To Blend or Not to Blend, That is the Question

         MacKenzie Crist, PGY1 Resident, University of Maryland Medical Center

         Blended learning has become a new “hot topic” in the academia world. Essentially, blended learning or flipped classroom includes mixing activities for students to individually complete at home with normal didactic lectures.¹ This teaching style has become increasingly prevalent with data supporting the role for blending learning in the classroom. Blended learning is taking center stage due to the ability of incorporating self-learning with typical didactic criteria in teaching students. This type of learning also allows students to review material outside of class multiple times to enforce mastery of the subject.

On the other hand, blended classrooms can be a burden on students with extra out-of-classroom material being included in an already overwhelming pharmacy curriculum. As more professors utilize flipped classrooms, students will have to complete more work at home. Sometimes, teachers from different courses don’t realize how much they are burdening the students with work because they fail to coordinate how much out of classroom work the students are overall receiving. Some students will go as far as skipping class if they have not reviewed the material required prior to class time due to spending time on other academic activities.

Guidelines and Best Practices

Kahanova and colleagues recognized a deficiency in guidelines for professors wishing to utilize flipped classrooms and attempted to create a resource for teachers.¹ This study looked at mid-point and final evaluations of 10 flipped courses over the span of two years.¹ Using a coding system, the researchers determined which factors were recurring throughout these evaluations.¹ The recurring themes that were brought up in student evaluations included: advantages of blended learning along with concerns about implementation, benefits of pre-class learning and factors that can negate the benefits, the role of the instructor for ensuring the flipped classroom activities are successful, and the need for assessments that coincide with what was taught during the blended lesson.¹ Overall, this study gives a good guideline of what professors should consider when including flipped classrooms in their curriculum and how to ensure this flipped classroom will be beneficial for everyone, teachers and learners, involved.

          Another study from the University of Wisconsin-Madison School of Pharmacy, looked at blended learning in depth and recorded answers of student’s perception of flipped classrooms.² This study took a group of P1, P2, and P3 students who were to give feedback on blended learning.² The major findings of this study were the answers to what that professors should have in place if one desires to utilize a blended classroom. The study listed factors as best practices for those who may want to include blended classrooms in their curriculum. The best practices listed from this study were: setting the stage, consistency with team teaching, timeliness, time on task, structured active learning, faculty feedback on student preparation, incorporating student feedback, reviewing online material during the class, and utilizing technology.² These characteristics help a course coordinator set up a blended learning environment for success. As a recent pharmacy student, I agree with most these best practices. It is important to outline to students what is expected and how much time the activity will take. During pharmacy school, time management was difficult as many classes would pull you in opposite directions and rotations had many assignments in addition to didactic courses. Having these parameters in place will facilitate the best learning environment for student success in flipped classrooms.

          Overall, blended learning has revolutionized how material is delivered to learners. This type of classroom allows the learner to supplement didactic material with online modules. There are many advantages and disadvantages to blended classrooms. It is important for the professors to have these benefits and pitfalls in mind while designing a flipped classroom activity.

           

References:

1.    Khanova J, Roth MT, Rodgers JE, et al. Student experiences across multiple flipped courses in a single curriculum. Med Educ. 2015 Oct;49(10):1038-48. 

Available from: http://onlinelibrary.wiley.com.proxy-hs.researchport.umd.edu/doi/10.1111/medu.12807/abstract;jsessionid=B686165E3CF7BE8E19F9BBDD0267B880.f04t02

2.    Margolis AR, Porter AL, and Pitterle ME. Best Practices for Use of Blended Learning. Am J Pharm Educ. 2017;81(3):Article 49.

