Collaborative Teaching: One Way to Improve Teaching and Learning

by Giang Le, PharmD, PGY1 Pharmacy Practice Resident, Baptist Memorial Hospital-Golden Triangle

I came across this interesting article the other day entitled “Teacher collaboration in curriculum design teams: effects, mechanisms, and conditions.”¹ This article got me thinking about my years in school. I recall only a few class sessions that had two or more teachers providing instruction together. For many courses, students are essentially learning from one teacher’s perspective — which is to say, one person’s perspective. Students might assume that what that teacher says is accurate and that piece of information must be the best answer.  I’m not sure that’s always true.  From the teacher’s perspective, I wonder if they get bored teaching the same materials every year? Do teachers ever get so used to their way of teaching that they become reluctant to change? Or unaware of the need to update their content or instructional methods? Maybe teachers need a partner. Maybe instruction is better when taught by a team. Indeed, there is evidence that collaborative teaching can help teachers update their knowledge, improve their practice, and enhance learners’ outcomes.^1,2

What are collaborative teaching design teams? These teams involve educators working together to design all classroom activities, including developing a curriculum, selecting the most effective teaching methods, creating test questions, and developing tools to assess performance. An essential part of being an educator is to continue to learn – not only about the content but also ways of teaching. However, it can be hard to keep up with all the newly available information, especially when there are thousands and thousands of scientific articles published every day. In the process of balancing work life and personal life, teachers can find themselves in situations where they quickly skim an abstract or a summary. Teachers often rely on their existing knowledge and beliefs to develop learning materials. This is when collaborative teaching can be of benefit. Having people with different knowledge, skills, and perspectives on a team creates more opportunities to share knowledge.¹ If a conflict arises (a conflict of ideas, not philosophies or personalities), teachers will have to provide evidence to support their reasoning and convince their peers. In this process of solving “constructive” conflicts, teachers begin to self-reflect on their existing knowledge and their ways of practice. Self-reflection is a critical and we should practice it every day, but it is always easier said than done. Collaborative design teams create the opportunities for constructive conflict and stimulate self-reflection.

One may agree that collaborative teaching can improve teachers’ knowledge, but the more important question is: Can it improve learner outcomes? That’s the ultimate goal that every educator should strive to achieve — improvements in students performance. This means that at the end of the course, we want our students to not only understand or recall but also be able to apply the materials in a variety of circumstances. Theoretically, all teachers should have a tool to assess the students’ performance to guide their teaching. With collaborative teaching design teams, teachers can work together to create these tools. Everyone can contribute based on their experience and what’s available in the educational literature. 

In a recent study, the investigators examined three specific forms of collaboration in teaching: (1) instruction-related, (2) project-related, and (3) organization, performance, and problems-related. Their study is a secondary analysis of the German Program for International Assessment (PISA) data. A sample of 869 schoolteachers was matched with a corresponding sample of 869 students. Students’ achievement in this study was measured by comparing their grades in the first half-year of the academic period. The relationship between the different forms of teacher collaboration and student achievement was estimated through a structural equation model. They found that the third form of collaboration—modified teaching based on students’ performance—positively influenced students’ achievement. However, an interesting aspect of this study was that the subject matter taught were primarily sciences (like maths, biology, physics, and chemistry). This might explain why the third form of collaboration focusing on practice problems would produce a positive outcome. In other subjects involving more discussions and debates, the knowledge-sharing and planning process might play a more important role.

Collaborative teaching design teams can theoretically improve other aspects of the learning process. For example, I remember when my class was divided into groups to do group assignments. From time to time, the professor would be occupied with one group and unavailable to others. This quickly led to frustration among students who had a hard time understanding the materials. Instructions that may seem easy to follow for the professor might not be interpreted the same way by the students. To finish the assignment within the class period, the students would turn in poorly done work and minimal learning occurred. Collaborative teaching would give students greater access to more instructors. This benefit also applies to practical labs where one professor cannot supervise the whole class to ensure everybody follows the instructions.

How do we implement effective collaboration? This process can be time-consuming since it requires team members to gather, discuss, and revise the course materials. A course may need to be developed a year in advance and regularly revised based on students’ feedback and performance. Another strategy for effective collaboration is to allow time to build relationships and foster a culture of trust, respect, and humility between the teachers on the team.³ It is best if each team member is willing and able to contribute in meaningful ways to the work of the group. Here is my favorite quote about teaching collaboration: “As a successful co-teacher, you need to (a) know yourself, (b) know your partner(s), (c) know your students, and (d) know your ‘stuff’.”⁴  Teachers will vary in their ability to effectively collaborate. Some may find it hard to work with partners who have different beliefs and teaching styles.  Others may find it hard to assess how well the students understand the materials. If teachers know their strengths and weaknesses, they can complement each other and support one another. While team teaching can be great, forcing collaboration when teachers are not on the same page will create more classroom confusion and negatively affect learners’ outcomes.

