Teaching Self-Directed Learning to Learners at All Stages of Development

By Erin Rodems, Pharm.D., PGY1 Pharmacy Resident, Veterans’ Affairs Maryland Health Care System

Self-directed learning theory is based upon several fundamental concepts.  First, all individuals have the capacity to engage in and develop self-directed learning skills.  Second, learners can (and should) take greater control over the learning experience.  Third, self-directed learning habits are transferable from one activity to another.  Therefore, the teacher’s role is to assist the student develop self-directed learning skills by providing direction and support based on the needs of the student and the activity involved.¹

Grow’s staged self-directed learning model provides a method for teaching students to become self-directed learners.  One of the fundamental principles of the model is that every student is different and not all students have the same capacity to self-direct their own learning.  The ability to self-direct may vary greatly with different types of activities.  For example, a student may be very skilled at self-directed learning in pharmaceutical calculations but may require a greater degree of direction in learning the pharmacotherapy of heart failure.

It is important to understand that self-directed learning is a skill that can be taught and Grow proposes the staged self-directed learning model in order to teach students to be more self-directed learners.  According to the model, learners are classified into stages I to IV based on their readiness for independent learning.  The teacher plays a different role at each stage of learning.  Stage I learners are very dependent on the instructor to guide the learning process.  The instructor serves more as a subject matter expert.  Examples of stage I learning would be attending a biochemistry lecture or learning to counsel a patient by watching a teacher-to-teacher role play.  At the other end of the spectrum, in stage IV, the students’ learning is largely self-directed and the teacher serves as a consultant.  A few examples of stage IV learning would be 4^th year advanced pharmacy practice experiences (APPEs) and residency training. 

In pharmacy education, all stages of self-directed learning are employed to some degree throughout the curriculum.  Stage I learning is employed when formal lectures are given by a subject matter expert.  The P1 year has the most stage I learning.  Stages II and III are employed during the P1 through P3 years with the goal that by the P4 year students are on there way to be coming self-directed learners with a high level of independence who can make the transition to independent practitioners at graduation.² 

By employing multiple stages of learning simultaneously throughout the pharmacy curriculum and gradually introducing more self-directed types of learning activities, students will start to make the transition to more independent learners.  For example, in a study conducted at the University of Maryland School of Pharmacy that evaluated pharmacy students’ readiness for self-directed learning and the effect that APPEs had on students’ readiness for self-directed learning, it was found that the pharmacy curriculum prepared most students to have a high degree of self-directed learning prior to going on APPEs.  70% of students possessed a high degree of readiness for self-directed learning prior to APPEs and 81% after the completion of APPEs.  This study is encouraging because it shows that the majority of graduating pharmacy students are prepared to assume the role of independent learner.³  Many aspects of the pharmacy profession require pharmacists to engage in self-directed learning.  Responding to drug information questions and maintaining a current knowledge base as new therapies become available and as guidelines change are prime examples of when pharmacists would need to employ self-directed learning skills in their professional lives.

Given that learners at each stage have different needs, it is paramount that the instructor accurately assess the learning stage of their students and tailor the instructional methods to best facilitate student learning at each stage.  At Stage I, teachers must gain the respect of the class by asserting him/herself as the subject matter expert.  Students in stage I struggle when instructors have unclear expectations for assignments or exams, therefore, students at this stage require clear objectives, a comprehensive syllabus with assignments defined in explicit detail, and examinations that focus on course objectives in order to improve their success in the course.

Students at stage II are often highly motivated learners with a need to understand the relevance of the course material.  A case study regarding a real patient with multiple medical problems would be an effective strategy to employ in stage II because it would allow students to apply their knowledge to a real-life scenario.  Students will then be able to see the relevance of the learning activity and it would motivate them to want to learn more.  Stage III learning should focus on teaching critical thinking and metacognitive skills to students who are ready to take responsibility for their own learning but need to learn the tools in order to do so. The teacher should serve primarily as a facilitator at this stage to help students develop metacognitive learning strategies.  Students who are stage IV learners benefit most from a teacher who grants them autonomy.  Teaching at this stage should focus on the teacher as a delegator who takes a more passive role in the students’ learning experience.² 

For an instructor to teach their students not only to be self-directed learners, it is paramount for the teacher to identify where students are in the self-directed learning process and tailor their learning activities to accommodate the students’ varying capacities to self-learn.  Instructors who are able to effectively assess their students and adjust their teaching styles to suit their students’ learning needs will not only win the respect of their students but they will be providing them with a lifelong skill.   Teaching students self-directed learning habits will help them become independent learners. 

