American Association of Immunologists Recommendations for an Undergraduate Course in Immunology

Immunology is challenging to teach in the undergraduate setting because of its rapidly advancing and expanding field of knowledge. The task of defining the key components of an undergraduate curriculum in immunology can be overwhelming to undergraduate educators, who are often challenged to cover the “essential” components of this vast field of science through a combination of smaller units in general biology courses or within a single semester-long introductory course (1, 2). Few resources are available that use a methodical approach to capture the key topics for inclusion in the course. In recognition of the critical need for enhanced guidance on undergraduate immunology curricular development, several recent publications have begun the process of advocacy around a more-unified approach to undergraduate immunology education (3, 4). Of note, a recent study that reported the results of surveyed immunology educators has helped identify current curricular practices by experienced instructors, which has highlighted curricular priorities for both course and curriculum design for the field (5). All of these efforts are rooted in the premise that broader attention to a cohesive set of key concepts and evidence-based curriculum design leads to improved student understanding and outcomes (5, 6). Professional scientific societies are uniquely poised to engage in broad curricular recommendations for their field based on the breadth of their membership expertise and the depth of their communication platform to reach a broad section of researchers, educators, and professionals in the field (7, 8). In response to the perceived need among immunology educators, the American Association of Immunologists (AAI) has undertaken a process to provide a general set of core recommendations for an undergraduate curriculum in the field of immunology. Ideally, curriculum guidelines would be developed with a top-down strategy identifying key topics that could be covered in shorter course modules and expanded subtopics that could be included in full-semester courses. Additionally, educators at the next level of learning (i.e., medical schools, graduate schools) or in the future work environment (i.e., biotechnology and pharmaceutical sectors) should have a seat at the table for decisions on key topics to make the undergraduate curriculum relevant. This reverse engineering strategy will provide the knowledge needed in the undergraduate curriculum to succeed at these higher levels. To meet these goals, the AAI Education Committee has embarked on a mission to gain broad community consensus on an undergraduate immunology curriculum that bridges undergraduate education and postgraduate education/career-relevant needs.

Starting in 2016, the AAI Education Committee initiated a new annual meeting session focused on improving immunology education: the Immunology Teaching Interest Group (ITIG). This Education Committee–sponsored session has been dedicated to sharing novel teaching practices for immunology education at undergraduate, graduate, and medical schools. ITIG speakers and attendees have included immunology educators spanning a range of institution types and serving students of different levels. The ITIG session has become a venue for the exchange of ideas and a way to provide suggestions to the AAI community as a whole. The group has grown from 20 participants in 2016 to more than 200 in 2020. Novel ideas and cutting-edge teaching strategies have been shared at the AAI Annual Meeting and in a special section of the AAI Newsletter that is dedicated to pedagogy. The rising interest in immunology education is also reflected in recently published articles, which have begun to highlight effective teaching pedagogies and topics to cover (4, 9, 10).

The AAI Education Committee received input from the ITIG highlighting a need for a comprehensive set of curricular guidelines for teaching immunology at the undergraduate level. In 2019, the Education Committee formed an Ad Hoc Committee to establish recommendations for undergraduate immunology instruction with the goal of providing a guide for instructors in immunology that will bridge undergraduate and graduate teaching and prepare students for subsequent careers in the biomedical and healthcare fields as well as other areas applicable to immunology. The Ad Hoc Committee was composed of educators from primarily undergraduate academic institutions, educators in various healthcare sectors, and a member of the biotechnology community. The recommendations were initially developed through consultation among the subcommittee members and then thoroughly vetted by ITIG members through a series of survey iterations, individual consultation, and a virtual workshop. The strength of these recommendations lies in the vetting and broad consensus achieved by engaging over 70 immunologists in a variety of professional roles and the flexible structure to allow for innovations and autonomy of topic emphasis within the curriculum.

