Embracing Failure

by Shiela Hwe, Pharm.D., PGY1 Community Pharmacy Resident, University of Maryland School of Pharmacy

When was the last time someone described a failure as a good thing?

In today’s society there is such a heavy focus on results and quantifying success, that the process of learning often gets ignored. For business owners, the end goal is to earn money. For most students, the measure of success is earning an A in every course.

Carol Dweck, a Stanford psychologist, has focused much of her research on how a person’s personal view of their personality and intelligence influences motivation. In her research, she describes a person with a “fixed mindset” as someone who assumes that our abilities are innate and unchanging, and success is the confirmation of intelligence.¹ The incremental theory describes a person with a “growth mindset” as one who believes that intelligence can be developed, and that failure is necessary and a motivator to improve.¹ (See Table 1)  Although “successful” students can can have either a fixed or growth mindset, their personal model influences how they respond to failures.²

Table 1. Characteristics of Fixed and Growth Mindsets.

Fixed Mindset	Growth Mindset
Avoids challenges	Embraces challenges
Gives up easily	Persistent in the face of setbacks
See effort as fruitless or worse	See effort as the path to mastery
Ignore useful negative feedback	Learn from criticism
Feel threatened by the success of others	Find lessons and inspirations in the success of others

When I first stumbled on Dr. Dweck’s research, I found it fascinating. I grew up in a household where education was the number one priority and hard work was the way to achieve success. Failing meant receiving a letter grade that was anything less than an A. The concept of a fixed or growth mindset is relevant to learners of all ages.  There are students who aren’t “challenged” until high school, college, or even graduate school. Personally, I skated through school without much effort. It was not until graduate school when I found myself studying harder and receiving lower grades. I was at a crossroads.  I could have adopted a fixed mindset - the grades I was receiving were an indicator that I was “failing.” (Remember, anything less than an “A” is perceived as a failure!).  Fortunately, I adopted a growth mindset.  I learned that my grades were an indicator that I needed to re-evaluate my study methods.

The incremental theory sounds great but is there proof that people who adopt a growth mindset are more successful?  In a five-year study, Dweck followed seventh and eighth grade students enrolled in mathematics courses. Once entering the study, students filled out a questionnaire used to classify them as having either a “fixed” or “growth” mindset. Achievement outcomes were based on a combination of exam scores, class participation, and homework. The results showed that students with a “growth mindset” were more likely to believe that working hard was “necessary and effective in achievement” and were less likely to “attribute a potential failure to lack of ability.”² Two years later, students who had expressed a higher “growth mindset” were outperforming those that believed intelligence was static.²

In a follow-up interventional study, half of the students were taught the incremental theory – in other words, how one’s mindset impacts performance.  The goal was to observe whether this intervention had an effect on motivation. Teachers reported improvements in classroom motivation and previously declining mathematics grades were halted.² This study showed that changing the beliefs of students about their intelligence helped stimulate enthusiasm and also enhanced academic performance.²

Although these studies focused on elementary school children, the same principles can be applied to adults. In a 2003 study, 128 pre-med Columbia University students taking a General Chemistry course were evaluated based on learning goals. Students with active learning goals (growth mindset) exhibited greater motivation, achieved higher grades, and demonstrated greater improvement over time.³ When faced with a challenging course in which they struggled, students with a growth mindset performed better than those with a fixed mindset.³  However, regardless of their mindset, students who did not struggle with the subject matter excelled in the class.³  Thus mindset seems to be most important when faced with failure.

