VARK – Know Your Style

By Vicky Shah, Pharm.D., PGY-1 Pharmacy Practice Resident, Suburban Hospital

Developing good study habits as a student is extremely important in order to obtain the knowledge required in school as well as life. To be an effective student, it is imperative that students understand how they learn. The VARK questionnaire is a sixteen-question survey that can assist students do exactly that.¹ Whether the questionnaire truly assesses a student’s best method for learning or simply reflects what method he/she currently uses is controversial.²

VARK is an acronym that represents the different categories of preferred sensory methods for learning: V (Visual), A (Auditory), R (Read/Write) and K (Kinesthetic). In completing the VARK questionnaire and identifying how one best learns, a student could then identify how to get the most out of studying. No one particular style is better than another.² In fact, very rarely do individuals learn by one method alone. There are a few lucky individuals who learn equally through ALL sensory methods; they fall into a category called “multimodal” learners.^1,2

Visual!    

Students who are visual learners need to make a few adjustments while they are in class to understand the material. Visual learners, perhaps more than other students, need to attend lecture or procure a copy of the handout.  It can be helpful for visual learners to imagine the words on a slide or highlight and underline key words on the handout for added emphasis. Visual learners experience things with their eyes, such as watching the teacher’s body language and facial expressions to fully understand what’s being presented. They prefer to sit near the front of the class and prefer to see pictures and graphs rather than wordy explanations. Diagrams, illustrations and interactive whiteboards further assist the visual learners.^{3, 4}

As a teacher, we can do plenty of things to ensure that our visual learners have everything they need. We can provide visuals aides, such as graphs or pictures, coupled with words on slides. There is nothing wrong with repeating the same information if you are presenting it differently, such as pictures and words. If the teacher’s preferred method of teaching is through paragraphs on the slides or handouts, try to highlight or underline key words or color code items of importance to help visual learners. ^{3, 4}

Auditory!             

Auditory students prefer learning through discussions, talking through topics, and listening to others explain the material. These individuals use the tone and pitch of a person’s speech to interpret emotion. Students who learn through auditory methods usually listen during lecture rather than diligently take notes. If they try to multitask, they may miss an important message.^{3, 4}

In order to help students who learn through auditory means, teachers need to understand that they cannot just show a slide and say “know this slide.” For students who learn best through hearing, they need to explain their slides so the students can fully understand the information. Teachers can encourage group learning and should allow students to tape record the lecture for further review.^{3, 4} The act of merely reading an abbreviated version of the material presented can be quite effective for an auditory learner.

Read/Write!                 

Individuals who learn through reading and writing benefit from taking notes, sometimes multiple times.  This can be done by simply rewriting the same thing over and over, or by rewording the material in a different way. Rewriting the notes using different words can help a student understand the concept rather than just memorizing a series of words. Students are encouraged to review their notes every day to ensure continuous absorption of the information. They can also organize graphs into statements rather than trying to be too visual.^{3, 4} Most read/write learners are also have visual or kinesthetic learning tendencies.

Teachers can assist students who learn by read/write by providing additional resources for students to consult for further explanation regarding the topic.  Teachers may need to slow down a bit to ensure that students who learn through reading/writing have sufficient time to write notes during class.^{3, 4}

Kinesthetic!         

Students who are kinesthetic learners prefer a more hands-on approach. They tend to learn by learning by “doing” something. They like to physically experience the topic, rather than just reading about it, hearing about it, or watching someone else. Many of these students tend to thrive during clinical rotations as they have the opportunity to put their knowledge to use. Hands on experiences are the best method for these students, but they can become distracted by their need for movement and must learn to control this urge or use it for their benefit.^{3, 4}

Teachers can assist by providing opportunities outside the classroom that benefit these students. Lab practicals and clinical experiences allow these students to “do” what they’ve told about in the classroom.  This helps them to understand better than a traditional written exam. Teachers can try to include brief group exercises interspersed throughout their lectures where students can practice counseling or medication preparation in the classroom.^{3, 4}

