Procrastination

Procrastination

Lisa Chen, PharmD
PGY1 Pharmacy Practice Resident
Adventist HealthCare Shady Grove Medical Center

Procrastination is something everyone has done at some point or another. It can have direct consequences on productivity at work, at school, or at home.1-3 Some people may be affected by it more or less than others. It can happen with anything from delaying everyday life tasks such as cleaning the house or washing the dishes to putting off writing a paper or studying for an exam. Sometimes procrastinating studying for the exam leads one to actually clean the house or vice versa. But what is procrastination? Merriam-Webster defines “procrastinate” as “to put off intentionally and habitually” something that “should be done.”4 Everyone procrastinates at some point, but not everyone is a chronic procrastinator.

There are many theories and scientific explanations for why procrastination occurs and why people have varying degrees of procrastination. A 2016 TED talk by blogger Tim Urban breaks it down into an extremely simple and (sadly) comedic model.5 In his talk, Urban compares a non-procrastinator’s brain to that of a procrastinator. A non-procrastinator’s brain has a “rational decision-maker” (RDM) at the helm of the ship making sensible decisions from day to day to get work done. A procrastinator’s brain, on the other hand, has an “instant gratification monkey” (IGM) who only cares about maximizing pleasure and fun in the present moment. In a procrastinator’s brain, the instant gratification monkey and rational decision-maker are constantly struggling for control of what you should be doing, resulting in a sort of purgatory that Urban denotes as the “Dark Playground”. The IGM is telling you to have fun and look at this video here or check out that social media post there, while the RDM is trying to pull you back to the task at hand to be completed. In the meantime, feelings of pleasure, guilt, self-hatred, and more are all mixed together into a complex smorgasbord of emotions because you’re “wasting time” enjoying leisurely activities that you haven’t “earned”. Finally, when there is imminent danger of a due date, for example, a final character that Urban calls the “Panic Monster” awakens. The only thing the IGM is afraid of is the Panic Monster, so, when it awakens, the RDM is able to regain control and allow the task at hand to be completed. However, when this series of events occurs, the completed product is often subpar or below the quality that the procrastinator had the potential to produce had they not allowed the IGM to take over.

There are a number of questions to be asked. Why are there some people who have this instant gratification monkey in their head? How can procrastinators allow the rational decision-maker to be in control more often than not? In what ways might procrastination be a positive asset? Does making a habit of procrastinating at school or work lead to procrastination in daily life or vice versa? What skills can educators use in the classroom to help students avoid procrastination? We could come up with a very, very long list of questions related to this topic; however, I would like to address just a few that would be more important for instructors and the classroom, as these are more relevant to the contents of this course.

First, why do some students fall into the vicious cycle of procrastination? The American Psychological Association provides a list of 15 procrastination rationalizations, at the top of which are ignorance, skill deficiency, apathy/interest, and fixed habits.6 Procrastination has also been classified into different types as well, such as dysfunctional/passive form and positive/strategic/”active” form.1,7,8 The dysfunctional/passive form is your “traditional” sense of procrastination that we are all familiar with: tasks are not completed due to indecision and unintentional delay. Reasons for these types of delay include feeling of inadequacy, lack of self-control for instant gratification and impulsivity, and even fear that success will raise others’ expectations of the procrastinator.9,10 On the other hand, “active procrastination” has been used to describe those who choose to delay tasks intentionally.8 These individuals seem to prefer to work under pressure because they believe that they achieve better results under a certain level of stress. One study showed that these active procrastinators delayed tasks to the same degree as passive procrastinators, but were more similar to non-procrastinators than passive procrastinators in terms of use and control of time, coping mechanisms, perspective of self-efficacy, and outcomes such as academic performance.8 Procrastinators may fall anywhere in between these two types of procrastination, but it is the true passive, habitual procrastinators who need the most help and motivation from themselves, instructors, or other people in their lives.

Second, what effects does procrastination have on academic performance, lifestyle, and personal satisfaction and achievement? The meta-analysis by Steel suggested procrastination may lead to negative academic performance such as lower grade point average, exam scores, and assignment grades.1,2 It can also negatively affect physical, mental, and social health, with procrastinators reporting higher levels of stress, anxiety, depression, illness, delayed treatment, loneliness, and more.2,3 Professionally, procrastination has also been found to negatively affect employment status, duration of employment, and income level.2 Clearly, the disadvantages outweigh potential short-term, pleasurable benefits of procrastination.

As such, what can we do, then, as educators to help students minimize procrastination and maximize time and task efficacy? As mentioned above, one major rationale for procrastination is feeling of inadequacy. As educators, we can use different styles of teaching to better understand each student and learn where they stand on the learning curve. Rather than pure lecture style, perhaps using more of a facilitator or delegator teaching style will allow educators to move around to different groups and different students more readily, providing a better environment for assessing each student. Granted, this may be more difficult for large university classrooms with hundreds of students, but for pharmacy classes of 80-150 students, this is usually manageable. Next, as Urban points out in his TED talk and as a study by Ariely and Wertenbroch showed, externally imposed deadlines allow procrastinators to complete tasks more readily than if students are free to establish self-imposed deadlines.5,11 While adding deadlines may seem more overwhelming for students and teachers alike (more assignments, more grading, etc.), actually setting and reinforcing hard deadlines for long-term projects can help students stay on track in the long run and complete projects throughout the course—much like with our Self-Directed Learning Project. Another method to engage students and keep their interest in various topics and assignments is to design non-traditional classrooms and activities, such as team-based learning or use gaming as a learning tool. One method that could be especially beneficial is using simulation software to lead them through various clinical scenarios as they might occur in real life inpatient, outpatient, retail, or other non-traditional environments. This was used in my therapeutics classes during pharmacy school.

