Laughter and Learning

by Jonathan Grant, Pharm.D., PGY1 Community Pharmacy Practice Resident, Johns Hopkins Home Care Group

Is there a role in the classroom for laughter that leads to learning?  Or is laughter merely a distraction caused by side conversations between students?  Educators are constantly looking for better ways to engage students to enhance the learning experience.  A few studies suggest that humor produces psychological and physiological benefits that help students learn.¹  While humor can be used during any of Gagne’s 9 Events of Instruction, it  is perhaps most effective as means to gain attention, present new the material, and assess performance. The use of humor can serve as an attention grabber, stimulate students’ multiple intelligences, and appeal to various learning styles.

Laughter can engage students. Studies have shown that students were more likely to recall information about a lecture when it was interjected with jokes relevant to the topic.¹ For example, Randy Garner, PhD, used the following during a lecture about statistics and research methods — a metaphorical joke about a planned escape from prison between two prisoners in a jail located in the middle of a desert.²  One prisoner tries to escape alone after an unsuccessful attempt to persuade the other to go with him. The prisoner escapes only to find miles and miles of sand.  He is captured and returned to his cell. Upon his return, the prisoner that escaped exclaimed, “You knew! Why didn’t you tell me!?” whereupon the other remarks, “Silly man, you should know no one reports negative results.”² Well planned, appropriate, and contextual humor help students associate concepts from various courses.  Humor can include the use of self-deprecating jokes, cartoons related to the material, and appropriate situational humor.

In one study comparing humor-enhanced sessions with “standard” online course delivery, students were more likely to log onto Blackboard and stated that they enjoyed classes that used humor effectively.³ In the study, students assigned to the humor-enhanced section used social/interactive features (such as lectures, features, course documents, etc., more than the standard section).  This was determined by monitoring the number of mouse clicks in each Blackboard course category throughout a ten week academic term. The humor-enhanced section registered a significantly higher average number of clicks when compared to the standard section (583 vs. 418; p < 0.05).³ Although there were no significant differences in final grades between the two groups, the humor-enhanced group earned a significantly higher class participation points than the standard group (98 vs. 92 points;  p < 0.05).³  One major limitation to this study was the relatively small sample size — each section included only 22 students.  I believe larger studies need to be conducted to further validate the results.

In addition to helping to enhance the learning experience, humor has been linked with other psychological and physiological benefits.  Humor is a helpful emotional response that can buffer and relieve stress.⁴ Laughter has been shown to stimulate a physiological effect that decreases stress hormones such as serum cortisol and epinephrine.¹ Humor has also been linked to reducing anxiety and tension.¹ From a teaching perspective, humor can facilitate increased attention span, information retention as well as improve performance, problem-solving, team work, collaborative relationships, and coping strategies of students.⁵

The use of humor as a teaching tool must be harmonious with the learning experience. The overuse of humor can be perceived as a distraction and take students’ focus off of the material as they try to anticipate the next joke.   The primary focus needs to remain on educating, not entertaining.  Students do not want a stand-up comedian!  They want appropriate humor that is relevant, lightens the mood, and, most importantly, makes the information memorable.  Humor should not be disrespectful, insulting, or obnoxious as this may make students feel defensive or insulted.⁵  If used improperly, laughter can be a source of hurt. The goal is to laugh with each other, not at one another. When using humor, appropriate boundaries must be set and strictly followed.

Zach Stambor in his article entitled “The ‘ham it up’ how to”, gives the following tips for interjecting humor into teaching.⁶

“Make your syllabus funny - insert jocular descriptions in various sections of syllabus to make students read the syllabus.

Use real or hypothetical humorous situations - use TV clips, YouTube, or cartoons to enliven abstract concepts.

Ask punch line questions during question and answer sessions - set up a joke after asking a question.

Make questions and examples outrageous, ridiculous, or exaggerated - use patient cases with exaggerated situations.

Dramatize your material - develop skits or demonstrations with music.”

