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.

Using Videos to Enchance Education

Brittany Vogel, PharmD, MBA, PGY1 Managed Care Resident at Kaiser of the Mid-Atlantic States

I have always been a fan of Ted Talks and when I came across this one, I thought it was so relevant to how we teach and learn today! Sal Khan presents a Ted Talk on using video to reinvent education. Khan is the creator of Khan Academy, an online collection of educational videos in subjects from history to calculus.

Khan starts off his talk by speaking about the feedback he received from his cousins after posting instructional videos online. He used to tutor his cousins in person and simply posted these videos online for their supplemental use. The first thing his cousins told him was that they preferred him online in the videos rather than in person. I, along with Khan, first found this funny but then realized how true this is nowadays.

Videos online allow the learner to pause, rewind and repeat something the learner might have missed or misunderstand the first time. Allowing the learning to pause also gives the learner more time to process what was just taught on the screen, or to simply use the bathroom without missing any important information. Being taught online really allows the student to go at their own pace and on their own time.

Other benefits of learning online can also include saving the student from embarrassment. I know I am one of those students that hates to ask questions in class because I think maybe I just missed what was said or I didn’t understand it, and I just need to review it. What if I ask a stupid question and everyone laughs or rolls their eyes at me? I also hate to waste people’s time, whether it be my fellow peers or my teacher. I also hate when teachers ask questions, expecting a response- what if I get called on and I don’t know the answer? I think many students can relate and have these same thoughts!

Khan continues to point out yet another benefit of online learning that may be overlooked- the opportunity to make the teaching experience more individualized rather than the one-size-fits-all lecture from the classroom. Teachers were starting to incorporate his videos into their lessons; they were “flipping” the classroom to have the students watch the videos as homework outside of class and do the typical homework assignments in class. This allowed for a more collaborative classroom. Instead of the students quietly sitting there trying to absorb the material and not talk to each other, they are allowed to interact and learn from each other.

Another interesting concept Khan discusses is testing the information the students are learning. This is usually done with a quiz or exam, in which the student will get a percent grade and move on to the next topic. But this does not necessarily mean that if they got a 100% on that particular exam they know everything or that they will remember it all. This happens frequently with students- they don’t learn the topic, but rather memorize or learn just enough to be able to pass the test. This prevents students from building on concepts and expanding their knowledge. Being able to build on concepts is important in all areas, but I especially see the value for pharmacists. Typically, we learn the basics during our first year- pharmacology, side effects, brand/generic drug names, patient counseling. If we don’t retain these basics onto our second year, where we learn about specific disease states and complex cases, it becomes more difficult to process. Khan says rather than being tested to a percentage, it is best for the student to keep practicing that concept until it is mastered. In order to get a concept mastered though, it involves failing and experimenting- something the learner should not be punished for.

Khan Academy allows student-specific data and class dashboards to be obtained by the teachers. For example, teachers are able to see what videos have been watched, how many times the videos were paused, what exercises they used, and even what or how many problems the students are getting right or wrong. This essentially allows the teacher to be able to focus in on specific areas that the class, or student, may be struggling with during the face-to-face teaching time. Khan states that the Academy has noticed that students may be slow in the beginning, but they use the resources they feel will help them the most and are able to move forward and get faster as they master the concept.

I think the use of video and other online resources to supplement the classroom teaching is exactly what is needed in schools, no matter the age of the learners or the difficulty of the subject. Society is continually developing and we, as educators, would be silly to not use the advances in technology to our benefit. Technology is how students are learning- it is what they are becoming used to. It is important to adapt our ways of teaching to be able to relate and communicate with the students in a way they are familiar with and that is most beneficial to them.

