Deep Learning Strategies

by Grace Orman, PharmD, PGY1 Pharmacy Practice Resident, North Mississippi Medical Center

We have all been there. The night before a big test. Maybe the week was busy. Maybe time got lost. Maybe this was the plan all along — to wait until the last minute. The next handful of hours are dedicated to quickly reviewing weeks’ worth of lectures and somehow manage to retain all those details to successfully pass the test. You may be great at cramming. You might even pass that test. But will you remember the information in a year? A month? Even this afternoon?

This is an example of surface learning. A form of learning where there is no understanding or application, only rote memorization.¹ The information gathered during “cramming” or last-minute studying for a test is not elaborated nor is the knowledge applied in any way. Often, the information is retained for only a brief period of time, if at all.² Surface, or shallow learning, is maybe the first step when learning new vocabulary or concepts, but it should not be the last step. Surface learning might get a student through an exam, a class, and maybe even a series of courses. But as teachers, we should encourage students to get beyond shallow learning and provide them with strategies for deep learning.³

Healthcare workers should possess a broad knowledge base, flexibility, problem-solving ability, and be pro-active.¹ Rote recall of an expansive fund of knowledge is not enough to excel in the professional and personal world post-graduation.² The ability to retain core knowledge is the minimum requirement in the world today. The ability to communicate knowledge and integrate that knowledge to solve problems is critical.  Moreover, all health professionals must be in charge of their own continuing education as knowledge is constantly evolving.^3,4 Thus deep learning is needed.  The fundamentals must be applied and repeated to re-enforce concepts. To achieve deeper learning, we have to change the way we educate. There are a handful of strategies to help facilitate deeper learning. These strategies align with three domains: cognitive, interpersonal, and intrapersonal.

The cognitive domain is where the basis of deeper learning stems: the mastery of core academic content and incorporating critical thinking skills. The Hewlett Foundation defines the mastery of this domain as the skillset to “develop and draw from a baseline understanding of knowledge in an academic discipline and to transfer knowledge to other situations.” Thus fundamental knowledge is used and applied in new situations.^2,3,4 This would incorporate “problem-based learning,” where the student would need to know the basics of the subject but then apply it to a series of cases (simulated “real-world” situations). This not only merges together the student’s core knowledge but also draws upon their experiences and imagination. Incorporating internship opportunities outside of school is another great way to practice and solidify one’s fundamental knowledge in a real-world environment. Other strategies to enhance the cognitive domain are self-check quizzing and discussion boards.

The second domain to promote deep learning is the interpersonal domain. This domain requires communication and collaboration. The ability to effectively communicate complex ideas to others and to collaborate together is essential in the world post-graduation. Effective communication can be achieved through peer teaching and presenting information to others. This can also foster peer-to-peer review and feedback. Group projects with alternating leaders allow for both communication and collaborative effects, allowing students to see the benefits and outcomes of working together. Internships can also help foster this domain. Incorporating these into the curriculum, whereby students are placed in real-work environments several days a week could solidify collaborative work between team-mates and co-workers.

Lastly, the intrapersonal domain consists of learning how to learn over a lifetime. Continuing education is a critical component of a life-long learner. It is essential to stay “in the know” of new concepts, information, and guidelines in healthcare. Being able to develop a process for self-directed learning is a key to staying current throughout one’s career. Students must be responsible for determining own their goals and assessing their progress. This could be achieved by self-management and self-evaluations. Teachers can help the student find their strengths and weaknesses and help guide them to self-reflection after group work or other activities. Instead of enforcing strict deadlines, letting students progress at their own pace while encouraging deeper learning, can foster the skills needed to continue to grow outside of the classroom.⁴

To become deeper learners, students must be active and engaged in their learning. Bringing together these three domains — the cognitive, the interpersonal, and the intrapersonal — can have a profound impact not only on their academic performance but preparing students for the life they must outside of the classroom. As teachers and mentors, we want our students to thrive in life as well as in class. Providing students with strategies that foster deeper learning can prepare them for life.

References: 

1. Lombardi P. Instructional Methods, Strategies, and Technologies to Meet the Needs of All Learners [Internet]. Montreal: Pressbooks; 2019. [cited 2021 Jan 24].
2. Peng M, Chen C. The Effect of Instructor’s Learning Modes on Deep Approach to Student Learning and Learning Outcomes. Educational Sciences: Theory & Practice. 2019;19(3):65-85.
3. Hailikari T, Katajavuori N, Ylanne S. The Relevance of Prior Knowledge in Learning and Institutional Design. Am J Pharm Educ 2008;72(5): Article 113.
4. Huberman M, Bitter C, Anthony J, O’Day J. The Shape of Deeper Learning: Strategies, Structures and Cultures in Deeper Learning Network High Schools [Internet]. Washington, DC. American Institutes for Research. 2014, 1-38. [cited 2020 Jan 17]

Reducing Black and White Thinking: Constructing Partial Credit Multiple Choice Exams

by Lauryn Easley, PharmD, PGY1 Pharmacy Practice Resident, North Mississippi Medical Center

During my many years in school, exams were given primarily in the classic, multiple-choice question format. The form of assessment has been the gold standard for many years.¹ While multiple-choice question examinations aren’t perfect, many would argue that “if it’s not broken, don’t fix it”. However, I would argue there is one significant shortcoming for the single best answer, multiple-choice tests —students begin to assume there is only one correct answer. This has led generations of students to view concepts with a “black or white” mentality. You are either right or you are wrong.  This kind of thinking is not helpful. Life is more nuanced. We need to help students understand that the world and our knowledge is actually rather grey.