References

1.  Hiemstra R.  Self-Directed Learning. Syracuse (NY): Syracuse University, Department of Instructional Technology and Adult Learning, 2004.  Available from: http://www-distance.syr.edu/sdlhdbk.html.

2.  Grow, G. Teaching Learners to be Self-Directed.  Journal of Adult Education Quarterly Spring 1991; 41 :125-149.

3.  Huynh D, Haines ST, Plaza CM et al. TheImpact of Advanced Pharmacy Practice Experiences on Students’ Readiness for Self-Directed Learning.  Am J Pharm Educ 2009; 73 : Article 65.

Attitude on Aptitude

by Yuze Yang, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

Most students have had to take several standardized tests throughout their academic careers.  Some gauge students solely on their knowledge and expertise, while others assess students on their aptitude.  Aptitude is defined as an innate ability, rather than an acquired knowledge, to perform certain tasks at a certain skill capacity.  Standardized aptitude tests have been utilized in a variety of ways, from identifying children with learning difficulties as early as in elementary school, to conversely distinguishing gifted students with higher propensities for scholastic success.  One of the most notable and notorious examples of an aptitude test, taken by millions of high school students each year to determine their readiness for college, is the Scholastic Aptitude Test (SAT).  On the surface, the SAT evaluates students’ achievement in basic algebra, geometry, reading and writing. However, in deeper ways, the exam is also similar to an IQ test in measuring students’ abilities to interpret and analyze presented information and solve problems.  Nevertheless, the validity and usefulness of employing aptitude tests to establish the paths in which students proceed in their academic careers still remains controversial.

Admission to most pharmacy schools in the U.S. follows similar requirement patterns as to undergraduate schools, including the use of a standardized aptitude test as one of the key components.  Endorsed by the American Association of Colleges of Pharmacy, the Pharmacy College Admissions Test (PCAT) has been the preferred qualification verifier for admission to pharmacy schools since 1975. It tests students in both aptitude and achievement in seven areas: verbal ability, quantitative ability, biology, chemistry, reading comprehension, and two writing sections.  The objective of the exam is to determine if they are suitable for a future in pharmacy by assessing not only the depth of background knowledge candidates have acquired, but also their capacities to learn and process new information.  The PCAT score is the most frequently used standardized test used as a selection criteria among colleges of pharmacy.  Several studies have been conducted regarding the correlation of PCAT scores with academic success, most of which have shown them to be significant predictors of pharmacy students' first-year GPA.¹  Allen and colleagues examined several pre-pharmacy predictors of success in pharmacy schools and found PCAT scores to be one of the best predictors not only for the first professional year but also for success in practice-related courses and clerkships.²  Despite these findings, some pharmacy schools have elected to NOT use the PCAT among their admission criteria and instead place more emphasis on prior academic achievements.  One such example is the University of California San Francisco (UCSF), whose pharmacy program has been ranked #1 for several years according to US News and World Report.³  Numerous factors are used to determine whether or not a candidate is accepted to UCSF.  Thus, opponents of standardized tests believe that such tests aren’t necessary to make good admission decisions and don’t enhance the successfulness of a school in terms of cultivating a student body or offering a excellent degree program.  Furthermore, PCAT test scores have not been correlated with future job performance.⁴

Since pharmacy schools produce future medical professionals who will become responsible for the well-being of the public, they must use the highest standards for selecting top-quality students that can master the material.  As more and more new schools of pharmacy open and accept growing pools of candidates to join the field, being able to discern who will excel in all aspects of pharmacy education, not simply test-taking and information acquisition, will be increasingly critical.  Hence, the success of students’ careers, both academic and professional, will likely rely on gauging not only the aptitude for learning material and scoring well on tests, but also the degree of motivation, conscientiousness, and dedication to translating information to improved patient care.  In other words, aptitude AND attitude are equally important.

References

1. Kuncel NR, Credé M, Woo SE.  Ameta-analysis of the validity of the Pharmacy College Admission Test (PCAT) andgrade predictors of pharmacy student performance.  Am J Pharm Educ. 2005; 69:3.

