Teach Me How to Teach

By Mallory Onisk, PGY1 Pharmacy Practice Resident, VA Maryalnd Health Care System 

How many of you took a course in pharmacy school that taught you how to be a good teacher?  I’m going to guess not many.  I know at my college of pharmacy we weren’t given any teaching tools or tips aside from what we learned by modeling our professors.  Nor were we trained on how to be a preceptor, give a lecture, engage a classroom, or evaluate students’ learning. I recently attended the ASHP Resident Visit Day where a poll was taken as to who was taught how to be a preceptor in pharmacy school.  Not a single hand in the room (fifty residents) went up.  At least I wasn’t alone.  But how are recent graduates supposed to become the future leaders of the profession when we haven’t been given the tools to educate those following us?  Unless you were fortunate enough to match to a residency program in a city that offers a teaching certificate program or a residency at a college of pharmacy, you might be on your own.  But surely there has to be a better way…

The Southern Illinois University Edwardsville (SIUE) School of Pharmacy has developed “concentrations” or tracks for their students to focus learning on career interests.  One track is an education concentration where students take 3 elective courses during the P3 year and an elective APPE in the P4 year with a teaching emphasis.¹  Drs. Poirier & Santanello describe this unique curricular concentration and evaluate its impact on students’ knowledge and attitudes in an article that recently appeared in the American Journal of Pharmaceutical Education.¹  The first course, Orientation to Teaching, explores learning theories and teaching philosophies.  Students compose their own teaching philosophy and discuss with professors what they believe constitutes teaching excellence.  The second course, Instructional Design and Strategies, highlights active learning strategies and different instructional methods.  Students take turns facilitating class discussion using these different instructional methods.  The third course, Assessment Strategies, familiarize students with various assessment strategies including learning portfolios, multiple-choice exams, and grading rubrics.  During the APPE experience, students lead 2 small group discussions, give 2 lectures, maintain a teaching portfolio, and present an manuscript during an educational journal club.¹  An evaluation of this education concentration was done with knowledge tests and an attitudinal survey.  The authors found that both attitudes and knowledge increased after completing the three elective courses.¹  Positive attitudes correlated with positive feelings about the subject matter and an increased likelihood of pursuing a career in academia.

This is not the first time I have heard about curricular tracks or pathways for students to follow their professional interests in pharmacy school.   Giving students the opportunity to take multiple classes that focus on a particular career interest can be a great way to accelerate learning prior to graduation.  The education concentration implemented at SIUE is a unique way to give interested students insight into the career of academia.  Many students in school might think they want to teach but don’t actually know what being a faculty member entails.  Giving a lecture may look easy enough, but what kind of time and preparation actually goes into creating the lecture? Prior to my experience with Educational Theory and Practice course I had very little understanding of educational theories.  I’ve come to learn that active learning strategies and instructional designs are core concepts that aid in creating effective educational sessions.  To students who may choose to pursue a career in academia, learning some of these fundamental models is beneficial and will help them become successful scholars. 

But a career path towards academia still doesn’t meet the needs of students who will become future preceptors.  What about the students who become clinical pharmacists working at hospitals or managers in community pharmacies?  Surely many (if not most) at one point or another will become preceptors.  A preceptor’s role is to create a positive environment where learning can be effective and efficient.²  A pharmacy preceptor should convey “enthusiasm, professionalism, and knowledge.”³ There are many factors that have increased the demand for quality pharmacy preceptors including the increased number of pharmacy schools and the increasing experiential requirements for ACPE accreditation.⁴  Whether by interest or demand alone, chances are we will need most pharmacy students to become preceptors.  Knowing these odds, shouldn’t we prepare students to be become dynamic preceptors? 

There are more reasons to teach students how to teach.  One of the most important roles of pharmacists is to serve as a patient educator. Being able to give effective, concise, and useful advice to patients is vital to aiding in their understanding of their disease process and the importance of their medications.  Communicating information to patients requires that we assess audience characteristics through needs analysis, identify learning objectives, and employ effective teaching strategies.  While we all might have been taught the basics of patient counseling in pharmacy school, my guess would be that most classes focused on what to say to patients (knowledge dumping) and less on how to do educate (assessing learning needs, selecting appropriate teaching strategies, and promoting self-directed learning).

