementary Figure 2, Supplementary Table 4).

Additionally, instructors teaching full courses or modules in immunology (31% more than laboratory instructors) reported it being more challenging to stay current with immunological advancements. In contrast, 22–28% more participants with HLI (compared with LLI participants) found it difficult to identify, address, and correct student misconceptions. Interestingly, addressing student misconceptions, including those related to vaccines, was not seen as a challenge by most LLI instructors (68%) or laboratory instructors (92%) (Figure 4B, Supplementary Figure 2, Supplementary Table 4).

Interestingly, participants also cited addressing vaccine-related misconceptions as a major part of teaching immunology. One instructor mentioned “vaccine hesitancy.” Despite this, the majority (88%) of participants indicated they did not hesitate to address vaccines in class due to political or social context, with 94% of stand-alone immunology lecture course instructors, 100% of laboratory instructors, and 95% of LLI instructors agreeing (Figure 4B, Table 2B, and Supplementary Figure 2, Supplementary Table 4).

3.4 Student Intrinsic challenges: student cognition dimension

The final dimension of challenges, intrinsic to the student, encompasses factors also described with Social Cognitive Theory as the “personal” or “cognitive” factors (Bandura and Cherry, 2020; Eccles and Wigfield, 2020; Schunk and DiBenedetto, 2020). We identified five key themes within this dimension: (1) difficulties in developing systems thinking in students, (2) student misconceptions or preconceived notions, (3) gaps in student knowledge and background, (4) lack of student buy-in, and (5) students feeling overwhelmed. The latter was identified as a new theme within survey open responses. Seventeen participants reported that these student-related challenges were significant within their open-ended responses, and instructors addressed them primarily through instructor-controlled strategies within the Extrinsic Microsystem (Figures 5, 6).

Figure 5

3.4.1 Challenges in students’ ability to connect immunology concepts

Instructors also reported challenges related to students’ abilities to make connections between immunology concepts, specifically in developing systems thinking skills (Momsen et al., 2022). Participants, however, noted variable levels of struggles in their student’s ability to make connections based on the topic. For example, some instructors (40%) felt that students understood antibodies but did not grasp their relevance to the immune system. These patterns were consistent across both low- and high-intensity lecturers, as well as instructors teaching an immunology module in some other course and instructors teaching a stand-alone immunology course. However, a greater proportion of lab instructors (36%) agreed that their students recognized the term “antibodies” without understanding their function. On the other hand, 62% of participants agreed that students knew about vaccines but did not understand how they work (Figure 4C), a perspective notably higher among instructors teaching a module (86%), lab instructors (72%), and LLI instructors (76%) (Figure 4C, Supplementary Figure 3). Open responses echoed these findings, with instructors highlighting students’ struggles in making connections and developing systems thinking, such as one instructor noting: “Students getting lost in the logistical details (mechanisms and terminology) and failing to see how components within an immunological response work synergistically” (Table 2C). This is reflected in our finding that 40% of instructors felt that students struggled to connect immunological processes to societal issues.

To gain more insights into where instructors found their students struggled within the levels of systems thinking, we included statements addressing each of the 4 levels of systems thinking (Momsen et al., 2022): Identifying and describing the system (Level 1), Analyzing and reasoning about relationships (Level 2), Analyzing and reasoning about the whole system (Level 3), and Reasoning within or across multiple systems (Level 4). Most participants (46-65%) agreed that their students struggled with one or more level(s) of systems thinking. The statement illustrating level 1 systems thinking had the highest level of agreement among high-intensity lecturers, stand-alone course and module lecturing instructors, however lab instructors were among the highest in indicating that their students struggle with a level 4 systems thinking. It is important to note that these responses do not necessarily indicate that an instructor’s students are actively thinking within one or more of the levels of systems thinking because they were not directly assessed (Figure 5 and Supplementary Figure 4). In addition, multiple participants described their students struggling with getting lost in details and were unable to see how these components interacted (n = 4), with participants specifically pointing out a lack of systems thinking skills. For example: “Students have a difficult time thinking in terms of systems and how they interact” (Table 2C).

