Tuesday, October 9, 2018

Cultivating Lifelong Learners


By Monica Tong, PGY2 Geriatric Pharmacy Resident
University of Maryland School of Pharmacy

No matter what you choose to do in life, lifelong learning is a valuable skill to have and nurture. Lifelong learning is mainly an intrinsic process within the learner, but it may not inherently active within the learner. As William Osler, one of the founding professors of John Hopkins Hospital, states, “The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation.”1 As educators, our mission and goal is not only provide information and skills to learners but also cultivate a love, passion, and strategy for lifelong learning.

First, what is lifelong learning and why is it important?

Lifelong learning has been defined in many different ways. The multiple definitions of lifelong learning all encompass the ideas that lifelong learning is a lifelong quest. It is “flexible, varied and accessible at all times and in different places” and a process to empower the learner to grow and apply knowledge, skills, and understanding in any situation.2  To concisely state what it empowers us to learn, it is “learning to know; to do; to live together, with others’ and learning to become a complete person.”3 For example, lifelong learning could be the continuing education pursued after medical training required by licensure or the learner taking the initiative to critically evaluate new scientific literature.

Lifelong learning is an important process because it encourages the learner to address problems that they may encounter and promote well-being. Other benefits of lifelong learning include “sharpens the mind, confidence, interpersonal skills, career opportunities and the ability to communicate.”4 Within this changing society and technology, it is important to have the skills to adapt and continue to grow.

What are key characteristics and skills of lifelong learner?

As educators, it is important to understand the key characteristics and skills of a lifelong learner to develop instructional design methods and teaching techniques to encourage the growth of those characteristics and skills. These characteristics and skills are self-motivated learners, metacognitive skills, reflective behavior, and self-monitoring skills.5 Self-motivated learning refers to both self-directed learning and motivation where you have a learner who is motivated to learn on their own. For lifelong learners, they need to have the intrinsic characteristic to take the initiative and control of their own learning. Metacognitive skills are “taking responsibility and ownership of self-learning, making strategies for learning and choose appropriate strategies, scrutinizing the growth of learning, taking corrective measures, and evaluating efficacy of learning strategies, and shifting to other learning strategies.”5 Overall, it describes a process for the learner to create a construct for developing and improving on one’s learning styles, which is key in lifelong learning to maintain the process. The reflective behavior and self-monitoring enable the learner to reflect on strengths and weaknesses and then apply new strategies and repeat the monitoring process to improve upon the learning behaviors. Combined all these skills and characteristics create a successful lifelong learner. 

How can educators encourage and cultivate lifelong learners?

Promote an environment for lifelong learning:
Before one can implement educational techniques, it is important to create an environment conducive to cultivating lifelong learning. Erren et al applied aspects from Hamming’s ‘Ten Simple Rules for Doing your Best in Research’ to create ‘Ten Simple Rules for Lifelong Learning’.6 Rule 1 focuses on the “style of thinking” rather than the facts, so it goes back to the ‘why’ behind knowledge instead of purely memorizing the facts.6 Rule 2 is adding structure to the learning instead of trying to absorb it all.6 Rule 3 prepares the learner to interact with the growing and changing society/field.6 Rule 4 prepares learners for the future but don’t ignore the past since there are lessons to be learned from the past.6 Rule 5 is adding that personal touch with learning.6 Rule 6 is learning from others especially their successes.6 Rule 7 is learn from your efforts and mistakes to find what works best for you.6 Rule 8 is it is up to you to learn.6 Rule 9 is have a vision of where you are headed.6 Rule 10 is “make your life count: struggle for excellence.”6 It seems there are many rules to implement within the educational setting, but with these rules, you have a framework. For example, when precepting a learner asking them the why behind decisions/recommendations, adding the personal touch with their involvement in the care, or modeling for them are educational techniques that can be incorporated to encourage lifelong learning.

Educational techniques for lifelong learning:
Problem-based learning, reciprocal teaching, and reflection are educational techniques that can be used to support the growth of lifelong learners.5

Problem-based learning (PBL) is an approach that presents a real-world problem to the learners. It encourages the learner to apply their knowledge and skills rather than presenting the information to the learner.5 Within PBL the learner goes through phases to hone different lifelong learning skills. For example, in the classroom of pharmacy students, a case study is given to each student group to work on and present. In Phase 1 of this PBL activity, the students would be analyzing the problem presented in the case, processing comments of group members, and creating strategies to meet the completion of the assignment.5 This process promotes metacognitive skills as the students create a construct for approaching the problem individually and as a group. In Phase 2 of this PBL activity, the students would then be working more individually through self-directed learning and motivation to complete the case. In Phase 3 of this PBL learning activity, the students will then apply the learning to the actual case. In Phase 4 of this PBL learning activity, the students will reflect on the knowledge gained in the process and develop self-monitoring plans and strategies.