Procrastination is a very real problem that affects everyone at some point in life. For the chronic procrastinators, the detrimental effects can take a toll on academic performance, employment, and personal well-being. As educators, we have the opportunity to engage students in a lively classroom and motivate them to complete tasks and assignments. The design of a course and each class session are crucial to maintaining interest, boosting confidence in abilities, and keeping students on track for success. Why wait?


References

1. Steel P. The nature of procrastination: a meta-analytic and theoretical review of quintessential self-regulatory failure. Psychol Bull. 2007;133(1):65-94.
2. Beutel ME, Klein EM, Aufenanger S, et al. Procrastination, Distress and Life Satisfaction across the Age Range - A German Representative Community Study. PLoS One. 2016 Feb 12;11(2):e0148054.
3. Tice DM, Baumeister RF. Longitudinal Study of Procrastination, Performance, Stress, and Health: The Costs and Benefits of Dawdling. Psychol Sci. 1997;8(6):454-458.
4. procrastinate. 2017. In Merriam-Webster.com. Retrieved October 25, 2017, from https://www.merriam-webster.com/dictionary/procrastinate
5. Urban, T. (2016, February). Tim Urban: Inside the mind of a master procrastinator [Video file]. Retrieved from https://www.ted.com/talks/tim_urban_inside_the_mind_of_a_master_procrastinator
6. The top 15 procrastination rationalizations. gradPSYCH. 2010;8(1):17.
7. De Palo V, Monacis L, Miceli S, et al. Decisional Procrastination in Academic Settings: The Role of Metacognitions and Learning Strategies. Front Psychol. 2017;8:973.
8. Chu AH, Choi JN. Rethinking procrastination: positive effects of "active" procrastination behavior on attitudes and performance. J Soc Psychol. 2005 Jun;145(3):245-64.
9. Kim J, Hong H, Lee J, Hyun MH. Effects of time perspective and self-control on procrastination and Internet addiction. J Behav Addict. 2017;6(2):229-236.
10. Novotney A. Procrastination or 'intentional delay'? gradPSYCH. 2010;8(1):14.
11. Ariely D, Wertenbroch K. Procrastination, Deadlines, and Performance: Self-Control by Precommitment. Psychol Sci. 2002;13(3):219-224.

Global Competence: An Emerging Trend in U.S. Education

Global Competence: An Emerging Trend in U.S. Education

Lola Omopariola

The U.S. public school system is rapidly approaching a new demographic era. In 2014, minority student enrollment in public schools rose to approximately 50.3%, which is a dramatic increase from 38% in the previous decade.1 This demographic shift translates to today’s classrooms consisting of multiple ethnic groups, religions, and spoken languages. 

Today, more than ever, it is essential for students to have the ability to collaborate with others from various cultures and understand the world from different perspectives. Students must be knowledgeable about current world affairs and socioeconomic issues that are impacting the globe beyond the borders of the United States. The concept of global competence is an emerging trend in 21st century education, ranging from elementary to graduate school.2 Global competence is an effort to equip students with the knowledge and tools necessary to develop a deeper understanding of the world’s economic, social, and political issues. This knowledge and skillset prepares students for life and employment in culturally diverse societies. 

Global competence is defined by the National Education Association (NEA) as the acquisition of in-depth knowledge regarding international issues, the ability to appreciate and learn from others from diverse cultural backgrounds, proficiency in a foreign language, and the ability to compete on a global level.2 In their policy brief on global competence education, The NEA notes several valid reasons why the concept is imperative in today’s society. Not only is American society becoming more culturally diverse, but the economy of the U.S. is also becoming more globally connected. An estimated one in five US jobs is connected to international trade, and that number will only continue to rise in the future.3 Furthermore, global challenges continue to emerge, including global health, natural disasters, global warming, and poverty. The ability to respond to these challenges requires an understanding of other cultures and languages to communicate effectively. 

The Organization for Economic Co-Operation and Development (OECD) proposed a framework for global competence which is divided into four dimensions – knowledge and understanding, skills, attitudes, and values.4 The first dimension requires the knowledge and understanding of intercultural and global issues. The next dimension includes several essential skills, such as the ability to communicate in more than one language, being able to effectively communicate with people from diverse cultures and other countries, and the ability to comprehend other people’s thoughts and beliefs in order to see the world from a different perspective. The third OECD dimension includes the attitudes of openness towards people from other cultures, respect for others, and a responsibility for one’s own actions. Finally, the last dimension requires valuing human dignity and cultural diversity.  

