December 3, 2014

Competition in the Classroom: Is it Healthy?

by Alice Lee, PharmD, PGY1 Pharmacy Practice Resident, Kaiser Permanente Mid-Atlantic States

You have competition every day because you set such high standards for yourself that you have to go out every day and live up to that.” 
– Michael Jordan

Competition exists in our daily lives. People often seek to achieve superiority in a variety of ways, from social situations to organizational charts. In the classroom, students compete for class rank, best exam scores, leadership roles within student organizations, or internship positions at well-known companies. Some people view competition as a problem in educational settings because, although some thrive on competition, it leads to loss and failure for others.  On the other hand, some see it as an important and potentially transformative educational method.

Competition can play an important role in student achievement as it motivates students to excel. A randomized control trial has shown increased efficiency and improved self-awareness in class activities when students were in a competitive environment.1 However, it also has some downfalls.  Competition can trigger stress, anxiety, and discouragement, which can lead to disengagement. Some may argue that it is important for students to face “real world” situations by artificially creating competitive class activities. However, this cab not only leads to unhealthy competition, but also forces students to adopt a specific world-view.1  To be effective, instructors need to have a good understanding of the purpose of competition, how students will perceive the situation, and what consequences the activities will bring. If the instructor’s focus is to determine winners and losers by comparing students to one another, the learning purpose of the activity will be diminished.  When competition become the goal, the students will focus on the end product and winning rather than the learning process and self-reflection on the completed task. Must there always be a winner and losers in a competition? Can competition be used to create mutual benefits for all students?


Instead of focusing on individual student’s success and achievement, the concept of competition can be used in the context of group work. The instructor can introduce competitive goals to the class and divide students into smaller groups. This can shift students’ attitudes from individualized achievement to reaching a goal through interdependent work. Some examples include knowledge based jeopardy and trivia questions. When forming a group, it is important to avoid any gender-based division or creating groups based on students’ academic status or the instructor’s personal biases. Grades should be distributed evenly with an emphasis on participation and group support. In addition, instructors should keep in mind that there is the potential for some team members to dominate, which can unintentionally lead to marginalization of less skilled students.

Several competition based team learning activities have been built into healthcare professional schools’ curriculums.  For example, Regis University School of Pharmacy’s curriculum describes the importance of team-based learning.2 Groups are assigned to complete a pre-class learning exercise. Each exercise is designed such that individual students fully contribute to solve challenging problems. During the class time, each group reveals their answers simultaneously and compete with other teams for correct answers. Each group is accountable for their own work. Through these competitive team activities, the faculty believe it motivates students who do not normally participate in group activities. This showcases the potential benefit of bringing competition into team-based learning activities.


In every competition, one person wins and others lose. Ideally, we want to see both winners and losers treating each party with respect and accept the results as part of the learning process. Students who did not win can sometimes take the loss personally and let that hinder their willingness to contribute in the future. To reduce these negative consequences, instructors should use structured post-activity evaluation to assess the fairness of the activity and the student’s self-reflection regarding their performance. Student can be asked the following questions immediately after the activity:3
  1. How did my participation impact my team’s and my personal results?
  2. What strengths did I bring to the team performance?
  3. What should I improve to achieve better results next time?
In Transformative Classroom Management,3 Shindler describes how to create healthy and avoid unhealthy competition in a classroom:

In healthy competition:
  • The primary goal is to have fun
  • The competition goal is not “real or important” nor is it characterized that way
  • The learning or growth goal is conspicuously characterized as valuable
  • The competition has a short duration and is characterized by high energy
  • There is no long-term effect from the episode
  • All individuals or groups have a reasonable chance of “winning”
  • Students all firmly understand these points 
In unhealthy competition:
  • It feels real - the winners and losers will be affected
  • The competitive goal/reward is “valuable” and is characterized that way
  •  The learning task is characterized as a means to an end (winning the competition)
  • Winners are able to use their victory as social or educational capital at a later time
  • Competition implicitly or explicitly rewards the advantaged students
  • Over time students develop an increasingly “competitive mindset.” 
Competition in the classroom can provide motivational learning opportunities and fun for the students if cautiously managed. Instructors must objectively evaluate the potential impact of competition and try to find an appropriate place for it in educational settings.

  1. Worm BS, Buch SV. Does competition work as a motivating factor in e-learning? A randomized controlled trial. PLoS ONE. 2014; 9(1):e85434.
  2. Regis University School of Pharmacy. School of Pharmacy Supplemental Student Handbook 2014-2015. 2014.
  3. Bender, D. Randall KE. Description of an interactive jeopardy game designed to foster self-assessment. The internet Journal of Allied Health Sciences and Practice. 2005; 3(4).
  4. Shindler J. Transformative Classroom Management, Positive Strategies to Engage All Students and Promote a Psychology of Success. San Francisco: Jossey-Bass; 2010.