Available from: http://www.ajpe.org/doi/full/10.5688/ajpe81349

Engaging Kinesthetic Learners in Pharmacy Education

Mallory Mouradjian, PharmD, PGY1 Pharmacy Resident, UMMC

Within any given classroom, each student may have a different learning style in which they best gather and store information. Some learners understand information best by reading information or interpreting graphical information while others may prefer to listen to a podcast. One common method used to classify learning styles utilizes the VARK modalities, first described by Fleming and Mills in 1992. The postulated that there were four categories that learning modalities could fall under:

• Visual: learn best through visual depictions such as charts and graphs
• Aural/Auditory: learn best via listening and reciting back in their own words
• Read/Write: learn best via textual inputs/outputs, like to read and digest information on their own time
• Kinesthetic: Learn best through hands-on experiences

Given the variety of modalities that students utilize to understand information, it is in the best interest of an educator to attempt to incorporate diverse activities into the structure of their courses. Busan et al. conducted a survey of 230 medical students in 2014 in an effort to characterize the distribution of learning styles of learning in the medical field. They issued a questionnaire that placed students into 3 categories, visual, auditory, and kinesthetic. They found that 33% were visual learners, 26% auditory, and 14% kinesthetic. The remaining students were classified as multimodal, meaning that they preferred two or more of the learning styles, namely 12% visual and auditory styles, 6% visual and kinesthetic, 4% auditory and kinesthetic, and 5% utilized all three styles¹.

Busan et al.  demonstrated that there is a significant portion of learners that are classified as kinesthetic learners. Despite this information, some academics claim that kinesthetic learners may be the least engaged group in modern education.² This is not necessarily a surprise as It can be a challenge to incorporate activities for kinesthetic learners in the classroom, especially if the format is lecture-based.

Kinesthetic learners, as the name implies, understand information best when they can carry physical, hands-on activities. They “learn by doing,” not by listening or reading material. They benefit from learning experiences that incorporate case study and real-world scenarios in which that can role-play and use critical thinking. When looking at pharmacy school programs, kinesthetic learners benefit most from the last year of experiential education but may be poorly engaged prior to this last year of clinical rotations. Some pharmacy schools have begun implementing activities in order to reach this under-engaged group of learners. Below are some possible activities that may help to engage kinesthetic learners.

Real-world Simulation with a Virtual Patient

A group of educators at MCPHS University incorporated a virtual patient software program into the curriculum of their pharmacotherapuetics course. The software allowed students the opportunity to interview a patient, perform a physical exam, and provide medication counseling to digital standardized patient. This was intended to supplement the therapeutics course as it focused on disease states that were being covered in the course. The students were evaluated on their ability to conduct a mock clinic visit. They found that students that utilized the software conducted more thorough patient interviews during their mock clinic visits and students felt that this experience had been helpful in their understanding of the material.³

Case-based Learning

Another strategy that can be utilized to engage kinesthetic learners is to complement traditional learning methods with case-based learning to encourage higher order thinking. Case-based learning generally involves the distribution of a realistic patient case, complete with all of the pertinent laboratory data and patient history, and students are required to work through the case, develop a care plan, and provide supporting literature. The case is then discussed in small groups of 6 to 10 students to encourage collaborative thinking and problem-solving. Jesus et al. found that students that participated in the case-based learning had improved clinical decision-making and learning motivation as well as higher post-exam scores.

Gamification

Gamification is the practice of adapting a game for a purpose of education. This method can reach kinesthetic learners because it allows them to learn while physically participating in an interactive activity rather than simply listening to a lecture. Educational games can range from Jeopardy-type games that facilitate memorization of drug names, indications, and adverse effects, to games that require students to apply information learned in lectures in realistic scenarios. In a systematic review from 2105 that reviewed the use of games in pharmacy education found that educational games may help “complement and reinforce taught material by promoting students’ participation and engagement in an interactive, enjoyable, and motivational learning environment”.⁵

Kinesthetic learners are an under-engaged group in the medical educations. It can be a challenge to incorporate activities that involve hands-on activities in a lecture-based course, however there are potential benefits from encouraging hands-on and critical thinking activities as a supplement to the class.