In this article, we first describe the methodology used for curriculum content development, which may be useful for other disciplines aiming to develop curriculum recommendations for complex, interdisciplinary subjects. Then we present the recommendations for curriculum content, as well as additional resources for further classroom enrichment, compiled from a survey of the AAI teaching community. Finally, we as educators are not only responsible for the scientific content in our courses but are also obligated by a responsibility to convey this content in an equitable manner to serve a diverse student population as effectively as possible. To speak to these principles, we have included recommendations for antiracist and inclusive teaching with a few examples of how to translate this desire into pedagogy. The intent of the AAI Ad Hoc Committee and ITIG members is to provide a resource for new as well as seasoned undergraduate immunology instructors for curriculum development and curriculum improvement.

The development of the recommendations was a highly inclusive and reiterative process (Fig. 1) designed to ensure that the recommendations would reflect topics that immunologists highly prioritize and bridge undergraduate and graduate immunology education. In October 2019, the AAI Education Committee formed an eight-member Ad Hoc Committee composed of current and former AAI Education Committee members representing undergraduate, graduate, and medical school educators as well as a member of the biotech industry. The Ad Hoc Committee created a list of key topics informed by current textbook content (11–16), other resources, requirements at the graduate/medical school level, needs for biotechnology and biomedical careers, and their own teaching experiences. These resources were selected based on individual experiences and not from a targeted validation study. Absence from the sources cited in this article does not reflect an intentional decision against inclusion. In December 2019, a survey was sent out to all members of the ITIG (203) for initial feedback to the suggested key topics (78 responses) and to recruit team members (47 volunteered) to define foundational concepts, determine subtopics, and identify examples in small working groups. Subsequently, in January 2020, working groups were formed with three or four participants facilitated by one Ad Hoc Committee member. Each working group included at least one undergraduate educator and one educator from a graduate school. From April to May 2020, the Ad Hoc Committee members compiled the working group recommendations, removed redundancies, sequenced the individual topics, and uniformly formatted the document. A second survey was sent out to the ITIG (10 responses) in June 2020, and the Ad Hoc Committee further refined the recommendations. Finally, the draft document was shared with the ITIG, and the ITIG was invited to provide written feedback and participate in a virtual workshop to further discuss the recommendations. This 3-h workshop (49 ITIG attendees) took place on July 24, 2020. In breakout sessions dedicated to one or two key topics and facilitated by the Ad Hoc Committee members, the current recommendations were further refined according to the survey comments, and in the following plenary session, a preferred sequence of the recommendations was discussed. In August 2020, the Ad Hoc Committee finalized the curriculum recommendations and developed a recommendation for inclusive and antiracist teaching. These materials were then presented in September 2020 to the AAI Education Committee, which approved the recommendations with some minor edits and presented them to the AAI Council, which endorsed the recommendations and suggested a broader dissemination in November 2020.

The curriculum recommendations provided are intended to serve a two-fold purpose: the first, to provide guidance for immunology content selection and the second, to provide a framework for equity in the classroom (17–19). The curricular content recommendations are presented first (Tables I–XV), followed by the recommendations for inclusive and antiracist teaching.

The format of the recommendations is layered, allowing educators to start with key topics of immunology, which are further broken down into foundational concepts that may be covered in each section. Key topics represent critical categories recommended for inclusion in undergraduate immunology curricula, and the foundational concepts are embedded beneath the key topics as important subcategories. If educators are interested in more-specific guidance within the foundational concepts, they can then refer to the subtopics and examples provided. Subtopics and examples offer flexible opportunities to elaborate and work with students on the foundational concepts. Advanced subtopics are flexible opportunities to explore concepts more in depth in accordance with an instructor’s interests, expertise, and available time. This layered approach provides the instructor with flexibility in how much detail they want to provide and allows the instructor to shape the curriculum according to the needs of their particular undergraduate students, the length of the module or course, and the instructor’s individual expertise. The examples are intended for new educators as a springboard for curriculum development in their classroom. They are also intended for seasoned educators as a cross-check to modify course content or to add a new module to an existing course. Although the Ad Hoc Committee key topics are intentionally arranged in their current order based on classroom experience, each key topic is self-standing and can be taught in any logical sequence according to the instructor’s preference. Additionally, content from one key topic may be distributed throughout the semester when related content is discussed. This may be most appropriate for the final four topics (Tables XII–XV), which have clinical relevance that may pique student interest throughout the course in the form of case studies or active learning projects. Although great effort was taken to remove unnecessary redundancy, some redundancy cannot be avoided in a subject matter with so many interconnected facets. In some cases, it was determined that the redundancy was actually important and necessary to reinforce important topics. Finally, instructors may be limited by the time they have available. Instructors are encouraged to prioritize the foundational concepts. For minimum hours available, instructors could choose to only cover material listed in Table II. For a quarter system–based course, instructors could plan to cover key topics listed in Tables II to X and incorporate the clinical material presented in Tables XI to XV in the form of case studies throughout the term, whereas a semester-long standalone immunology course could allow for incorporating all key topics.