Reciprocal teaching is a technique where the learner may act as the teacher. It is “instructional procedure that takes place in a collaborative learning group and features guided practice in the flexible application of four concrete strategies to the task of text comprehension: questioning, summarizing, clarifying, and predicting.”5 Examples of reciprocal teaching in the classroom include small group discussions and cases. Reciprocal teaching encourages the learner to develop metacognitive skills and self-directed learning as they take on the role of the teacher in the discussions. The teacher is still there to support the learning process and discussion.

Reflection activities help the learners develop mindsets for identifying learning strengths and areas of improvement and take responsibility for their learning. From reflection, the learner will create strategies to improve upon their learning and monitor growth. For example, in the classroom setting, there may be reflective evaluation assignments for the students to complete after completing a project. Within this reflective activity, students are encouraged to think critically about what they learned during their experience and how to improve.

Through educational techniques that promote self-motivated learners, metacognitive skills, reflective behavior, and self-monitoring skill, as educators, we can take steps to cultivate lifelong learners.

References:
  1. Sir William Osler. “Osler's "a Way of Life" and Other Addresses, with Commentary and Annotations”. Duke University Press 2011; p.339.
  2. Talati JJ. Lifelong learning: Established concepts and evolving values. Arab J Urol. 2014;86 - 95.
  3. Delors J, Mufti IA, Amagi I, et al. Learning: the Treasure Within Report to UNESCO of the International Commission on Education for the Twenty-first Century. UNESCO: Paris; 1996; 2013 p. 37. Available from: http://unesdoc.unesco.org/images/0010/001095/109590eo.pdf
  4. Laal M and Salamati P. Lifelong learning; why do we need it? Procedia - Social and Behavioral Sciences. 2012; 399 - 403.
  5. Mahajan R, Badyal DK, Gupta P, et al. Cultivating lifelong learning skills during graduate medical training. Indian Pediatr 2016; 53(9):797-804.
  6. Erren TC, Slanger TE, Grob JV, et al. Ten Simple Rules for Lifelong Learning, According to Hamming. PLoS Comput Biol. 2015; 11(2):e1004020




Working Memory and Learning


Gaelle Njonkou, PharmD
Pharmacy Resident
Holy Cross Health

What is the working memory? The working memory is the mental ability to process, store, retain, and apply information1, therefore a process for higher-order cognition in connection to both short-term and long-term memory processes. There are two different types of working memories: the auditory memory, which consists of processing information presented orally, then storing and retrieving it when necessary; and the spatial memory where we retain observed information1. For example, when students are taught new equations or physics concepts, they need to remember the related basic formulas in order to identify what operations to use to solve a specific problem. The concept of spatial memory also applies to pharmacy students as they learn pharmacy calculations and pharmacokinetics of vancomycin or aminoglycosides, which are extensively used in practice to provide appropriate doses to patients. The part of the brain related to the working memory is also responsible for focus and concentration. The working memory is therefore key for remembering information, attention, creativity, and learning.  Moreover, the auditory memory and visual-spatial memory are associated to attention functions of the brain, which helps us navigate from one object to another or update the working memory, to reach targeted goals.2 As a result, the working memory allows us to navigate from one concept to another, combine previously acquired knowledge, and comprehend complex tasks, including making clinical decisions. Understanding basic memory processes could enlighten instructors, as they guide their students at all stages of development and education, including health professional schools.

Students or learners are provided with information, which they store and retrieve to conduct tasks; however, students are different and might require an individualized approach to learn complex tasks. Research has found that training the working memory could ameliorate learning and education.3 Historical evolution and understanding of the working memory and learning have found that information should first exist in the working memory in an appropriate form in order to subsequently enter the long-term memory for retrieval at a later time.3 Sometimes the suitable form is modality-specific. For instance, Baddeley, Papagno, and Vallar investigated how a patient with minimal verbal short-term memory span could thrive in most ways and demonstrate average learning competencies.3,4   They concluded she exhibited a selective deficit and could not learn new vocabularies, which emphasizes variances in word-learning capabilities in children and adults.3 The differences in learning and memory abilities should be accentuated in pharmacy education in order to prepare students to become well-rounded pharmacists and effectively care for every patient they encounter. In addition, instructors, including in pharmacy, could adjust their teaching styles based on the students’ backgrounds and educational levels in order for them to retain and be able to apply lessons learned. Educational theories applied in pharmacy schools should possibly be designed using what we know about the working memory.  