3.4.2 Student misconceptions and gaps in foundational knowledge as barriers to teaching

Instructors frequently cited student misconceptions, which are often rooted in prior knowledge gained outside the classroom, as a significant barrier to effective immunology instruction. Over half of all participants (56%) agreed that their students held multiple misconceptions about immunology. This challenge was especially pronounced among instructors teaching immunology as a module (75%) and among those using low-intensity lecturing approaches (62%, compared to 50% of high-intensity lecturers). Interestingly, a substantial proportion of lab instructors (36%) were neutral on this issue, neither agreeing nor disagreeing (Figure 4C and Supplementary Figure 3). Two instructors explicitly noted that addressing misconceptions and preconceived notions was their greatest teaching challenge, particularly when students entered the classroom with misinformation from social media or when topics like vaccine hesitancy arose (Table 2C).

While fewer instructors (29%) agreed that their students entirely lacked the foundational knowledge to understand immunology, a majority (62%) reported that students struggled to connect new information with prior knowledge. This challenge was most common among high-intensity lecturers and instructors teaching immunology modules. Nearly half (49%) of all instructors also agreed that student variability in background knowledge created instructional barriers, particularly among high-intensity lecturers and module instructors (Figure 4C and Supplementary Figure 3). Eleven instructors described these knowledge gaps as a central difficulty in teaching immunology, especially when time constraints limited their ability to address both foundational and advanced concepts. As one instructor shared, “Having so many types of students makes focusing the class based on student needs difficult.” These challenges were compounded by inconsistent curricula and gaps in prerequisite coursework (detailed in the Extrinsic Macrosystem section above), as described by another participant: “Students tend to have insufficient background/basic understanding, which means I have to spend more time on material that would have preferably been dealt with in earlier classes” (Table 2C).

3.4.3 Engaging students with immunology

Student approaches to studying and class engagement emerged as key challenges, particularly in relation to student buy-in. A majority of instructors (52%) agreed that students relied too heavily on memorization to earn a grade, with this concern especially prevalent among module instructors (68%). Additionally, 39% of participants found that students struggled to apply their knowledge to new contexts, revealing a gap between surface learning strategies and deeper conceptual understanding (Figure 4C, Supplementary Figure 3). For two participants, lack of student buy-in was a central struggle. One noted that students resisted efforts to encourage deeper learning, while another described how some students actively pushed back against active-learning strategies, though those who embraced the approach found it engaging and enjoyable (Table 2C).

An additional theme that surfaced in open response survey items related to students feeling overwhelmed by the complexity and density of immunology content. This cognitive barrier appeared especially when instructors reported limited class time to unpack difficult topics. As highlighted in the Extrinsic Macrosystem dimension, the rapidly evolving and content-heavy nature of immunology often left students feeling intimidated or lost. One instructor noted that non-majors, in particular, found the material daunting: “They’re terrified of anything that involves cells and molecules” (Table 2C).

3.5 Instructor responses to challenges

In addition to identifying the challenges faced by immunology instructors, we also collected open-ended responses about how instructors responded to these challenges (Figure 6). Most participants described ways they actively addressed the issues they encountered. In many cases, instructors adapted their teaching strategies at the Extrinsic Microsystem scale, within their own classrooms, to mitigate constraints imposed by broader Extrinsic Macrosystem challenges, such as limited instructional time. Notably, some instructors also made contributions at the Extrinsic Macrosystem, developing resources or initiatives that extended beyond their individual courses to benefit colleagues and students across programs or institutions.