Collaborative teaching is an ongoing process with evidence that it can improve teachers’ and learners’ outcomes. Teachers may find the collaboration not only a beneficial way to enhance their knowledge but also an opportunity to update what and how they teach.  Like any form of collaboration, the process will take time, effort, and commitment to achieve success.

References

1. Voogt JM, Pieters JM, Handelzalts A. Teacher collaboration in curriculum design teams: effects, mechanisms, and conditions. Educational Research and Evaluation. 2016; 22: 121-140.
2. Mora-Ruano JG, Heine JH, Gebhardt M. Does teacher collaboration improve student achievement? Analysis of the German PISA 2012 sample. Frontiers in Education. 2019; 13: Article 3389. (Accessed 2021 Oct 12).
3. Lauren D. Teacher collaboration: how to approach it in 2020. Schoology Exchange. 2020. https://www.schoology.com/blog/teacher-collaboration (Accessed 2021 Oct 12).
4. Keefe EB, Moore V, Duff F. The four “knows” of collaborative teaching. Teaching Exceptional Children. 2004; 36 (5): 36-42.

Listen, Clarify, and Appreciate! Best Practices When Receiving Feedback

by Camron Jones, PharmD, PGY1 Pharmacy Practice Resident, Magnolia Regional Health Center

 “It takes humility to seek feedback. It takes wisdom to understand it, analyze it and appropriately act on it”
-Stephen Covey.¹

What do you feel when you hear the word feedback? Do you feel nervous?  Perhaps scared about what the person might say? Do you clam up thinking you have done something wrong? I have a love/hate relationship with feedback. I love knowing how I am performing.  But I sometimes fixate on the things I did “wrong.” It can be intimidating and sometimes we get stressed out about the small things. For many people, it’s hard to accept feedback because it’s perceived as a negative judgment. I have grown to appreciate feedback because it helps me understand what I am doing well and what I need to work on. I think it’s intimidating to ask for feedback. This is something that I am working on. Not only is feedback hard to ask for, but it’s hard to give.

Feedback is the act of someone providing information about a person’s performance of a task and the recipient using the information as a basis for improvement.² Frequently we talk about how to formulate feedback so that we can help another person excel. But receiving feedback is a critical skill too. All of us need to learn to receive feedback graciously and not jump to conclusions. Both giving and receiving feedback are difficult! If we use the right techniques, we can learn as well as teach others. Let’s take a deep dive into receiving feedback by examining the best practices and how to teach it.

There are three crucial steps that should be adhered to if we want to maximize the benefits of receiving feedback. These include actively listening, clarifying the feedback, and expressing gratitude.^3,4  Listening with an open mind is a huge part of the feedback process. Listening promotes our personal and professional growth. Too quickly we jump the gun and interrupt the person providing the feedback. In the Christian Bible, there is a saying that resonates with that I believe applies to receiving feedback: “..let every man be swift to hear, slow to speak.” When receiving feedback, we must consider all of it before responding. Reflecting on the feedback is so important because it helps us grow.

When you hear words that you interpret as negative it can bring you down. But it’s important to ask questions because without getting clarification, you can create an injustice and take feedback too personally. The feedback is about your performance, not about you as a person. I feel like this is critical to understanding how to receive feedback. The person giving the feedback is only trying to help us succeed and grow.  If we dismiss or reject the feedback, we are disadvantaging ourselves.  So, ask clarifying questions!  Make certain you fully understand what the person giving the feedback is telling you. Ask for specific examples.

Finally, it’s important to express appreciation to the person providing the feedback. Remember, the person giving the feedback is usually uncomfortable.  Giving feedback and telling someone something they might perceive as negative can be intimidating. It's easier just to not say anything.  Or to tell someone everything is perfect. But the person giving feedback took the time to carefully consider how to help you improve and they want you to succeed! If we show appreciation, they will feel encouraged and more willing to share with us. 

Tips for Receiving Feedback:3

Be a good listener When in doubt, ask for clarification Embrace the feedback session as a learning opportunity Remember to pause and think before responding Avoid jumping to conclusions, and show that you are invested in the learning process and keen to improve Think positively and be open to helpful hints Learn from your mistakes and be motivated Be a good sport and show appreciation Be proactive – ask for feedback!