Although set standards for global competence are not yet officially adopted in most schools’ curricula, today’s educators are already incorporating the concept in their instructional methods. For example, this may be achieved by lesson plans about various cultural festivals, climate change, and expanding the teaching of foreign languages. AFS-USA (formerly the American Field Service) is a non-profit leader in intercultural learning. The organization has developed a “Teacher’s Toolbox” consisting of lesson plans for educators to adopt which relate to global competence.5 The toolbox includes comprehensive lesson plans on various world topics such as human rights, cultural studies, global awareness, and intercultural learning. The AFS-USA website also includes several key global competency resources for additional information. These tools are great sources for educators looking to incorporate the concept of global competence in the classroom today.    

Global competence is an exciting new field in education that will only continue to grow in the coming years. When implemented systematically, it will have the ability to surmount cultural barriers and enhance student achievement both inside the classroom and out. 

References:

1. Badger E. The rapid demographic shift of American public schools. The Washington Post. 2014. Accessed Oct 21 2017. Available from: https://www.washingtonpost.com/news/wonk/wp/2014/08/18/the-rapid-demographic-shift-of-american-public-schools/?utm_term=.36680199931d

2. National Education Association Policy and Practice Department. 2010. Global competence is a 21st century Imperative. Accessed Oct 21 2017. Available from: http://www.nea.org/assets/docs/HE/PB28A_Global_Competence11.pdf 

3. U.S. Census Bureau. Exports from manufacturing establishments.

2005. U.S. Department of Commerce, Washington, DC. Accessed Oct 21 2017. Available from: www.census.gov/mcd/exports/arp05.pdf 

4. The Organization for Economic Co-Operation and Development. 2016. Global competency for an inclusive world. Accessed Oct 21 2017. Available from: https://www.oecd.org/education/Global-competency-for-an-inclusive-world.pdf

5. AFS-USA. 2017. Teacher’s Toolbox. Accessed Oct 21 2017. Available from: http://www.afsusa.org/educators/teachers-toolbox/

Learning Through Reflection

Learning Through Reflection

Deirdre Yarosh, PharmD, MA

PGY-1 Pharmacy Practice Resident, MedStar Georgetown University Hospital

“We do not learn from experience... we learn from reflecting on experience.”

― John Dewey

What is reflection

In today’s fast-paced learning environment, many students suffer from information overload. In this setting, sifting through the overwhelming amount of information to identify key concepts can be challenging for learners. To build upon key concepts, learners must pause and reflect to consider what has been learned, the significance of what has been learned, and what they plan to do with that information. Through reflection, learners create connections between recent experiences and past experiences to problem-solve and develop a strong foundation to expand upon what has been learned. Reflection serves as a valuable tool to develop higher level thinking skills.¹

Mezirow described reflection as an active process that involves assessment of assumptions contained in beliefs, including beliefs relating to problem-solving.¹ However, he explains that critical reflection, a subset of reflection, refers to the action of challenging the validity of assumptions from past learning experiences.¹ Through critical reflection, learners evaluate the appropriateness of their understanding and beliefs, considering recent learning experiences and present contexts.¹ Therefore, learning through critical reflection allows learners to elaborate, differentiate, and reinforce frames of reference or to develop new, valuable insights and perspectives.¹   

Value of reflection

Evaluating the value and efficacy of learning through reflection can be a challenge. However, Di Stefano et al. recently conducted a study at Harvard Business School with the purpose of comparing the effectiveness of different sources of learning.² Their goal was to determine which learning source yielded the greatest benefit relative to future performance.² Specifically, the authors studied learning at the individual level and evaluated the degree to which individuals learn by additional experience compared to “articulation and codification” of past experiences (reflection).² Their hypothesis stated that once an individual has gained experience with a task, the benefit of additional experience is inferior to the benefit of reflecting on the experience.² The authors implemented a mixed-method design incorporating results from laboratory experiments and field studies.² Three separate studies were conducted to evaluate the hypothesis and reflective behaviors versus accumulation of additional experiences did result in benefits for individual learners.² The results support the idea that reflection is a powerful tool for learning.  

Models of reflection

There are a variety of models of reflection in existence to aid in individual reflection. Information regarding some of the more common models of reflection is presented below.

·         Borton (1970): This model includes three questions: 'What?', 'So What?' and 'Now What?' The ‘what’ refers to what happened.³ The ‘so what’ refers to why it matters.³ The ‘now what’ refers to what will be done because of the experience.³ The learner must consider each question and construct responses thereby reflecting on what they have learned and to help them develop ways in which to improve.

·         Kolb's Learning Cycle (1984): This model relies on personal experiences which are then analyzed and evaluated in three stages.⁴ The cycle starts with an experience, the next stages include reflective observation, followed by abstract conceptualization, and, finally, active experimentation.⁴ At the completion of the cycle, new experiences accumulate and the cycle begins again.

·         Gibbs Model of Reflection (1988): This model includes six stages of reflection.⁵ The first stage is description (what happened), followed by feelings (describe thoughts/feelings), evaluation (what did you like/dislike), analysis (take home message), conclusion (what else could have been done), and action plan (what would will be done differently in the future).⁵  

·         Brookfield (1995): This model encourages the learner to reflect through four different perspectives (or lenses).⁶ Through viewing the experience through the autobiographical lens, the individual considers the situation in relation personal past experiences and current feelings.^3,6 The students’ lens allows the individual to view the experience through the eyes of their students.⁶ The colleague (or peer) lens encourages the individual to view the situation through the eyes of their colleagues.⁶ The last lens is the theoretical lens.⁶ This lens requires the learner to refer to literature to evaluate theories to develop a better understanding of the situation.^3,6 All four perceptions offer new insights into a situation in order to help the individual learn and identify ways in which to improve.