The good news is that mindsets is not permanent!  Teachers can take steps to help learners view “failure” in a positive light. Here are 5 tips to encourage students to embrace failures:^1,2,3,4,5

• Teach your students about incremental theory.  Studies have shown that students who believe that intelligence is not stagnant, and failure is just a stepping-stone to success generally have more motivation and perform better when faced with difficult situations.
• Praise wisely.  Praising intelligence or only the outcome orients your learner to a fixed mindset, and encourages the need for constant reassurance. Rather than telling students how smart they are or how well they performed, praise the process. Praise your learner’s persistence and effort too. 
• Encourage independent learning.  Particularly in experiential education, allow the students to have independence and autonomy to make mistakes and be accountable.  This will service as motivation for continued learning.
• Take the most common errors and analyze them together, as a class.  By utilizing social cognitive theory to engage your class as a whole, students can identify what problems they are experiencing, and also observe what other students are doing to fix these problems. This also helps the learner feel they are not the only ones having problems, and encourages them to improve with the class.
• Be specific when identifying mistakes.  Rather than pointing out that your learner answered 5/10 questions incorrectly, discuss what caused these errors. By being able to pinpoint where in the process the mistake happened, students can focus their efforts there the next time.

When we are working with learners, regardless of age, it is important to instill the idea of a “growth mindset.” By teaching your students to process errors or “failures” in a way that leads to improvements in the future, you are setting your learners up to view failures as learning opportunities, and to be equipped with the attitude that promotes learning for life.

References

1. Popova, M. Fixed vs growth: The two basic mindsets that shape our lives. BrainPickings. January 29, 2014.  Accessed October 20, 2015.
2. Blackwell, LS, Trzesniewski, KH, & Dweck, CS. (2007). Implicit theories of intelligence predict achievement across an adolescent transition: A longitudinal study and an intervention. Child Development 2007; 78: 246–263.
3. Grant H, Dweck CS. Clarifying achievement goals and their impact. J Pers Soc Psychol, 2003; 85: 541-553.
4. Dweck, C.  The power of believing that you can improve [Video file]. November 2014.  Accessed October 20, 2015.
5. Maats, H, O’Brien, K. Teaching students to embrace mistakes. Edutopia. March 20, 2014.  Accessed October 20, 2015.

The Jigsaw Discussion Protocol Puts the Pieces Together

by Sara M. Ayele, PharmD, PGY1 Pharmacy Practice Resident, VA Maryland Health Care System

According to the Accreditation Council for Pharmaceutical Education (ACPE) Standards, graduates from pharmacy schools must be active, lifelong learners.¹ Pharmacists are  playing an increasinging role in team-based patient care, according to a new study from the Pharmacy Workforce Center.²  Thus, student pharmacists must become effective communicators as well.³  Yet, most teaching methods used during pharmacy school emphasize content delivery rather than developing the skills a health professional needs on a team. Ideally instructional methods should not only deliver content, but also build communication and self-directed learning skills. The jigsaw technique appears to be an excellent way to achieve all of these aims.¹

The jigsaw technique requires students to explore the content by bringing together multiple pieces of information, like a jigsaw puzzle. In order to master the material, students must gather all the “pieces” of the puzzle. Once the instructor determines the theme or content area to be explored, students are randomly divided into several small groups that are called “teaching” groups. Then, each student in the teaching group is assigned a portion of the material to be learned.  Next, students in the various "teaching" groups who have been assigned the same material form an “expert group.”  The expert group works together and decides how best to deliver, communicate, and teach the material to the members of their respective “teaching” group. Finally, the teaching groups reconvene so each group member teaches others about their piece of the puzzle until all the experts have presented and all of the material has been covered.¹ Using this strategy, each student has a piece of the topic’s puzzle.  And like a health professional team, working together they complete the puzzle to achieve the goal.