The VARK questionnaire benefits students by providing them with information on their learning style and preferences. This tool benefits teachers by reminding them that each student is an individual and learns in a different way. By understanding the different ways through which learning occurs, teachers can reach more students and help foster stronger teacher-student relationships.⁵

References:

1. Fleming N. VARK -- A Guide to Learning Styles. VARK-LEARN Limited, 1987. Web. 10 Sept. 2014.
2. Fleming N and Baume D. Learning Styles Again: VARKING up the Right Tree!" Educational Developments 2006; 7: 4-7.
3. Cherry K. What Are the 4 VARK Learning Styles? About. About Education, n.d. Web. 10 Sept. 2014.
4. VARK: Learning Styles: Visual, Auditory, Read/Write, Kinesthetic. Southwestern Community College. Web. 10 Sept. 2014.
5. Fleming N. I'm Different; Not Dumb. Modes of Presentation (VARK) in the Tertiary Classroom. Research and Development in Higher Education, Proceedings of the 1995 Annual Conference of the Higher Education and Research Development Society of Australasia (HERDSA). HERDSA, 1995; 308-13. Web. 10 Sept. 2014.

Should Modified Essay Questions Be the Primary Method to Assessing Performance?

By Kim-Ngan Tran, Pharm.D.,  PGY1 Pharmacy Practice Resident, Medstar Union Memorial Hospital

Multiple-choice questions (MCQs) are widely used as the primary means to assess student performance in most pharmacy and medical programs because they are a standardized method that can yield an objective score for a large number of test takers in a short period of time. Medical/pharmacy programs have changed their curricula to include more problem-based learning, which is an essential skill for a clinical practitioner. However, it is quite challenging for teachers to construct good MCQs that evaluate a student’s problem-solving skills.

Let’s discuss the advantages and disadvantages of MCQ and essay exams. MCQ exams are cheap and easy to score.  They can test a breadth of knowledge within a short examination time.  Moreover, it is the most commonly used as an evaluation method for licensure and board examinations.  Therefore, student must get practice with the MCQ format in order to confidently take licensure and board exams.  Another positive effect is that students’ final exam scores often improve because they have been previous tested on similar material during the semester.¹ Despite those advantages, MCQs have some weaknesses. There is a risk of students guessing answers and thus the results are not a true reflection of what the student knows. Writing MCQs is very time-consuming and fairly difficult because you would want to produce questions that can evaluate students’ ability to understand and apply concepts — not just recall facts based on memorization. Because of these challenges, many teachers do not return an exam or discuss exam answer keys with students in order to reuse the questions in the future. Thus students are not able to review missed or wrongly answered questions … and thus failing to learn important concepts.¹  In contrast to MCQ exam, an essay exam is relatively easier to write and less time consuming for teachers to create. This method provides teachers a better away to assess their students’ thought process, critical thinking, and writing skills. By providing an answer and not selecting choices, guessing is minimized. Nevertheless, grading essay exams is very time consuming and difficult to score objectively. Longer examination times are needed for students to finish an essay exam when compared to a MCQ exam if you wish to test an equal breadth of knowledge. Thus, essay exams are typically used for small classes and when teachers desire to measure students’ problem-solving skills.

Is there another approach?   Is there another question type that has the advantages of both the MCQ and traditional essay exam technique?   The modified essay question (MEQ) was developed by Hodgkin and Knox as an examination tool for the Royal College of General Practitioners.² MEQ exams include multiple problem-solving questions that are designed to test higher cognitive skills and can be consistently, objectively, and efficiently scored. By using MEQs, teachers can measure the knowledge retained and evaluate the students’ thinking and reasoning skills.^2,3 A typical MEQ provides a clinical scenario and one or more short answer questions based on Bloom’s taxonomy (memorizing, understanding, evaluating, analyzing, and creating).^4,5 For example, instead of using MCQ to test students about chronic obstructive pulmonary disease, a teacher could use MEQ to assess students’ ability to evaluate and provide an appropriate treatment plan for a patient scenario (Table 1). Students have to understand signs and symptoms related to the disease state and how to diagnose that condition. Then, they must apply their knowledge to develop an individualized treatment plan.