Table I lists the key topics and their foundational concepts that were universally identified as critical content for an undergraduate immunology course. The foundational concepts are numbered in the sequence that was deemed to be most conducive for learning immunology. There was extensive discussion around some of the key topics, and the rationale for final selection and sequence are highlighted in this article. Teaching about immunological techniques early in the course is intended to prepare students for the inclusion of primary research papers. Although educators often express interest in introducing undergraduates to reading and interpreting scientific research articles, there can be hesitancy that without background in scientific techniques it is difficult to interpret data. Early introduction and reinforcement of key techniques open up new possibilities for higher learning in the undergraduate classroom. Tolerance, which is often introduced later in an immunology course when autoimmune diseases are discussed, was merged with the development of adaptive immune cells as development is tightly linked to selection of self-tolerant cells. This connection will allow students to gain a clinical context for development of adaptive immune cells early on.

The topic, integrated immune response, is intended to allow students to construct an understanding of the entire immune response as a dynamic and interdependent system. It is important for students to put together all of the information they have learned up to that point before delving more in depth into the more-complex, clinically relevant topics. Understanding the mucosal immune response provides a foundation for immunizations and, therefore, the topic mucosal immunity was placed before the topic on active and passive immunizations. Tumor immunology follows active and passive immunizations because of the common principles applicable to generation of tumor immune response and the significance of tumor vaccines. In medical school, allergies and hypersensitivities are often taught along with autoimmune diseases in a combined approach reflecting the pathophysiological similarities. However, it was felt that for an undergraduate curriculum, autoimmune diseases should be covered as a separate topic because undergraduate students are still building their knowledge and are not exposed to the depth of clinical experience more typical for medical students. To highlight the importance of turning off the immune response after Ag removal, downregulatory mechanisms are taught across the topics. Finally, instead of creating a separate key topic for the therapy of diseases involving the immune system, therapies are embedded where the diseases of the immune system are discussed to reinforce the underlying pathophysiological mechanisms and frequently used to engage the students who are typically genuinely interested in how immunology is applied to treat diseases.

We have created tables for each key topic to list the associated foundational concepts with subtopics and examples and advanced subtopics. The subtopics are numbered to show the sequence deemed to best advance student understanding and learning. Bullets identify subtopics, advanced subtopics, and specific examples. The advanced subtopics were contributed by IGIT members according to their in-depth knowledge in a given area, and instructors are encouraged to use advanced subtopics from their own specialized area.

Table II summarizes the key topic overview and terminology of the immune system, which primarily serves the goal to establish vocabulary and a common ground for all students. Here, students are introduced to critical components of the immune response at the molecular, cellular, and tissue level and the respective terminology. Because immunology is notable for its substantial, and often intimidating, nomenclature, establishing the terminology early is critical for establishing a working “language” for the remainder of the course. Table III summarizes important immunological techniques from molecular and cellular in vitro approaches to animal models. Ab-based techniques are extensively covered because of their applications in research, diagnostics, and therapeutics. Flow cytometry is included because it is a commonly used technique that is central to immunology findings described throughout each topic. There was strong consensus to introduce immunological techniques as a dedicated key topic early in the course to provide students with a robust basis for understanding primary immunology research papers throughout the course.