2. Allen DD, Bond CA. Pre-pharmacy indicators of success in pharmacy school: grade point averages, pharmacy college admissiontest, communication abilities, and critical thinking skills. Pharmacotherapy. 2001;21:842-849.

3. US news and world report pharmacy school rankings (2008). Retrieved October 23, 2011 from

4. Munson JW Bourne DW. Pharmacy College Admission Test (PCAT) as a predictor ofacademic success. Am J Pharm Educ. 1976; 40:237–9.

Does Matching A Student's Learning Style Really Help?

by Sara Hummel, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

While browsing the internet, I came across something in The Chronicle of Higher Education entitled “Matching Teaching Style to Learning Style may not Help Students” by David Glenn.¹  This immediately caught my attention.  For the past few weeks we have been discussing learning styles in this course and how knowing the students’ style can positively impact learning.  Now someone proposes that this may not help us at all.  I wanted to know more.

The article refers to a review of the primary literature done by Pashler and colleagues published in the journal Psychological Science in the Public Interest.²  The authors contend that there is insufficient scientific evidence supporting the commonly held notion that matching one’s teaching style to your students’ learning style enhances teaching effectiveness. Pashler reports that they found little research regarding learning and teaching styles that used an experimental design.  Glenn’s article points out that other researchers in the field and supporters of learning-teaching style “matching hypothesis” felt that Pashler’s statements seemed biased and “largely ignorant of the field”.

The “matching hypothesis” purports that a student learns best if his/her learning style is matched with a corresponding instructional method.  However, Pashler found little to no evidence in support of the hypothesis.  Indeed, many studies showed contradicting evidence.  Instead, Pashler proposes, that it may be more important to match the instructional method to the content.  In a study by Massa and Mayer, subjects showed no differences in performance when given instructional methods matching their preferred learning style.³  Subjects were given a computer based electronics lesson with help screens either matched or opposite to their learning style preference- either visual (pictures) or verbal (text).  The researchers found no differences in performance among the subjects.  Instead, the experiment found that all learners benefited more from visual than verbal help during the lesson.

Pashler gives another example (that I could well relate to) from a student’s perspective. When teaching molecular structure, students often learn better when taught with stick models (kinesthetic learning) than by reading assigned text book chapters (verbal learning) – regardless of the student’s preferred learning style.  Other examples that come to my mind from personal experience is learning how to take a patient’s blood pressure (highly kinesthetic) or analyzing a poem in a literature class (highly verbal).  The content of the instruction is probably most relevant in terms of deciding what teaching methods to employ – not the students’ preferred learning styles.

Another study done by David W. Laight used concept maps as an instructional tool to teach pharmacy students about health care.⁴  In his study, Laight asked students to report the usefulness of concept maps and participate in a learning style preference evaluation.  Although this study was not designed to evaluate the "matching hypothesis" per se, the results showed no statistically significant association between the students’ reported usefulness of concept maps and their preferred learning style.  This surprised me, since I would have expected visual learners to prefer such a tool when compared to verbal or kinesthetic learners.

So why should we learn about learning style in this class?  Learning about learning style differences probably makes us better teachers.  Knowing that students have individual preferences for receiving information helps us to be more open-minded and to consider incorporating different instructional methods into our teaching repertoire.

I personally think that Pashler brings up some valid points.  I disagree with his view that there is no basis for matching the instructional method to learning style.  He admits that matching the two results in higher student satisfaction. And we know that motivation is important to learning.

I do, however, agree that not all topics can be taught using any instructional method in an attempt to tailor it to a specific group of students or learning style.  It seems logical to me to teach hands on (aka kinesthetic) topics with “hands on” instructional methods.  It is important that one considers both, the topic to be taught, as well as, the learners’ preferences, before deciding on how to teach the content.

References

1. Glenn D. Matching teaching style to learning style may not help students. The Chronicle of Higher Education, December 15, 2009.

2. Pashler H, Mcdaniel M, Rohrer D. Learning styles: concepts and evidence. Psychological Science In the Public Interest 2009; 9: 105-19.

3. Massa LJ, Mayer RE. Testing theATI hypothesis: Should multimedia instruction accommodate verbalizer-visualizercognitive style? Learning and Individual Differences 2006; 16 : 321-5.