Applying reflection in education

For pharmacy students, reflective assignments can be especially valuable tools for developing critical thinking skills during experiential learning. The students have learned the foundational material in the classroom and learn to apply this information during experiential learning courses. The process of reflection can help a student formulate new ideas based on their observations and hands-on experiences allowing them to make connections between classroom learning and living, breathing patients. Incorporating reflection into the education process can, at times, be challenging. For instance, reflective assignments require a great deal of time and are better suited for experiential based versus lecture based courses. However, building assignments into the curriculum can help to reinforce key concepts. Some examples of activities to encourage reflection include, blog posts, journals, group discussion, think-pair-share, and essays (ex. what, so what, now what). As we continue to transition into teaching roles, we can not only apply these reflective models and strategies to help our students learn but to help improve our learning as well.

References

1.    Mezirow J. How critical reflection triggers transformative learning. In: Fostering Critical Reflection in Adulthood. San Francisco, CA: Jossey Bass; 1990: 1–20. http://184.182.233.150/rid=1LW06D9V6-26428MK-1Z64/Mezirow's%20chapter,%20How%20Critical%20Refletion%20Triggers%20TL.pdf. Accessed October 15, 2017

2.    Di Stefano G, Gino F, Pisano G, Staats B. Making experience count: the role of reflection in individual learning. Harvard Business School NOM Unit Working Paper No. 14-093; Harvard Business School Technology & Operations Mgt. Unit Working Paper No. 14-093; HEC Paris Research Paper No. SPE-2016-1181. Updated June 14, 2016. https://poseidon01.ssrn.com/delivery.php?ID=467087112103026082095078029015111081113017041087020051010016076024098095122102109089004033055004033104044081104002005112087064062033006049092000076115080021095026003066018121021083029116079016127126093065095007125127006093116121024123076107089084097&EXT=pdf. Accessed October 15, 2017.

3.    Mcclean T. Models of reflection. The Institute. Updated 2013. https://theinstitute.gov.gg/pluginfile.php/2086/mod_page/content/23/Reflective%20Writing%20Booklet.pdf. Accessed October 15, 2017.

4.    Brown N. Reflective model according to Kolb. Updated August 25, 2015. http://www.nicole-brown.co.uk/reflective-model-according-to-kolb/. Accessed October 15, 2017.

5.    Reflective writing. Skills for Learning. Updated April 12, 2016. http://www.salford.ac.uk/__data/assets/pdf_file/0009/604665/Reflective-writing.pdf. Accessed October 15, 2017.

6.    Brown N. Reflective model according to Brookfield. Updated August 28, 2015. http://www.nicole-brown.co.uk/reflective-model-according-to-brookfield/. Accessed October 15, 2017. 

Open License Education Materials

Open License Education Materials

Brandon Biggs 

As many students matriculate to their choice of college every year, tuition and other fees continue to rise. In fact, student debt is at an all-time high, estimated at $1.45 trillion dollars in the United States alone.¹ Students are paying for tuition, but also fronting the high-cost of living expenses, lab fees, and educations materials by borrowing money.

One of the major expenses that comes with attending college and graduate schools is textbooks. These may run students upwards of $1,000 in just one semester. Aside from the high price tag, textbooks are also quickly outdated and locks educators into a strict lesson plan.

Last week, Blackboard and OpenEd announced a collaborative effort to offer K-12 students free open-licensed online resources and digital content.² This, and many other forms of free, open-source licensing material has become increasingly available to aid educators over the last 10 years. In fact, free educational tools are quickly emerging as a common option for students of all ages. Sal Khan, a former financial analyst and graduate from Massachusetts Institute of Technology (MIT) started his free online educational video company, Khan Academy, in 2003. Kahn says the mission of Khan Academy is to “accelerate learning for students of all ages. With this in mind, we want to share our content with whoever may find it useful”. Khan Academy features free tutorial videos covering a number of topics including algebra, organic chemistry, calculus, and statistics and has over 1.2 billion views online.³

When educators are preparing for an upcoming semester with their students, one of the major steps that must be taken is deciding on course materials. Previously, before the availability of open source education materials, one textbook or source material would often be chosen by a department head or other representative of a school for all students and educators to use to maintain consistency. With the implementation and availability of open education resources (OER), some educators are able to provide a wider variety of learning tools.⁴ OER textbooks are normally of high quality and allow educators more flexibility in their lesson plans due to the availability of multiple resources.³ If students are struggling to understand a topic, educators can provide alternative resources. More specifically, this approach allows learning from more than just one textbook.