Figure 6

The use of active learning was used to respond to many challenges found within all three dimensions of the adapted CFTC framework. This approach was used by participants to address many challenges within the Extrinsic Macrosystem: the dense and rapidly evolving field of immunology, restrictions on in-class time with students, challenges in course infrastructure and challenges associated with programmatic curricula. To mitigate the density of the field, participants mentioned “Working in groups and open book assessments” and “I have tried implementing a flipped classroom approach” as a response, which are active-learning approaches. In response to a lacking lab component (classroom infrastructure challenge), participants used the ‘hands-on’ learning provided by active-learning by including case-studies, team-based and problem-based learning, and discussion of methods. For example, a participant writes “I still have students analyze data through primary literature” while another referred to applying the active-learning approach as a “dry” lab supplemented with primary literature. To address the limited time in class to cover the breadth of immunology, its applications and foundational prerequisite content, active learning was again used, however with more student work done prior to coming to class. For example, a participant assigns outside reading with reading quizzes outside (prior) to class time, so the instructor could use class time for think/pair/share, group discussions, and/or polling questions, referred to as a flipped-classroom format (Riedl et al., 2021). To address the curriculum management challenge found within the Microsystem scale, participants implemented active learning to address student engagement and incentivize student participation. Participants flipped their classroom to better manage content and address student needs. Finally, active learning was used to address Student Intrinsic challenges of gaps in knowledge and background, Students struggle with systems thinking, and student misconceptions or preconceived notions. Even if the level of their students were unknown, instructors found ways to teach their class assuming all their students have these knowledge gaps and included undergraduate learning assistants (ULAs), incentivizing participation in class and providing pre-class videos for students to watch. Case-studies involving social issues (e.g., vaccination) were used to address student misconceptions or preconceived notions about social issues. To support the development of systems thinking in students, active-learning approaches of concept mapping and decision trees were implemented throughout class curriculum to “develop this skill” and make connections to societal issues (i.e., allergies). However, these adjustments presented participants with new challenges. For example, active learning is time-consuming but can be mitigated by limiting content or having additional resources allowing for scaling up this approach in large classrooms. Student buy-in became a struggle but was mitigated by incentivizing participation.

In response to Extrinsic Macrosystem scale challenges of course infrastructure involving class size and using online formats, participants using active-learning needed to adjust implementation of existing active-learning approaches more conducive to large class sizes such as concept mapping and non-graded activities. Students that have successfully passed their course were also recruited to help facilitate student discussions and in-class activities (i.e., undergraduate learning assistants). Participants also created opportunities to bring students into small groups outside of class or special class sessions. Adjustments to using active learning online included approaches involving model drawing and worksheet-base assignments.

Limiting immunology content was another common response to challenges found within all three dimensions. This approach was used to address the Extrinsic Macrosystem scale challenge of having less time in class with students. Not all students navigated through the Programmatic curriculum (ie., prerequisite training and courses) in the same way creating a student audience with different levels of prerequisite knowledge. Therefore, instructors dropped immunology content to make room in their curriculum for prerequisite content. The Extrinsic Microsystem challenge of curriculum management and Student Intrinsic challenges of student knowledge gaps and students being overwhelmed were also mitigated by lowering or reframing content. A participant chose to reframe the content to normalize cells and molecules by anthropomorphizing immune cells as humans with jobs. Though the instructor found success in using analogies to make the content more relatable and less overwhelming, such as anthropomorphizing immune cells, the participant acknowledges the potential of introducing misconceptions (a new challenge). Another participant reduced the amount of terminology and focused more on concepts, such as ‘packaging’ the cytokines based on functions rather than covering each individual cytokine. Instructors based their content selection by either focusing on student gaps identified by speaking to colleagues within their program, focusing on student interests assessed by a pretest, focusing on topics not covered in other courses in the programmatic curriculum, focusing on content close to the instructor’s expertise, focusing on content students struggle with, focusing on content instructor determined as “basics” or “fundamental” to the field, or focusing on applications of immunology which is closer to students’ interests (e.g., Autoimmunity). However, some participants continued to struggle and requested more guidance.

Participants also create or source Supplementary material to better support students and their immunology curriculum by either sourcing them or creating them. Extrinsic Microsystem scale challenge of curriculum management and Extrinsic Macrosystem scale challenges of course infrastructure (a missing lab component) and Programmatic curricula (missing prerequisite training). Instructors provided pre-class resources to prepare students for class, such as a pre-class assignment involving interactive resources like “The Immune System” developed by HHMI. Videos were also used to mitigate the lack of a lab component; however this presented a new challenge as it did not work well to support students in grasping important immunology concepts.

Instructors addressed Student Intrinsic challenges of gaps in knowledge and background and their struggles with developing systems thinking by providing support based on student needs. Instructors volunteered their time by providing first-year students the option of a review session or an invitation to meet with the instructor in small groups throughout the semester. Instructors utilized undergraduate learning assistants (ULAs) as a resource to support the learning process in an equitable way so those lacking in the most background had the appropriate support. Participants also made contributions at the Extrinsic Macrosystem level by teaching prerequisite courses themselves and being intentional in including background foundational knowledge required for immunology or by volunteering with a pipeline program that supports students interested in STEM from 7th grade to college, benefiting students beyond those in their classrooms.