4.  Laight DW. Attitudes to concept maps as a teaching/learning activity in undergraduate healthprofessional education: influence of preferred learning style. Med Teach 2004; 28: 229-33.  

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.

References

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.

Professionalism: An Important Lesson

by Brandon Shank, Pharm.D., PGY-1 Pharmacy Practice Resident, The Johns Hopkins Hospital

When I entered pharmacy school, the concept of professionalism was presented early in my program.  I distinctly remember reciting the Oath of a Pharmacist at my white coat ceremony.  However, at that time, I did not fully understand the importance of professionalism or the skills needed to behave as a professional. The American Pharmaceutical Association Academy of Students of Pharmacy (APhA-ASP) and the American Association of Colleges of Pharmacy Council of Deans (AACP-COD) Task Force on Professionalism defined professionalism as the demonstration of the traits of a professional.¹ The American Board of Internal Medicine describe professionalism as the commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge, sustain the interests and welfare of patients, and the responsiveness to the health needs of society.²

The Ten Traits of a Professional according to APhA-ASP and AACP-COD are:¹

1.     Knowledge and skills of the profession

2.     Commitment to self-improvement of skills and knowledge

3.     Service orientation

4.     Pride in the profession

5.     Covenantal relationship with client

6.     Creativity and innovation

7.     Conscience and trustworthiness

8.     Accountability for his or her work

9.     Ethically sound decision making

10.  Leadership

When teaching professionalism, it is essential that educators lead by example. Faculty should act in a manner that exemplifies professionalism and creates an environment in which students can effectively learn. A systematic approach to teaching professionalism should be implemented.  Having students set goals and objectives as well as tracking and assessing progress are important steps to fostering a student’s development as a professional. Expectations should be established early on in the pharmacy program. Opportunities for students to learn and practice professionalism should be made available. Such opportunities may include professional organizations, Introductory Pharmacy Practice Experiences (IPPEs), Advanced Pharmacy Practice Experiences (APPEs), community service, and work experience.

Assessing a student’s professionalism can be challenging.  Dr. Chisholm and colleagues developed a pharmacy professionalism self-assessment instrument.³  Their 18-item instrument assesses six tenets: excellence, respect for others, altruism, duty, accountability, and honor/integrity. The authors compared the professionalism of first year pharmacy students with recent graduates. There were no differences between the two groups.  Another study found that professionalism measured by this instrument was greatest during the first and fourth professional years of pharmacy school.⁴  Therefore, widely implementing this tool may have limited utility for the purpose of monitoring an individual student’s growth. Preceptor or faculty evaluation offers another avenue for evaluating professionalism in didactic and experimental components of a pharmacy curriculum. However, the opinion of faculty and preceptors can be subjective.  Thus further research is needed to develop objective evaluation methods. At the present time, preceptor and faculty facilitated discussions and formative feedback is the most appropriate way to teach and assess professionalism until validated tools are created.

Professionalism remains a core element of a pharmacy student’s education. More research is needed regarding the effectiveness of various methods to develop student’s professionalism skills. Patient interaction throughout the curriculum, in the form of IPPEs and APPEs, will aid in fostering professionalism traits beyond what can be learned in the classroom. Schools of pharmacy should strategically integrate, assess, and track students’ professionalism.

References

1.     American Pharmaceutical Association Academy of Students of Pharmacy and American Association of Colleges of Pharmacy, Council of Deans Task Force on Professionalism. White Paper on Pharmacy Student Professionalism [Internet]. 1999 July 1 [cited 2011 Oct 2]

2.     American Board of Internal Medicine, Committees on Evaluation of Clinical Competence and Clinical Competence and Communication Programs. Project Professionalism [Internet]. Philadelphia, (PA): American Board of Internal Medicine; 1995 [updated 2001; cited 2011 Oct 2]

3.     Chisholm MA, Cobb H, Duke L, McDuffie C, Kennedy WK.  Development of an Instrument to Measure Professionalism. Am J Pharm Educ. 2006;70(4):1-6.

4.     Duke LJ, Kennedy WK, McDuffie C, Miller M, Sheffield M, Chisholm M. Student attitudes, values, and beliefs regarding professionalism. Am J Pharm Educ. 2005;69:1-11.