Instructors at the Midwestern University Chicago College of Pharmacy used the jigsaw technique during a clinical skills pharmacy practice laboratory.³ The goal of the laboratory was to give students the opportunity to evaluate the literature regarding switching oxybutynin transdermal from a prescription to a nonprescription product. Students were asked to make a recommendation based on the evidence they found in the literature. The instructors provided readings regarding the disease (over active bladder), drug (oxybutynin), and regulatory aspects of a potential prescription to OTC switch. Teaching groups of 5 to 7 students were randomly assigned. Each member of the teaching group was given a different reading. Expert groups collectively discussed the material then students reunited with their teaching group to inform the group about the assigned materials. The teaching group came to a consensus on whether they would support the nonprescription switch. At the conclusion of the workshop, each student took a quiz. The questions covered all the “puzzle pieces” covered in the reading assignments.  The average score on the quiz was 10.5/12, demonstrating that the technique was successful in teaching the concepts. Students performed equally well regardless if they were members of the expert group that was assigned the specific reading material. Most students preferred (74%) the jigsaw technique in terms of the ability to enhance understanding of the concepts, applying the information, stimulating interest in the topic, encouraging feedback, and developing communication skills. Further, 65% of students reported they would enjoy using the jigsaw technique more often throughout the pharmacy curriculum.¹

Teachers at the University of North Carolina School of Pharmacy used the jigsaw technique to teach pharmacokinetics.⁴ In one module, students learned about renal drug clearance.  Each student was assigned a drug that was renally eliminated but by different mechanism such as filtration, active tubular secretion, and passive tubular reabsorption. A select list of drugs banned by the International Olympic Committee (IOC) and the National Collegiate Athletic Association (NCAA) were chosen, including atenolol, methamphetamine, and nandrolone – all of which are renally eliminated, but by different mechanisms. Students propose a way to beat a urine screen for their assigned drug and were expected to teach other members of their “teaching group.” Following the activity, students’ comprehension was assessed on a comprehensive exam (which covered a number of content areas in the course). The average score on the renal subsection of the exam was 8.7 out of 10 (87%).⁴ Student surveys indicated they enjoyed the jigsaw technique; however 43.5% of students preferred traditional lectures and only 11% of students wanted the jigsaw technique incorporated more frequently throughout the curriculum.^4,5. These data suggests that although students comprehended the material, it wasn’t a technique that everyone enjoyed or preferred.

Although the jigsaw technique has several advantages in terms of learning and skill development, it isn’t a panacea. Some students find teaching others difficult/burdensome and their work in other classes suffers due to the amount of time required preparing to teach others.  Based on past negative experiences doing group work where members failed to do their fair share, some students may feel apprehensive about participating in a group project. Scheduling can also be a barrier – especially if the students are expected to meet in their “expert groups” outside of class time.⁴

The jigsaw technique is a discussion protocol that encourages peer-to-peer collaboration, content exploration, and skill development. It is best employed when there is a large amount of content to teach, when students can meet with their assigned “expert” groups at times conducive to their schedules, and when students are given plenty of time to digest the material.⁵ The jigsaw technique make students accountable for not only their own learning but also each other’s learning. This teaching strategy helps students hone their listening, communication, and problem-solving skills, which are essential in practice. The jigsaw technique not only helps students develop their factual knowledge for exams but leads to long-term retention and promotes self-directed learning.  As healthcare professionals we certain cannot know everything, but it is important that we know how and where to find information and use problem solving skills. So, next time you are preparing a lecture on a complex topic, consider implementing the jigsaw instead. After all, “learning together is the thing for all of us.”⁵

References:

1. Phillips J and Fusco J. Using the Jigsaw Technique to Teach Clinical Controversy in a Clinical Skills Course. American Journal of Pharmaceutical Education. 2015; 79 (6): Article 90.
2. American Pharmacists Association. Pharmacists’ roles on the health care team are expanding. April 9, 2015. [Internet]. Accessed on September 30, 2015.
3. Howard M and Persky A. Helpful Tips for New Users of Active Learning. American Journal of Pharmaceutical Education. 2015; 79 (4): Article 46.
4. Persky A. and Pollack G. A Hybrid Jigsaw Approach to Teaching Renal Clearance Concepts. 2009; 73 (3): Article 49.
5. Social Psychology Network. Jigsaw Classroom. December 10, 2000. [Internet]. Accessed on September 30, 2015.