October 31, 2014

Service-Learning: From Theory to Practice

by Margaret Miklich, Pharm.D., PGY-1 Pharmacy Practice Resident, University of Maryland Medical Center

Service, combined with learning, adds value to each and transforms both.1
                       -Honnet and Paulsen (1989)

When asked why they’ve chose their career path, many health professionals say “I like helping people.”  I would argue that serving rather than helping people is really what drew them. I initially began contemplating this concept after reading Rachel Naomi Remen’s essay entitled Helping, Fixing or Serving?  In it she states, “Fixing and helping create a distance between people, but we cannot serve at a distance. We can only serve that to which we are profoundly connected.”  I’ve reflected on this concept for many years.

Service-learning embodies the idea that community service and classroom learning can be intimately intertwined.  Service is more meaningful when informed by theoretical frameworks.  And conceptual knowledge is better understood when examined through the lens of real world experiences.

While the first formal service-learning program was established in 1965, it wasn’t until the 1980’s and 90’s that a concerted effort was made to develop the theory and refine the practice of service-learning.2  Today, service-learning activities are pervasive and commonplace in curricula — from elementary school to undergraduate and graduate programs. In 2008, 20% of elementary schools across the nation participated in some form of service-learning.3 In the same year, a Campus Compact survey revealed that 93% of member colleges and universities offered courses that included some form of service-learning.  That’s 24,271 course offerings at 627 responding institutions!4

Given the vast number of service-learning opportunities, it's not surprising that a number of theories have been proposed to explain why service leads to learning.  And there are an even greater number of practices that attempt to guide how to conduct service-learning activities. There are common themes running through the proposed theories.  More important, all agree (proponents and critics alike) that how service-learning activities are constructed is extremely important.5,6 Before we examine the how, let’s take a quick look at the theoretical framework of service-learning.

Service-learning is most often explained using constructivist educational theory.  Constructivists believe that learners construct meaning from their experiences.  Learning is an active process prompted by new experiences and interactions that challenge prior understanding. An essential component of constructivism is for the learner to critically reflect on the new experience. It is only through reflection that learners decide if, when, and how they will alter their current knowledge and perceptions.7

There are several scholars who contributed to the theory of constructivism including Jean Piaget, John Dewey, and Maria Montessori (who developed an educational approach and schools bearing her name). David Kolb (who developed the Learning Style Inventory) used constructivist theory in his work on experiential learning.

Service-learning leads to learning so long as it includes experience, inquiry, and reflection.8 In order for knowledge to be recalled and applied, it must be gained through a situational experience. Inquiry then takes place when this new experience seemingly defies or contradicts prior knowledge.  Finally, reflection demands that inconsistencies between prior knowledge and knew experiences be reconciled.9

Individuals, organizations, and expert panels have all weighed in on how to best construct service-learning activities. While there is significant diversity in the proposed approaches to service-learning, common themes have emerged:

1) Service learning should be integrated into the curriculum or course in a purposeful way. Clear goals for both the service and the learning components must be articulated. Service activities should be designed with course objectives in mind and should clearly connect to learning goals.1,5,10

2) Requiring students to reflect on the experience is critical. Reflection must occur before, during, and after service. Not only should reflection take place at regular and purposefully constructed intervals, but it should be rigorous. Methods for reflecting should be varied and should include written, oral, and nonlinguistic approaches. Reflections should be self-assessed by students and assessed by instructors.1,5,9,10

3) Service-learning should be meaningful. The service activity should address a legitimate, unmet community need. Meaningfulness can also be achieved by allowing students to choose the issue they want their service to address. Moreover, meaningfulness is achieved through the relationships that students form while they are completing the activity.1,5

4) Service-learning requires a significant time commitment. The time commitment should be sufficient for students to have multiple experiences coupled with inquiry and reflection. One experience is unlikely to be sufficient. Moreover, rigorous inquiry and reflection requires elaboration in the form of papers, discussions, and other forms of expression. It is only through inquiry and reflection that students recognize discordance between their prior experiences and modify their knowledge, perspectives, and opinions.1,5,8 All of this takes time!

Three-quarters of colleges and schools of pharmacy reported some form of service-learning in their curriculum in 2002.11 There are many ways to structure a service-learning course but using proven strategies is likely to be more effective. One paper describes a service-learning course at the Worchester/Manchester campuses of the Massachusetts College of Pharmacy and Health Science (MCPHS) and studies student learning.12 The course consisted of five components: 1) service work in community settings; 2) seminars on topics such as communication and diversity, 3) guided journal writing (reflection); 4) guest speakers on community service activities such as homeless shelters and AIDS services; and 5) student-led presentations about their service activities and what they learned.