The use of these type of video and online resources to supplement in-person teaching in the classroom would especially be ideal if incorporated into pharmacy school curriculums, for many reasons. One reason to start with is that a large portion of pharmacy students these days are second career students, or students that may have a family. Having an opportunity to review videos outside of the classroom may make it more convenient for these types of students if for some reason they have something come up during class times. It would also be beneficial to these type of students because it may have been a while since they sat in classes, and they may learn better watching videos outside of class where they can take their time and process the information, rather than potentially having to ask questions and get embarrassed during class. Another scenario that this type of teaching would be beneficial for is the other end of the pharmacy student spectrum- those that are fresh out of undergrad or just got their prerequisites. These students may need more structure and providing that both outside of the classroom and during class would be beneficial.

Ideally, the incorporation of video usage and student-specific data in pharmacy education should be used whenever possible.  I don’t think this tactic should be limited to any one particular class. I would recommend this tactic be started in the first year of pharmacy school, slowly getting the students adjusted to this type of education and the tools available to them. This would also be a good time frame for the educators to learn about their students as well to see how they are impacted. By the second year, not only will students have discovered how they learn best and what approach is most beneficial in their learning experience, but the teachers will also have a good working knowledge of how their students learn. This would especially be valuable during second year when pharmacotherapy topics are started, topics that often build upon previously learned material. I think the repetitiveness and individualized learning experiences via instructional videos and materials online will only help developing pharmacy professionals throughout their pharmacy career.

 

References:

1. Khan, Sal. “Let’s use video to reinvent education.” TED. Mar 2011. Lecture. Available at: https://www.ted.com/talks/salman_khan_let_s_use_video_to_reinvent_education?utm_source=tedcomshare&utm_medium=referral&utm_campaign=tedspread

Teaching Students to Think - Focusing Beyond the Grade

By Chih-Wei Hsu, PGY-1 Pharmacy Practice Resident, MedStar Union Memorial Hospital

With grades being one of the criteria for admission to most colleges and graduate schools, getting student loans, and applying for scholarship, it is hard for students to not to put their attention to grades. For instructors, grading is a pretty straightforward measure to evaluate how well the students are learning and how much they understand the materials delivered in the class. However, this distracts instructors from providing a more positive and effective classroom environment for learning and it also distracts students from focusing on learning and lead them to more studying just to pass the class. But we can’t really blame students on being too focus on getting good grades at school. The reason being although most of the time when you get into real-world work environment, no one cares about the grades, but before getting to that stage grades sometimes matter depending on which career pathway you choose. For instance, if pharmacy students are thinking about getting into residency after graduation, all the programs have minimum GPA requirements!

Grading is definitely still one of the essential tools used for providing feedbacks regarding one’s performance. First. let’s take a step back and look at how grade system developed in the past. The first official record of a grading system was back in 1785 in Yale and it was graded into four categories: Optimi, second Optimi, Inferiores, and Perjores.¹ At some point in the early 1900s, 100-point scale was very commonly used with the purpose of providing a more uniform measure in grading, but it was found that 100-point scale was actually not that reliable and different teachers teaching different subjects assigned grades very inconsistently. That lead us to the A-F grading system that we currently use the majority of the time because researchers thought this provided more reliable communication of the evaluation between institutions and from teacher to teacher. Of note, neither the 100-point scale or A-F grading system were designed to motivate students to learn. With that being said, it is quite concerning when seeing one of the studies found that faculty members who were classified as “easy graders” were given better evaluations by students instead of evaluating from the viewpoint of how much knowledge they learned from the faulty members.²

The A-F grading system instructors currently use to evaluate students’ performance will probably not change in the near future, but what can instructors do to achieve the balance and make students’ pay attention not just to their grades but also why and what they learn?

1.   Come up with their own goals and objectives: This helps students to conceptualize the purpose of their learning and can motivate students to think about the things they are learning or what they want to learn, not just studying for good grades.

2.   Think about how the knowledge will be used before the class starts: An author from one of the articles provided a very good example. There was an instructor asked his students to think about their professional destination, what skills and knowledge they are going to need in a real work environment, and do they have enough of those skills or knowledge? Give students some time to do self-reflection prompts them to examine what knowledge or skills they need to acquire in order to be successful for their future careers and be more responsible for their own learning experience.

