The Power of the Mind in Education

By Jackoline Costantino, PharmD, PGY-1 Pharmacy Practice Resident, University of Maryland Medical Center

TEDx talk, available on YouTube, from Dr. Alia Crum, https://www.youtube.com/watch?v=0tqq66zwa7g&t=380s

This talk was particularly impactful for me because when teaching students and even learning, the

power of our mindset can override our aches, pains, daily dread, dead dog tired, bad moods and in the life of a resident/teacher/mentor I can attest that there are days where it’s mind over matter to get through to tomorrow. Our mind is so powerful. Throughout this read, I want each of you to think of how you can implement this into your day to day learning and teaching activities.

What is a mindset?

She describes a mindset as simply a lens or frame of mind which orients an individual to a particular set of associations and expectations.  These mindsets are not inconsequential, but rather they play a huge role in our health, wellness, capacity to learn, motivate our self, and others, and to comprehend our day to day inputs. Many people are currently working on research to tap into our mindset to shift our perspectives and make substantial changes in our outcomes. To tie this to teaching and learning, Carol Dweck, 2012, demonstrates that if we can shift our mindset about intelligence, talent and something that’s fixed to something that’s moldable over time, it can drastically change our academic and professional success. Students that believe that intellectual abilities are qualities that can be developed (as opposed to qualities that are fixed) tend to show higher achievement across challenging school transitions, and greater course completion rates in challenging math courses. Also, new research has demonstrated that believing (or being taught) that social attributes can be developed can lower aggression and stress in response to peer victimization or exclusion and result in enhanced school performance.

Ability to Heal

Dr. Alia Crum, Mindset researcher and professor at Stanford University, begins her talk with a story about a group of researchers, Benedetti and colleagues, 2003, studied patients that were undergoing thoracic surgery. Following this procedure the sedation would ware off and the patients would require pain medications. The research was designed to see if patients felt better from medication delivered by a provider or medications delivered from a pre-programmed pump (PCA). What this study found was that patients had a better response to pain relief to provider delivered medications despite the dose of medication given. The study went to further test this hypothesis on other treatments like anxiety and hypertension. When the providers informed the patients of the results of their intervention vs not informing the patient, the effects were consistently profound. Regardless of the medication, dose or procedure, the patients who were not informed had a markedly blunted response and in some cases no affect was demonstrated while the patients that were informed showed dramatic responses to their treatment.  You could associate this with what we frequently call the placebo effect. But, what is the placebo effect? The placebo affect is a powerful, robust, consistent demonstration of the ability of our mindset, in this case the expectation, to heal and recruit healing properties in the body.

The Athlete

She then goes on to talk about working with Ellen Langer, a professor and Psychologist at Harvard Medical School. Crum, a Division 1 athlete spent hours in the gym daily to prepare her body for the challenges her sport would require of her. Dr. Langer, upon finding out she was an athlete, said “you know, exercise is just a placebo, right?” So this got her thinking, was she getting fitter and stronger because of the time and energy put into working out daily, or was it because of believing in this process that helped her get fit and strong? 

To test this theory, she found a group of housekeepers that were normally very active daily, on their feet > 30 minutes completing at least moderate activity. However, when asked if they workout regularly, 2/3 of them said no. When asked on a scale of 0-10 (0 being no exercise and 10 being at least daily), how much exercise do you get daily, 1/3 said they got no exercise at all. What if you change that mind set? She then split the women into two groups, measured them on a variety of elements: weight, blood pressure, body fat, job satisfaction and gave one half a 15 minute presentation. The presentation consisted of explaining to them that their job satisfied the Surgeon General’s description of daily physical activity. She explained the benefits to a daily active lifestyle.   She then re-measured the previously determined elements described above 4 weeks later. The group that didn’t receive the information had no changes in their clinical characteristics. However, the treatment arm lost weight, reduced their blood pressure, dropped body fat, and had a better job satisfaction. This is presumably without changing behavior, their health and wellness changed by a 15 minute presentation.