Table IV summarizes the key topic innate immunity. As one of the major conceptual “arms” of the immune system, this key topic helps frame an understanding of how the organs and cellular systems first recognize and combat potentially dangerous microbial or environmental encounters. This key topic was created with primarily bacterial and viral infections in mind; thus, innate responses to fungal and protozoan microbes are listed as advanced subtopics, reflecting instructional directions that are traditionally less common in curricula. In addition to complement, phagocytic cells, and NK cells, epithelial cells are included as effector cells in the innate immune response as they exemplify how different cell types and tissues, not traditionally considered part of the immune system, can play key roles in immunity. Table V summarizes the key topic inflammation. It is recommended that instructors also highlight the beneficial aspects of inflammation and begin this key topic with a discussion of the protective aspects of acute inflammation. Inflammation leads to initiation of the adaptive immune response, and thus, this key topic is followed by the key topic development and activation of self-tolerant adaptive immune cells, which is summarized in Table VI. The concept of tolerance is introduced under this key topic because the development of lymphocytes is tightly linked to tolerance. The importance of self-tolerance for lymphocyte development is also reflected in the title of this key topic. Instructors who want to highlight oral tolerance or tolerance in pregnancy may wish to introduce these advanced topics here.

Table VII summarizes the key topic adaptive immune cell effector function. Dendritic cells, effector CD4 and effector CD8 T cells, Ab response, and Ab function are first examined, and then the adaptive immune response over time is described. Germinal centers and NK cell functioning can be explored as advanced subtopics. Table VIII summarizes the key topic integrated immune response, which aims to provide students with a general understanding of how the innate and adaptive immune responses interweave over time. This section also defines the locations where the interactions between Ag, innate, and adaptive immune cells take place throughout the course of the immune response. To highlight that the immune response to pathogens is tailored to the specific type of pathogens, the immune responses to two different pathogens could be compared and contrasted according to the instructor’s expertise. It is highly recommended that instructors choose pathogens that are relevant or well-known to the students.

Table IX summarizes the key topic mucosal immunity, which examines the immune response in the mucosa with special attention paid to the gut mucosa. Here, examples for pathological conditions affecting the mucosa can be introduced as advanced subtopics. Many types of immunizations target the mucosal immune system. Thus, the key topic active and passive immunizations, summarized in Table X, follows the key topic mucosal immunity. A brief historical overview and a description of parameters for vaccine success have been included as a foundational concept to increase awareness of the complexity and difficulty of developing a protective vaccine. Passive immunization is focused on Ab-related subtopics. Table XI summarizes the key topic tumor immunology. This key topic follows the key topic active and passive immunizations because many novel approaches of cancer immunotherapy employ mechanisms of active and passive immunization. The key topic tumor immunology first explores mechanisms of tumor surveillance, then investigates tumor escape from the immune response, and concludes with subtopics on cancer immunotherapy.

The remaining four key topics are dedicated to pathology associated with the immune system, and each include therapeutic interventions as a foundational concept. Table XII summarizes the key topic allergies and hypersensitivities. With a reference to the medical school curriculum, hypersensitivities are first introduced as pathological responses to Ag that can be classified as allergies, autoimmunity, and transplant rejection. Thereafter, hypersensitivities are classified based on the underlying mechanism according to the Gell–Coombs classification more consistent with the undergraduate immunology curriculum, and the remainder of the key topic follows this classification. Table XIII summarizes the key topic autoimmune diseases. The foundational concepts include causes and epidemiology of autoimmune diseases and a classification based on their underlying mechanism. It is strongly recommended that instructors choose clinical examples for autoimmune diseases based on student interest. Table XIV summarizes the key topic transplant rejection and includes references to both organ transplants and blood transfusions. Finally, Table XV summarizes the key topic immunodeficiencies, which are presented as primary and secondary immunodeficiencies. As time permits and according to instructor expertise, one or more examples for each type of immunodeficiency can be presented. Diagnostic assessments used for both primary and secondary immunodeficiencies are included here and may be a tool to reinforce immunologic techniques described earlier in Table III.