3.   Present the topics they are interested in: When people are doing things they like and are interested, it increases their engagement in process. “If you can teach it you know it.” By letting learners prepare their own teaching materials, they would at least master part of the course content.

However, it would be hard to implement these activities if class size is large and could potentially make teaching less effective. Take therapeutics courses in pharmacy school for example, those are required courses that every pharmacy student has to take. This tells you that you are going to have a lot of audiences at baseline, so this is probably the time that traditional teaching strategy and A-F grading system are preferred. On the other hand, for some of the elective classes for specialized pharmacotherapy (e.g., oncology, geriatric, infectious disease, … etc.), the activities listed above could be feasible and more applicable since the class size is usually smaller and most of the students already have baseline interests to those topics when they enroll in these classes. Let’s change the setting a little bit. Preceptors of IPPE/APPE rotations may consider to have students complete activities 1 and 2 prior to their rotations and activity 3 during rotations. This way not only it helps preceptors to know what the students want to get out of that rotation, but it also gives students opportunities to reflect on themselves to see if they achieve their goals at the end of the rotations. Keeping the balance being between evaluation-oriented and learning-oriented is hard. Therefore, when appropriate, use the three activities suggested above to engage learners more and have them take control in their learning process and to shape the learners’ mindset more towards learn to think, not just learn to get good grades.

References:

1.   Schinske J, Tanner K. Teaching More by Grading Less (or Differently). CBE Life Sci Educ. 2014 Summer; 13(2): 159–166.

2.    Kidd RS, Latif DA. Student Evaluations: Are They Valid Measures of Course Effectiveness? Am J Pharm Educ. 2003;68(3): Article 61.

3.   Farias, G., Farias, C. M., and Fairfield, K. D. Teacher as judge or partner: The dilemma of grades versus learning. Journal of Education for Business. 2014; 85: 336-342.

To Grade or Not to Grade?

By Deanna Bauerlein, PGY-1 Pharmacy Practice Resident, VA Maryland Health Care System

In traditional education, students are evaluated using number or letter grading systems. Grading in various forms have been used since the 1600s¹. The first letter grading system used was in 1984 by Mount Holyoke College in Massachusetts¹. Their grading system originally used letters A through E, but in 1898 they switched E to F to signify failure¹. As the number of schools grew there became a need to have uniform grading across universities², creating the grading culture we know today. However, there is much debate on whether this system is beneficial to the learner. There are numerous thoughts that make one question the use of grading systems. First, do grades motivate or punish students? Second, how well do grades translate to a level of understanding of the material? Such questions allow one to explore that pros and cons of grading systems.

The first question is whether grading helps or harms the learner. Grades can motivate the learner to do well in hopes of getting a good grade. This positive reinforcement however, may encourage the student to only study for a test to get a good grade, rather than to understand the material. Students may become competitive against one another to get the best grades. This can be good as it pushes and challenges students, however some personality types can take this to an extreme and obsess unhealthily over grades. For students who obsess and/or have a family culture that highly values grades, grades may act as negative reinforcement if students fear bad grades which can cause stress, anxiety, and shame¹. This can lead to a negative feedback loop, that for some students, can be hard to break. Additionally, do low grades motivate students who are doing poorly to work harder - or to give up²? This likely differs from person to person as everyone has varying levels of resilience. All things considered, grades may do more harm than good for students where psychological benefits are concerned.

The next thing to consider about grading systems is the actual value grades have. Tests can either be free-response or multiple choice. Free response questions are great because the teacher can really get a sense of the understanding of the student. However, grading of these types of questions is very subjective; different teachers may grade the same answer differently, and one teacher might grade the same answer differently from one day to the next. Multiple-choice questions are more objective however, they limit the student’s ability to think critically and can underestimate how much a student truly understands if they just happened to guess correctly. 