As mentioned, there are other benefits as well. Using OER textbooks and online resources to teach students can save a common class of 100 individuals who would normally spend $200 each for a textbook upwards of $20,000 total, and that is just for one class. Extrapolating these numbers to a semester’s worth of 15 credits may save students $100,000.³

Through this cost-savings and accessibility, research has shown students exclusively using OER textbooks may take more classes and even perform better, as purchasing an expensive textbook can be a barrier to studying course material.³

One drawback of courses using OER is that the approach, though over a decade old, is still in its infancy. There are plenty of resources and information available online, but the streamlined approach using reliable databases with OER is still limited. As use continues, growth will surely follow, but the option is struggling to become a mainstay on most college campuses. However, universities like University of Alaska are making an effort to make the use of OER a common practice by advertising it as an option to both students and faculty.³

Online learning and OER continue to push the boundaries of traditional education. As the internet and technology use grows in schools, and the costs of other resources, textbooks, and tuition continue to rise, free online education resources will continue to expand. The cost of receiving an education is at an all-time high and OER does not solve the problem of rising tuitions, but it is a fresh approach to an old problem that is gaining popularity.

1.       A Look at the Shocking Student Loan Debt Statistics for 2017. Student Loan Hero. September 13, 2017. Accessed October 14, 2017. Available from: https://studentloanhero.com/student-loan-debt-statistics/

2.       Tate E. Blackboard now offering over half a million open educational resources to K-12 students. Edscoop. October 11, 2017. Accessed October 14, 2017. Available from: http://edscoop.com/blackboard-now-offering-over-a-million-open-educational-resources-to-k-12-students-with-open-ed

3.       Dejesus -Remarklus, M. Open educational resources can be beneficial and cost-effective for students. The Northern Light. October 9, 2017. Accessed October 14, 2017. Available from: http://www.thenorthernlight.org/open-educational-resources-can-be-beneficial-and-cost-effective-for-students/

4.       Temple, J. "Salman Khan, math master of the Internet – SFGate". Articles.sfgate.com. December 14, 2009. Accessed October 14, 2017. Available from: http://www.sfgate.com/business/article/Salman-Khan-math-master-of-the-Internet-3278578.php

5.       OER Commons. Open Educational Resources. Accessed October 14, 2017. Available from: https://www.oercommons.org/

Flipping the Classroom: Pharmacy Education Perspectives

Flipping the Classroom: Pharmacy Education Perspectives

By Jesse Rungkitwattanakul PharmD

Pharmacy Practice Resident, Georgetown University Hospital

“Flipping the classroom” has become an interesting topic for discussion in the past several years among educators. A generation is “a group of individuals belonging to a specific category at the same time”¹. Their shared experiences and stories greatly influence the way the learner processes information. Academia currently involves the coexistence of several generations including traditionalists, Baby Boomers, Generation X, and Generation Y, and each generation has a unique teaching and learning method/style¹. In the classroom, it is often common to see the oldest generation (the professor) instructing the youngest generation (the pharmacy students), creating a generation gap. Because of the different teaching and learning styles associated with the generations, this gap can be an obstacle to both teaching and learning. Therefore, the flipped classroom may be a way to bridge that gap.

What is the flipped classroom?

The flipped classroom approach has been used for several years in a variety of disciplines, notably within the humanities and social sciences. This method encourages students to gain first-exposure learning prior to class and focus on processing part of learning such as synthesizing, analyzing, problem solving in class through guidance from the instructor. To ensure that learners complete the preparation necessary for productive class time, the assignment-based model, in which learners have to produce or brainstorm work before coming to class is proposed. With the appropriate preparation from home, the learners receive productive feedback through the process or activity performed in class. This reduces the need for the instructor to provide extensive background teaching and allows the student to achieve a higher level of comprehension². A successful flipped classroom should have three goals: (1) allow the students to become critical thinkers, (2) fully engage students and instructors, and (3) stimulate the development of a deep understanding of the material.

Does the “flipped classroom” work?

What are the evidences to support the use the pharmacy education?

Koo et al conducted a study determining whether a flipped classroom design would improve student performance and perceptions of the learning experience compared to traditional lecture course design in a required pharmacotherapy course for second-year pharmacy students³. Students viewed short online videos about the fundamental concepts and answered self-assessment questions prior to face-to-face sessions involving patient case discussions. By comparing before and after, the final grades of an A or B were more prevalent after the implementation as compared to before (88% vs. 67%, p=0.005). Additionally, the study conducted by William Prescott et al also showed a similar trend, in which the program implementation resulted in the higher course grades in the intervention group as compared to the traditional classroom setting (90.3% vs. 85.8%, p<0.001)⁴.

On the other hand, regarding the student’s perception, Khanova et al reported some interesting key aspect from the learner’s perspective⁵. The researchers evaluated students’ perception of the flipped classroom on a required pharmacotherapy course by giving students pre-course and post-course surveys. Before the course, the vast majority of students in the study sample (72%) expressed preference for traditional lecture by the professors over flipped classroom. When students were asked at the conclusion of the course whether they preferred coming to class to listen to a professor lecture or learning the basic content prior to class and using class time for applied learning, 83% indicated that they preferred the former. Regarding the free text answers, comments indicating preference for traditional lecture, such as “I would much rather come to class and be lectured” were common, but many students stated they liked “the idea” of “learning concepts prior to class” and using class time for discussion and other forms of active learning. The main critical perspective regarding the overall course design was under the perception of time-consuming activity as seen as “With all of our other classes, I did not have time to read the large amount of material before each class. This made class time very confusing and unproductive”. This study essentially highlights practical challenges of implementing a flipped learning model. Student feedback informed potential redesign of the course and the development of a more effective model for pharmacy education.