November 26, 2014

Servant Teaching: Applying the Principles of Servant Leadership to the Classroom

by Ashlee Mattingly, Pharm.D., Clinical Instructor, University of Maryland School of Pharmacy

There has been a push in recent years for education to transition from teacher-centered approaches, which is mainly comprised of didactic lecturing where students passively learn the information, to student-centered methods, where students and teachers interact more and students take a more active role in their learning experience.  While the research has shown that student-centered methods are superior to teacher-centered methods, to effectively make this transition there must an attitudinal change.1

Robert K. Greenleaf first coined the term “servant leadership” in The Servant as Leader in 1970.  The servant leader puts the needs of others first and focuses on their growth and development.  The servant leader is servant first and leader second.2  In 2008, J. Martin Hayes proposed a model of servant teaching by applying the principles and values of servant leadership to teaching.3

If we apply McGregor’s Theory X - Theory Y styles of management to education, there would be two distinct teaching styles.  The Theory X teacher would be the authoritarian leader of the classroom.  The teacher determines what will be taught as well as how it will be taught.  The student is believed to lack motivation, be dependent on the teacher, and requires close supervision.  In contrast, the Theory Y teacher relinquishes the power and control.  The teacher instead allows the student to play a large role in determining the material and instructional methods.  The student is more autonomous and the teacher acts as a facilitator to guide the student.3,4  While traditional teaching more closely follows the Theory X method, J. Martin Hayes argues that Theory Y is consistent with the principles of servant teaching.3

Larry Spears describes how the ten characteristics of servant leaders can be applied to teaching.5  (See Table 1)  Servant teachers allow the students to determine their own learning needs.  Instead of the teacher simply transmitting the knowledge that they deem important to the student, the teacher must listen to what the students are saying (or not saying) in order to best serve the needs of the students.3,4,5,6 

Table 1 – Characteristics of Servant Teachers
Listen to students to help them determine their learning needs.
Understand the students’ perspective and foster an learning environment where student can openly express their thoughts
Some students will fail.  It’s an important part of the learning process.  Rebuild the student’s self-confidence after failure.
Help students understand the importance of an concept but allow freedom to formulate their own opinions
Be aware of students’ response to your teaching methods and be adaptable
Plan carefully using student-centered methods
See the big picture.  How do all the parts fit together.
Commitment to Growth
Help each student reach their potential.  Foster your own growth at a teacher.
Seek to improve the community and the profession.
Build Community
Create a welcoming environment but help students hold themselves and others accountable.

The servant teacher must understand that students have a lot of trepidation when they enter the classroom.  This may be due to a concern over a lack of knowledge or simply a fear of the unknown.  The teacher must be able to empathize with the students in order to calm these fears.  In order for the servant teaching method to work, the students must feel comfortable expressing their thoughts and opinions and it is the teacher’s responsibility to foster an environment that encourages this behavior.3,5,6

Servant teachers must also accept that students will fail and to understand that failing is an important part of the learning process.  The teacher must provide a safe environment to allow the student to fail but then to work to heal and rebuild the student’s self-confidence and self-esteem after a failure.3,5,6

The servant teacher relies on the power of persuasion (not their authority) and focuses on helping students understand why a certain answer (or approach) is correct.  The servant teacher explains to students why a certain topic (or concept) is important but allows students the opportunity to formulate their own opinions instead of merely forcing an idea.3,5

Servant teachers must be aware of how the students react to the lesson plan and teaching methods.  They must be able to adapt to serve the needs of the students.3,5  Moreover, servant teachers should use foresight and try to predict how students would react to a certain lesson plan or teaching method.  Teachers should plan for the unknown and make the commitment to foster a student-centered learning environment.3,5,6  Servant teachers must conceptualize how all of the parts fit together to make the whole and are able to communicate the importance of this to the students.3,5,6

The servant teacher makes a commitment to growth, not only the growth of each student but also one’s own personal growth.  The teacher understands that the learning process is never finished and is continually seeking feedback in an effort to improve.5,6

The servant teacher accepts the role of steward for the community and their profession.  They strive to encourage the students to be stewards as well.3,5,6  As stewards, servant teachers understand the importance of building a community in and outside the classroom.  They work to create a welcoming environment in the classroom where students feel comfortable sharing their ideas and opinions.  The teacher instills into the minds of the students the importance of holding others accountable, whether this is through group assignments or class participation.3,5,6