In a world full of possibilities, leading our students to develop black and white thinking causes them to misunderstand situations. They only see the two extremes and not the in-betweens.¹ Traditional multiple-choice examinations potentially stifle students’ creativity, as well as enable them to put forth minimal effort, thus producing lazy learners.^1,2 If students were made to explain their reasoning or defend their choices, we could move away from simplistic answers and move towards students better able to stand by their viewpoints and use evidence to support them.^1,2 Furthermore, multiple-choice exams inhibit the instructor’s ability to truly know whether the students fully grasp the concepts being taught. With traditional multiple-choice exams, students can guess the answers to most questions and still pass. A savvy test-taker might not actually comprehend the material.

Traditional multiple-choice tests can lead to “over-thinking” because the student assumes there is only one correct answer, even though other answer choices seem appropriate.² As a type-A, over-thinker, I would find myself reading a question and looking for additional details to help make a complex decision.  But sometimes I was making the question far more complicated than the teacher intended. Because of this, I would sometimes pick an “incorrect” answer simply because I misunderstood what the teacher was asking me. In traditional multiple-choice exams, I had no way of explaining my reasoning.  I was forced to choose one answer over another. For this reason, I rarely reviewed questions I answered incorrectly on a test because I did not like to rehash my errors. Looking back, this was not a healthy mindset. None-the-less, I think it’s an important question. Should we move away from traditional multiple-choice exams, and if so, what are some suitable alternatives?

There are, in fact, a few different options, including awarding partial credit for answers that are okay but less than ideal, utilizing select all that apply questions, and short-answer questions.^1,2,3

Partial credit focuses on awarding the most points to students picking the “most correct” or “best” answer but not fully penalizing students for picking an answer that may not have been the best option among the choices offered but is a reasonable option in some circumstances. Scoring questions in this manner can also help instructors move away from factual, straightforward, there is only one “right” answer to questions and move toward conceptual questions that require deeper thinking.^1,2  For example, a question might ask about various treatment options for a disease or problem. While the “best” or “preferred” option might be among the choices, the student might be awarded partial credit for an option that is effective and unlikely to cause patient harm. In this case, the answer choice the student picked could be awarded partial credit, rather than full credit. The instills the idea that some answers are better than others but there is a range of “acceptable” choices. Other advantages of awarding partial credit – it may be easier for instructors to create distractors for the question and there may be fewer post-exam arguments from students seeking credit for their selected answers.

 Duckor and Holmberg give the example below to illustrate the benefits of organizing answer choices into bins, where certain bins are worth partial credit and other bins are considered incorrect.³

When the time is taken to organize and categorize each answer choice, instructors will have a better grasp of how well their students understand the topic, where common misconceptions lie, and where clarification with additional instruction may be beneficial. 

Select all that apply questions always discouraged me as a student because they were treated as all-or-nothing questions at my school.  You had to select ONLY the correct options and not select the incorrect options in order to get credit.  If you selected (or didn’t select) 5 out of the 6 options correctly, you go NO points. In other words, a student who got 5 out of 6 options correctly received the same number of points as a student who got 0 out of the 6 options correct.  It seemly likely the two students' understanding of the material is VERY different, but in terms of performance on the exam, they both received the same score. While some national certification examinations score select all that apply questions as all-or-nothing, this is not conducive to learning and doesn’t acknowledge what students DO know about the subject matter. To encourage students, they should be granted partial credit for each correct response option chosen and, conversely, points should be deducted for each incorrect option chosen. So, for example, if a student was correct on 5 out of 6 options, the student would receive +5 – 1 = 4 points.  If a student had 3 out of 6 options correct, the student would receive +3 – 3 = 0.  Awarding partial credit while also subtracting points for incorrect answers prevents students from gaming the system and simply selecting all options just to get some points.

As a student, I’ll admit that I didn’t like short-answer questions. However, in employing this testing format, we allow students to show us how much they understand and we can get a glimpse of each student’s thinking.¹ Short-answer essay questions really require students to thoroughly prepare. The student is forced to formulate a response – they can’t rely on recall to select from a list of possible responses.  Short-answer essays can be combined with the multiple-choice format whereby the student must provide a rationale for the response they selected.  In this way, students must know the correct or “best” answers but also must defend their choice.¹  Points could be independently awarded for selecting the correct answer and for the rationale.  Or points might be awarded only when the correct rationale is provided.  This would prevent “guessing” the correct answer.

I think these testing formats would encourage more students to review their responses to questions on an exam and encourage them to fully grasp the concepts being tested. It could lead more students to dig deeper into the materials to assess why they missed certain questions and why the best answer was, in fact, better than the other choices.

While a majority of these testing options may require more time and effort for either preparing or grading examinations, they give us a much clearer picture of how our students are doing and how well they grasp the material.^1,2 More importantly, rather than reinforcing black and white thinking, these alternative exam formats promote critical thinking, encouraging students to weigh the merits of different options.

References: 

1. Harrnstadt D. Pivot away from multiple-choice testing [Internet]. Bethesda (MD): Walt Whitman High School, The Black & White; 2019 Mar 23 [cited 2021 Jan 28].
2. Berwick C. What Does the Research Say About Testing? [Internet]. San Rafael (CA): George Lucas Educational Foundation, Edutopia; 2019 Oct 25 [cited 2021 Jan 28].
3. Duckor B, Holmberg C. Two Strategies for Assessing for Learning: The Partial Credit Scoring Key and the Scoring Guide [Internet]. Alexandria (VA): Association for Supervision and Curriculum Development, Inservice; 2018 Jul 23 [cited 2021 Jan 28].