by Ellen Varner,
Pharm.D., PGY1 Community Pharmacy Resident, University of Maryland School of
Pharmacy
As I navigate through my first year as a practicing
pharmacist, I sometimes find myself acutely aware of just how much
responsibility rests on my shoulders.
Occasionally, the requirement to make complex clinical decisions on my own
seems overwhelming and makes me wonder
if I missed something important in a class I took. Although I know it is impossible for one person
to know it all, at times I wonder if the collaborative techniques widely used
in my school’s curriculum inadvertently created some gaps in my knowledge. In a profession that often requires a high
level of independence, is placing a heavy emphasis on group-work and
collaborative learning actually doing a disservice to pharmacy students?
“None of us is as
smart as all of us.” ~Warren Bennis
In his book titled Organizing
Genius: the Secrets of Creative Collaboration, Warren Bennis, an
organizational consultant and leadership guru, describes the rise of the “Great
Group.” 1 The “Great Group” is
one that is able to achieve tremendous success often with very limited
resources. The members of the group have
high levels of commitment and their collective performance leads to high-output.
This fascination with group-work and
collaboration has transformed U.S. corporate culture into one that tends to
elevate teamwork above all else. According
to an article published in the journal Small
Group Research, by the year 2000 half of all U.S. organizations had moved
towards using teams, knocking down walls to create open-plan offices and shared
workspaces.2
Not surprisingly, the entire education system (pre-K to
graduate school) in the U.S. has moved to adopt a collaborative approach to
learning, hoping to teach students how to thrive in a team-oriented culture. A report published in 2002 by the Center for
Survey Research and Analysis at the University of Connecticut highlights this
shift in the structure of classroom learning.
Among the fourth grade teachers surveyed, 55% identify cooperative
learning in small classroom groups as their preferred form of teaching; 51% of
eighth-grade teachers reported the same preference. The results from this survey suggest that an
increasing number of teachers have de-emphasized traditional methods of
classroom instruction, such as lecturing or passing out homework assignments,
in favor of creating teams.3 During my own elementary school
education, I remember rearranging our neat rows of desks into “pods” – forming
small groups we were required to work with throughout year.
Creating groups that facilitate teamwork has also become a
major focus of the U.S. healthcare system, partly in response to an Institute
of Medicine (IOM) report titled To Err is
Human: Building a Safer Healthcare System.
The report details the high rate of preventable medical errors, many of which
were thought to be the result of poor or dysfunctional teamwork. The IOM report suggests that teamwork is required
for effective patient management because treatments are increasingly complex,
specialized, and risky.4 Medical education itself is also shifting
to place more emphasis on team-based learning (TBL) and problem-based learning
(PBL), which is often conducted using a small-group format. In many institutions, lectures have been
replaced with group-based projects or “fishbowl” activities where students
approach patient cases together as a group.
While the importance of teamwork within medicine is difficult to refute,
I am more hesitant to accept its dominating prevalence within medical
education.
The Case for
Individual Study
In Academically Adrift:
Limited Learning on College Campuses, the authors question the value of
group work. The book details the findings
of a University of Virginia study that tracked a nationally representative
sample of more than 2,000 students who entered 24 different four-year colleges.
Surprisingly, the results suggest that
college students who spend the majority of their time studying alone learn more
than those who work together in groups.5 An experiment conducted by the University of
Michigan found that people learn better after a quiet walk in the woods than
after a noisy walk down a city street.6 The question is – why is solitude so important
for learning? Anders Ericsson, a research psychologist, theorizes that solitude
is so crucial because it represents the only time when a person is alone and
can engage in something he calls “Deliberate Practice.” Ericsson states that “Deliberate Practice” has
four essential steps: 1. Identifying tasks or knowledge that are just out of
your reach 2. Striving to upgrade your performance 3. Monitoring your progress
and 4. Revising accordingly.7
For students participating in collaborative learning, it is almost
impossible for them to do these important tasks. Moreover, from an instructor’s point-of-view,
group work makes it difficult to identify students who are struggling (step
one) and provide individual feedback (step three).
When is Three (or
even Two) a Crowd?
While groups and teamwork shouldn’t be avoided, I think it
is important for educators to use discretion when designing their
curriculum. Although teaching students
how to work in a team is important, putting too much emphasis on collaborative
learning may actually be detrimental.
Instead of reserving complex patient cases for group projects, students
should also be given the opportunity to approach these challenges as
individuals so they can engage in “Deliberate Practice.” Group projects with collective evaluations can
make it difficult to identify knowledge or skill deficits in a particular
student. Further, students who spend too
much time working in groups may find that they lack the confidence to complete
a task on their own. Asking students to
perform clinical activities, such as patient interviews, on their own can help
them to become more confident in their own knowledge and skills. In addition, participating in a “fishbowl”
activity, one where a student can time-out to ask his or her classmates for
help while interviewing a patient, does not necessarily paint a realistic
picture of real patient-pharmacist interaction. For pharmacists who work in community pharmacy
settings, the ability to work independently and make autonomous decisions is as
crucial as being able to work effectively on a team.
References:
- Bennis WG, Biederman PW. Organizing Genius:The Secrets of Creative Collaboration. New York: Basic, 2007.
- Devine DJ. Teams in Organizations: Prevalence, Characteristics, and Effectiveness. Small Group Research. 1999; 20: 678-711.
- Barnes C. What do teachers teach? A survey of America’s fourth and eighth grade teachers. Civic Report no. 28. Center for Survey Research and Analysis, University of Connecticut, 2002.
- National Research Council. To Err is Human: Building a Safer Health System. Washington, DC: The National Academies Press, 2000.
- Arum R, Roksa J. Academically Adrift: Limited Learning on College Campuses. Chicago: University of Chicago, 2011.
- Berman MG, Jonides J, Kaplan S. The Cognitive Benefits of Interacting With Nature. Psychological Science. 2008; 19: 1207-212.
- Cain S. Quiet: The Power of Introverts in a World That Can't Stop Talking. New York: Crown, 2012.
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