In one field based study traditional-age (18-24 years old) college students were surveyed regarding the characteristics they associated with their most and least effective teachers.7  The survey was was based on Laub’s Servant Organizational Leadership Assessment instrument.  This instrument utilizes the characteristics of servant leaders and attempts to measure perceived servant leadership qualities.8  Not surprisingly, the most effective teachers had strong servant leader qualities.7

Servant teaching can serve as the starting point for student-centered learning.  On an end of course evaluation where a teacher used a servant teacher approach, one student wrote, “The room had been transformed into an incredibly unique learning culture.  The class had established some of the highest levels of trust, respect and honesty that I have ever experienced in study or work…”3  If teachers accepting their new role as facilitators, students will take a more active role in their learning which will empower and better prepare them for the future.9

  1. Corley MA.  Student-Centered Learning.  Just Write! Guide.  American Institutes for Research.  February 2012:23-25. Accessed November 15, 2014.
  2. What is Servant Leadership?  Robert K. Greenleaf Center for Servant Leadership. Accessed November 1, 2014.
  3. Hays JM.  Teacher as Servant-Applications of Greenleaf’s Servant Leadership in Higher Education.  The Journal of Global Business Issues.  Winter/Spring 2008(2);1:113-134.
  4. Balfour DL, Marini F.  Child and Adult, X and Y: Reflections on the Process of Public Administration Education.  Public Administration Review Nov/Dec 1991(51);6:478-485.
  5. Spears LC.  Character and Servant Leadership: Ten Characteristics of Effective, Caring Leaders.  The Journal of Virtues and Leadership.  2010(1);1:25-30.
  6. Robinson FP.  Servant Teaching: The Power and Promise for Nursing Education.  International Journal of Nursing Education Scholarship.  2009(6);1:1-18.
  7. Drury S.  Teacher as Servant Leader: A faculty model for effectiveness with students.  School of Leadership Studies Regent University.  Servant Leadership Research Roundtable. August 2005.  Accessed November1, 2014.
  8. Laub JA.  Assessing the Servant Organization: Development of the organizational leadership assessment (OLA) instrument.  Dissertation, Florida Atlantic University, Boca Raton, FL.  Accessed November 15, 2014.
  9. Hannay M, Kitahara R, Fretwell C.  Student-Focused Strategies for the Modern Classroom.  Journal of Instructional Pedagogies.  March 2010; 2: 1-16.  Accessed November 15, 2014.

November 18, 2014

Role Play to Teach Cultural Competency

by Ijeoma Ekeocha, Pharm.D., PGY1 Pharmacy Practice Resident, the Johns Hopkins Hospital

Cultural competence is the capacity and awareness to care for a diverse patient population. Such awareness often requires being respectful and sensitive to the cultural differences of patients.1 In a world where patients may come from all walks of life, cultural competence is an essential skill that must be taught in curriculums intended to equip learners with the necessary tools to interact with people. One method that instructors can use to develop cultural competence is role play, which can be particularly useful in patient care settings.  Role play encourages learners to express their feelings and portray individuals from various backgrounds.  There are few opportunities for learners to do so in traditional teaching settings.2 In one study where role play was used in an industrial psychology course, students reported that role play was more valuable than conventional teaching approaches.3

Role play has been around for decades, and was originally developed to effect attitudinal changes during psychotherapy.  In 1956, Moreno, founder of psychodrama, utilized players to recite pre-defined lines.  This became the basis for role play in educational settings today.1 The definition of role play has since evolved.  It is a tool that promotes active learning and cultivates learner knowledge, skills, and attitudes.4  Role play entails the “acting-out of a specific situation based on the adopting of another character ‘role’.”5  An in depth look at the technique unveils questions to ponder. Are the roles actual, imitational, or fictional? Are they spontaneous or scripted? How structured and extensive should the role be?2

Using role play to teach cultural competence gives learners the opportunity to learn the material from a different perspective. When learners engage in role play, they take on a new persona. This provides students with deeper insights into the responsibilities of members of the healthcare team, such as the role of the nurse, dietitian, or patient. While every role on the healthcare team is important, the patient’s role is at the center. Therefore, when using role play to teach cultural competence, students should assume the role of a patient.  In so doing, it cultivates the student's interpersonal abilities.