References:

[1] Busan A. Learning styles of medical students. Curr Health Sci J. 2014;40(2):104-110. Full Text

[2] Wood N, Sereni-Massinger C. Engaging online kinesthetic learners in active learning. Proceedings of IMCIC – JCSIT 2016:116-119. Full Text

[3] Taglieri CA, Crosby SJ, Zimmerman K, Schneider T, Patel DK. Evaluation of the use of a virtual patient on student competence and confidence in performing simulated clinic visits. Am J Pharm Educ. 2017;81(5):1-9. Full Text

[4] Jesus A, Gomes MJ, Cruz A. A case based learning model in therapeutics. Inov Pharm. 2012;3(4):1-12. Full Text

[5] Aburahma MH, Mohammed HM. Educational games as a teaching tool in pharmacy curriculum. Am J Pharm Educ. 2015;79(4):1-9. Full Text

Cultural Sensitivity in Shaping Education

By Mari Cid, PharmD, PGY1 Community Pharmacy Resident

University of Maryland, School of Pharmacy

According to a paper published by the American Medical Association, cultural competency, or cultural awareness and sensitivity, is defined as, "the knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own. It involves an awareness and acceptance of cultural differences, self awareness, knowledge of a patient's culture, and adaptation of skills".¹ The foundation of our American culture is in our cultural diversity as the melting pot of the world. Though there is beauty in our differences, diversity is not without its challenges. It is important to grow as a society as we grow in our diversity and one of the ways that begins is within our education system. Implementing cultural sensitivity and awareness into our education system will shape new ways of learning and is important to the success of future generations.

Historically, the most vulnerable students come from low income background and are people of color who are usually at the bottom of achieve gap with the lowest graduation rates. It is naive to think that one perfect system will work for every student. Across the United States, difference cultural values and economics play a vital role in the curriculum at different schools. As a Pilipino-American who grew up in Southern California, I was fortunate to grow up with many people who shared my similar background of immigrant parents. This identity in our community shaped curriculum in our school districts. With a significant number of us growing up Asian-American, I was able to take a Filipino class and learn about the culture of the Philippines through language, food, and dance in a classroom and never had to struggle with feeling a connection to classmates and teachers. I excelled in school, eventually earning my Doctorate in Pharmacy. Unfortunately that is not always the case.

In his TED talk, Manuel Hernandez, an educator, author, ESL (english second language) teacher in New York City describes seeing a lack of connection to curriculum as a challenge in his classroom. ² He saw that multicultural students wanted to learn, but classroom materials, such as Shakespeare, weren’t relatable to their own cultural experience. To meet this challenge, he introduced Latino/a literature and noticed a significant difference in the classroom when culturally relevant materials were introduced into the learning experience.² He noticed students began to participate and were more engaged in the class.² Through his efforts, he was able to bridge the gap of communication to help teach his students to learn English, to read, stay in school and pass citywide exams.

In a another TED talk, Dr. Melissa Crum noticed that many teachers had challenges teaching and relating to students who did not share their same cultural background.³ Most teachers today are female coming from a middle income, white background which is not a reflection of the students today. To help bridge this gap, Dr. Crum worked with a museum educator to create an arts-based professional development series that helps educators think about how they are thinking about their diverse students. Though discussion was sometimes uncomfortable, better understanding of different cultural backgrounds was essential for the educators to be able to reach the students. Dr. Melissa Crum also states that studies have shown that that students who are more engaged have high academic achievement, lessen the dropout rate, and result in more productive citizens.³