Let’s examine whether this course followed the best-practices principles for service-learning. Objectives were clearly set and service activities appeared to connect to course objectives. The reflection activities were not described in detail but students were required to answer a series of questions in weekly journal entries. Of note, when compared to the other components of the course, student reported learning the least from the journaling activity. It is difficult to say whether the service activities were meaningful but presumably they met real community needs. Students were allowed to rate their interests and had some say in the service activities they completed. With regard to duration, students were required to participate in two hours of service each week in addition to attending a weekly one-hour session at the school. The time allotted appears to be sufficient for students to make repeated site visits, gain new experiences, develop relationships, and engage in inquiry and reflection.

By understanding constructivist theory and intentionally applying the best practice principles, instructors can successfully implement service-learning activities into their schools’ curriculum. Service-learning is an excellent example of how theory informs practice.

  1. Honnet EP and Poulsen . Principles of Good Practice for Combining Service and Learning. Johnson Foundation, Inc.
  2. Marullo S. Service-Learning: A Movement’s Pioneers Reflect on its Origins, Practice and Future. Michigan Journal of Community Service Learning 1999; 6:133-137.
  3. Community Service and Service-Learning in America’s Schools [Internet]. Corporation for National and Community Service. 2008.
  4. Service Statistics 2008: Highlights and Trends from Campus Compact’s Annual Membership Survey [Internet]. Campus Compact. Boston: MA. 2009.
  5. Billig SH. Unpacking What Works in Service-Learning. Growing to Greatness. National Youth Leadership Council. 2007.
  6. Eby JW. Why Service-Learning is Bad. 1998.
  7. Kaufman DM. ABC of learning and teaching in medicine: Applying educational theory practice. BMJ 2003;326:213-6.
  8. Giles DE and Eyler J. The Theoretical Roots of Service-Learning in John Dewey: Toward a Theory of Service-Learning. Michigan Journal of Community Service Learning. 1994 Fall; 1: 77-85.
  9. Bringle RG and Hatcher JA. Reflection in Service-Learning: Making Meaning of Experience. Educational Horizons. Summer 1999. 179-185.
  10. USCDornsife. Joint Educational Project. University of Southern Californa. 2014.
  11. Peters SJ, MacKinnon GE. Introductory practice and service-learning experiences in US pharmacy curricula. Am J Pharm Educ. 2004;68(1): Article 27.
  12. Kearney KR. A service-learning course for first-year pharmacy students. Am J Pharm Educ. 2008;72(4):Article 86.

Formulating Small Groups for Success

by Christine Ji, Pharm.D., PGY-1 Pharmacy Practice Resident, MedStar Union Memorial Hospital

Have you ever participated in small learning groups? Were you satisfied with how the group experience turned out? Effective small group activities should be designed to promote positive interactions among students where everyone feels connected, engaged, and included. The potential advantage of small group learning is that students from different backgrounds and experiences come together to exchange ideas and learn from different perspectives.1 Before the 1960s, small group learning was relatively uncommon, and the education system was largely focused on what the individual learned through interaction with the instructor. Unfortunately, this created competition between students and final assessments were usually based on individual effort and accomplishment.  Things have changed and small group learning is now widely accepted. Indeed, some teachers prefer this instructional method for students at all levels.2

Small group learning may increase student accountability for acquiring the content knowledge outside of the classroom and applying it to the group discussions. Students reported that they are able to develop their communication skills and ability to effectively work as a team member.  These are important skills in the real world, particularly in work environments. Students also enjoy active engagement in the classroom setting and this can result in improved course grades.3

Despite the benefits that small group learning can offer, not all small groups work well and not all students have a positive experience.  For teachers, it is difficult to find practical guidance and effective methods to create and organize small groups to maximize the chances of success. Some have described group learning as “sinking or swimming together.”4  When small group work really succeeds it's the result of “participants' striving for mutual benefit so that all members of the group benefit from each other's efforts.” 4 Therefore, planning and managing small group learning activities is an important part of the instructional design process. Small group learning should be reflective of positive interdependence, face-to-face interaction, individual and group accountability, social skills development, and group evaluation.6

When assigned to small groups, students have two main responsibilities: learn the assigned material and make sure that all other members of the group learn the assigned material. Students should work together, striving for individual accomplishments as well as team success. Students can encourage and help each other to reach the group’s goals by exchanging needed resources, providing each other feedback to improve performance, and challenging one another to promote a higher quality of a task completion. Students are held responsible for their own contribution and also for achieving group objectives. By practicing in small groups, students are expected to be better prepared to complete similar work in the future. Furthermore, students get to know and trust one another and need to learn how to resolve conflict. Lastly, students learn about how well they perform and adjust learning strategies to better achieve goals. Through group evaluation, students should strive to maintain good working relationships and share feedback about participation. Students should be taught how to celebrate the success of the group and reinforce the positive behaviors of other students.

