Did Video Kill the Classroom?

by Jess Chasler, Pharm.D., PGY1 Pharmacy Practice Resident, the Johns Hopkins Hospital

When used appropriately, technology can enhance learning by transmitting information and improving active engagement with the material to be learned.  One technology that has become increasingly popular among institutions of higher learning, including pharmacy schools, is video-recorded lectures.  These videos are made available online for students to watch. Video-recordings allow students to re-watch parts of lectures they may have found confusing.  Some schools have used this technology to asynchronously transmit lectures to a satellite campus. Although such recordings may be beneficial in terms of improving students’ understanding of the material, their routine use often leads to reduce classroom attendance.  Does this technology have a net benefit when it comes to learning in professional schools? Do teachers need to change their approach in order to attract more student to attend class?   Should professors change how they teach in order to accommodate a world where most lectures are viewed online?

Classroom Attendance.  What motivates students to attend class in the first place?   And for that matter, does attendance even matter at all?  Studies in the field of education have revealed a positive relationship between classroom attendance and academic performance.¹ Focus groups and surveys have identified various reasons for attendance and absenteeism. Commonly cited reasons for absence include longer breaks between classes, class scheduled before or after a test, availability of course content outside of class, a belief that the class is easy, or the perception that not much is learned when attending class.^2,3   Reasons students cite for attending class relate to the classroom environment and the relationship between the professor and students.  Student are more likely to attend when they perceive the faculty has a high level expertise and credibility.  Students also indicate that they are more likely to attend when they get to apply the information being taught to solving real problems.²  There is also a propensity to attend class when students perceive that the instructors notice and care that they are present or when they feel obligated to attend.³ Reasons for attendance and absence vary from class to class and but, surprisingly, class size does not influence attendance.^2,3

Beyond Learning.  Although absenteeism may impact academic performance, there is also evidence suggesting that there are other important aspects of professional development that may suffer. Presence in class helps to foster relationships between students and faculty, and these types of relationships have been shown to impact professional behavior, attitudes, and occupational values.²   Professional socialization involves the transformation of students into professionals.⁴ This transformation relies on the interaction between students and exemplary pharmacists, which includes faculty members.  By coming to class and forging relationships with faculty, students are able to identify and emulate these professional role models, and even transform relationships from that of professor and student to one of mentor and mentee. Additionally, being present on campus for class helps to encourage participation in professional organizations. If students do not come to campus for class, it is unlikely they will come to campus for an organizational meeting.

Video Recording Lectures.  Absenteeism from class has been associated with poorer academic outcomes, however this may not hold true for students who watch lectures from home. Indeed, some studies have shown that when lectures were posted online, students scored higher on exams.^5.6 In one therapeutics course, there was a substantial (25-75%) decrease in attendance but has not be consistently seen in all cases.⁵  A similar study found that attendance was not impacted when lectures went online.  However, students in this study had to wait 72 hours following the live session to gain access to the online video of the lecture.⁶ In both studies, an overwhelming majority of students found the online video to be a useful resource and recommended implementing the technology as a permanent change.^5.6

A Personal Perspective.  In an editorial discussing online lecture capturing, Romanelli and colleagues make the argument that classroom attendance should not be the deciding factor as to whether or not to implement this technology. They argue the focus should be on facilitating student learning.⁷  But beyond achieving the stated learning objectives on exams, it is also important to keep in mind unmeasured, often hidden outcomes, such as the formation social and mentoring bonds that are an important part of professional development.  As a recent graduate of a school that made lectures available online for students, I can say that it was helpful to have access to them. I found it beneficial to pause, rewind, and (occasionally) watch lectures on “double-speed.”  But relying online video-recorded lectures did come at a cost.  I felt less engaged in pharmacy school when compared to my experience as an undergraduate.  Now as I prepare to lecture to pharmacy students at my alma mater this spring, I can’t help but hope that most students will attend. Cues from the class can help guide a lecture, and I worry I may not know until weeks later if a concept I was attempting to convey was not clearly explained.

There is no doubt that in the age of video-recorded lectures, faculty must lead the way by inspiring students to be actively engaged in school.  Relegating purely didactic instruction to the web and implementing active learning strategies for all face-to-face sessions is one potential solution.⁸  Faculty should also be vocal about encouraging their students to come to class and should be adaptable by changing the format and style of their lectures in those circumstances when many will choose to watch the lecture online. Delaying access to online videos may encourage students to attend while also taking advantage of this technology.  Policies that encourage attendance may also help keep students on-track.

So, do video-recorded lectures have a net benefit for students in professional schools?  There are no clear cut answers but one thing is certain: future faculty must work to create a classroom environment that is both engaging and functional for online viewing. Further work in this area is needed so that students can gain the necessary knowledge, skills, and attitudes to become professionals.

