October 15, 2009

Passive versus Active Learning

By Josephine Heinz, Pharm.D., PGY1 resident, Sinai Hospital of Baltimore

I remember the long hours I sat through my pharmacokinetic classes wondering what all the symbols my instructor was talking about meant. Wow, I thought, does all this really happen in a patient? Most of the equations were meaningless abstractions to me and it didn’t make any more sense to me at the end of the lecture.

Healthcare concepts are most often learned through traditional methods where the instructors figuratively pour information onto their students and students sit passively hoping they could retain all the knowledge and recall it for an exam. I had flashbacks to my experience as a pharmacy student when I read an article by Robert Dupuis and Adam Persky (Am J Pharm Educ 2008; 72(2): Article 29.) The investigators applied the principles of active learning to enable students to develop critical thinking, self-direction and practical application of information related to pharmacokinetics. Students were divided into small groups, assigned cases and had to present it to the entire class in the presence of the instructor. Individual responsibility was also emphasized by assessing each student’s preparedness for the presentation by quizzing them before class and also comprehensive examinations. Members of each group were chosen by the instructor based on their knowledge and skills rather than permitting students to make the groups for themselves. By placing students with various knowledge and skills together, this allowed students to understand how others think through problems. In their study, the authors compared the new teaching strategy to a traditional, passive approach of teaching the material. They found that not only did the students like this active teaching approach better; they could also relate the concepts to clinical practice and felt comfortable and confident when addressing real patient cases.

This study answered some questions that perplexed me as a pharmacy student. The traditional educational paradigm is like a "Container-Dispenser model" – it assumes the transference of knowledge is primarily the instructor's job and students' minds are like empty receptacles (Bonwell CC, Eison JA. Active learning: Creating excitement in the classroom. ASHE-ERIC Higher Education Report No. 1. Washington, DC: The George Washington University, School of Education and Human Development; 1991). Students are expected to passively absorb information in silent isolation during a lecture and later on, recall the knowledge when given a test or assessment. A lot of passive teaching occurs in pharmacy schools, and most students only get to apply the knowledge they have acquired during experiential rotations in the final year of the curriculum. This leaves the students feeling frustrated and inadequate because they cannot answer commonly encountered medication problems. This year, during my residency, I’ve heard students say “I just want this rotation to be over,” because they feel they have no time to sit down and read through all the lecture notes they have accumulated over the years. This is a concern for our profession. Do we have to force all graduates from doctor of pharmacy programs to get an additional year of practical training, or can we address the current curriculum to include more self-directed and active learning?

I recommend that we follow the example of Dupuis and Pesky by incorporating more active learning strategies into the pharmacy curriculum. Active learning is more than just "doing" but requires the student to "think about the things they are doing.” With active learning, the responsibility for learning shifts from the instructor to the student. Let us create an environment similar to what students will face in the real world so that they do not flounder when they get into practice. The challenge today is to encourage students to move beyond standard technical solutions and apply clinical reasoning. Active learning promotes the development of abilities in addition to knowledge, attitudes that employers require, and behaviors that better meet the demands of professional practice.

[Editor's Commentary: Active learning strategies - engaging students in meaningful activities - work. Active learning strategies generally require students to find the information (facts) for themselves and to apply this newly acquired (and their existing) knowledge to solve a problem. Many teachers (at schools of pharmacy and elsewhere) have embraced these strategies and use them extensively throughout their courses. Others are experimenting and use these strategies sporadically. Still others are unwilling or, perhaps, afraid to try. Admittedly, active learning strategies are a bit messy and the teacher must relinquish control of the content and the process. And if you extensively employ active learning strategies you can't tell students about all the great knowledge YOU possess. And isn't teaching all about sharing your wisdom with others? Not exactly. The teacher's knowledge and wisdom is no doubt important. It should help guide the creation of meaningful learning activities and authentic assessments of performance. Teachers and experts are great resources to students during their learning voyage. But telling people about everything YOU know isn't particularly helpful ... and it won't help a student construct their own understanding of the material and how to apply it. If you want to include more active learning strategies in your classroom, check out the Active-Learning Inventory Tool created by Jenny Van Amburgh and her colleagues at Northeastern University. -S.H.]

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