The working memory has been found to be instrumental for scholastic achievements and cognitive functioning in general.2, 5Accurate identification of differences in working memory capacity between individuals could positively impact learning. Memory and attention capacities represent the aptitude to retain goal-relevant information in primary memory and to retrieve the information from the secondary memory, which is essential in complex span tasks (CSTs) where attention must progress between mental representations and recall of information.5After completing these tasks, information might be quickly forgotten. For example, pharmacy students will learn about pharmacokinetics and remember all the equations in order to pass an exam, possibly retain these concepts, and apply them in practice as externs on rotations and pharmacists in the future. CSTs necessitate storage of the information of a simple span task, such as remembering a list of words in order, in addition to processing the targeted task. 5

Research has found that CST performance is correlated to reading comprehension, cognitive ability, fluid intelligence, and ability to execute tasks necessitating attention control.5 Therefore, CSTs could be instrumental to assess capabilities of our working memory. In addition, intelligence and working memory could be further elaborated through associative fluency, divergent thinking idea generation, and convergent thinking (idea analysis). 6 Divergent thinking, which is the ability to generate ideas or a vast range of solutions to a problem could be beneficial to assess creativity or even solve problems. Studies have associated performance on divergent thinking tests to real-life creative behaviors and different creativity indicators at the elementary, junior high school, undergraduate, and graduate levels. 7 As a result, the utilization of divergent thinking by learners to generate ideas or find solutions emphasizes creative thinking and a progression toward convergent thinking to streamline the thought process and  “think outside of the box” in order to attain an appropriate solution. For example, pharmacy students participate in various national competitions, such as the Business Plan Competition, during which they design a business plan for a novel and potential pharmacy establishment. In addition, associative processing could then constitute a bridge between divergent thinking and convergent thinking by accessing remotely related ideas to create an effective solution to a problem or complete a task, such as utilizing information presented in a patient case to identify patient-specific therapeutic plans using lectures provided in class and/or identifying guidelines and relevant literature.

The working memory dictates the synchronous storage and processing of information during activities, such as the acquisition of knowledge, reading comprehension, and problem solving, as well as prevailing over distractions and balancing attention. These concepts all apply to learners at different stages; and efficiency in using our working memory could depend on age, experiences, educational levels, and cognitive abilities. Moreover, individuals with high working memory capacity have an advanced probability to succeed in developing novel approaches and responding to creative thinking tasks efficiently 7, expanding to critical learning and problem-solving. As a result, having a baseline understanding of the working memory and processes of learning could help instructors improve and tailor their teaching styles to their audience. Health professional students, including pharmacy students, are encouraged and taught to provide a holistic care to patients, including assessing health literacy and cognitive abilities when necessary.

References
1.      Morin, A. (2008). 5 Ways Kids Use Working Memory to Learn. Retrieved September 2018, from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/5-ways-kids-use-working-memory-to-learn
2.      Gade, M., Zoelch, C., & Seitz-Stein, K. (2017). Training of Visual-Spatial Working Memory in Preschool Children. Advances in Cognitive Psychology, 13(2), 177–187. http://doi.org/10.5709/acp-0217-7
3.      Cowan, N. (2013). Working Memory Underpins Cognitive Development, Learning, and Education. Educational Psychology Review, 26(2), 197-223. doi:10.1007/s10648-013-9246-y
4.      Baddeley, A., Papagno, C., & Vallar, G. (1988). When long-term learning depends on short-term storage. Journal of Memory and Language, 27(5), 586-595. doi:10.1016/0749-596x(88)90028-9
5.      Redick, T. S, et al. (2012). Measuring Working Memory Capacity With Automated Complex Span Tasks. European Journal of Psychological Assessment, 28(3), 164-171. doi:10.1027/1015-5759/a000123
6.      F. (2017, February 06). Divergent vs. Convergent Thinking: How to Strike a Balance. Retrieved September 2018, from https://www.extension.harvard.edu/professional-development/blog/divergent-vs-convergent-thinking-how-strike-balance
7.      Lee, C. S., & Therriault, D. J. (2013). The cognitive underpinnings of creative thought: A latent variable analysis exploring the roles of intelligence and working memory in three creative thinking processes. Intelligence, 41(5), 306-320. doi:10.1016/j.intell.2013.04.008
8.      K. (2017, May). Balance the Human-Computer Partnership to Enhance Creativity - Hot Topic. Retrieved September 2018, from https://www.knowledgebrief.com/hot-topic/balance-the-human-computer-partnership-to-enhance-creativity