Furthermore, the use of curves when a class does poorly should be considered. It is assumed that a class is a sample of the population, and thus grades should be normally distributed¹. When the grades do not come out as such, teachers can adjust the grades to represent a bell-shaped curve. This causes two problems. First, grades become based on the test taking abilities of each specific class. If the class average is below what the population average should be, those students are rewarded with an improved grade because the class was not a true sample of the population. In addition, if a class as a whole does poorly, it may not be entirely the fault of the students. Perhaps the test was too challenging or poorly written, or the teacher did not prepare the class well - or a combination of such factors. The second problem curving creates is that classes from one year to the next cannot be compared to each other, as some grades may have been inflated with curving. Therefore, it goes back to the issue of whether grades can be translatable to different students and classes. This was shown in a study done by Rojstaczer, et al. (2012) that showed grading standards have lowered and that A was the most common grade given in 135 colleges across America³. 

The bottom line is there is no perfect way to grade, and with that grades need to be taken with a grain of salt. Even if one can get past how we grade, the specific student needs to be accounted for. There are many bright people who are poor test takers and there are many people who test well, but may not be able to retain or apply the knowledge. Therefore, grades do no correlate to future success. Yet grades are so highly valued, and sometimes students are not even considered for a job or residency because their GPA is too low. Meanwhile, maybe a student’s GPA is low because they were very active in extra-curriculars or had a full-time job. Thus, it is not fair to define the value of an employee based on one number. However, I do not see this changing because it is easy to use this objective information to compare students and to weed out job applicants. If I am ever in the position to hire employees I will not be using GPA as my sole criteria on evaluating candidates. If I did, I would be doing my institution a disservice by potentially missing out on excellent candidates. Especially in health care, subjective information is more important because to me it does not matter if you can take care of a paper patient on a test. I want to know how you take care of real patients in real life settings that are not as black as white as tests. Meeting candidates and asking them about certain situations and how they handled them, in addition to references from previous preceptors and supervisors would be more useful information. Although this may be true in some cases, I do not think a pharmacist who did poorly in school would make a bad pharmacist. I personally feel I have learned and retained more on APPE rotations and residency than I learned in school. So even if a student genuinely did not understand certain topics in school does not mean they will never understand. Maybe they just needed to be exposed to the topic a few more times or have it explained in a different way. Although it is great when someone has a high GPA, it should not be the only thing that matters as this number tells so little about the specific student.

As one can see, there are many flaws with grading systems. However, they are used by most schools since there is no better method for tracking a student’s progress and making a determination if the student understands the material enough to progress. This does not mean that modifications are not needed. One way to take the pressure off both students and teachers would be to have some assignments assessed just for effort and participation alone¹. This can encourage students to try their best for the sake of learning rather than just to achieve a good grade. Another method would be to have students correct their own assignment or have peer reviews. These grades do not have to be recorded, but giving the student a chance to recognize his/her own mistakes has additional learning benefits. Peer reviews allow for students to learn from each other and not from the teacher alone.  Two other strategies for grading is to use rubrics to limit subjectivity of grading and to avoid curving test grades. If a class does poorly on a test, extra credit can be assigned such as students correcting their tests. This allows students to earn an improved grade and encourages the student to rectify what they misunderstood before¹. In conclusion, grading systems will always be used as a way to evaluate students, but it is up to the teacher to use a grading system that motivates students and measures understanding as accurately as possible.

References

1.   Schinske J, Tanner K. Teaching more by grading less (or differently). Life Sciences Education [Internet]. 2014 [cited 2017 May 7];13(2):159-66. Available from: https://www.researchgate.net/publication/274836095_Teaching_More_by_Grading_Less_or_Differently

2.   Grant D, Green WB. Grades as incentives. Emprical Econom [Internet]. 2013 [cited 2017 May 7];44(21):1563-92. Available from: http://www.shsu.edu/dpg006/gincentives2.pdf