Shake It Off

 After digesting the results from the previous trial, she describes her next challenge of setting out to determine if mindset has a direct effect on diet. She sets up a study (Crum, 2011) to determine if our mindset controls our physiologic response to eating. She made shakes with the same ingredients except she put two different labels on the shakes.  One shake, Sensi-Shake, depicts a rather boring picture, ingredient list and low calories. The other shake, Indulgence , had a picture of a decadent delight with whipped cream to top it all off and triple the calories. Blood samples were taken to measure ghrelin, a peptide made in the stomach, also known as the hunger hormone. When we are hungry, ghrelin starts to rise and signals to the brain we are ready to eat. It also slows the metabolism down in case we don’t find food.  When we consume food, ghrelin decreases and our metabolism speeds up to breakdown the food we consumed. In response to eating the Sensi-Shake the ghrelin dropped 20 points. A week later the same patients came back to try the other shake. After consuming the Indulgence shake, the ghrelin dropped by 70 points. This would make sense if the shakes consumed were actually different caloric intake, however, the shakes were the exact same undenounced to the patient. Here, mindset matters. It might not be just calories in, and calories out, but rather what we believe and what we expect has an objective impact on our outcomes and our body’s response. 

Stress and Mindset

Lastly, to drive the point home, she set up a study (Crum, 2013) about stress and the interpretation of stress from employees that just found out they lost 10% of the workforce in an already labor tight setting. Half the employees watched a 3 minute video prior to starting their shift called “stress is debilitating” and the other half watched a video called “stress is enhancing.” Both videos presented the same information, except each video was either directed to the negative effects of stress or it was directed to the positive effects of stress. Over the course of 3 weeks, the “stress is enhancing” group reported less negative health symptoms (less back pain, less muscle tension, less insomnia), and higher level of engagement and performance at work. Whereas the “stress is debilitating” group had little to no change from baseline in health symptoms or work performance.

Application to Pharmacy Learning:

Students in competitive programs such as medicine, engineering, and architecture all have one thing in common: a seemingly unending amount of exams and an often constant state of stress. These frequent, high stakes exams can take a significant toll on a student who lacks mental stamina or a strong support network. However, based on the experiences mentioned above there are some efforts we can explore to potentially improve student performance by changing their mindset.

We often hear of the value of finding quick, easy wins to build confidence and momentum personally, or within an organization. I believe these same tenants have the potential to lessen test anxiety, and improve performance on exams without sacrificing academic rigor. For example, what if we were to design an exam in which one question was given to students ahead of time and it was made clear that this question would be representative of all future questions. This would give the instructor the opportunity to demonstrate the structure of their questions and allow them to show that their questions were drawn from the terminal learning objectives presented at the beginning of the lecture.  Furthermore, if this question was positioned at the beginning of the exam it would give the student confidence that would hopefully shift their mindset, and build their self-esteem to face the rest of the exam. Thinking back through my pharmacy school experience I definitely felt more confident when I knew the first several questions on an exam versus starting the exam with a challenging or difficult question. By simply understanding the mindset of our students we can empower and assist them to perform and learn at their highest levels rather than be bogged down or inhibited by stress.

Conclusion:

In these four studies, Dr. Crum demonstrates the power of mindset on medicine, exercise, diet, and stress. While I think it’s important to construct a classroom representative of intellect and rigor, I am also a believer that these simple adjustments could make a large impact in the life of a learner. Coupling a quick “stress is beneficial” video close to the start of the course, as well as designing the test to reflect “easier” questions at the beginning are simple technique to empower students, build their confidence and change their mindset not only about the course, but also learning.

References:

·         Crum AJ. (2014, Oct). Change your mindset, change the game. [Video File]. Retrieved from https://www.youtube.com/watch?v=0tqq66zwa7g&t=380s

·         Benedetti F, Maggi G, Lopiano L, Lanotte M, Rainero I, Vighetti S. Open Versus Hidden Medical Treatments: The Patient's Knowledge About a Therapy Affects the Therapy Outcome. Prevention & Treatment. 2003;6 Article 1

·         Crum AJ, Langer EJ. Mind-set matters: Exercise and the placebo effect. Psychol Sci. 2007;18(2):165-71

·         Crum AJ, Corbin WR, Brownell KD, Salovey P. Mind over milkshakes: mindsets, not just nutrients, determine ghrelin response. Health Psychol. 2011;30(4):424-9

·         Finniss DG, Kaptchuck TJ, Miller F, Benedetti F. Placebo Effects: Biological, Clinical and Ethical Advances. Lancet. 2010;375-(9715):686-695

·         Yeager DS, Dweck CS. Mindsets that promote resilience: When students believe that personal characteristics can be developed. Educational Psychol. 2012;47(2):302-314

Behavior Management in the Classroom

Priyana Kumar, PGY-1 Pharmacy Practice Resident, MedStar Union Memorial Hospital

Behavior management is an important aspect in managing a classroom and its students.  It is important to establish order in the classroom during the early stages of teaching in order to build a good relationship with the students and to get the students to listen to the material being taught¹.  Additionally, students’ behavior can have an effect on the behavior of other classmates and peers and can impact the manner in which the teaching content is delivered.