The Extrinsic Macrosystem challenge of budgetary restrictions was addressed by being resourceful with laboratory reagents, such as splitting kits, ordering dry reagents used across academic years, making reagents themselves, running computer simulations, or using one kit as a demonstration to the class. Participants worked with vendors to demonstrate equipment in their classrooms or to take advantage of their educational discounts. A participant teaching graduate and undergraduate students at a PUI reaches out to local R1 institutions for equipment, supplies or samples that can be spared.

Finally, to address the Extrinsic Microsystem challenge of instructors lacking in experience, participants sought opportunities for growth or invited experts. For example, an early career participant explains complex topics to novices outside of work hours. Another instructor invited outside experts in the form of vendors to demonstrate their equipment (ie., Flow cytometer) in their classroom. Most instructors, however, mentioned that they wanted, but have yet to, gain more teaching experience. We found that about half of instructors were non-immunology experts (Figure 2), suggesting training and expertise could be an approach towards overcoming this barrier.

3.6 Persisting gaps in immunology education

Certain challenges became barriers for instructors. A small subset of participants did not or were not able to address their challenges. In some cases the instructor stopped teaching altogether or relevant programmatic curricula did not include needed immunology courses or modules (such as immunology modules within a microbiology course). This limited response was found as a result of the Student Intrinsic challenge of misconceptions and preconceived notions and the Extrinsic Microsystem challenge of curriculum management. A subset of participants made adjustments to content and course curriculum to prevent student attrition. In one instance instructor attrition resulted. The participant, who stopped teaching immunology, was presented with challenges in each of the three CFTC framework dimensions: a lack of administrative support for resources including budget (Extrinsic Macrosystem), inability to modify content (Extrinsic Microsystem), and lack of student buy-in (Student Intrinsic).

The Extrinsic Macrosystem dimension involves challenges that are imposed on the instructor, and where the instructor has limited control in removing or changing the imposed barrier over the short term. Participants lacked a response, only partially addressed, or specifically indicated that they still struggled with challenges associated with restrictions on time with students, restrictions on content, programmatic curricula, course infrastructure, and lacking resources. Although participants disclosed how they responded to challenge(s), they were not directly prompted on if their challenge was overcome. A subset of participants voluntarily disclosed the outcome of addressing the challenge of restrictions on class time and on course content (Extrinsic Macrosystem). Three participants revealed not covering the full extent of the immunological content or dropped core immunology content, when they lacked expertise to adjust the content to their context. Participants who limited course content did not all use a consistent method to identify core immunology concepts, and some even asked for guidance (Figure 6).

A participant teaching in medical school shared that they are beholden to strict timing linked to other courses and assessment goals and to a prescribed curriculum, limiting their ability to make adjustments. Challenges associated with online platforms and class size limited one participant’s ability to implement active learning during class time resulting in implementing activities asynchronously. Restrictions on class time and content resulted in 4 participants not making any adjustments as well as a participant leaving no response to the challenge of teaching “vaccine hesitancy.” Although many participants (88%) do not hesitate to address vaccines in class, a small subset of participants (8%) did and 28% of participants found it challenging to address these topics sensitively (Figure 4B).

Challenges associated with classroom physical space, such as those not conducive to group work, was mentioned. No adjustments were made by the instructor, however they were waiting for a new building; an adjustment made by administrators (Extrinsic Macrosystem scale). Eight participants shared that their curriculum would benefit from an immunology course or additional immunology content. Two participants shared that they do not offer an immunology stand-alone course, which would address the challenges of only having an immunology module within another course. One participant added that the lack of a stand-alone immunology course was due to not having enough faculty in the department: “From a curricular perspective, we could be offering an Immunology course, but there is not enough faculty in the department.” In addition, two other participants wrote that they “did not have immunology in [their] intro Micro class” and “We teach molecular biotechnology courses and immunology techniques have not ‘infiltrated’ yet!” Four participants mentioned that the lack of an immunology lab (as a course component or stand-alone course) hindered their students’ ability to learn concepts more deeply. Two participants shared that this lack of offerings may be due to a lack of expertise, a limited budget and/or missing equipment such as a Flow Cytometer. These participants were either from a Master’s granting institution, an R1 Doctoral-granting institution or a PUI Minority-serving institution. Additional responses suggested budget as a reason for a missing lab component, including one from a Minority-serving institution (Figure 6).