3.   Rojstaczer S, Healy C. Where A is ordinary: The evolution of American college and university grading. Teachers College Rec [Internet]. 2012 [cited 2017 May 7];114(7);1-23. Available from: http://www.gradeinflation.com/tcr2012grading.pdf

Cultural Competency and Teaching

By Sinead Cooper, PGY-1 Pharmacy Practice Resident, Western Maryland Regional Medical Center

To be a competent and successful teacher, it is vital to be aware of different cultures to appropriately teach all of your students.  One seemingly innocuous comment can offend a student and can alter their whole perception of you as well as the class.  Being culturally competent is an essential tool in the teacher’s arsenal to have an effective and thought-provoking class.  When teaching a technical class, such as a pharmacy or science course, it may appear to be cut and dry and unsusceptible to unintentional offense, but this is not the case.    

          While different cultures stems from more than just different ethnicities, it is what one generally thinks of when different cultures are discussed.  Thirty percent of the US population is racial minorities, and by 2050, minorities are expected to become the majority¹.  Different cultural backgrounds can have different characteristics such as gender, ethnicity, sexual orientation, country of origin among other demographics.  Every individual has different cultural boundaries, and while it is not realistic to cater to every aspect of every individual, it is important to not isolate students.  A big issue is unintentional cultural blindness, where people are unaware that what they are doing is offending others.  To become culturally competent, you, as the teacher must develop interpersonal awareness as well as leaning specific bodies of cultural knowledge.  Gaining cultural intelligence is important to teaching everyone.  In teaching different cultures, you must have knowledge of different cultures, an awareness of how culture shapes individuals, an understanding of social context of different, and an ability to delineate information in a way your pupils can understand².  Additionally being flexible and adapting to new situations or responses from your students is key.  An interesting article by Tanner and Allen discussed how to gain cultural competence in the college biology classroom.  I found this to be very applicable to teaching in science courses in general as well as pharmacy courses³.  

          Studies have shown that some students of different cultural backgrounds are a driving force for course selection³.  Students may be unwilling to abandon their own cultural identities and assimilate to a different cultural identity; they may not identify with their peers in the science community and may feel like an outsider.  An issue that has been identified is teaching concepts without context to the real world.  Some people, particularly females of color found this narrow focus had a negative impact on their learning³.  An easy remedy is relating it to real world scenarios, to keep the audience engaged and motivated. 

          To become a culturally competent teacher one must not only be aware of cultures other than their own but a self-reflection on the role their culture played on their education.  Four main ways were identified in the above mentioned study to teach with cultural competence.  The first is monitoring and changing ordinary language in the classroom to avoid any assumptions and unintended exclusions.  Another way is to become aware of patterns of interaction with students. This includes who we call on typically, who we praise or scold; even who we say when referring to a group project.  You, as a teacher can work on this by seeing who you normally talk to, looking at demographics of students, and if a small classroom setting, trying to understand each students backgrounds.  A third tactic is to integrate cultural relevance and diverse role models into your curriculum.  Some of your students may not have any role models in science that they can feel they can really relate to, for whatever reason.  As a women growing up, I didn’t know of any female leaders in science, it was only until I got older and did more research I was able to find female role models.  Highlighting the backgrounds of some of the people mentioned in courses, I think, could play an important role in creating more role models.  Finally the last tactic is confronting and revising differing expectations and stereotypes of the students, and is perhaps the most difficult.  Confrontation is never easy, and when dealing with stereotypes it get particularly dicey.  Subconsciously some teachers may treat students differently or have different expectations for their students.  The teacher’s expectations for students, regardless of their accuracy can have an impactful effect on students; this phenomenon is known as the Pygmalion effect³.  When a teacher has high expectations, the student will do better academically, regardless of their abilities³.  Removing these unintentional stereotypes is the end goal to become a culturally competent teacher and require hard work and dedication.   

          Becoming a culturally competent teacher is an important aspect in being a well-rounded and impactful teacher.  Despite many people’s perceptions that science classes are removed from bias, studies have shown that is not the case.  Through work and dedication of others cultures and being open can help new teachers become culturally competent.     