Studies have repeatedly shown that effective feedback has a powerful influence on how people learn. In one study involving medical students, they looked at methods to teach how to use feedback. They developed a 2-hr workshop that focused on writing goals in a learning contract, defining effective characteristics of feedback and practicing the use of feedback in response to feedback received. Following the workshop, student group scores increased significantly. They also looked at how coaching improved students' perception of their feedback skills. They noted how students' feedback interactions improved, especially during informal interactions. In a model that defines the communication pathway, they described how the process of feedback could falter. This could be due to previous experiences from the receiver, also the fear of damaging relationships between the giver and receiver.⁴

Another study enrolled second and third-year internal medicine residents. This study focused on a One-Minute Preceptor model. This was a conversation between the resident and the teacher to help improve the resident's clinical skills. One of the greatest benefits of the One-Minute Preceptor model is feedback. At baseline, feedback was ranked as one of the weaker areas. Significant improvements were reported at the end of the study. Feedback was shown to have the greatest impact on performance.⁵ 

Another good resource is the ask-tell-ask feedback model.⁶ For example, say you are a student, and you provided education to a patient about anticoagulation therapy. With the first ask, the preceptor asks the student to talk about how they thought the experience went. The preceptor then gives feedback on what was observed, both positive and negative aspects of the performance.  This is the tell component of the model. During the last ask, the student then reflects on what the preceptor has told them and they both set goals moving forward.⁶ This allows the receiver to actively participate in the conversation and formulate an action plan. I personally experienced this method of feedback in my last year of pharmacy school. Not only did it help me improve, but it also helped me be more open to feedback.

As teachers, we must learn to give feedback in a way that positively affects our students. We should allow students time to self-reflect before giving feedback. This gives the students an opportunity to think about the strengths and weaknesses of their performance. As a learner, we must learn from the feedback and use it as a tool for us to improve. Be sure to listen, clarify, and appreciate!

References

1. Covey, SR. Stephen R. Covey interactive reader-4 books in 1: The 7 habits of highly effective people, first things first, and the best of the most renowned leadership teacher of our time (Internet). Mango Media. 2015 (Cited 2021Oct1)
2. “Feedback”. Merriam-webster.com dictionary, merriam-webster. www.merriam-webster.com/dictonary/feedback. (Cited 2021Sept29).
3. Hardavella G, Aamil-Gaagnat A, Saad N, et. al. How to give and receive feedback effectively. Breathe 2017; 13:327-333. 
4. Bing-You RG, Bertsch T, Thompson JA. Coaching medical students in receiving effective feedback. Teaching and Learning in Medicine 1998; 10(4):228-231. 
5. Furney SL, Orsini AN, Orsetti KE, et al. Teaching the one-minute preceptor. J Gen Intern Med. 2001;16:620-624.
6. Jug R, Jiang X, Bean S. Giving and receiving effective feedback: a review article and how to guide. Arch Pathol Lab Med 2019; 143 (2):244-250.

Accelerated Curriculums: Potential Benefits … and Harms

by Brett Lambert, PharmD, PGY1 Pharmacy Practice Resident, North Mississippi Medical Center

For those looking to pursue a career in pharmacy or other health professions, the decision as to which school to attend is often based on a few key factors. Important factors applicants typically assess include the duration of the program, the passage rates on licensure exams, the quality of the education, the benefit to their career, and the memories that can be made with peers or the quality of the social life. Some colleges/schools offering an accelerated program and prospective students are left to consider the benefits of completing their desired curriculum faster than normal. It is therefore important to consider the potential benefits (and harms) of completing an accelerated curriculum.

Accelerated programs provide an opportunity for students to complete their preferred professional program in a shorter period of time than a normal curriculum length. For pharmacy schools, this means students complete their doctoral degree in three years rather than the usual four years. To accomplish the same curriculum in 3 years, accelerate program conduct classes year-round without end of semester breaks like summer or winter break. According to the American Association of Colleges of Pharmacy, as of July 2020, there are a total of 142 colleges or schools of pharmacy.¹ Of these schools, there are at least fifteen programs that offer an accelerated Pharm.D. curriculum.

One way to determine if accelerated programs are as good or, perhaps, superior to traditional programs is to compare pass rates on the licensure exam.  In pharmacy, the NAPLEX (North American Pharmacist Licensure Examination) is required to become a pharmacist.  The NAPLEX first attempt passage rates from the past three years (2017,2018, and 2019) for the fifteen accelerate programs were substantially lower than the national average passage rate. Using data reported by the National Association of Board of Pharmacy,² accelerated programs averaged a passage rate that was 3-5% lower than the average national passage rate.