Our society is undergoing transformative changes in the awareness of institutional racism and structural inequality that limit the participation of all. It is imperative to recognize the need to include different perspectives in solving scientific problems. Yet it is not enough to enable all to come to the table where decisions are made; rather, it is time to reconstruct this table, collaboratively informed by all participants’ vision in our society. We, as educators, have an opportunity to take part in eliminating institutional racism and structural inequality (19). Inclusivity in science education means expanding access to educational and professional opportunities to underrepresented groups and crafting our teaching in a way that specifically acknowledges and engages all learners and validates their individual and collective experiences. Our teaching practices must be informed by not only our students’ personal histories but also the history and dynamics of how their world is and was shaped before their arrival into our classroom.

As educators, we hope to empower the next generation through knowledge and agency. As educators in the sciences, we have a responsibility to ensure that all of our scholars from diverse backgrounds—representing individuals who differ in racial, cultural, and ethnic identity; gender identity; sexual orientation; age; physical and intellectual disability; spiritual beliefs; and socioeconomic status—will have an opportunity to contribute to the scientific enterprise. Students in an immunology course typically come academically prepared by having completed prerequisite courses in general biology and general and organic chemistry. However, their life stories and their living circumstances at the time they take your immunology course will vary widely. Some students might be caregivers or breadwinners, live in crowded quarters, and may have grown up doubting their qualifications to be in your class and/or not realizing that immunology also applies to them. It is paramount that we create a culturally responsive learning environment that accommodates our students’ diverse backgrounds and fosters an authentic sense of belonging. There are changes we should make in curriculum and pedagogy to embrace differences without compromising standards.

We can start without delay working toward this goal. We can engage in implicit bias training and make small changes in our teaching with great impact. Examples include initiating activities that bring personal lived experiences (including culture) into the classroom, rebranding “office hours” as “student hours,” offering low-bandwidth options in remote learning (e.g., using real-time chat rather than video/audio conferencing or discussion boards for asynchronous online courses), providing flexible dates for assignment submissions that accommodate outside responsibilities, including curriculum materials that are authored by researchers from diverse backgrounds, sharing success stories of former students and inviting them as panelists, including images of people from diverse backgrounds in case studies, and tapping into the experiences of our students in class projects. In addition, we can include group work as a pedagogical tool to support the social and emotional needs of both underrepresented and majority students (20). We can implement the question formulation technique to foster self-confidence and use various types of formative and summative assessments (21).

Furthermore, we can actively promote equity, diversity, and inclusion among our faculty by participating in search committees and creating a welcoming and inclusive environment for our new colleagues. We can reach out to members across all identity groups on our campuses to become fully aware of diverse cultures, lifestyles, and interests and become allies who infuse inclusive pedagogy. Moreover, we can enroll in institutional programs that target faculty training in equity, diversity, and inclusion, such as those offered by the Association of American Colleges and Universities and The Leadership Alliance. If these opportunities are not available on campuses, we can begin a conversation to institute new antiracist or allyship programs, whereby additional resources on antiracism for the biomedical research training community are available on the Diversity Program Consortium Web site (funded by the National Institutes of Health). Finally, yet importantly, through the AAI Teaching Interest group, we can exchange ideas with like-minded faculty striving to eliminate race-based, socioeconomic, and other barriers to learning. We are keenly aware that the writing above does not do justice to this enormous topic, but there is an absolute urgency to begin moving our educational practices toward inclusive and antiracist teaching, and we consider the suggested steps as important possible first steps.