I think that the inclusion of some humor can maximize the learners’ experience. As a teacher, it is imperative that you put yourself in the shoes of the student when developing or incorporating humor into your instruction.  Humor should not only relate to the subject matter but be relevant to the audience as well.  This requires some extra effort but the more a student can relate and connect abstract concepts with familiar ones, the more likely the student will recall, retain, and apply the new material.  Most importantly, be yourself and have fun teaching!  Use humor as your instructional defibrillator — it can have beneficial psychologically and physiologically effects!

References
1. Stambor Z. How laughing leads to learning. American Psychological Association. June 2006, 37 (6): 62.
2. Garner RL. Humor in Pedagogy: How ha-ha can lead to aha!  College Teaching 2006, Vol. 54 (1); 177-180.
3. LoSchiavo F & Shatz M. Enhancing Online Instruction With Humor. Teaching Psychology, Vol. 32, No. 4;246-248.
4. Smith M & Segal J. Laughter is the best medicine. May 2013. Accessed October 8, 2013.
5. Chauvet S & Hofmeyer A. Humor as a facilitative style in problem-based learning enviroments for nursing students. Nurse Education Today. May 2007. Vol. 27 No. 4; 286-292.
6. Stambor Z. The ‘ham it up’ how to. American Psychological Association. June 2006 Vol 37, No. 6; 64.

Rote vs. Meaningful Learning

by Merid Belayneh, Pharm.D., PGY1 Pharmacy Practice Resident, VA Maryland Health Care System

“The mind is not a vessel to be filled but a fire to be kindled.”
― Plutarch (46 – 120 AD)

Karaste J. Available from: http://commons.wikimedia.org/wiki/File:Midsummer_bonfire_closeup.jpg

In pharmacy school I was encouraged to understand the material and not merely memorize it.  My professors were likely referring to the difference between rote and meaningful learning. Today, faculty and preceptors are strongly encouraged to use and frequently employ active learning strategies throughout the pharmacy curriculum.^1,2  While active learning is often used to foster meaningful learning, it is important to recognize that active learning does not ensure that meaningful learning actually occurs.³  Rote learning is still important and often pre-requisite.

Rote learning frequently involves repeating information until it's remembered.  Learners often resort to rote memorization because they are unable to relate new information to prior knowledge.^3,4 Meaningful learning is characterized by relating new information to prior knowledge.  When one recalls prior knowledge, all related information is more easily recalled.^3,4  Rote and meaningful learning lie on a continuum — they are not two separate entities.  Novak et al. describe three required conditions for meaningful learning: (1) the learner needs to possess relevant prior knowledge; (2) the material to be learned must be conceptually clear and presented with language relatable to the learner’s prior knowledge; and (3) the learner must choose to learn meaningfully.³  The student’s willingness to learn in a meaningful manner is something that teachers have the least control.  It can be indirectly influenced by using instructional and evaluation strategies that foster meaningful learning such as using active learning and team-based activities and reducing the amount of verbatim facts tested on exams.³

In order to encourage meaningful learning many pharmacy schools have employed a variety of active learning techniques including: cooperative learning, problem-based learning, team-based learning, and case-based learning.⁵   These methods of teaching enable students to identify their knowledge deficits as they attempt to apply their amassed knowledge.^3,5  However, these methods assume that students are willing to engage and have sufficient knowledge to convert their rote learning into meaningful learning.³  Unfortunately, students who lack (or unable to access their) prior knowledge often get very little out of these active learning sessions.  As pharmacy curriculums increasingly rely on these active learning techniques, there should be continued discussion on how to cultivate students’ abilities to develop a strong knowledge base.  Often this requires students to memorize material via rote learning.

