Head Over Heels for New Teaching Strategies: Focus on the Flipped Classroom

 By Michael Plazak, PGY-1 Pharmacy Practice Resident, 

University of Maryland Medical Center

An increasing number of educators and institutions are moving away from the traditional lecture format and instead utilizing a variety of new teaching techniques. Some of these new approaches include: team-based learning, “flipped” classroom models, case-based learning, and online content through mediums such as modules and videos. Constant educational innovation was a ubiquitous theme during my four years at the University of North Carolina. I had the opportunity to experience all of these contemporary teaching methods first-hand throughout my time in pharmacy school, however, the “flipped” classroom was utilized most frequently by course coordinators. My first pharmaceutics class as a first-year pharmacy student harnessed pre-class online videos to introduce the concepts. Students were expected to master the material on their own prior to attendance at a physical class session. In-class activities included facilitated case discussions, the use of polling software, and quizzes that further elucidated the material and supplemented previously learned topics. My experience in a second-year pharmacokinetics course was very similar. Pharmacokinetic concepts were introduced to students through an abbreviated textbook, and then students were asked to solve complex cases during the in-class sessions. These contemporary teaching techniques mainly drew from the educational theory of cognitivism. My opportunity to experience all of these techniques first-hand intrigued me, therefore, I wanted to evaluate the actual outcomes of these educational practices.

Flipping the Classroom

       

Advances in technology during the 21^st century have allowed educators to utilize video and module-based lecture material for easy facilitation of pre-class learning. This method allows for actual class time to transition from content delivery in the form of a lecture to the promotion higher-order reasoning through cases and complex problems. Employing this technology within a course seems like a logical next step for today’s generations that already rely on it in every other aspect of daily living. In a randomized, between-subjects pilot study comparing an online module-based pharmacokinetics course to a lecture-based pharmacokinetics course, no difference was found between the learning formats in terms of knowledge gains and both groups rated these experiences highly. Additionally, students in this study were asked to rank their individual preferred learning style. Reading was ranked last by both cohorts (56% in the lecture-group and 66% in the module group)¹. This pilot study supported the idea that the modern student is more apt to utilize software, rather than read material as a supplement to in-class lecture and discussion. However, this preference for module-based activity did not translate into any meaningful outcomes. Students in both cohorts performed equally on class quizzes and exams. While this may not directly translate to true knowledge gained, I believe it does emphasize the point that students learn best in a variety of different ways. One limitation of this pilot study to note is that the multimedia module and reading material were not truly compared. Students in each cohort did not have access to both the modules and the reading material.

        A follow-up study in 2015 attempted to further elucidate the results of the previously mentioned pilot study. This study was conducted in the same “flipped classroom” pharmacokinetics course. The course still utilized online pre-class materials (an online PDF and an online module) and team-based learning, however, students were given access to both mediums for pre-class preparation. Throughout the semester, students were given a total of five quizzes on the material covered in the pre-class readings or videos. Additionally, students were asked to comment on their preferred preparation medium. A total of 364 students responded to a survey at the end of the course. Of those that responded, 67% preferred the online reading material compared to 16% who preferred the module (p=0.05). The major reasons for PDF preference included: ability to self-pace learning and the ability to easily restudy the material prior to a quiz². In an age where technology’s grasp continues to take over the lives of more and more people, these results are intriguing. It is important to consider that this study was conducted in a pharmacokinetics course, which may not translate well to a video-based format. Many learners still prefer to work out examples when arithmetic and algebra are at the core of a topic.

        These small studies barely scrape the surface of the ever-evolving world of education, and they highlight the idea that each student learns best in different ways. These new concepts of a “flipped classroom”, team-based learning, case discussions, and the use of online modules provide unique learning opportunities for students, however, they also have a diversity of educational theories at their core. The theory of cognitivism can be found in the pre-class material. It allows students to draw on knowledge and ideas learned prior to class, and asks them to critically think about a complex problem, and ultimately provide the best solution. The theory of social learning is emphasized in team-based activities. Students have the opportunity to learn from each other and therefore, are exposed a broader range of concepts and thought processes. This diversity exposes students to a variety of teaching philosophies, and allows each student in a course to progress their knowledge in different ways.  

 References: 

1.   A.M. Persky, Multi-faceted approach to improve learning in pharmacokinetics, Am J Pharm Educ, 72(2) Article 36, 2008

2.   A.M. Persky, Qualitative analysis of animation versus reading for pre-class preparation in a “flipped” classroom in a professional pharmacy program, J Excel College Teach, 26(1): 2015

Different Student Learning Styles: Why This Matters In Your Classroom

By Sarah Williford, PGY-2 Critical Care Resident,

University of Maryland School of Pharmacy

 

During my 19 years of formal education, I knew very little about the concept of learning styles, and it was never formally discussed in any of my courses. I began to learn more about the different styles during my PGY1 year when we took a quiz to help determine our preferred learning style, and I was interested to discover that my learning style differed from the other residents. I am a kinesthetic learner, and, looking back, this helps explain why I sometimes struggled to learn in traditional lecture-based classroom settings. My learning skyrocketed during my PGY1 year because I spent the majority of that time in hands-on, real-world learning situations. It is important for instructors and learners to be familiar with the different types of learning styles and know what activities appeal to each style. It’s also important for instructors to learn which styles their students prefer.  