Table 1: Example MEQ

A 56 year old African American male presents to the emergency department with a complaint of worsening shortness of breath and cough for two weeks. He is a smoker with 40 pack year history. His past medical history includes hypertension, diabetes, hyperlipidemia, chronic obstructive pulmonary disease (COPD), and obstructive sleep apnea. List the differential diagnoses based on this patient’s symptoms? List the laboratory tests needed to confirm the diagnosis? What is the best initial treatment plan for this patient? After 3 days, the patient is stable and can be discharged. What is the best discharge treatment plan for this patient? State the current guideline that supports your answer.

To ensure the quality of the exam, questions must be relevant, valid, reliable, and objective. Teachers should define intended learning objectives to be assessed by each question. Patient cases should be clearly developed, include the relevant data needed to answer questions, and avoid extraneous information. MEQs should not be long.  Ask a colleague  to review the exam and provide suggestions to improve the questions. The common problem of essay exams is that grading may not be standardized. To address this problem, teachers should have key answers for all questions and assign a specific number of points to each. Then, if a student’s answer matches the keyed answers, he/she will get full credit. Partial credit can be given if a question contains more than one part; therefore, each answer must be assigned points in the key. The duration of the exam and the amount of time allotted to each question is important because if you do not give students enough time to answer questions, they will perform poorly and you can’t evaluate the students’ actual performance.

The MEQ model will work better if a teacher has help from a teaching assistant (or colleague) to grade all the responses. MEQs should only be used in a class that requires students to build higher-order thinking skills. Clearly, Pharmacotherapy and therapeutics course are intended to build critical thinking and decision-making skills.   These would be appropriate environments to use MEQ to evaluate students’ clinical knowledge.

References

1. Roediger H, Marsh E. The positive and negative consequences of multiple-choice testing. J Exp Psychol Learn Mem Cogn. 2005;31: 1155-9.
2. The Boards of Censors of the Royal College of General Practitioners. The modified essay question. J Roy Coll Gen Practit. 1971;21: 373-6.
3. Stratford P, Perice-Fenn H. Modified essay question. Physical Therapy. 1985;65: 1075-9.
4. Khan M, Aljarallah B. Evaluation of modified essay questions (MEQ) and multiple choice questions (MCQ) as a tool for Assessing the Cognitive Skills of Undergraduate Medical Students. International Journal of Health Sciences. 2011;5: 39-43.
5. Palmer E, Devitt P. Assessment of higher order cognitive skills in undergraduate education: Modified essay or multiple choice questions? Research paper. BMC Medical Education. 2007;7:49.

Consumerism and Entitlement: What is Education Worth?

by Gina Stassinos, Pharm.D., Clinical Toxicology Fellow, Maryland Poison Center and University of Maryland School of Pharmacy

Recently, I took advantage of Maryland’s tax free week and bought myself a few clothes. I wasn’t entirely sure of a few purchases.  So I asked about the return policy. Indeed, I later discovered that some things didn’t fit me well.  Economic exchanges can be a risk, especially large economic exchanges. What if that product being purchased was an education? A professor at a graduation ceremony once told the class that, unlike other things that can be lost, an education can’t be taken away from you. An education may be the single best investment anyone can make.  But I’ve heard some graduates say they would not make the same decision to pursue pharmacy as a career path or enroll in a specific program or school if they could do it over. Indeed, this question was included on the Pharmacy Alumni Survey distributed by the American Association of Colleges of Pharmacy and the Accreditation Council for Pharmacy Education.

It is difficult to believe that the value of an education could be in disputed. Like the dress sitting in my closet, some people haven’t gotten much use out of their degree.  Some degrees are tied to a specific set of skills that have perceived value in the marketplace. But if the necessary skill set changes or demand shifts, the anticipated return on investment will be diminished or lost. There are also people who enroll in a specific school only to find the culture isn’t a good fit for them.  Lastly, educational value can be viewed from a quality standpoint. Teachers and schools today are ranked and evaluated based on numerous parameters.

