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.