Tuesday, September 25, 2018

Optimizing self-actualization in a learner



Optimizing Self-Actualization

O'Neal Malcolm, Pharmacist, University of Maryland Medical Center

     Over the years I’ve had the opportunity to precept pharmacy students with various backgrounds, interests and motivation.  I have encountered students who appeared to excel academically, but seemed severely preoccupied with life events that affected their learning.  In fact, some students shared with me some social, academic and home issues that left them feeling dull and unexcited about finishing the final few months of their last Advanced Pharmacy Practice Experience (APPE) rotation.  Those students were more inclined to focus on solving their “life” problems rather than engaging in active learning, and some expressed extremely low interest in pharmacy careers after graduation.  To be fair, some of the issues students shared with me would be overwhelming for anyone who had to deal with them, and while I didn’t get a sense that they were clinically depressed, they lacked motivation. There is a strong correlation between motivation and academic performance among pharmacy students (Pate, Payakachat et al. 2017).

     My goal as a preceptor is to ensure that students successfully complete the rotation’s learning requirements, and are inspired to be highly competent pharmacists in any position. I believe I was successfully able to achieve those goals based on students’ feedback, and progress reports from past students.  For students in situations described above, it was different because they didn’t demonstrate any learning difficulties, but appeared more self-defeated compared to other students who completed the rotation.  Such students seemed to be thinking of putting learning on the “back burner” a few months before graduation. It was therefore important for me in those circumstances to find away to not just merely provide verbal encouragement to those students during the rotation, but to implement practical strategies within the rotation’s design and curriculum that would shift their focus back to learning and achieving.  This posed a challenge because I would have to modify the curriculum which would take time and energy, both of which are fleeting.  None-the-less it was worth the effort, plus the situation gave me an opportunity to re-review previous Continuing Education (CE) information and notes on strategies for improving motivation in students. The review of CE notes led me to the concept of Maslow's Hierarchy of Needs. 

     Maslow's Hierarchy of Needs posit a five-stage model of human needs, often portrayed as ranked levels within a pyramid.  In ascending order these include: (1) physiological (e.g. food, home, clothing and rest), (2) safety (e.g. absent parents and unsafe neighborhood), (3) love/belonging (e.g. friendships, family relations, and extracurricular activities), (4) esteem (e.g. confidence, achievement, and recognition), and (5) self-actualization (desire for self-fulfillment).  Lower needs should ideally be gratified before higher-tiered needs can be attained.  The first four tiered needs are considered deprivation needs; which means that an individual who did not achieve one or more of those needs will be motivated towards achieving the deficient need(s) ( Burleson & Andrew, 2018). 
Aside from directing students to resources and possible programs, It is near impossible to address all deficient needs for students such as clothing, shelter, and adequate sleep (physiological needs).  It was possible, however, to address safety needs such as providing clearly defined rotation expectations and learning behaviors/outcomes, providing daily schedules of assignments/activities, and allowing students to feel comfortable expressing their thoughts whether through answering questions, asking questions, or providing feedback, without fear of ridicule.  I developed opportunities to address ‘belonging’ needs such as informing students regularly that they were a valued member of the department’s team, and that all of their efforts are appreciated (Burleson & Andrew, 2018).

     I’ve utilized a modified Maslow type questionnaire to elicit and address students’ current basic and learning needs.  Implementation of the Maslow type questionnaire would be conducted after obtaining consent from students. Results of the questionnaire often demonstrate that low motivated students have little to no deficiency of stages 1-4, but seemed to be lacking self-actualization (stage 5).  While it was a relief that I wouldn’t have to contend with any deficiency needs for stages 1-4, and focus more on their growth needs (self-actualization), I wondered how I would practically optimize self-actualization over 5 weeks. 

     Self-actualization according to Maslow is a desire for growth and fulfillment of ones  potential or meaning in life.  Maslow suggested that few individuals would fully attain self-actualization since it is impacted by deficiency needs (stage 1-4) (Selva, 2018).  Finding practical examples of self-actualization was challenging since most studies reviewed discussed self-actualization as a theoretical concept versus stages 1-4 where practical examples could be found.  A few studies and online resources highlighted techniques that were integrated into the curriculum (Janowiak and Hackman 1994, Jackson, Santoro et al. 2014).  These include: (1) using "real" life scenarios to make learning meaningful, (2) utilizing metacognitive activities in lesson plan, (3) assigning students to self-expressive projects, and (4) allowing students to be involved in creative activities and projects (SUNY Cortland,1994).  Specifically, students discussed and reviewed with me weekly cases of patient and provider encounters; and for the metacognitive activity students engaged in weekly self-reflection of rotation activities focused on goals achieved, skills learned/acquired, strategies used to solve problem(s), and self-assessment/evaluation of progress towards completing requirements for the rotation. Creative activities involved students creating color coded medication reminders to improve medication adherence; and others collaborated on a “high-risk re-admitted patients” project with an interdisciplinary team consisting of a physician, nurse, social worker, community health worker, and pharmacist.
Weekly self-reflection sessions with students demonstrated improvement in motivation and desire to learn and achieve.  Students involved in performance improvement exercises expressed favorable satisfaction, and those involved in collaborative project felt a sense of satisfaction by being a member of a valued team.  All students believed that the learning activities focused on self-actualization kept them busy and productive, and less focused on their problems.

     Preceptors can contribute to identifying students’ need(s) to improve ability to learn and achieve.  This does, however, require time and effort to get to know the students’ need(s) by (if applicable) using motivational and theoretical constructs such as Maslow’s Hierarchy.  Maslow's Hierarchy of Needs allowed me to use a systematic approach and framework for addressing barriers to learning.  The more a preceptor understands the learning needs of his/her students, the higher the probability of minimizing learning obstacles and optimizing learning.
Application of Maslow’s Hierarchy of Needs has resulted in struggling students successfully completing the rotation. Previous students have shared updates such as pursuing PGY1 and/or PGY2 pharmacy residency programs; or working in leadership positions.




References
Burleson, S., & Andrew, C. (2018). Maslow’s Hierarchy of Needs and Its Relation to Learning and Achievement. Retrieved from https://edis.ifas.ufl.edu/pdffiles/WC/WC15900.pdf


Jackson, J. et al. (2014). Improving Patient Care Through the Prism of Psychology: application of Maslow’s Hierarchy to Sedation, Delirium and Early Mobility in the ICU. Journal of critical care, 29(3), 438-444.


Janowiak, J. J., & Hackman, R. (1994). Meditation and college students' self-actualization and rated stress. Psychol Rep, 75(2), 1007-1010.

Pate, A. et al. (2017). Measurement of Grit and Correlation to Student Pharmacist Academic Performance. American Journal of Pharmaceutical Education 81(6): 105.


Selva, J. (2018). What is Self-Actualization: A definition plus examples. Retrieved, from https://positivepsychologyprogram.com/self-actualization/


SUNY Cortland. (1994). Suggestions for application of Maslow's theory to education, Retrieved from http://web.cortland.edu/andersmd/MASLOW/SUGGEST.HTML














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