References

1.  Hidayat L, Vanal S, Kim E, Sullivan M, Salbu R. Pharmacy Student Absenteeism and Academic Performance. Am J Pharm Educ. 2012; 76(1): Article 8.
2.  Fjortoft N. Students’ Motivations for Class Attendance. Am J Pharm Educ. 2005; 69 (1): Article 15.
3.  Westrick SC, Helms KL, McDonough SK, Breland ML. Factors Influenceing Pharmacy Students’ Attendance Decisions in Large Lectures. Am J Pharm Educ. 2009; 73 (5): Article 83.4.  Hammer DP, Berger BA, Beardsley RS, Easton MR. Student professionalism. Am J Pharm Educ. 2003;67:Article 96.5.  Elsasser GN, Hoie, EB, Destache CJ, Monaghan MS. Availability of Internet Download Lecture Audio Files on Class Attendance and Examination Performance. International Journal of Instructional Technology and Distance Learning. 2009; 6(2); 19-23.6.  Bollmeier SG, Wenger PJ, Forinash AB. Impact of Online Lecture-capture on Student Outcomes in a Therapeutics Course. Am J Pharm Educ. 2010; 74(7): Article 127.7.  Romanelli F, Cain J, Smith KM. To Record or Not to Record? Am J Pharm Educ. 2011; 75(8): Article 149.
8.  Stoner SC, Fincham JE. Faculty Role in Classroom Engagement and Attendance. Am J Pharm Educ. 2012; 76(5) Article 75.

Required Readings: Turn Reluctance into Enthusiasm

by P. Tim Rocafort, Pharm.D., Assistant Professor, University of Maryland School of Pharmacy

I still remember the days when I impatiently waited for the end of the school year. I could hear the summer sun knocking on the windowpane of my 7^th period British Literature class, while I struggled to keep up with my teacher’s ramblings about Rudyard Kipling’s “The Jungle Book.”  All I could think about was escaping from that concrete forest called high school and onto the sandy shores where homework was left far away. But before I bolted out to freedom, I was shackled by the required reading list distributed by the teacher.  All I could think was “so long sweet summer.”  Yet, to my surprise, by the first quarter of the next school year, I was passionately participating in group discussions of the assigned books. What happened to swayed me from being a literary antagonist into a Shakespearean fan?  How has this revelation influenced my perspective on required readings?

From summer readings to manuscript about investigational studies, required readings to most students is often a dreadful task that a learner “must” complete. The fact that reading is labeled as “mandatory” or “assigned” may deter the learner from pursuing it and often induces sleep when attempted.  Even worse, if students are dissuaded by the obligatory nature of the reading, they may eventually develop apathy to reading as a whole. Some may argue that there are three reasons why this happens: 1) learners can’t do it, 2) learners don’t want to do it, and 3) learners just want to get through it. 

Learners can’t do it.  Poor reading comprehension may explain why some students dread required readings. If the selected readings are too difficult and beyond the reader’s level, they will intimidate and deter rather than stimulate and encourage.¹ The learner’s educational background, which included reading exercises that varied in quality and resulted in differences in analytical and critical thinking skills when compared to peers, has a critical role in this problem.¹ Information regarding past educational experiences is vital in analyzing the learner’s baseline reading comprehension; however, this assessment is often never done because educators are much too eager to overload learners with materials that promote “independent learning”.²  Primary source text (like clinical trials) and other forms of academic research, may be too difficult or confusing for learners to grasp if introduced too early in their training.  So they may simply just give up or not try at all, despite their initial yearning to learn.^2,3,4

Learners don’t want to do it.  In today’s world, where technology makes obtaining information easier and quicker, it is challenging to find a “place” for required readings intended to provoke thought and expand perspectives.⁵  In an era when students expecte dynamic discussions, interactive videoconferencing, and activities that promote “doing” or application rather than “passive” undertakings, required readings are often poorly received by students.^{5, 6} Moreover, educators now rely heavily on these new “exciting” tools to replace traditional instructional methods. Changing social-cultural influences and generational perceptions are key contributors to the listless view of required readings by students.⁵

Learners just want to get through it.  Many learners have a “just get through it” attitude when it comes to required readings.⁶  This sentiment may be exacerbated by educators who feel obligated to hand-hold or spoon-feed the students to ensure delivery of the information.  Learners suffer from a lack of effort and fail to achieve deep and long-lasting understanding.  Instead, they settle for rote memorization.

So, how was I converted from being a reluctant follower to an enthusiastic supporter of required readings? I owe much of my personal development to teachers who identified the issues and addressed them with instruction.