These “value” propositions often espouse an ideology that view students as consumers — consumers entitled to a quality produce at a reasonable (competitive) price.  Students (the consumers) are not accountable for the quality of the product.  Rather, an education is something to be purchased and it is a means to employment. Academic entitlement is a term used to describe the tendency of students to expect academic success without taking personal responsibility for achieving the success. Entitled behaviors include being overly critical of instructors, contesting grades, demanding accommodations, and arriving late to class.¹  A number of causes have been identified.  The millennial generation has been described as coddled narcissists.  There has been a rise in the number of market-driven degree programs and for-profit educational institutions.  Moreover, consumerism — societal trends to acquire ever increasing amounts of goods and services as well as to protect consumers against useless, inferior, or dangerous products — has become pervasive.² Several negative consequences of academic entitlement and student consumerism have been described. The rigorousness of instruction and school-wide morale are reduced when professors must cater to student desires and are pressured to make the “numbers look good” by inflating grades.  When the student is a consumer, teachers and schools are more apt to tolerate unprofessional behaviors.  In the end, more graduates may be unemployable because they lack the knowledge, skills, and attitudes needed.

Are students today really entitled narcissists? Academic entitlement is certainly not new.  It has been described as early as 1986.³  A study conducted at Roseman University of Health Sciences attempted to develop an objective and measurable way to identify individuals who are “academically entitled.”  They found that only 10% of their graduating students (14 out of 141) were “academically entitled” based on the criteria they developed.²  In the end, the authors concluded that there is a lack of empirical data about whether academic entitlement is a growing problem.

Let’s look at student consumerism using a different variable – the cost of education. A study comparing national data regarding pharmacy and other health care professions found that pharmacy students’ total debt increased 23% over the last 5 years compared to 4.7% for dental and 8.5% for medical students. It also found that the return on investment expressed as a ratio of average salary to indebtedness was now below 1.0 and the number of pharmacy positions in the United States is no longer increasing.⁴ The authors concluded that institutions were shifting are greater cost burden to students. It could be that students are painfully aware of their degree of indebtedness and as cost increases so do their expectations.

What is the solution to student consumerism and risky educational investments? Many have proposed to decrease tuition, increase government regulation, or decrease the number of graduates.  In reality, controlling the ebb and flow of an economy isn’t easy.  Centrally controlled economies (think the old Soviet Union and Eastern Block countries!) don’t have a particularly good track record.  Most agree that an undue cost burden should not be placed on students as this fuels consumerism. Some experts believe that academic entitlement in health professional education can be combatted by rightfully acknowledging that the patient is the consumer (not the student).⁵

Instructors should be prepared to face entitled students by increasing their awareness of the issues and cautiously considering student demands, and designing assessments that reinforce student accountability.¹  

All consumers, whether they are buying a dress or paying for tuition, should accept that there is risk in their decisions. It is common practice to assign value to intangible assets, like a college degree, more can be done to measure the quality appropriately.⁶  More objective data is needed to differentiate reasonable student requests from entitled ones. Student requests may be reasonable when they are based on four fundamental rights: 1) opportunities to learn, 2) to learn from faculty members dedicated to the best teaching practices, 3) to learn within a curriculum designed to prepare them for the profession, and 4) to have access to resources necessary to succeed.⁷ Clothing stores may go out of business and clothes will get used and thrown away, but education lasts a lifetime.  There will always be patients needing high quality providers. The focus should not be on whether the purchase should occur or if it fits just right, but on how we can enhance its value and take pride in our profession.