In terms of formulating groups, there is no “right” way of assigning students.  However, when students self-select groups, they tend to assimilate with people they already know and may exclude students who don’t fit into any group. On the other hand, when teachers randomly assign groups, it saves time and avoids any discrimination; but there is a risk of imbalances that hinder the group’s performance.5 Although it is more time consuming, selecting groups based on certain criteria such as gender, ethnicity, linguistic ability, personality, prior achievement, levels of competency, and work styles to promote heterogeneity may be a better alternative in terms of encouraging positive learning interactions and individual accountability. With regard to group size, it is important to come up with a number that is small enough to have interactive discussions, but large enough to tolerate an occasional gap in the attendance and allow smaller subsets (of 2 and 3 student) to engage in more  focused activities. Groups can be rearranged at the mid-semester point to allow students to rotate and interact with various people.2

For small groups to succeed, it is important to plan ahead. Arrange the physical environment to maximize group interaction and avoid any pitfalls such as students coming to class unprepared, being reluctant or refusing to participate, or letting one student dominate the discussion. It is important to give student adequate time ahead of class time to prepare and, if they not prepared, to ask why. Teachers should try to understand why some students are not participating. The reasons may be due to their past experiences in other classes. It can be helpful to start out with an easy, engaging question and to discuss the goals and outcomes of small group learning with the class ahead of time. During small group discussions, teachers and facilitator should invite everyone to speak and use structured discussion protocols.4


  1. Steinert Y. Student perceptions of effective small group teaching. Medical Education. 2004; 38:286-93.
  2. Kitchen M. Facilitating small groups: how to encourage student learning. Clin Teach. 2012;   9:3-8.
  3. Ferreri SP, O’Connor SK. Redesign of a large course into a small-group learning course. Am J Pharm Educ. 2013; 77: 1-9.
  4. Jaques D. Teaching small groups. BMJ. 2003; 326: 492-4.
  5. Meo SA. Basic steps in establishing effective small group teaching sessions in medical schools. Pak J Med Sci. 2013; 29: 1071-1076.
  6. Roger T, Johnson DW. An overview of cooperative learning. Campbell University, NC. 2013

October 24, 2014

Does Class Size and Student:Teacher Ratio Matter?

by Andrew Wang, Pharm.D, PGY1 Pharmacy Practice Residency, Howard County General Hospital

Does class size and student:teacher ratio affect student performance? How should this factor affect how we teach? This issue is relevant whether we are teaching elementary or secondary or post-secondary schools.  There has been an ongoing dialog about the value of reducing class size and student:teacher ratio versus the cost of education.1 While proponents for each side of the debate point out the advantages and disadvantages of each position, does the focus on the number of teachers or the number of students really lead to improvements in student performance? The focus of this blog post isn’t to compare which is better but rather, it is using data to examine the benefits and limitations of both. In examining both sides of this issue, we as educators can make better choices with regard to instructional design and teaching style.

Why is class size so important? Some state governments have pushed for smaller class sizes as a means of improving student test scores and overall success. Class size affects a host of variables when it comes to teaching. For example, class size can impact teacher-student interactions, both quantitatively and qualitatively. It is highly unlikely that in a class of 200 students, one professor would have the ability to spend much time directly interacting with each student. Moreover, those teacher-student interactions will be lacking in quality. Thus, class size is an environmental factor teachers must consider when determining the methods of instruction and when making instructional design decisions.2 The approach a teacher should take in a large class differs from that of a small class.

Proponents of higher student:teacher ratios argue that strong evidence is lacking regarding the benefits of smaller classes, particularly in the setting of undergraduate and graduate education.  One meta-analysis suggested that student performance was independent of class size.4  Could student achievement and class size really be independent? The key conclusion made by this study was the fact that it focuses on post-secondary education. In classes where students already possess higher-level thinking abilities, class size may not impact student performance.  Indeed, there may be some benefits to larger class sizes such as greater competition, more ideas, more resources, and more efficient use of resources.