Arguably, one of the most culturally diverse states is Hawai‘i. A research study there indicated that learners thrive with culture-based education (CBE), especially indigenous students who experience positive socioemotional and other outcomes when teachers are high CBE users and when learning in high-CBE school environments.⁴ Researchers from the study believed educational progress will come from forward-oriented research and leadership that embraces the cultural advantages of students with diverse experiences of racism, poverty, cultural trauma, and oppression.⁴ As an alumni of the Daniel K. Inouye College of Pharmacy from Hawai‘i, I experienced first hand how they integrated culture into our curriculum as school. Being a student from the Mainland (the continental United States), the roles were now reversed with me having to learn the culture of the classroom. From learning local language to be able to better communicate with patients, to familiarizing myself with local customs such as paying respects to the ʻĀina, and spreading aloha spirit. I took the cultural experiences I had from when I younger and applied the same mindset to learning about another culture to expand my perspective and education. I felt that the additional training of cultural competency adding value to my education as a future pharmacist. It gave me unique opportunities to apply what I learned in the classroom to real world experiences.

Cultural competence training has grown to be a fundamental part of the work environment. It is an essential part of any new employee and professional training. It is important to apply our cultural competency training, especially as healthcare workers because our job is to help our patients achieve their optimum health no matter what background they come from. Studies have already shown that cultural competence in healthcare plays an important role in patients being satisfied with their providers, as well as patients willingly and actively participating in their treatment.⁵ This has contributed to expanding technology to bridge the language barrier in communication. As pharmacists, we are also educators and it is essential that we practice cultural sensitivity with our patients and continue to find new and innovative ways that we can educate them on their medications so they can achieve the best outcomes of their therapy.

In conclusion, practicing cultural sensitivity is another way we can improve education in our diverse communities. I am an example of applying cultural sensitivity in my education and I continue to apply what I learned and grow through my new experiences as a pharmacist. As a society, continuing to find ways to integrate this mindset into our education system is where we can start to contribute to the growth of a stronger, wiser, and understanding students. 

References:

1. Fleming M, Towey K. Delivering culturally effective health care to adolescents. Chicago (IL): American Medical Association; 2001. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/39/culturallyeffective.pdf. Retrieved August 26, 2017.
2. Hernandez, Manuel. (2015, March). Bridging the cultural gap in the classroom | Manuel Hernandez Carmona | TEDxAmoskeagMillyard. [Video File]. Retrieved from https://www.youtube.com/watch?v=Br22BFA7bAg
3. Crum, Melissa. (2015, July). A Tale of Two Teachers | Melissa Crum | TEDxColumbusWomen. [Video File]. Retrieved from https://www.youtube.com/watch?v=sgtinODaW78
4. Kana‘iaupuni SM, Ledward B, Malone NO. Cultural Advantage as a Framework for Indigenous Culture-Based Education and Student Outcomes. American Educational Research Journal. 2017;54(1):311S-339S. doi:10.3102/0002831216664779.
5. Brunett M, Shingles RR. Does Having a Culturally Competent Healthcare Provider Affect the Patients’ Experience or Satisfaction? A Critically-Appraised Topic. Journal of Sport Rehabilitation. 2017:1-14. doi:10.1123/jsr.2016-0123.

Teaching Controversial Topics Using Conflict

By James Leonard, PharmD, Clinical Toxicology Fellow, University of Maryland School of Pharmacy

“Medicine is black and white.” This is a phrase not commonly uttered in medical practice.(1) Diagnoses are based on probabilities; therapeutic decisions are based on balancing the benefits (number needed to treat) with the risks (number needed to harm). Medicine is fraught with controversy, but we teach students, residents, and new practitioners that they need to be practicing guideline directed care. There are many fields of medicine (cardiology, infectious disease, epilepsy) that have practice guidelines based on robust data and large studies. We teach these topics as right and wrong, asking students to go down the steps of adding antihypertensives based on JNC-8 or adding the “correct statin” based on a patient’s risk profile. On the other hand, my area of practice, toxicology, has a limited evidence base and practice is highly based on experience and small studies. This means that the field if full of controversy. This blog post will cover educating learners on topics filled with controversy.

What is controversy?