Conclusions

The flipped classroom is a useful alternative to the traditional classroom. It is a method that embraces students' need for active learning in a group setting while maintaining the traditional classroom method for introducing the didactic information. Active learning increases student engagement and can lead to improved retention of material as demonstrated on standard examinations. However, the program must be cautiously implemented since it requires a significantly higher amount of preparation prior to class.

References

1. Berret D. How “flipping the classroom can improve the traditional lecture. The Chronical of Higher Education 2012: [cited 2017 Oct 20]. Available from: http://www.chronicle.com/article/How-Flipping-the-Classroom/130857

2. Rotellar C, Cain J. Research, Perspectives, and Recommendations on Implementing the Flipped Classroom. Am J Pharm Educ 2016; 80(2): 34. [cited 2017 Oct 15]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827585

3. Koo CL, Demps EL, Farris C, Bowman JD, Panahi L, Boyle P. Impact of Flipped Classroom Design on Student Performance and Perceptions in a Pharmacotherapy Course. Am J Pharm Educ. 2016 Mar 25; 80(2): 33. [cited 2017 Oct 15]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827584

4. Prescott WA, Woodruff A, Prescott GM, Albanese N, Bernhardi C, et al. Introduction and Assessment of a Blended-Learning Model to Teach Patient Assessment in a Doctor of Pharmacy Program. Am J Pharm Educ. 2016 Dec 25;80(10):176. [cited 2017 Oct 15]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289732

5. Khanova J, McLaughlin JE, Rhoney DH, Roth MT, Harris S. Student Perceptions of a Flipped Pharmacotherapy Course. Am J Pharm Educ. 2015 Nov 25;79(9):1. [cited 2017 Oct 15]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727361/

Interprofessional Education: The Format of the Future

Interprofessional Education: The Format of the Future

Lindsey Zeplin, PharmD

PGY-1 Managed Care Pharmacy Resident

Kaiser Permanente of the Mid-Atlantic States

Medicine today is becoming increasingly complex due to higher prevalence of chronic diseases, growth in the patient population, and a shortage of medical providers (1). Advanced knowledge and skills are required to meet the demands of the medical field, and, as a result no one healthcare worker can manage all of a patient’s needs. To accommodate, healthcare delivery is moving away from the traditional physician-centered model of care to a team-based model.

Traditional student training models promote monoprofessional learning and endorse a hierarchy in healthcare that encourages competition rather than fostering teamwork (2). A different approach is needed to provide workers with the knowledge, skills, and attitudes to effectively work together. Interprofessional education (IPE) integrated into healthcare curricula is a promising means to achieve this training.

What is IPE?

As established by the World Health Organization (WHO), IPE occurs “when two or more professions learn about, from, and with each other to enable effective collaboration and improve healthcare” (3). IPE has been adopted as an accreditation requirement for many healthcare professions including pharmacy, nursing, dentistry, public health, and medicine (4).

What does IPE look like in practice?

IPE can be incorporated into a variety of program types: workshops, experiential education, didactic courses, and embedded throughout the pharmacy school curriculum. Institutions have taken different approaches to IPE.

Cooper Medical School of Rowan University and University of the Science Philadelphia College of Pharmacy (5)

First and second year pharmacy and medicine students are placed on teams. The teams complete an experiential rotation together, working at a clinic and other sites, along with attending a didactic course.

South Caroline College of Pharmacy (6)

Third year pharmacy students complete nine IPE activities embedded in a required course, Clinical Assessment. Students participate in activities such as a “code blue” simulation, making recommendations to an attending physician, and working on teams providing acute care and developing a transition of care plan for discharge. During these activities, pharmacy students work with medicine, nursing, and/or physician-assistant students.

University of Michigan College of Pharmacy

From personal experience, I can recount that students complete a semester-long IPE course focused on clinical decision-making. At the beginning of the term, students are divided into teams made up of third-year pharmacy students, third-year dental students, master of social work students, medical students, and advanced-practice nursing students. Students remain on the same team all semester and rotate through a series of discipline-specific modules where they work together to solve patient care cases.

How do educational theories apply?

Educators should embrace IPE and work to incorporate it into pharmacy school curricula. However, this type of education comes with its challenges. The ADDIE model is a guideline for building effective training tools. It is comprised of five phases: analysis, design, development, implementation, and evaluation (7). This model will be important to follow when developing a new IPE course given this type of instruction is new and has not been tested as much as traditional health professional teaching. Analyzing student needs will be more complex because multiple disciplines need to be included; disciplines that have been taught different content using different instructional methods. The capabilities of each profession must be assessed, and the content must be tailored in a way that is meaningful to each profession – not too challenging for one or too basic for another. Designing material appropriate for the entire audience will be no simple feat, but it will help advance the future of healthcare by best preparing its upcoming providers.

References:

1.       Bodenheimer, T., Chen, E., & Bennett, H. D. (2009). Confronting the growing burden of chronic disease: can the US health care workforce do the job?. Health Affairs, 28(1), 64-74.