4 Discussion

Here we present the current landscape of challenges instructors across diverse teaching institutions face when teaching immunology. We found that there were many common challenges across institution type, teaching approaches, and curriculum. We found that having enough time to teach the full breadth of immunology with the approaches selected by the instructor was challenging for many of our participants, particularly when students were underprepared when coming into their class. These challenges were largely addressed by implementing or attempting active-learning or evidence-based approaches, however resources to support these efforts are limited. We also present an adapted K-12 conceptual framework of teaching challenges, based on Bronfenbrenner’s Ecological Systems Theory that can help drive other studies seeking to uncover instructor challenges (Figure 7).

Figure 7

4.1 Challenges are context-dependent but instructor responses can be unified

Across the United States, many instructors report that the limitations on class time and complexity of immunology are among the most challenging barriers for them, often requiring them to refocus content or use different approaches to better support their students’ needs. Importantly, we found that instructors are often positioned as a “middle-man,” having to navigate both institutional and field level challenges (i.e., budget, time restrictions), as well as challenges their students bring to the classroom (i.e., misconceptions around core immunology concepts or low engagement with the material). Instructors shared challenges about working within the parameters imposed on them by the field and course logistics. However, without tools, resources or awareness of existing resources to compensate for these set parameters, it can be challenging, particularly for new instructors. One unified response to this challenge was for instructors to rely on immunology specific learning frameworks, where endorsed core concepts and competencies in immunology can help instructors prioritize what to teach in time-limited scenarios (Pandey et al., 2021). In other biology subdisciplines, taking a backwards curriculum design approach where learning objectives inform the course progression helps instructors stick to these frameworks (Withers, 2016). Providing materials for students to read prior to class must be aligned with the instructor’s intended approach and, as we have found, there is a need for concept-focused resources to support instructors using active-learning approaches.

Additionally, some instructors suggest taking a Student-Centered Learning approach to overcoming barriers with the dense content found in immunology, specifically in content areas with many misconceptions. These approaches have been shown to narrow opportunity gaps and limit student attrition from STEM disciplines (Freeman et al., 2014; Theobald et al., 2020). Student-Centered Learning approaches allow for flexibility in how topics are approached in the classroom by giving students the authority to direct their learning based on interest. In this environment, students are encouraged to apply their knowledge around immunology through data analysis and projects and ultimately how students use their identities to make-sense of these concepts (Siantuba et al., 2023). For example, Inquiry-Based Learning, where students work with relevant data to make sense of a concept, or Place-Based Learning, where students integrate their communities into their learning of a concept (Adkins-Jablonsky et al., 2020; Teshera-Levye et al., 2025). This could be particularly impactful practice for immunology concepts with social implications, such as vaccination, and has been a successful approach for other biological subdisciplines covering climate change (Vance-Chalcraft et al., 2024).

4.2 Challenges unique to immunology instruction

Our findings overlap with challenges identified by faculty teaching other higher education science disciplines, including financial burdens, lack of professional development opportunities to learn about evidence-based pedagogies. A study in ecology education identified a variety of challenges categorized into student-level, teacher-level, and societal level; mirroring our adapted CFTC framework embedding Extrinsic Macrosystem (societal, institutional, programmatic challenges), Extrinsic Microsystem (course or instructor-level challenges), and Student Intrinsic (cognitive factors) dimensions. Many of the challenges overlapped with those we found in our study such as student background knowledge and skill level (e.g., mathematics), emerging biological challenges (e.g., climate change or vaccine hesitancy), and institutional-level challenges. The challenges found to be more specific to ecology seem more nestled in the field of ecology, such as gaps in student numerical and computer skills, students’ disconnect between people and nature, fieldwork, technology use in ecology, and societal perceptions of ecology (Cooke et al., 2021). We also found this to be true of our findings with the field of immunology being rapidly evolving, complex with an emphasis on memorization for learners in addition to a lack of immunology-specific resources, such as experts, instructional laboratories, and tailored teaching materials. Studies have found additional challenges that could also be relevant to immunology education, but were not specifically addressed by our study. For instance, student or instructor language barriers, equality and diversity, graduate career opportunities, teacher data handling skills, transitioning to online or hybrid formats and a growing reliance on adjunct faculty (Cooke et al., 2021; Malik et al., 2024).