References:

1.    Kripalani S, Bussey-Jones J, Katz MF, and Genao I.  A Prescription for Cultural Competence in Medical Education.  J Gen Intern Med 2006;21:1116-1120.  Accessed Apr 2017

2.    Seeleman C, Suurmond J, and Stronks K.  Cultural competence: a conceptual framework for teaching and learning.  Medical Education 2009;43: 229-237.  Accessed Apr 2017

3.    Tanner K and Allen D.  Cultural Competence in the College Biology Class Room.  Amer Soc Cell Bio.  2007;6:251-258.  Accessed Apr 2017

Incentives in Education

By Sheena Matthew, PGY-1 Pharmacy Practice Resident, Medstar Union Memorial Hospital

Many theories have been created, and presented within this class, to aid teachers in their quest to teach. Some theories outline various learning styles that students possess, while others describe different teaching methods that may be effective to convey knowledge. Although there is already much guidance that exists, one of the largest struggles that teachers still face is eliciting the attention of their students so that they are able to retain the information with which they are presented. However, a newly proposed solution for this problem has been gaining the attention of many teachers and students alike.

Researchers at Bentley University in Massachusetts recently conducted a study which evaluated the influence of a cash incentive on students’ standardized test scores. A randomized, controlled trial was done in which students from nine different middle and elementary schools in Chicago were offered a $90 reward for a passing test score. Students were given a small test, with a cash reward, within the same week as their standardized test, for which no reward was offered. While these students were already deemed to be at risk of not passing their state reading and math tests, they were found to score substantially better on their test when a cash reward was being offered. Additionally, students tended to score higher on easier questions, when offered a financial incentive, suggesting that better scores came from students trying harder and more carefully reviewing their work when they were offered an added benefit.

Although this study already affirms the notion that students who work harder are more inclined to perform better in school, it also suggests that nearly all students are equally capable of achieving such goals. While some argue that such incentives may undermine the actual ability of the teacher to guide their students, I believe that this method of offering an incentive for learning may actually emphasize the teacher’s ability to do so. For example, Gagne’s Nine Events of Instruction outlines that an effective learning process includes gaining attention, providing a learning objective, stimulating recall of prior knowledge, presenting material, providing guidance for learning, eliciting performance, providing feedback, assessing performance and enhancing retention and transfer. There are many ways in which this technique aligns with Gagne’s steps. By extending a performance based cash reward, the teacher will nearly always gain the attention of his/her students; the students will instantly become interested in the topic at hand because they see the instant benefit of learning the material in the form of cash. Additionally, the student will then be assessed on their performance, in the form of a test, in which those students who perform well will be rewarded.

While this technique addresses some of the steps of Gagne’s Events of Instruction, it does not address how the material should be delivered or what methods may work best for ensuring students learn the material at hand. This will have to come from the experience within the classroom and what styles the students find most helpful to aid in their learning process.

Realistically, in terms of pharmacy school, students would benefit from a system like this; however, again, monetary rewards would not be feasible. Gaining the attention for these students would most likely be best achieved when concepts are taught and applied to real world situations, or simulated with actual patients. Additionally, it would be beneficial to provide incentives including less assignments or bonus points when a task is done well.

Although this unique idea of extra motivation for students poses a potential aid to the teaching environment, it of course, may not be feasible to offer all students cash rewards for every task at hand. Even if only offered as a way to assess some performances, this may hinder students’ performance on other tasks and make the student less motivated when a reward is not offered. While this may not be the best solution for both teachers and students, it does provide an interesting idea and helps show how some of the teaching strategies that have been presented within our class can be put into practice.

References:

Kamenetz A. Paying students may raise test scores, but the lesson is not over. NPRED. May 2016.

Khadjooi K, Rostami K, and Ishaq S. How to use Gagne’s model of instructional design in teaching psychomotor skills. Gastroenterol Hepato Bed Bench. 2011. 4(3):116-9.