2.       McNair, R., Brown, R., Stone, N., & Sims, J. (2001). Rural interprofessional education: promoting teamwork in primary health care education and practice. The Australian journal of rural health, 9, S19-26.

3.       World Health Organization, 2010. Framework for Action on Interprofessional Education and Collaborative Practice (WHO/HRH/HPN/10.3) (Geneva, Switzerland).

4.       Zorek, J., & Raehl, C. (2013). Interprofessional education accreditation standards in the USA: a comparative analysis. Journal of Interprofessional Care, 27(2), 123-130.

5.       Rotz, M. E., Dueñas, G. G., Zanoni, A., & Grover, A. B. (2016). Designing and evaluating an interprofessional experiential course series involving medical and pharmacy students. American journal of pharmaceutical education, 80(5), 85.

6.       Shrader, S., & Griggs, C. (2014). Multiple interprofessional education activities delivered longitudinally within a required clinical assessment course. American journal of pharmaceutical education, 78(1), 14.

7.       Allen, W. C. (2006). Overview and evolution of the ADDIE training system. Advances in Developing Human Resources, 8(4), 430-441.

In-Network Disparities for Mental Health

Kaysee Gruss

PGY-1 Managed Care Pharmacy Resident

Kaiser Permanente

In-Network Disparities for Mental Health

Concerns regarding adequate access to mental health care providers for members within health plan networks have been raised. From 2003 to 2013 there was a decrease in the number of practicing psychiatrists in the United States while there were increases in the numbers of primary care physicians and other specialties such as neurologists.¹ In addition, the amount of mental health care providers’ that participate in plan networks is low compared to primary health care providers, especially for psychiatrists. According to 2016 data of provider levels from the Affordable Care Act (ACA) Marketplaces, only 42.7% of psychiatrists and 19.3% of non-physician mental health care providers participate in any network.² Members who participate in narrow network plans are three times more likely to see out-of-network care for mental health services compared to primary health care providers. The use of out-of-network providers results in higher copayments, coinsurance, and deductibles for members. A higher financial burden may prevent members from seeking or being able to afford these services.² The patient population that is most effected by the limited in-network access to mental health services are those who are relatively poor and/or have a lower education level.¹

Mental health conditions are common in the United State with 25% of adults reporting having a mental health condition at any point in time. The need for mental health services is increasing due to improved treatment options, better defined diagnostic criteria, and expanded categories for diagnosis. Increased awareness of these mental health conditions has helped to reduce the stigma toward people with these conditions that may have been associated with the low amount of coverage of these services from insurance companies.³ Despite improvements in treatment options, the majority of people affected by mental health conditions do not receive help for these conditions. Untreated mental conditions can affect quality of life leading to morbidity and mortality. This population is at an increased risk of substance abuse, suicide, homelessness, and development of chronic diseases making the limited access to mental health services a public health concern.¹

One explanation for this discrepancy of care is the benefit of a narrow-network design for insurers. Approximately half of the plans offered in the Marketplaces in 2016 had narrow networks, defined as less than 25% of providers in any health insurance network. A narrow network design is a cost-containing strategy available to insurers, allowing for selectivity for providers in regard to performance. A narrow network may also help to prevent the inclusion of high-cost providers. Insurers can negotiate lower reimbursement rates with in-network providers. Narrow networks are also associated with lower premiums, which may influence member choice when choosing a health plan. This can further expand the problem. If members choose a plan solely based on the premium, that plan may not be able to provide affordable access to all the members’ health needs with in-network providers.²

Another explanation for this lack of participation of mental health professionals in plan networks is due to there being little incentive. Mental health providers receive low reimbursement rates from insurers regarding appointment length. Low reimbursement, on top of a growing demand for mental health care and a shortage of providers provides some insight into why mental health professionals may not wish to participate in plan networks. Only about half of number of practicing psychiatrists even accept health insurance.¹ This suggests that mental health professionals do not need to participate in a plan network due to a high demand for these services.²

Several regulations have attempted to account for the discrepancy in coverage and target the stigma surrounding mental health conditions. The Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 sought to reduce coverage gaps for mental health services by requiring benefit coverage to be similar to general medical services.² The Affordable Care Act (ACA) attempts to insert regulation by requirement mental health service be one out of ten benefits as well as requiring Marketplace plans to maintain a network that meets a sufficient number and variety of providers.² Components of these regulations have been left up to the states determination, creating inconsistency in coverage. Regulations have help to ensure that there is financial coverage for mental health services and increased awareness of the subject has helped to reduce the negative stigma surrounding these conditions, but the various interpretations of these regulations make it difficult to consistently regulate plan features and measure network quality.^2,3

Resources:

1     Bishop TF, Seirup JK, Pincus HA, Ross JS. Population Of US Practicing Psychiatrists Declined, 2003-13, Which May Help Explain Poor Access To Mental Health Care. Health Affairs. 2016; 35(7):1271-1277. Available at http://content.healthaffairs.org/content/35/7/1271.full.pdf+html. Accessed October 10, 2017.

2.     

         Zhu JM, Zhang Y, Polsky D. Networks in ACA Marketplaces are narrower for mental health care than for primary care. Health Affairs. 2017; 36(9):1624-1631. Available at http://content.healthaffairs.org/content/36/9/1624. Accessed October 6, 2017.

3.    