I propose that students should have the opportunity in school to learn how to be successful preceptors and patient educators.  This could be done through a classroom-based course, seminars, or other learning methods.  Metacognitively students would benefit from understanding the role of a preceptor prior to advanced practice experiences.  If students are taught how to teach, they could develop awareness and reflect during courses and APPEs on ways to improve as a learner and as a future teacher.  Learning about who people learn and how to address learning barriers would make us better health professionals.  With knowledge and experiences, students would be more prepared to precept students and educate patients.  Incorporating such instruction into pharmacy school is important to strengthen the leaders and teachers of tomorrow.

References:

1.  Poirier TI, Santanello C. Impact of a Pharmacy Education Concentration on Students’ Teaching and Attitudes.  Am J Pharm Educ 2010; 74(2) Article 23: 1-8.
2.  Kleffner JH. Becoming an effective preceptor [Internet]. Austin (TX): The University of Texas at Austin College of Pharmacy; 1998 [revised 2001, 2004, 2007, 2010; cited 2011 Oct 22]. Available from: Becoming an Effective Preceptor.
3.  Skrabal MZ, Kahaleh AA, Nemire RE, et al. Preceptors’ perceptions on benefits of precepting student pharmacists to students, preceptors, and the profession. J Am Pharm Association 2006; 46(5): 605-612.
4.  AACP: American Association of Colleges of Pharmacy [Internet]. Alexandria: American Association of Colleges of Pharmacy; c2011. Academic Pharmacy’s Vital Statistics 2011 July [cited 2011 Oct 20]. Available from: Academic Pharmacy's Vital Statistics.

Who’s Who: Getting to Know Your Students in Large Classes

By Ashleigh Lowery, PharmD, PGY1 Pharmacy Resident, University of Maryland Medical Center

I walked into my undergraduate Organic Chemistry class ready to begin the semester.  I had a new notebook, pencils, and the large expensive textbook.  Our professor started by reviewing the syllabus, as expected, and then unexpectedly passed around a blank index card to each of the 120 students in the lecture hall.  “I want you all to write your name, where you are from, your major, and something interesting about yourself.  Telling me that you want to go to med school is not interesting.  I want a real fun fact – like you were on Who Wants to be a Millionaire.”

I was impressed and surprised at the next lecture when he told us all about some of the people in our class.  One had taught English in Thailand, one had just run his first marathon and one person, in fact, had been on Who Wants to be a Millionaire.  I was even more impressed when I had an appointment for office hours later in the semester and the professor began by asking me about my hometown and interests.  It was obvious he had pulled my index card.  Over the semester, it was clear that this professor had developed great communication with our class and was able to form relationships despite the class size.  He was not just teaching to anonymous faces in a crowd.  I learned a lot that semester and was never hesitant to approach our professor when I had a question.

In large lectures, getting to know your students does not come as easily as it may in smaller teaching settings.  However, it is just as important in order to create a positive learning environment for your students.  It just may take some more creative approaches, or 120 index cards.

In an article in College Teaching, Jan Armstrong of the University of New Mexico describes a similar approach to getting to know her students.¹  The article is titled, “Write me a letter: challenging anonymity in large-enrollment classes.”  Armstrong hands out sheets of lined paper and asks students to write an informal introduction letter, stating “Tell me a little bit about yourself and why you are taking this course.  Tell me whatever you think I should know about you.”  She then reviews all of the letters and spends a few minutes in subsequent class sessions introducing individual students to the class and incorporating noteworthy or humorous information.

The University of North Carolina Charlotte provides a “Survival Handbook for Teaching Large Classes,” which includes a section titled “How can I reduce the feeling of student anonymity.”²  This provides an assortment of ideas, from taking Polaroid pictures of your students to greeting each student at the entrance of the classroom.  Some of the other suggestions include:

-  Ask students to wear nametags so that you can call on them by name

-  Have students place name cards in front of them during exams so you can learn names while you wander the room

-  Hand back tests individually to associate names with faces

-  Arrive early to class and chat with students who are already there

-  Stay after class to answer individual questions

-  Invite groups of students to coffee to get acquainted

The University of Maryland Center for Teaching Excellence also provides a guide for teaching large classes.³  One of their interesting ideas is for professors to host an “open house” during the first class session when students have a change to meet and talk with the professor.  They also emphasize the importance of having frequent and flexible office hours in order to meet and help more students.