There are several techniques that can be used by the educator to ensure that proactive measures are being taken to measure behavior and to pre-emptively avoid conflict. Often, this strategy requires planning, but with strong planning, a foundation for positive classroom behavior can be built. Visualizing the possible challenges and reviewing strategies to deal with them can be helpful in terms of dealing with these problems when situations do arise³. In addition, it is extremely important to make expectations clear from the beginning to avoid any surprises to the learners and to ensure that the learners know what is expected of them. When setting expectations, they should be realistic, positive, and concise³. In addition to setting expectations, it can prove to be beneficial to also delineate the consequences of not meeting the expectations. Hand-in-hand with clearly delineating expectations, consistency is key so the students do not get confused and will most likely listen to what is being said.

Modeling positive behavior to students and encouraging all students alike can also prove to be a useful method in managing the different behaviors in classroom. It is always beneficial to show respect to all of the students by listening to their needs. Another method to manage students is to keep them busy and challenged, minimizing the time students have to behave poorly. Additionally, listening to the students suggestions in order to take the individual needs of the students into account can help maximize learning, provide the students with the opportunity to self-develop, and less likely set a tone for disruptive behavior².

Apart from common behavioral management techniques, it can be useful for the educator to utilize the reinforcement method¹. By being observant about student activities and what their least and most favorite activities are, the educator has the opportunity to learn what students would like to avoid as well as things they would earn as a result of positive behavior. The educators can then use this knowledge to their advantage in managing the behavior of the students when the students get disruptive. Some examples of reinforcement include primary reinforcers, secondary reinforcers, and social reinforcers². Primary reinforcers include items such as food and drinks. These often work best with younger students and with any age when there are high stress levels. For example, the educator can pass out candy to students that are actively participating in the classroom to motivate other students to do the same. Secondary reinforcers include tangible items such as erasers, notebooks, and such. Educators can also take advantage of these and motivate students to display good behavior and participate in classroom activities by handing out classroom items for students to keep. Social reinforcers are the highest level of reinforcement such as having less homework and having increased break time; like the primary and secondary reinforcers, these methods can be utilized similarly.

The behavioral management techniques described in the article are relevant to the course, as being able to manage a classroom is fundamental for every educator and at every level. A disorganized classroom without order can make it very difficult for both the instructor and the learners in terms of teaching and learning, respectively. For example, in a disorganized classroom, often the learners are lost and do not know what to do, causing them to go off task and cause disruptions. By minimizing these disruptions, the students can have the opportunity to be more engaged in learning, making the transmission of information more efficacious for both the educators and the learners.

Behavior management is applicable to pharmacy education as well, as it is applicable to all populations, including small groups, large groups, and when precepting students. For example, it is important for educators to apply behavioral management principles when leading topic discussions in a small group setting, in order to maximize learning from the socratic teaching method. Similarly, the same principles can be applied to deliver the teaching content to a larger audience when delivering a lecture. When the pharmacy professor takes the audience into account while both developing and executing the lesson plan, the educator is better able to deliver the pharmaceutical content and all of the learners are able to maximize their learning. Additionally, when precepting pharmacy students, behavior management can also be utilized to ensure that the students are making the most out of their educational experiences. Often, when precepting students, the students are given a lot of autonomy and without employing the behavioral principles including rewards and punishment when necessary, it can be easy for them to go off-track. Overall, behavior management is an important tool for all educators, and is relevant to pharmacy practice.

References:

1. DiGuilio, Robert. Positive Classroom Management, 2nd Edition. Thousand Oaks, CA, 2000: Corwin Press.
2. Edwards, Clifford H. Classroom Management and Discipline, 3rd Edition. New York: John Wiley and Sons, 1997.
3. Teacher-Parent Collaboration Printables, Articles, & Resources - TeacherVision. Printables, Articles, & Resources - TeacherVision. https://www.teachervision.com/teaching-strategies/teacher-parent-collaboration. Accessed April 1, 2017.