Breaking Down the Barriers that Hinder Class Participation

by Teyrra Crawford, Doctor of Pharmacy Candidate 2018, University of Maryland School of Pharmacy

“Show of hands. How many students think the answer is choice A.”

As instructors work to incorporate review questions and checkpoints in their presentations, many students decline to participate out of a fear of being wrong.¹ The lecturer is unaware of their students’ gaps in understanding the material and students miss opportunities for clarity out of fear of saying the “wrong” thing.

So how can we bridge the gap? How can instructors encourage students to be open and engaged during class discussions and when review questions are posed?  By creating a classroom that is psychologically safe – that’s how. The concept of psychological safety, simply stated, is the idea of “feeling safe”² in the situation or environment. This is not about physical safety (although that may be a factor), it is more about the student’s comfort in sharing their thoughts without fear of being attacked or judged by their peers or the instructor. But the fear of being wrong is not the only barrier. In addition, students need to know their input is appreciated and, regardless of a difference of opinion, respected.

Let’s revisit the example about asking the students to select the correct choice for a checkpoint question:

Several students raise their hands for the various answer choices: A, B, and C. While the students still have their hands raised for answer choice C the instructor points to one of those students and asks her to explain how she arrived at that answer choice.

Depending upon the age of the students/participants as well as the content, this type of “on the spot” attention may invoke anxiety or withdrawal from the student (from a behaviorist perspective) as well as others (from a social learning perspective). The goal in creating a psychologically safe classroom environment based on mutual respect and openness, as well as providing a variety of opportunities for meaningful participation that results in learning success. By establishing a culture within the classroom that fosters active participation and engagement by the students, it will lay the basis for a classroom that is psychologically safe.

Understanding that every student learns differently based on personality and experience, “putting someone on the spot” may be counterproductive and make the student feel less “safe.”³ But fear not instructors — all is not lost! There are several strategies that can be employed to inspire students to actively participate. Instead of students raising their hands, if they have access to electronic devices, they can submit their answer choices through a polling system via the internet, or using software and devices designed to increase interaction. Classroom response devices and online polling, test student knowledge and providing a way to share the results while maintaining a level of anonymity. These classroom aids (like ActivClassroom, iClicker, RW poll) can be used to teach and reinforce concepts throughout the course while still tracking the individual progress and challenges of the individual student. Such technology has been integrated at Ron Clark Academy Middle School⁴, a school that focuses on making learning fun and effective for students. It can also be used in health professional education!  In a comparative study conducted between 2008 and 2009 at an Indian medical school, clicker technology was used during lecture activities and the researchers measured it’s impact on test scores. The results showed that test scores and retention up to 12 weeks after the course were both higher in the group that used clickers.⁵

Due to budget restrictions, using such tools may not be an option. However there are other ways in which instructors can cultivate an environment where students enjoy sharing. Instead of simply stating that a student is “right” or “wrong”, open the response to the entire class for feedback. In an article published on Education Week’s website, an instructor discusses the strategy of “sticking with the student” that she learned from the book, The Skillful Teacher.⁶ In the article, McCaffrey suggests how to engage the student after a less than optimal answer is given without making the student feel like he was on the hot seat. The instructor has to be conscious of their own body language and tone when responding. Additionally, when responding to answers, the instructor should praise the student’s thinking, while encouraging them to think a little more about the answer.  Sometimes the instructor should reword the question to help the students explore the concepts more deeply. Another strategy she suggests using is “turn and talk” session. Using this strategy, students have an opportunity to discuss their responses with peers before having to provide individual responses to the teacher.  This relieves some of the immediate pressure from one student while actively engaging thought and participation from the rest of the class.⁷ Instructors can incorporate “get to know me” exercises so that students may become more at ease with their peers.

While different tools help to engage students, the fundamental component of building a psychologically safe classroom is consistency.⁸ For example, let’s say students have been allowed to turn in homework two days late without penalty. Let’s assume, mid-way through the course, a student turns in an assignment a day late and receives a zero. Such inconsistency incites anxiety in students and can destabilize that feeling of “safety” in the classroom. Once standards are set in place, they should stay in place.  Or if changes must be made, adequate explanation for the change should be provided to support consistency and trust between the students and the instructor.

Some points to remember:

1. Set the tone, be clear of what expectations are, and be consistent!
2. Provide a variety of opportunities for students to participate and show what they know!
3. Do some research and prepare activities in advance to maximize outcomes, minimize confusion, and reduce stress.
4. HAVE FUN!!  Your enthusiasm will rub off on your learners!

****Please share your comments and experiences with establishing and thriving a psychologically safe classroom!****

References

1.    Schreiner CS. Handbook of research on assessment technologies, methods, and applications in higher education. Hershey, PA: Information Science Reference; 2009. p. 53-57.

2.    Preisler J. Being Safe vs. Feeling Safe [Internet]. Fosteringperspectives.org. 2016 [cited 2016 Feb 1].

3.    Nilson L. Teaching at its best. Bolton, MA: Anker Pub. Co.; 2003. p. 129-131.

4.    YouTube. The Ron Clark Academy ActivClassroom - Top Ten Ways [Internet]. 2016 [cited 2016 Feb 1].

5.    Datta R, Datta K, Venkatesh M. Evaluation of interactive teaching for undergraduate medical students using a classroom interactive response system in India. Medical Journal Armed Forces India. 2015;71(3):239-245.