Proponets of smaller class size and lower student-teacher ratios argue that more and purposeful student-teacher interactions result in enhanced learning, particularly when it comes to helping students develop their higher-order thinking and complex reasoning skills.5  When the class size is larger, the teacher has less influence over teaching and places more responsibility on students to learn.6 In larger classes it is harder for the teacher to have command over the environment. Lastly, class size may play a role in the teacher’s attitude and commitment.  In smaller classes, the teacher is more likely to be committed to every student’s success whereas in a larger class setting, the focus may not always be teaching.7

How should class size influence our approach to teaching? It starts with the instructional design. One must consider the desired result and goal of the class. For example, in a larger class setting, knowledge transmission may the goal and it may sufficient to completely and logically present information in the form of a lecture.   In smaller class setting, the desired result may go beyond mere knowledge transmission.  The approach to achieving the desired result may also differ in a smaller vs. larger class size. For example, in a smaller class size, informal interactions and one-on-one customized learning activities can be used while in a larger class size, a more structured lesson plan might be needed. Some modes of delivery might include lecturing, video media, and group discussions. It is important to note that in larger class settings, the same material must be provided to everyone.8  In a smaller class environment, it is possible for information to be conveyed differently to each student, which allows the educator evaluate each student’s needs and give additional assistance as needed.

Lastly, the evaluation process usually differs. In a larger setting, it is typically necessary to have examinations at the conclusion of instruction in order for students to demonstrate competency and understanding of the material.  These exams must be efficient to administer and score.   In contrast, in a smaller class setting, evaluations can occur almost simultaneously as one teaches the material.

Class size should influence on how the educator approaches instructional design. The educator needs to tailor his or her instructional approach and create an effective environment for learning. Whether the class is large or small, the educator still has control of how students are educated. Student performance is influenced by multiple factors: background knowledge, interactions, participation, attitude, course material … and class size. Success is multi-factorial and cannot simply be solved by focusing on one aspect. While class size does have some influence, it is not the only variable that determines student performance and success. And in the end, well-planned instructional designs is perhaps important that class size and student:teacher ratio.   

  1. Kezar, AJ. The impact of institutional size on student engagement. NASPA Journal. 2006;43(1):87-91.
  2. Taft SH, Perkowski T, Martin LS. A framework for evaluating class size in online education. Quarterly Review of Distance Education. 2011;12(3):181-97.
  3. Ice P, Gibson AM, Boston W et al. Exploration of differences between community of inquiry indicators in low and high disenrollment online courses. Journal of Asynchronous Learning Networks. 2011.15(2);44-69.
  4. Slavin, R. Class size and student achievement: Is smaller better? Contemporary Education. 1990;62(1):6-12.
  5. Rawat KJ, Thomas M, Quazi W. Factors that inhibit teachers from adapting a student – centered teaching approach. The European Journal of Social Sciences. 2012:28(3);383-90.
  6. Radders, SK. Design for class size: A study for instructional designers of large courses [dissertation]. [Minnesota]. Capella University; 2012. 7-20 p.
  7. Savage, A. Why going to a small college rocks [Internet]. 2014 May 24 [cited 2014 Oct 10].
  8. Clark, D.R. Design Methodologies: instructional, thinking, agile, system, or x problem? [Internet]. 2012 [cited 2014 Oct 18].

October 21, 2014

Get Smart: Smartphones to Complement Classroom Learning

by Jessica Pyhtila, Pharm.D., PGY1 Pharmacy Practice Resident, VA Maryland Health Care System

"The advent of the smartphone ushers in a myriad of possibilities for its use in education to complement classroom learning," I narrate into the Siri app of my beloved iPhone 5. It’s the opening sentence to this blog essay regarding smartphone use in education for a graduate school class I’m taking.  It’s by no means the first time I’ve used my smartphone as a tool to facilitate my academic work.  It’s not even the first time I’ve used it in this class, a decentralized internet-based class that meets online via Blackboard Collaborate. I’d like to take decentralization one step further by using my iPhone to participate in this class (or any class) from any location of my choice.

I am far from the only person who sees the potential for smartphone use in education, which has become a hot topic among educators. Long lists of educational activities have been published over the past year, encouraging teachers and learners to use smartphones to complement classroom instruction.1,2 Ideas on these lists include everything from “remembering notes” (e.g. allowing students to photograph the chalkboard/whiteboard) to “blogging” to attendance-taking using location-based apps.1,2

Smartphones are also being used in health profession education, both inside and outside the classroom. One study found 55% of medical students and 75% of medical school faculty reported that smartphone use had a positive impact on medical education, and 41% reported they used smartphones every day for clinical self-education.3 Further, 75% of medical students reported using smartphones for medical calculators, and 70% of reported using smartphones to access online textbooks.3 Another study of undergraduate health professional students found that smartphone use for educational purposes was focused on accessing medical reference material, and that smartphones were used for this purpose inside the classroom, outside the classroom, and between patient visits.4 Yet another study showed that more than 50% of medical students use smartphones to assist with drug information, clinical guidelines, point-of-care information, calculations, and differential diagnoses.5