    McGinty e, Pescosolido B, Kennedy-Hendricks A, Barry CL. Communication strategies to counter stigma and improve mental illness and substance use disorder policy. PS in Advance. October 2017. Available at http://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.201700076?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed. Accessed October 6, 2017.

The Theory of Grit – Is Grit a Predictor of Success?

The Theory of Grit – Is Grit a Predictor of Success?

Natalie L. Kokta, PharmD    

PGY-1 Pharmacy Resident at Kaiser Permanente of the Mid-Atlantic States

“After several more years of teaching, I came to the conclusion that what we need in education is a much better understanding of students and learning from a motivational perspective – from a psychological perspective.”¹ – Angela Lee Duckworth, Founder and CEO of Character Lab

The conclusion Angela Lee Duckworth refers to in her latest TED Talk is regarding the theory of grit. Dr. Duckworth completed her undergraduate degree in advanced neurobiology studies and her PhD in psychology. She is the founder and CEO of the non-profit, Character Lab, with the mission to advance the practice and science of character development. Dr. Duckworth’s research focuses on social studies involving grit and self-control.^2,3

What is Grit?

Past research looked at various individuals, both adults and children, in a variety of challenging situations and settings, attempting to answer the question why some individuals accomplish more than others of equal intelligence? It has been shown that many qualities are present in high-achieving individuals, including but not limited to, creativity, vigor, charisma, emotional intelligence and stability, and self-discipline. It is thought that some of these traits, such as self-discipline may be essential to success no matter the situation or setting. However, it was found that while self-discipline aids in success, it does not always lead to sustained, long-term success or positive outcomes. Whereas one characteristic not mentioned in the list above, emerged among successful, prominent leaders in a multitude of fields as a significant predictor of sustained, long-term success – grit.^4,5

Grit is defined as “perseverance and passion for long-term goals.”⁴ It involves working persistently towards challenges while maintaining interest and consistent effort despite difficulty, progress plateaus and failures faced.

In her latest TED Talk, Dr. Duckworth mentions that the one thing we know how to measure best in education is IQ – but what if doing well in school and in life was dependent on something much greater than IQ? What if the ability to learn and think quickly or even easily was also dependent on something greater than IQ or even greater than talent? The theory of grit IS something greater.

The theory of grit means to live life as if it were a marathon and not a sprint. What is meant by this is that grit is not the number of hours put into a project or task, or the all-nighter spent studying for an exam to receive a successful grade – grit is not a sprint. Grit is a marathon – it means to commit to oneself daily. The commitment involves frequent self-reflection and check-ins with the ability and willingness to recognize and admit one’s own weaknesses to target and improve identified weaknesses. Individuals with grit do not waste time focusing on what they already know, instead they quickly identify opportunities for improvement and then work hard daily to grow.

During the Educational Theory Course, different mindsets were discussed. Specifically, the fixed versus growth mindset. Individuals with grit have a growth mindset as they do not see failures as set-backs, but as opportunities which will prepare them for future challenges. This mindset and the theory of grit work hand-in-hand in order to support sustained long-term success.

It is important for all individuals to understand this theory, how to build grit and how to apply the theory to everyday life. For educators, this is key to improving student outcomes and planting seeds for lifelong personal and professional success.

Building Character with More Grit

Dr. Duckworth developed a questionnaire for her continued research focused on measuring and deepening our understanding of grit. This questionnaire has the potential to be utilized as a tool to deepen personal self-reflection and to monitor progress along the journey to becoming more “gritty.”

As mentioned previously, building grit is essential to success. Grit is something that can be constantly built upon – all it takes is a commitment and willingness to begin. The first step to building grit is to pursue something of interest. Interested development is huge as if one does not find something interesting there will be no opportunity to develop passion. Second, practice – then practice some more. Grit involves hard work. Hard work develops skill. Skill develops confidence. Confidence leads to new experiences, ultimately leading to success. 

Third, seek purpose. The difference between an individual with grit and an individual who works hard is that the individual with grit will seek meaning in all that they do – how the task is meaningful to them and those around them. Lastly, by having hope and believing that things will get better or improve because you are working to improve them is much greater than one may think. Hope is not just a feel-good emotion, but it helps individuals overcome difficult situations or failures – something we all face. Those with grit are more adept to stick out and overcome challenging situations by having hope and a growth mindset.

Educators have the unique opportunity to speak life and success into learners. By understanding the importance of grit, we can adjust the way we teach and give feedback to not only promote a growth mindset but to promote the daily commitment to oneself. Having a growth mindset alone is simply not enough for sustained success in the long-term, but having a growth mindset with grit is.

References

1.       Duckworth AL. Grit: The Power of Passion and Perseverance. TED Talks Education. April 2013.

2.       Duckworth AL. True Grit: Can Perseverance be Taught? TEDxBlue. TEDx Talks. November 2012.

3.       Scelfo J. Angela Duckworth on Passion, Grit and Success.  NY Times. April 2016.

4.       Duckworth AL, Peterson C. Grit: Perseverance and Passion for Long-Term Goals. J Pers Soc Psychol. 2007; 92(6): 1087-1101.

5.       Duckworth AL, Eskreis-Winkler L. True Grit. Association for Psychological Science. April 2013.