One noteworthy finding of this study is that a high proportion of immunology instructors do not have formal academic training in immunology, which can pose challenges for instructional effectiveness, curriculum delivery, and addressing student misconceptions (Figure 1). These challenges can be mitigated through targeted professional development and collaborative support networks. ImmunoReach, for example, fosters interdisciplinary connections that allow instructors to learn from peers with complementary expertise. With this approach, an ecologist can gain immunology content knowledge from an immunologist, and vice versa. For those seeking pedagogical guidance, Faculty Mentoring Networks have been used to provide training on backward design, active learning, and other evidence-based strategies using immunology-focused topics.

Challenges with teaching immunology can span the Student Intrinsic, Extrinsic Microsystem and Extrinsic Macrosystem framework due to its inherent interdisciplinary nature and reliance on significant amounts of field-specific terminology for full understanding of components and processes. Understanding immunologic processes often requires an understanding and application of foundational principles from other science disciplines. Although it may be beneficial for learning, there is little time in the one-semester immunology classroom to remind students of and reinforce those foundational scientific principles. An approach taken by some institutions is to expand time in the science curriculum for immunology. A few institutions offer undergraduate “microbiology and immunology” or “immunology and infectious disease” or “medical microbiology and immunology” majors, which require two immunology courses and offer up to two more immunology-related elective courses. The University of Alabama at Birmingham (UAB) offers a uniquely focused immunology major: the Undergraduate Immunology Program (UIP) (College Navigator, 2025). This curriculum offers seven immunology-focused courses starting in the freshman (first) year in parallel with other introductory science courses. Students in the UIP take a one-semester overview of immunology courses in the spring of their sophomore year. During the junior and senior years, students take four more courses that expand on immunology topics such as innate and adaptive immunity, host-pathogen interactions, and immune-mediated diseases and review foundational science topics. This curriculum provides time to integrate the foundational science principles required for immunology, which is used as an application of these biological processes (e.g., central dogma and antigen receptor rearrangement), enhancing biological literacy (AAAS, 2011; Pandey et al., 2023, 2024).

4.3 Instructor self-efficacy amidst challenges

High instructor self-efficacy, or the belief in one’s ability to teach effectively (Gibson and Dembo, 1984), is often associated with perseverance during challenges and the adoption of a growth mindset when faced with circumstances beyond one’s control (Gordon et al., 2023). Additionally, instructor self-efficacy can influence student interest (Gerde et al., 2018). In this study, we found that instructors reported a wide range of challenges across all three levels of the CFTC framework, including institutional budget constraints, limited confidence in the subject matter, and difficulties with student engagement. Although these challenges varied by individual and institution, many instructors cited a lack of expertise in immunology and time constraints as key barriers to effective teaching. These findings suggest that instructors are often teaching outside their area of specialization and have limited time to find resources, seek peer advice, or stay current with the rapidly evolving field of immunology. All of these factors contribute to lower self-efficacy, which can, in turn, affect both instructor retention and the quality of education students receive (Swackhamer et al., 2009; Golubtchik, 2024).

In this context, we find it concerning that a small subset of participants did not or were not able to address the challenges they reported, and that one instructor stopped teaching altogether. In this survey we recruited many respondents who were actively teaching immunology and not instructors that have recently left the field. It is therefore likely that we are only picking up on what may be a larger problem in the field, especially in the wake of the COVID-19 pandemic, where online learning and new challenges around teaching in STEM have emerged (Alamri, 2023).

In summary, this study adapts a K–12 framework to examine the multifaceted challenges faced by immunology educators in higher education. Macro-extrinsic barriers, such as limited instructional time, insufficient institutional support, and lack of resources, emerged as the most prevalent and impactful challenges for our respondents across institution types. Instructors also cited intrinsic and micro-extrinsic factors, including underprepared students and the demands of teaching outside their training. Despite these obstacles, many responded with creativity and commitment, using active learning and curricular adaptation to overcome challenges. These findings highlight an urgent need for field-wide shared frameworks, community-based support structures like ImmunoReach, accessible professional development, and a consensus on core immunology concepts and competencies to guide curriculum design. Advancing immunology education will require both systemic change and stronger networks that empower instructors to translate a rapidly evolving field into meaningful student learning.

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