References

1. Cain J, Romanelli F, Smith KM. Academic Entitlement in Pharmacy Education. Am J Pharm Educ 2012; 76: Article 189.
2. Jeffres M, Barclay SM, Stolte SK. Academic Entitlement and Academic Performance in Graduating Pharmacy Students. Am J Pharm Educ 2014; 78: Article 116.
3. Dubovsky SL. Coping with entitlement in medical education. N Engl J Med. 1986;315:1672–1674
4. Cain J, Campbell T, Cogndon HB, et al. Pharmacy Student Debt and Return on Investment of a Pharmacy Education. Am J Pharm Educ 2014; 78: Article 5.
5. Holdford DA. Is a Pharmacy Student the Consumer or the Product? Am J Pharm Educ 2014; 78: Article 3. 
6. Cain J, Noel Z, Smith KM, Romanelli F. Four Rights of the Pharmacy Educational Consumer. Am J Pharm Educ 2014; 78: Article 115.
7. Fazlagic A. Measuring the intellectual capital of a university. Paper presented at: Conference on trends in the management of human resources in higher education; 2005 Aug 25-26; Paris, France.

Relationships Matter: Lessons for Teachers, Managers, and Clinicians

by Joey Mattingly, PharmD, MBA, Assistant Professor, University of Maryland School of Pharmacy

Teacher quality is often cited as one of the most important variables in student achievement and this quality varies significantly.^1,2  Are we stuck with a predetermined stratification of teacher talent, or is it possible to dig deeper and identify ways to improve organizational environments to achieve gains in teacher quality?  This post attempts to break down an important variable in education, the teacher-student relationship, and identify strategies for individuals and institutions to create environments that improve this exchange.

Figure 1

From a process analysis perspective, learning is an exchange between teacher and student(s) that takes place through a dyadic relationship (See Figure 1).  Since the student (member) essentially reports to the teacher (leader), this dynamic reflects organization reporting structures described in business literature.  The Vertical Dyad Linkage (VDL) and Leader-Member Exchange (LMX) theories were created to examine the impact of these relationships on important business outcomes such as efficiency, profitability, employee turnover, and job satisfaction.^3,4  In the clinical setting, we see research on the patient-doctor relationship (PDR) model and impact on healthcare outcomes and patient satisfaction.^5,6  While all of these theoretical models are being studied by researchers in various fields, there are a few common threads that we can all learn from (See Figure 2). 

Figure 2

Empathy

John Maxwell simplified the importance of empathy in his book The 21 Irrefutable Laws of Leadership through a quote he often shared with his employees, “People don’t care how much you know until they know how much you care.”⁷  A physician may be brilliant and considered a leader by peers, but a patient’s decision to continue the patient-doctor relationship is significantly influenced by whether or not the patient perceives that the physician actually cares.⁸  An educator who displays empathy toward students is able to build a positive classroom climate, stimulate growth, and cultivate more productive learners.⁹ 

Respect

Multiple studies have demonstrated the importance of respect and the relationship between teacher-student.^10-12  Teachers that respect their students, managers that respect their employees, and healthcare professionals that respect their patients are able to build stronger relationships.  Listening is a great way to demonstrate respect.  Students’ perceptions of their professor’s respectfulness are also associated with stronger student self-confidence and motivation.¹²

Accessibility

Top-down accessibility and availability has been cited as an important variable in the dyadic relationship.  One of the components of the VDL and LMX theories within management is the “high quality” and “low quality” relationships that develop between supervisor and subordinate(s).  Dansereau, Graen, and Haga described this phenomenon as employees being divided into the “in group” or the “out group” in terms of relationship quality.  They found that leaders devoted more time, attention, and support to subordinates within the “in group” even though employees in the “out group” needed more support.³  Building strong relationships with students, employees, or patients requires time and making oneself available.

A Leader’s Dilemma

While evidence supports the need for leaders to incorporate empathy, respect, and accessibility into interactions with subordinates, profit- and efficiency-maximizing strategies are often not conducive to relationships building.  An organization wishing to gain economies of scale through growth will increase the number of members reporting to each leader in the organization.  Similarly, a teacher may see class size grow from year to year or a physician may be required to see more patients in order to increase revenues (aka “Do more with less”).

On the flip side, a 1:1 student-teacher ratio would not be practical (and too costly) to implement in most cases even though it would definitely allow the teacher to focus all efforts on one subordinate.  So what is the answer?  Is there a magic number of subordinates that would allow teacher, manager, and physician to build strong relationships with the members they serve? 