Controversy is a type of conflict where one person’s understanding and conclusions are incompatible with another’s.(2,3) It is incredibly easy find controversy in issues rooted in ethical, r

eligious, or political beliefs.(3) Most of these issues are more difficult to study with hard science and are dependent on emotional and experiential arguments. On the other hand, medical practice is primarily based on experimental “facts” and practicing outside of those facts is often deemed unreasonable. With our history of medical reversal (disproving what is “known” about a medical practice through completion and publication of superior trials; think about beta-blockers as contraindicated in heart failure prior to the 1990s), it is important to question the facts and learn to practice with an understanding that there is always controversy in medicine.(4)

How can we use it to teach medicine?

We can use controversy to teach medicine more thoroughly than most other methods. In their article “Energizing Learning: The Instructional Power of Conflict,”(2) Johnson and Johnson describe using controversy to teach by a few simple steps. First, you assign students either alone or in small groups to learn “their” side of a controversy. Next, both sets of students present their arguments in a situation that is not a conventional debate; there is no winning. The instructor plays devil’s advocate, chimes in with experience, and acts as mediator. Next there is an open discussion with students presenting facts, supporting their positions, and engaging with each other. The fourth step requires students to swap perspectives and learn and argue the other side of the issue or other aspects of treatment. Finally, students get together to devise a new, integrated solution. The authors hypothesize that this method provides a higher level of understanding of their original side of the controversy, challenges their understanding, and then sparks their epistemic curiosity, leading to seeking out new knowledge. I think of this process as very similar to forcing students along the Dunning-Kruger curve by challenging their understanding of a topic by immediately introducing healthy doubt (Dunning and Kruger presented the idea that people often do not know what they do not know, but will be confident in their abilities regardless of their knowledge. The graphs from their seminal article have been combined as shown and elaborated on by some authors).(5) Additionally, more experienced practitioners can step in to remind learners that patients do not read textbooks to know how they should present or react to therapies. The teaching certificate course utilizes different teaching theories and use of controversy in combination with other theories can add to our arsenal of teaching methods.

What problems occur with controversy?

The setting needs to be right and rules need to be put into play. Learners need to have the emotional quotient to poke holes in only ideas and not attack others personally. Additionally, learners need to recognize that their opinions are being challenged. There is a fear that emotions can get heated in the classroom and things may get “out of hand.” Warren and Center provided a series of tools to manage students that get heated and to encourage learning despite controversy.(6) Some of their most useful tools include only letting students attack ideas and if the conversation gets too heated, intervene and have students leave the conversation temporarily. If students do not have open minds, they can misunderstand the exercise and get emotionally attached to their side of the topic.

Has controversy been used to teach medicine before?

In short, the answer is yes. The Social Media and Critical Care annual conference utilized debates in medicine taking on hot topics like code status, use of c-collars, and the evolution of emergency medicine. These are debate style discussions, but often assign speakers to promote the side they have been publicly against.

Medicine is full of controversy whether we like it or not. Teaching students underlying evidence and presenting their summaries with opposing opinions can enhance the learning of everyone involved. Preceptors can act as mediators, play devil’s advocate, and offer experiences that stimulate conversation. This method of teaching, while time-intensive, encourages learners to get excited about topics and has potential to revolutionize education.

References:

1.   Simpkin AL, Schwartzstein RM. Tolerating Uncertainty - The Next Medical Revolution? N Engl J Med. 2016 Nov 3;375(18):1713–5. Full Text

2.   Johnson DW, Johnson RT. Energizing Learning: The Instructional Power of Conflict. Educational Researcher. 2009 Jan 1;38(1):37–51. Full Text

3.   Hendricks JS, Burkstrand-Reid B, Carbone J. Teaching Controversial Topics. 2011. Full Text

4.   Prasad V, Cifu A. Medical reversal: why we must raise the bar before adopting new technologies. Yale J Biol Med. 2011 Dec;84(4):471–8. PMC3238324

5.   Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999 Dec;77(6):1121–34. Full Text

6.   Warren L, DB Center. Managing hot moments in the classroom. Cambridge. 2006. Full Text

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.

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