Without a doubt, these efforts to get to know your students are worth it.  A study at the University of Illinois at Chicago assessed the impact of student-faculty informal contact and college outcomes and found that significant positive associations exist between extent and quality of student-faculty informal contact and students’ education aspirations, their attitudes toward college, their academic achievement, intellectual and personal development, and their institutional persistence.⁴ 

Richard Tiberius of the University of Toronto described the importance of this relationship well by stating, “The relationship between teachers and learners can be viewed as a set of filters, interpretive screens, or expectations that determine the effectiveness of interaction between teacher and student…within [effective] relationships, learners are willing to disclose their lack of understanding rather than hide it from their teachers; learners are more attentive, ask more questions, are more actively engaged.”⁵ 

Regardless of your style, pharmacy education is bound to include some large lectures.  We should all remember to make our best efforts to get to know our students, for both our benefit and theirs.

References:

1.  Armstrong J. Write me a letter: Challenging anonymity in large-enrollment classes. College Teaching 2008; 56: 63.

2.  Ives SM.  A Survival Handbook for TeachingLarge Classes.  University of North Carolina Charlotte Faculty Center for Teaching; 2000.

3.  Large Classes: A Teaching Guide:Personalizing the Large Class.  University of Maryland Center for Teaching Excellence; 2008.

4.  Pascarella ET.  Student-faculty informal contact and college outcomes.  Review of Educational Research 1980;50:545-595.

5.  Tiberius RG, Billson JM.  The social context of teaching and learning.  In Menges RJ, Svinicki MD, editors.  College Teaching:  From Theory to Practice.  San Francisco:  Jossey-Bass Publishers, Inc; 1991.  p. 67-86.

The Benefits of Humor in the Classroom

By Robert Eagen, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

They say that laughter is the best medicine and the effects of humor in medicine have long been studied.  But what about the effects of humor on learning? This is the question that “Humor in Pedagogy: How Haha Can Lead to Aha!” by R.L Garner attempts to answer .¹  In the article, Garner, an associate dean at Sam Houston State University, details a study he performed looking at the effects of humor in asynchronous distance learning and discusses the merits and hazards of using comedy to teach. The study involved 114 students who watched a series of three forty minute recorded lectures on research methods and statistics.¹  Both the experimental group and the control group watched the same recorded lectures with one exception.  Three humorous stories or metaphors included in each of the lectures in the experimental group were seamlessly edited out of the control group’s lectures.  The subjects were asked to rate the presentations after watching each one and again after finishing all three.  After finishing all three lectures, the subjects were assessed on their retention on the material presented.

The results of the study show that humor can be a powerful tool when used in the classroom.¹ The overall opinion of the lessons was significantly higher in the experimental group.  Students indicated in the “humor” group that the information was communicated more effectively and gave the teacher higher ratings.¹  Further, the students in the experimental group were significantly more able to recall and retain the knowledge from the lectures.¹

Often times, our most memorable lectures (or professors) are those in which humor was used.  Garner cites numerous studies that show the positive effects of using humor in the classroom. According to the article, humor is a powerful teaching tool that can create a positive “emotional and social environment” in which students can lower their defenses and focus more on what is being presented.¹ Garner also says that humor can “initiate and sustain student interest” as well as improve students’ divergent thinking and memory of the topic presented.¹

While there are many benefits, the use of humor when teaching a lesson can also have its down sides. After all, a teacher should teach not be a standup comedian! Humor is very personal and what is considered humorous varies from person to person. A comment that one person finds funny can completely fall flat with another, or even worse, be insulting. According to Lei, Cohen and Russler in their article “Humor on Learning in the College Classroom: Evaluating Benefits and Drawbacks From Instructors’ Perspectives”, humor that is offensive or degrading to students can have a negative impact on students’ learning.² Additionally they posit that too much humor can be detrimental as it can undermine the credibility of the instructor and result in a loss of focus of the instructional objectives.² Garner also warns that just because you are telling jokes does not mean you are teaching effectively. According to Garner, the humor needs to match 3 criteria to be effective. It must be specific to what you are teaching, targeted to enhance learning, and appropriate for the audience.¹

Humor is a powerful force. It can encourage an atmosphere of openness, develop students’ divergent thinking, improve their retention of the presented materials, and garner respect for the teacher. But like most things in life, it needs to be used in moderation. Too much humor can result in a loss of respect and inappropriate jokes or jokes at the students’ expense can create a hostile classroom environment. It is important to keep this in mind when teaching.   Laughter isn’t just the best medicine, it’s a valuable teaching tool as well.

References

1. Garner LA. Humor in Pedagogy: How Haha Can Lead to Aha!. College Teaching. 2006.  Accessed September 25, 2011.

2. Lei SA, Cohen JL, Russler KM. Humor on learning in the College Classroom: Evaluating Benefits and Drawbacks From Instructor’s Perspectives. Journal of Instructional Psychology. 2010.  Accessed September 25, 2011.

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.