The Right Span

If we want to improve the quality of our teachers, managers, and physicians, then we need to consider ways to build an optimal span of control.  Dr. Harold Koontz identified several underlying factors for leaders to consider.¹³  For example, employees require different levels of training based on abilities and experiences.  A manager of a new location of a retail franchise with a high percentage of recently hired employees may be unable to adequately supervise 10 direct reports while a manager of a more established location with more experienced employees may be able to manage 15 people.  When applied to education, a professor leading an undergraduate course on basic microeconomic principles may have an easier time managing 100 students in a large lecture hall as compared to a professor managing a doctorate level course focused on an in-depth analysis of the Nash Equilibrium and other non-cooperative game strategies in economics.  A doctorate level student actually has more training to do the “job” of learning and one would expect a graduate school professor would be able to “manage” more students, but the complexity and intensity of training actually requires more instructional effort and thus limiting the professor’s span of control.  Understanding the variables that influence a leader’s span of control may help determine the right number of subordinates for each teacher, manager, or physician.

Reducing class size or number of patient visits may be difficult from a business perspective, but that doesn’t mean our hands are completely tied.  Knowing how Koontz’s factors influence a teacher’s span of control can help them improve educational outcomes, whether through advocating for appropriate class size changes or applying techniques to improve information exchange.  Improving the quality of communication and the clarity of plans helps simplify the instructions for each subordinate and reduces the amount of time the teacher needs to spend communicating.  Utilizing technology may also help leaders gain efficiencies to tackle their workload.

Identifying strategies to improve the different vertical relationships within organizations should be a top priority.  Developing stronger connections based on a foundation of empathy, respect, and accessibility could help schools, businesses, and health-systems reach desired outcomes. 

For more posts written by Dr. Joey Mattingly, please visit Leading Over The Counter, a blog dedicated to leadership and management topics for pharmacists and other health professionals.

References:

1. Riley RW. Our teachers should be excellent, and they should look like America. Education and Urban Society. 1998; 31:18-29.
2. Slater H, Davies NM, Burgess S. Do teachers matter? Measuring the variation in teacher effectiveness in England. Oxford Bulletin of Economics and Statistics. 2012; 74:629-645.
3. Dansereau F, Graen G, Haga WJ. A vertical dyad linkage approach to leadership within formal organizations: a longitudinal investigation of the role making process. Organizational Behavior and Human Performance. 1975;13:46-78.
4. Thomas CH, Lankau ML. Preventing burnout: the effects of LMX and mentoring on socialization, role stress, and burnout. Human Resource Management. 2009;48:417-432.
5. Mikesell L. Medicinal relationships: caring conversation. Medical Education. 2013; 47:443-452.
6. Weng HC. Does the physician’s emotional intelligence matter? Impacts of the physician’s emotional intelligence on the trust, patient-physician relationship, and satisfaction. Health Care Manage Rev. 2008; 33:280-288.
7. Maxwell J. The 21 Irrefutable Laws of Leadership. Nashville, TN: Thomas Nelson; 2007.
8. DiMatteo RM, Prince IM, Taranta A. Patient’s perceptions of physicians’ behavior: determinants of patient commitment to the therapeutic relationship. J Community Health. 1979; 4:280-90.
9. O’Brien LM. Caring in the ivory tower. Teaching in Higher Education. 2010; 15:109-15.
10. Lammers WJ, Smith SM. Learning factors in the university classroom: faculty and student perspectives. Teaching of Psychology. 2008; 35:61-70.
11. Micari M, Pazos P. Connecting to the professor: impact of the student-faculty relationship in a highly challenging course. College Teaching. 2012; 60:41-47.
12. Komarraju M, Musulkin S, Bhattacharya G. Role of student-faculty interactions in developing college students’ academic self-concept, motivation, and achievement. J of College Student Development. 2010; 51:332-42.
13. Koontz H. Making theory operational: the span of management. J of Management Studies. 1966; 3:229-43.