To examine the importance of rote learning, let’s review two studies that looked at how students learn two different subjects: language and math. The first study evaluated two groups of 4th-5th graders.  One group had students that memorized root words for 20 different sessions and the other group did not.^6,7 The group that had memorized root words learned new vocabulary and figured out the meaning of words in context easier than the other group.^6,7  The second study evaluated the reasons for why students were making errors on complex math problems.  It found that most errors were due to fact inaccuracies (e.g. memorizable facts) and not algorithm errors (e.g. processes or rules that are used to meaningfully learn).^6,8  These studies illustrate the need to know (memorize) the basics in order to use meaningful strategies for learning. Pharmacy can be seen as a subject matter that requires students to learn a new language (i.e. brand and generic names, acronyms, medical terminology) and math (i.e. dosing, compounding, converting).  These studies give us insight regarding the necessity of rote learning in pharmacy curricula.

According to the FDA, in 2011, there were 8969 molecular entities approved in the United States and each drug has indications, side effects, dosing, pharmacodynamics/pharmacokinetics profiles, and patient education requirements.⁹  Although health professionals have technology to assist in retrieving most of this information, it is essential that the pharmacists have a substantial breadth of this knowledge stored away in their long-term memory.  Active learning assumes that students have the relevant prior knowledge (Novak’s 2^nd requirement) and that materials are taught in a manner that is relatable to the learner’s prior knowledge (Novak’s 3^rd requirement).  Thus, it does not negate the need for students to learn in a rote manner because they must possess sufficient knowledge. Thus, curricula must also teach students the basic facts and develop techniques that enable them to efficiently acquire new information.  Some rote learning techniques that could be employed include: (1) using acronyms (i.e. MONAB, SAAB), (2) using mnemonics (i.e. Hot as a hare meaning hyperthermia), (3) using physical or electronic flash cards (i.e. Top 200 drug cards), and (4) creating and providing cheat sheets of the most important facts discussed in each class.

Rote and meaningful learning are both important. Plutarch’s famous quote suggests that the mind is “a fire to be kindled.”  What modern learning models tend to neglect is the fuel required.  Before meaningful learning can be achieved, students need to possess sufficient prior knowledge (kindling wood).  Only then can teachers ignite the fire through active learning techniques.

References

1.    Donohoe L, Mawyer M, Stevens T, Morgan A, Harpe E. An Active-Learning Laboratory on Immunizations. Am J Pharm Educ. 2012; 76 (10):198. 
2.    Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree (Guidelines Version 2.0). Accreditation Council for Pharmacy Education (ACPE).  2006 [Updated 2011, cited 2013 Sept. 21].
3.    Novak J, Cañas A. The Theory Underlying Concept Maps and How to Construct Them. Technical Report IHMC Cmap Tools. Florida Institute for Human and Machine Cognition. 2006 [Updated 2008].

4.    Firestone M. Rote Memorization in Education: Definition, Techniques & Quiz [internet].  Education Portal; [cited 2013 Sept. 21].

5.    Gleason B, Peeters M, Resman-Targoff B, Karr S, McBane S, Kelley K, Thomas T, Denetclaw T. An active-learning strategies primer for achieving ability-based educational outcomes. Am J Pharm Educ. 2011; 75(9):186. 

6.    Murphy A. Why Kids Should Learn Cursive (And Math Facts, and Word Roots). Yew Chung Parenting Resources. Times Ideas. 2012 [cited 2013 Sept. 21]. 

7.    Bowers P, Kirby J. Effects of Morphological Instruction on Vocabulary Acquisition. Reading and Writing: An Interdisciplinary Journal. 2010; 23 (5): 515-537. 

8.    Cumming J, Elkins J. Lack of automaticity in the basic addition facts as a characteristic of arithmetic learning problems and instructional needs. Mathematical Cognition. 1999; 5 (2): 149-180.
9.    Huang R, Southall N, Wang Y, Yasgar A, Shinn P, Jadhav A, Nguyen D, Austin C. The NCGC Pharmaceutical Collection: A Comprehensive Resource of Clinically Approved Drugs Enabling Repurposing and Chemical Genomics. Science Translational Medicine. 2011; 3 (80): 80.