October 20, 2011

Creating a Critical Learning Environment

By Calvin J. Meaney, Pharm.D., PGY-1 Pharmacy Practice Resident, University of Maryland Medical Center
In his widely celebrated book “What the Best College Teachers Do”, Ken Bain proposes that a vital asset of an effective teacher is the ability to create a “natural critical learning environment.”1 In this environment, a student is able to apply prior knowledge and encounter a new idea or concept.  In so doing, the student is require to critically evaluate the idea and draw conclusions based on guidance from the teacher and shaped by their own knowledge in collaboration with other students.

An atmosphere such as this would be ideal!  But many educators struggle with implementation.  Bain argues that such an environment can be created in nearly any class or discipline.  Below is a step-wise guide:

1. Ask a question
By posing an intriguing question or problem to students they will be internally motivated and feel engaged in their learning.  It demonstrates to the students that the teacher respects their autonomous thought process and has genuine interest in their assessment of the question.  Selecting a provocative or controversial topic is an effective technique to stir the pot and stimulate student participation.

2.  Explain the significance of the question
The context and importance of the question/problem needs to be emphasized by the teacher.  This will further motivate students.

3. Encourage high-order intellectual activity
Bloom’s taxonomy recognizes that evaluation, analysis, and synthesis are at the top of the cognitive pyramid.2  Engaging in these higher order activities are the goal of a critical learning environment.  Bain defines effective learning in that it makes “a sustained, substantial, and positive influence on the way a student acts, thinks, and feels”.  This is achieved through high-order intellectual activity.  This step is the “meat” of the critical learning environment and often the most difficult to achieve.  Engaging in active learning techniques is fundamental.  Michael Prince reviewed the available literature on effectiveness of active learning techniques in an engineering curriculum.3  He concluded that all modalities of active learning have proven benefits, with problem solving and cooperative activities having the largest effect size.

4. Facilitate the student’s ability to answer the question 
An effective critical learning environment should foster the ability of the students to draw conclusions based on evidence and prior knowledge.  The teacher needs to recognize when re-direction needs to be given students or groups by evaluating their progress through the given problem.  Key verbs are:  encourage, engage, and challenge.  Students should be motivated to make a stance and defend it. In order for a student to think critically they must feel comfortable.  The atmosphere should be non-judgmental, feedback should be constructive and consistent, and collaboration between students should be encouraged. 

5. Leave the students with a question
If the learning environment has been successful, students should leave with a thorough understanding of the topic, but should also be inquisitive about what comes next.  The “so now what?” question should be raised at the end of class to emphasize this.
How do we apply this to pharmacy education? 

In pharmacy education, the case-based approach appears to be the ideal mechanism by which to create a natural critical learning environment.  This student and problem-centered approach to instruction has been shown to improve critical thinking and clinical decision making.4,5  An active learning approach to the cases facilitates the learner’s involvement and can improve participation and motivation.

From my own experience in my doctor of pharmacy program, I can recall class sessions when active, case-based learning activities created an effective critical learning environment.  My large class was divided into groups of ten students and each group was given a different case related to the same topic.  There were four questions posed for each case that were intriguing because they were open, complex, and controversial.  Each group was given time to research the case, consider the questions, and discuss their responses.  The instructor would walk around the room during the small-group research/discussion period to foster critical thinking by asking additional questions, providing guidance in a non-judgmental fashion, and giving feedback on preliminary answers.  Later, each group presented the case, questions, and answers to the whole class.  As each group presented their case, the questions were displayed on the screen so that the other groups could consider what their own responses might be.  The group would then present their responses, justifications, and defend them if questioned by other groups or the teacher.  At the end of each session, students were asked to write on an index card two things that they learned and two unanswered questions.

This method incorporates all 5 steps outlined in best practices for creating a critical learning environment and was, in my opinion, a very effective teaching strategy.  Indeed, the performance of the students on the exam we took after this session was one of the highest during our entire four-year program.

1.  Bain K. What the Best College Teachers Do. Cambridge, Massachusetts: Harvard University Press; 2004.
2.  Bloom B, Engelhart M, Furst E, Hill W, Krathwohl D. Taxonomy of educational objectives: the classification of educational goals. In: Green, editor. Handbook I: Cognitive Domain. New York: Longmans; 1956.
3.  Prince M. Does Active Learning Work? A Review of the Research. Journal of Engineering Education 2004;93:223-31.
4.  Fisher RC. The Potential for Problem-Based Learning in Pharmacy Education: A Clinical Therapeutics Course in Diabetes. Am J Pharm Educ 1994;58:183-9.
5.  Cisneros RM, Salisbury-Glennon JD, Anderson-Harper HM. Status of Problem-Based Learning Research in Pharmacy Education: A Call for Future Research. Am J Pharm Educ 2002;66.

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