One of the most common questionnaires used to determine preferred learning style is the VARK model- visual, auditory/aural, read/write, and kinesthetic, which uses a sensory approach to break down different learning styles (http://vark-learn.com/introduction-to-vark/). The questionnaire is short and simple and allows the user to click more than answer if they feel it applies to them. As a medical professional, one question I found particularly interesting was:

   You have a problem with your heart. You would prefer that the doctor:

A.   Described what was wrong

B.   Showed you a diagram of what was wrong

C.   Used a plastic model to show what was wrong

D.  Gave you something to read to explain what was wrong

Based on your response to this question, it makes it clear what learning style you would prefer. In medicine, we often verbally explain things to patients, however I wonder if they would grasp medical concepts better if they were explained in a multimodal approach?

 

A question pertaining to education that might be of interest to teachers is:

   Do you prefer a teacher or a presenter who uses:

A.   Handouts, books, or readings

B.   Diagrams, charts or graphs

C.   Question and answer, talk, group discussion, or guest speakers

D.  Demonstrations, models, or practical sessions

Keep in mind, the user can select more than one answer, which is why some participants score in the multimodal category in either the VARK Type One or VARK Type Two subset. Multimodal learners do not have one standout learning preference and score highly in more than one learning category. Vark Type One multimodal learners choose a different learning style based on the situation they are working in and can even have equal preference for learning in all of the categories. Vark Type two learners gather input from each mode of learning and take their time processing or learning the material. They take their time delving into the information they gather from each mode of learning and this approach gives them a deeper and broader understanding. In 2014, a descriptive- cross sectional study was performed using the VARK questionnaire to assess learning styles of health professional students (medicine, health, and nursing) in Iran. The authors found that 42% of students favored a single learning style, while the rest were multi-modal learners with the overall preferred learning styles being aural and read/write.

 

Visual learners learn by observation and benefit from charts, graphs or diagrams that can consolidate information into visual graphic form. Visual learners can close their eyes and picture charts or graphs to help them remember information. This type of learner is often attracted to color and can be easily distracted by sounds. Some recommendations if you are a visual learner are to sit in the front of the classroom (to avoid distractions), color code notes, and to convert notes into drawings, diagrams, or hierarchies with colors and arrows. Movies or films may also be of benefit when learning information along with silent reading and flashcards.

Aural/Auditory learners respond well to information that is heard or spoken in lectures, group discussions, or oral reading. Encouraging this type of learner to use oral language is key – useful study methods include reading aloud, repeating concepts aloud to help with memorization, listening to taped lectures, or talking things through with a group or professor to help solidify understanding. If you are an aural/auditory learner choose a spot in the classroom where you can hear clearly, record lectures, read study materials out loud, or record yourself reading or explaining something and then listen to that recording.

Read/Write learning is a popular style amongst both teachers and students who tend to be “traditional” studiers- those that take notes during class and then study those notes or re-copy them. This style utilizes “text-based input and output”, so reading information and then writing that information which can then be read again. If you prefer this learning style take lots of notes! These notes can be transcribed later and put into your own words to help solidify understanding. If charts or graphs are not helpful, transform that information into words, perhaps with bullet points to keep the text succinct and organized.

Kinesthetic learners are most successful when “real-life” simulations and demonstrations are used. These learners remember concepts by connecting them to things they can touch or see. Beneficial activities for kinesthetic learners are games, role-playing, demonstrations, building models, lab work, or teaching others to help cement their understanding of a topic. For example, in pharmacy school, students may receive written directions about the steps needed to take someone’s blood pressure manually. A kinesthetic learner may not fully understand and connect all the pieces until they take those directions and apply them on an actual patient.

An interesting thought in health professions education (nursing, medicine, pharmacy, etc) is to try to put all of these styles together at the same time to help drive home concepts with students. For example, a cardiovascular module taught in pharmacy school might include lectures, diagrams, etc. Following the lectures, students could go to a hospital or clinic and meet actual cardiac patients, take their blood pressure, feel for a pulse, and listen to rhythms with a stethoscope. This would meet the needs of all learning styles. Taking this a step further would utilize an interprofessional educational approach and have the different types of students discuss patients from different perspectives. Nursing students could discuss taking vitals and reading an EKG while a medical student discusses how to diagnose different cardiac diseases and a pharmacy student discusses treatment options and different cardiac classes of drugs. Interprofessional learning and discussion can be beneficial to all learners!

It is important for instructors to survey their students at the start of a course or activity to find out what type of learners they are teaching. This way different activities can be designed to appeal to each learning style. At the same time, students should know their preferred learning style and use some of the tips above to set themselves up for success.

References:

1.   Pennsylvania Higher Education Assistance Agency. 2011. What’s Your Learning Style? The Learning Styles. Retrieved from http://www.educationplanner.org/students/self-assessments/learning-styles-styles.shtml

2.   BCPS.org. Learning Styles. Retrieved from https://www.bcps.org/offices/lis/models/tips/styles.html

3.   VARK Learn Limited. 2017. The VARK Modalities. Retrieved from http://vark-learn.com/introduction-to-vark/the-vark-modalities/

4.   Peyman, H, et al. 2014. Using VARK Approaches for Assessing Preferred Learning Styles of First Year Medical Science Students: A Survey from Iran. Journal of Clinical and Diagnostic Research, 8, 1-4.