6.    McCaffrey B. Sticking With Students: Responding Effectively to Incorrect Answers [Internet]. Education Week Teacher. 2014 [cited 2016 Feb 10].

7.    Phillips M. Creating an Emotionally Healthy Classroom Environment [Internet]. Edutopia. 2014 [cited 2016 Jan 31].

8.    Coetzee M, Jansen C. Emotional intelligence in the classroom. Cape Town: Juta; 2007. p. 31-32.

9.    Jordan R, Lin Foo M, Hooley R. Science engineering - McGraw Center - Princeton University [Internet]. Princeton.edu. 2010 [cited 2016 Feb 1].

Mastering the Fundamentals of Precepting

by Sahil Sheth, Pharm.D., PGY-1 Pharmacy Practice Resident, Suburban Hospital

Residency training is a unique experience in the life of pharmacists. They are expected to demonstrate and develop clinical knowledge, organizational skills, and interpersonal communication while practicing pharmacy for the first time.¹ Therefore, effective teaching in this setting is essential. It requires flexibility, time commitment, and devotion to the resident. Preceptors need to address the resident’s desires as well as have flexible teaching methods and approaches.² This can be difficult because many preceptors are new to their roles and are developing their teaching skills. In one recent study, thirty percent of pharmacists indicated that they have been a preceptor for less than two years and over fifty percent had been a preceptor for less than five years.³ Using appropriate preparation techniques, effective teaching methods, and honest feedback strategies can help alleviate potential problems between preceptors and their trainees. Moreover, implementing these fundamentals can help the resident succeed.

Preparation and planning are key components of a successful practice-based teaching and learning experience. At the beginning of the clinical experience, preceptors should meet with the resident to discuss the resident's learning style, learning goals, and career aspirations so that the experience can be tailored to meet the resident’s needs. For example, a critical care preceptor can tailor major presentations such as journal clubs and patient cases in infectious diseases for a resident who is interested in applying to a PGY-2 Infectious Diseases residency. In addition to tailoring the rotation to residents’ interests, preceptors should outline day-to-day activities as well as longitudinal projects that the resident is expected to complete by the end of the experience. For instance, the preceptor can create a flow sheet outlining pre-rounding, discharge counseling, and follow-up tasks that needed to be completed each day. As a result, there is no miscommunication regarding the daily requirements and expectations.

Preceptors should teach critical thinking skills so that the resident becomes a detective able to gather relevant evidence, reflect on the information gathered, and manage patient interactions and follow-up.⁴  This can be done using different teaching styles. The two general preceptor approaches are the “sink or swim” method and the “manipulated structure” method.⁴ In the “sink or swim” method, the resident is assigned a panel of patients and is expected to manage those patients independently with no visible support from the preceptor.⁴ This includes pre-rounding on patients, attending interprofessional care rounds, performing medication reconciliations, and following up with interventions. There is minimal support from the preceptor besides providing “back up.” The “manipulated structure” approach involves selection of patients accompanied by preceptor consultations before and after interprofessional patient care rounds.⁴ Using this teaching strategy, the preceptor’s determines what the appropriate patient volume and complexity is based on the resident’s current level of skill and future developmental needs. There are several important factors that influence the selection of teaching approaches, but the most important factor is the resident’s prior experience. New residents (in July and August) will likely flounder if the “sink or swim” method is used, whereas residents in the final half of the residency year will likely thrive and appreciate the independence. It is important to select an approach that best fits the resident’s current skills and to conservatively advance the level of independence.

In addition to effective preparation and use of appropriate teaching methods, providing constructive feedback is essential to the resident-preceptor relationship. It is important for preceptors to provide ongoing feedback to residents – not just during the midpoint and final evaluation.¹ Moreover, feedback should always be done in a manner that helps the resident to perform better in the future.¹ Detailed and specific examples can help residents understand their strengths and weaknesses. For example, saying “You were lackluster today” is not sufficient. Instead, a more complete explanation like “Your medication reconciliation was incomplete for 5 out of the 10 patients that you followed today.  Be sure to ask about over the counter medication use in the future” is constructive. Preceptors can also conclude feedback sessions by asking the resident to reflect on the lessons learned.  This can help residents refocus and renew their efforts to perform better in the future.⁴

It is imperative for preceptors to prepare for the arrival of residents (and students), to use effective teaching methods, and to provide honest but constructive feedback. Developing a framework with these fundamental principles in mind will make the teaching and learning experience better for everyone. The roles and responsibilities of preceptors may differ, but the basic skills and teaching approaches are the same.

References

1. Anderegg SV, Christenson JC, Padgett CP. An accelerated, practice-based model for fostering precepting skills in pharmacy residents. Hosp Pharm. 2014;49(8):713-6.
2. Vaughn L, Baker R. Teaching in the medical setting: balancing teaching styles, learning styles and teaching methods. Med Teach. 2001;23(6):610-612.
3. Hartzler ML, Ballentine JE, Kauflin MJ. Results of a survey to assess residency preceptor development methods and precepting challenges. Am J Health Syst Pharm. 2015;72(15):1305-14.
4. Burns C, Beauchesne M, Ryan-krause P, Sawin K. Mastering the preceptor role: challenges of clinical teaching. J Pediatr Health Care. 2006;20(3):172-83.