Smartphone prevalence is increasing as well. In the USA alone, 71% of the US population owns a smartphone, according to Nielsen—a percentage that increases to 85% for people age 18-24 and 86% for people age 25-34.6 Additionally, there is a negligible gender divide, with 70% of men owning smartphones vs. 72% of women, as of 2014.6 Use is believed to be prevalent even among young children, with one estimate that 20% of children age 5-7 use a smartphone, generally belonging to their parents.7 That number increases to 70% of children age 13-17.7 Furthermore, the top-selling iPhone education applications are generally apps which have been designed for children.7 As of this blog post, 9 of the top 20 selling paid education apps on iTunes were aimed at children under the age of 11. Children and teens can be heavy users of smartphones and are highly reliant on phone-based communication and networking.  A 2012 Pew study showed that the average teen sends 60 text messages a day.8

Corporations are taking note. Textbook companies such as Pearson are leaping on the trend, offering not only digital versions of graduate-level medical textbooks and textbook auxiliary material, but also flashcards and educational games aimed at young children. McGraw-Hill is also offering flashcard applications aimed at young children to enhance their academic skills. Smaller companies have invested in this trend too, with a wide array of products aimed at both teachers and learners of all levels. Products include everything from free polling apps for teachers to simulate multiple-choice questions on tests, to social-networking style apps for student collaboration that leverage the theory of social learning, which postulates that learning takes place within a social context and construct.

With the use of any new technology—particularly one with such a wide variety of applications available—comes the need to appropriately evaluate its value using it for educational purposes. Carly Shuler, a Cooney Fellow at the Joan Ganz Cooney Center, advocates a “3 Cs” approach to evaluating the appropriate use of smartphones to complement education.9 (This approach was initially developed by Lisa Guernsey to evaluate children’s media).9
  • Content – what is the design of the application? Is it appropriate to the age group and education level of the learner? Is the data contained therein trustworthy?
  • Context – how is the learner applying what they are learning from the app? Are they learning a skill which they can then translate into a different activity? Is there a discussion period after the app use has been completed?
  • Child (or, more broadly, learner) – what types of apps work best for this particular learner? Is there a type of app that seems more efficacious and engaging? Is the learner able to engage with others when not using the app?
Taking this approach into consideration alongside the real-world studies that have incorporated smartphones in teaching and learning, we should pose a few questions teachers should ask as they evaluate whether smartphone use can complement their classroom instruction. First, educators should evaluate the educational needs that might be served by smartphone use—such as remote access. Second, they should evaluate if the need is present in the classroom itself, or outside the classroom. Third, they should evaluate what types of resources and applications might best complement these needs. Lastly, they should consider evaluating smartphone use in the classroom using the “3 Cs” approach.

  1. 40 Simple Ways To Use A Smartphone In The Classroom [Internet]. Te@chthought. 2012 Oct 10 [cited 2014 Oct 5].
  2. Heick T. 50 Reasons It’s Time For Smartphones In Every Classroom [Internet]. Te@chthought. 2014 Jan 27 [cited 2014 Oct 5].
  3. Wallace S, Clark M, White J. ‘It’s on my iPhone’: attitudes to the use of mobile computing devices in medical education, a mixed-methods study [Internet]. BMJ Open 2012 [cited 2014 Oct 10];2: e001099.
  4. Davies BS, Rafique J, Vincent TR, et al. Mobile Medical Education (MoMEd) - how mobile information resources contribute to learning for undergraduate clinical students - a mixed methods study [Internet]. BMC Med Educ. 2012; 12: 1
  5. Boruff JT, Storie D. Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information [Internet]. J Med Libr Assoc. 2014; 102: 22-30.
  6. Ring the Bells: More Smartphones in Students’ Hands Ahead of Back-to-School Season [Internet]. Nielsen. 2013 Oct 29 [cited 2014 Oct 5].
  7. Mobile Millennials: Over 85% of Generation Y Owns Smartphones [Internet]. Nielsen. 2014 Sep 05 [cited 2014 Oct 5].
  8. Lenhart A. Teens, Smartphones & Texting [Internet]. Pew Research Center. 2012 Mar 19 [cited 2014 Oct 5].
  9. Hoffman T. Can Smartphones Make Kids Smarter? [Internet]. Education.com. 2013 Aug 27 [cited 2014 Oct 5].