While this data is not a full analysis of the data available, it does provide some insight as to how these programs compare to the traditional four-year programs. However, the length of the curriculum is but one factor and there are other factors that could affect NAPLEX pass rates. One of which is the age (or maturity) of the program. In a recent survey that examined pharmacy school characteristics and their first-time NAPLEX pass rates, pharmacy schools established before 2000 had significantly higher first attempt pass rates on the NAPLEX than those established after.³ Thus historic (or more mature) programs seem to produce students better prepared to pass the NAPLEX on the first attempt. The authors also reported that between 2015 and 2016 when the NAPLEX testing structure was changed, a smaller percentage of four-year programs experienced a 10% or greater decrease in first-time pass rates than three-year accelerated programs (c²=5.54, p=.02).³ The pass rate dropped from 92.5 to 86.6 among traditional four-year programs and from 90.2 to 80.4 in three-year accelerated programs.  This difference was significant.³

Another study compared the length of advanced pharmacy practice experiences (APPE) to determine the correlation with first-time pass rates. The lengths of the APPEs included four, five, or six-week blocks.⁴ However, the results provide no evidence that APPE rotation length correlated with a higher first attempt pass rate for the NAPLEX. This would argue that the length of clinical rotations does not affect a student’s ability to pass the NAPLEX.

One metric that some programs use to boast about the quality of graduates they produce is the number of students that match with PGY-1 and PGY-2 residency programs. According to the National Matching Service, the official matching program for PGY-1 and PGY-2’s, in 2020 there was a total of 7535 students who registered for the match and 3904 who matched; which is a 51.8% match rate for all programs. The 15 three-year programs had a match rate of 39.7% compared to a 53.1% match rate for four-year pharmacy programs.⁶

Another difference between programs of different lengths that is more difficult to quantify is the impact an accelerated curriculum might have on a student’s social life. A curriculum that completely consumes a student’s life and does not allow enough time to get involved in professional or social organizations, maintain hobbies, or spend time with family reduces opportunities for a healthy social life. These barriers to social and professional development could affect the student’s interactions with patients, peers, or co-workers.

Given the potentially negative consequences of accelerated curriculum, why would any student consider applying to or attending such a program? The most obvious benefit is that by graduating a year early the student enters practice a year sooner – which translates in an extra year of work, an extra year of practical experience as a pharmacist, and can lead to an improved financial situation in both the short and long-term. However, there is no promise of a better job, career, or future opportunities.

The debate about accelerated professional programs is not unique to pharmacy — the medical professional is now deliberating the merits of accelerated medical school programs. Recently, there have been medical school programs that are reviving a three-year program structure. These three-year accelerated programs originated during WWII when there was a shortage of physicians.⁵ Once the war was over, the students who graduated from the accelerated programs felt the need for more courses.⁵ Which suggests that graduates from these accelerated programs didn’t feel fully prepared despite the fact that they received on-the-job experience. Surprisingly, these three-year programs were not discontinued due to lower pass rates of the USMLE (the United States Medical Licensing Examination) compared to those of four-year programs. Indeed, there are no differences between the pass rates based on program length.⁵

It seems to me that when designing a program and teaching students, there needs to be time for the information to sink in. The literature suggests that out-of-class learning, including extra-curricular activities, can be very beneficial to one's career. This includes building leadership skills through service in professional organizations and developing social skills.  Students also need time to think deeply about the material covered in class. There are many factors that influence licensure pass rates, but I don’t think we know yet the key ingredients to creating a shorter curriculum that is equally effective.

References

1. Academic Pharmacy's Vital Statistics. American Association of Colleges of Pharmacy. Published July 2020. Accessed February 20, 2021.
2. North American Pharmacist Licensure Examination Passing Rates for 2017—2019 Graduates Per Pharmacy School. National Association of Board of Pharmacy. Published February 25, 2020. Accessed February 20, 2021.
3. Williams JS, Spivey CA, Hagemann TM, Phelps SJ, Chisholm-Burns M. Impact of Pharmacy School Characteristics on NAPLEX First-time Pass Rates. Am J Pharm Educ. 2019;83(6):Article 6875.
4. Ried LD. Length of advanced pharmacy practice experience and first-time NAPLEX pass rate of US pharmacy programs. Curr Pharm Teach Learn. 2020;12(1):14-19.
5. Schwartz CC, Ajjarapu AS, Stamy CD, Schwinn DA. Comprehensive history of 3-year and accelerated US medical school programs: a century in review. Med Educ Online. 2018;23(1):1530557
6. NUMBER OF APPLICANTS APPLYING FOR PGY1 PROGRAMS BY SCHOOL 2020 MATCH – COMBINED PHASE I AND PHASE II. National Matching Services. Published 2020. Accessed April 1, 2021.