Participating in role play allows learners to practice and develop skills and techniques that would be useful when encountering patients in real life. As learners get more exposure through these constructed exercises, it gradually increases their understanding of other cultures.  This, in turn, translates into increased respect for other cultures. Respect of others is a critical component of cultural competence that must be cultivated in school and necessary for success in clinical practice today.3

To successfully implement role play exercises, instructors must deliberately bring to light various issues that students may face in practice. Specific items that instructors should consider when developing role playing activities include: 3
  • Objectives
  • Time frame for the activity
  • Role specifications
  • Monitoring the role play process
  • Relating role play to theory
  • Delineating criteria to grade performance
  • Indicating the role of observers
  • Facilitating constructive analysis
When designing a role play exercise, instructors must consider the type of role play and clinical content to include. There are five types of role play, all of which can be employed depending on the anticipated outcome. The first type of role play is “Role-play as a creativity technique.” This type of role play is designed to elicit ideas from the role play experience. Learners must “bodystorm,” meaning they take part in a staged situation, which allows them to empathize with the character in the given situation. The actors transform into the characters which offers insight into the specific role.6

Another type of design is “role play as a research method.” This type of role play is most often use in settings to trial software in scenarios which can be useful in determining the success of marketed products. In these simulated scenarios, designers use role play to analyze feelings and insights of the end users while operating their product.6 This form of role play is often created for testing in a predetermined environment to identify how individuals will react in the real world.

While role-play can evoke ideas from the individual involved, it can also serve as a valuable tool for spectators.6 By incorporating concrete and intangible ideas, role-play can reveal important messages to the audience. This type of role play may be recorded so that students are able to replay the scenario and watch themselves through a recording. This role play is often used in schools so that students can learn from and evaluate their own performances.

“Role play as an artifact” is the result of a user experience.5 In this case, the role play is a product of the experiment. For example, this type of role play can be used to highlight a specific failure mode seen in the medication use system. A medication safety officer may design a role that includes an insulin pen that is verified appropriately by the Pharmacist, filled incorrectly by the technician, and is incorrectly checked by the checking pharmacist. This scenario allows pharmacy personnel to explore different failure modes of the medication use system through the use of role play drawn from a previous experience.

Lastly, role play can be used as a training method.6 This type of role play is often utilized in classrooms to help learners safely practice appropriate actions in simulation environments.6 Examples of this type of role play can be seen in mock code situations intended to prepare practitioners for real world emergencies.

In order to equip students with skills necessary to achieve the intended outcome of the role play, instructors must methodically develop a design that is tailored appropriately to their learners, which means considering the proficiency level of the learners. Once a design has been selected, teachers must incorporate a narrative that reflects the environment being portrayed. This step includes providing students with a clear and detailed description of the role in addition to information about the environment.3

Because role-playing may be carried out by different people, it can be difficult to reproduce. Therefore, instructors must provide materials such as a scripted dialogue(s), prop(s), and detailed setting description to help create an authentic scenario.6 In addition, the instructor must be cognizant of gender identification, race, and other demographics which will help bring the role to life.

During the final step, instructors should focus on debriefing with learners. This step is extremely important as it allows the students to reflect and evaluate the role portrayed. Instructors must encourage students to debrief after each role play and to analyze key issues that occurred during the activity.2  It is through reflection that new knowledge is generated.6

While all the steps outlined are important in creating a successful role play, I believe the most critical steps include the narrative and debriefing. In the narrative, instructors choose a role play type that will allow him/her to achieve the learning outcome.  Just as it is important for learners to debrief following a role-play activity, instructors must assess the learner’s performance during the activity. To assess the role play activity, instructors can use rubrics designed to assess oral communication.  Rubrics contain the framework of expectations for a specific learning exercise. The instructor’s assessment coupled with the learners self-evaluation will help maximize learning. In addition, role play may be assessed by students’ reaction to the simulation.3

Role play can be a useful learning tool that allows students to creatively develop and practice skills needed in various clinical settings. Role play is a useful and unique technique to teach cultural competence as it drives students to develop interpersonal skills required to communicate with patients from different backgrounds.

  1. Shearer R, Davidhizar R. Using Role play to develop cultural competence. Educational Innovations. 2003;53(6):273-76.
  2. Kodotchigova MA.Role Play in Teaching Culture: Six Quick Steps for Classroom Implementation. Identity, Culture and Language Teaching.2002:1-7.
  3. DeNeve KM, Heppner MJ. Role Play Simulations: The Assessment of an Active Learning Technique and Comparisons with Traditional Lectures. Innovate Higher Education.1993;21(3):231-56.
  4. McIlvired DE, Prucka SK, Herbst M, Barger C. The use of role-play to enhance medical student understanding of genetic counseling. Genet Med. 2008;10(10):739-55.
  5. Shapiro S, Leopold L. A Critical Role for Role-Playing Pedagogy. Perspectives. 2012;29(2):120-30.
  6. Thoring K, Mueller RM. The Role of Role-play: Intangible Systems Representation for Business Innovations. International Design Management Research Conference. 2012 Aug 8-9; Boston, MA.