The final product of the AAI Ad Hoc Committee and ITIG is a living document that will be reexamined by the AAI Education Committee over time to make sure the content stays up to date, topical, and cutting-edge. This work is a powerful testament that the combined efforts of a dedicated group of educators with a common purpose can provide a novel tool to improve course content and delivery in the field of immunology. This work comes on the back of other successful efforts to provide consensus on topics such as chemistry, physics, and microbiology. The guidance document published in this article can be easily paired with pedagogy strategies for immunologists, which are provided in the AAI Newsletter throughout the year. Future work is necessary to provide example learning outcomes for educators employing the new AAI curriculum recommendations.

To meet the needs of different learning styles, it is paramount to enrich the curriculum with varied tools. To gather supplementary teaching resources, including sources for case studies, primary literature, and visual tools, members of the AAI ITIG were surveyed for their recommendations for teaching sources. Their compiled recommendations are listed below. They reflect current teaching practices and do not represent a comprehensive evaluation of teaching resources.

1. Basic Immunology: Functions and Disorders of the Immune System, 6th Edition, by Abul K. Abbas, Andrew H. Lichtman, Shiv Pillai; ISBN-13: 978-0323549431; ISBN-10: 0323549438.

2. Immunology: A Short Course, 7th Edition, by Richard Coico, Geoffrey Sunshine; ISBN-13: 978-1118396919; ISBN-10: 111839691X.

3. How the Immune System Works (The How it Works Series), 6th Edition, by Lauren M. Sompayrac; ISBN-13: 978-1119542124; ISBN-10: 111954212X.

4. Case Studies in Immunology: A Clinical Companion, Seventh Edition, by Raif S. Geha, Luigi Notarangelo; ISBN-13: 978-0815345121; ISBN-10: 9780815345121.

5. National Center for Case Study Teaching in Science at the University at Buffalo (https://sciencecases.lib.buffalo.edu/collection/).

6. Primary literature: AAI collection of Pillars of Immunology articles (https://www.jimmunol.org/pillarsofimmunology).

7. YouTube channels such as Armando Hasudungan's channel (https://www.youtube.com/user/armandohasudungan/search?query=immunology).

8. Lumen Learning (https://lumenlearning.com/courses/).

9. InQuizitive learning tool from Norton’s, accompanying their textbooks (Janeway’s and Parham’s).

10. Immunopaedia.org (https://www.immunopaedia.org.za/), a nonprofit educational Web site.

These recommendations could not have been developed without the dedication and contributions of the following teaching-invested individuals: Carla J. Aldrich, Tzvia Abramson, Pierette Appasamy, Anil K. Bamezai, Tatiana Barichello, Fabian Benencia, Aimee Bernard, Alex Boyden, Deborah Brown, Catherine Brennan, Jack Bui, Gerald Buldak, Althea Campuzano, Benjamin Christmann, Sarah Collier, Maurizio Costabile, Beckley K. Davis, Brittney Dinkel, Kerry Empey, Diana L. Flanagan, Sherry Fleming, Fabiani Gai Frantz, John Frelinger, Vitaly Ganusov, Keith Garrison, Abby Geis, Jennifer Grier, Melanie Gubbels Bupp, Jeniffer Hernandez, Katrina Hoyer, Gentaro Izumi, Stephanie James, Hans-Martin Jäck, Paula Kavathas, Brian Knoll, Ashwini Kucknoor, Cynthia Anne Leifer, Kara Lukin, Lydia Lynch, Charitha Madiraju, Jennifer Manilay, Clinton Mathias, Michelle Messmer, Fernando Monroy, Jeff Novack, Steve O’Barr, Kirstin Parkin, Todd Pearson, Nicholas Pullen, Parameswaran Ramakrishnan, Jason Rawlings, Sarah Beth Redmond, Sophia Sarafova, Jean L Scholz, Anil Shanker, Penny Shockett, Laurie Shornick, Keri Csencsits Smith, Doreen Szollosi, Steven Taffet, Rebekah Taylor, Yanet Valdez, Hector Valenzuela, Michael Violin, Crystal Walline, Tim Wilson, and Heather Minges Wols. We also thank Krishna Foster, Andre Ellis, and Marla Parker for helpful discussions on the statement on inclusive and antiracist teaching.

The authors have no financial conflicts of interest.