From my teachers I learned that required readings are a tool to establish one’s own thoughts regarding the subject.  They are not a be-all and end-all fountain of wisdom.  Using therapeutic guidelines in a patient-centered care approach is a good example of ensuring knowledge is taken beyond the fine print and into day-to-day clinical practice. The educator must take the initiative to point out key facts and pose significant questions that motivate learners to complete the assigned task in an active, evaluative manner.  Simply providing a student a package insert to interpret drug information may not be the best way to educate a student about patient-specific dosing and drug interactions. Including case-based scenarios along with a series of Socratic questions may effectively supplement this approach and allow for students to create more patient-focused judgments about the meaning of the written materials. The educator should also engage students in vibrant learning sessions by encouraging students to share their thoughts and allowing the class to systematically analyze the material. Involving students in journal club discussions, pharmacotherapy rounds sessions, and patient case presentations will help elevate their reading comprehension and understanding of the subject. The educator must also demonstrate proficiency of the subject by being prepared to discuss key issues from the readings. With the educator’s facilitation and expertise, required readings become a more effective exercise that involves active reading that improves the analytical and critical thinking skills of learners.⁷

Instead of leading to a dead end, required readings should direct learners to a more enlightened and enriched path.  At the end of the day, it is up to the learner to take responsibility for completing required readings, but it is up to the educator to set a positive tone and to use them wisely to develop deeper insights.

References:

1. Ryan T.E. Motivating novice students to read their textbooks.

Journal of Instructional Psychology. 2006; 33(2), 135-140.

2.  Linderholm T., Wilde A. College students' beliefs about comprehension when reading for different purposes. Journal of College Reading and Learning. 2010; 40(2), 7-19.

3.  National Endowment for the Art. To read or not to read: A question of national consequence. Washington, D.C.: National Endowment for the Arts. 2007

4.  Concepción D.W. Reading Philosophy with Background Knowledge and Metacognition. Teaching Philosophy. 2004; 27(4): 351-368. 

5.  Oblinger D.S.,  Oblinger J.L. Educating the Net Generation. Educase. 2005.

6.  Paulson E.J. Self-selected reading for enjoyment as a college developmental reading approach. Journal of College Reading and Learning. 2006; 36 (2), Spring, 51-58.

7.  Wade S.E., Moje E.B. The role of text in classroom learning: Beginning an online dialogue. Reading Online, 2011; 5(4).

Games in Healthcare

by Melissa Weaver, Pharm.D., PGY1 Pharmacy Practice Resident, Carroll Hospital Center

I love Angry Birds. Fire the slingshot to send the single-minded birds on their mission!  Victory comes when the evil pigs die! Getting engaged in the game is so easy.  On level 1-1, the player gets three angry birds to kill one evil pig in a wooden and ice structure.  Usually, the player needs only one angry bird to succeed at the mission and feels like a “rock star” after the victory. The story and feelings build with each episode and level.¹

But how do suicidal birds relate to healthcare and education?  Think of the last time you sat in a class and were captivated by the topic.  Compare that to the last time you played a video or computer game and were completely engrossed. In which situation were you more engaged and involved?  I’ll admit, I often feel more involved when I play Angry Birds than when I listen to a lecture.

So what exactly is a game?  The definition seems to be evolving, but Roger Caillois, the French sociologist, said that games have six elements: (1) non-obligatory (2) separate in time and place (3) uncertain course (4) unproductive (5) governed by rules and (6) make-believe.²  Games are designed with multiple ways of keeping the player participating and involved.  Most presentations I have seen lack that level of engagement. The lecture is thought by some to be an inefficient, stifling, and clunky means of delivering instruction; a blunt tool in an age of laser precision.³

Why do games make a difference now?  Games are not new to healthcare education.  In 1995, one of my preceptors played Jeopardy! during her pharmacy residency at the University of Illinois, Chicago.  But technology has improved significantly since 1995.  The proliferation of mobile devices such as tablets and smart phone pave the way for using these devices to teach.  These devices are the first to overcome the limitations of handsets as learning tools.³ The technology also allows the speed and scope of information to be more current than is typically seen in academic courses.⁴ 

How are games being used in healthcare?  Currently, there are more than 300 health-related games on the market aimed at patients in two general themes – physical exercise and brain fitness games.⁵  But disease-specific games are also available such as Re-Mission, a video game for young people with cancer.  The lead characters for Re-Mission include Roxxi, a microscopic robot that fights infections and cancer at the cellular level; Smitty, a retired nanobot who provides holographic guidance to Roxxi; and Dr. West, creator of the self-aware artificial intelligence nanobots and the nanotech chronic illness treatment program.⁶  From a patient education standpoint, the game addresses the importance of taking oral chemotherapy regimens, prompt reporting of symptoms and side effects, proper nutrition, as well as anxiety, nausea, and pain management.⁷ A randomized controlled trial compared adolescents and young adults who played a standard commercial video game versus Re-Mission.  Participants were asked to play the game at least one hour per week for the three-month study period. The conclusion of the trial is that treatment adherence and indicators of cancer-related self-efficacy and knowledge were significantly improved in those who played Re-Mission.⁸

Games are engaging.  They can be used to teach by allowing the learner to apply newfound knowledge to new situations.  Game scenarios can be easily modified to reflect the continuous influx of healthcare information updates.  While playing the game, the learner has the opportunity to make decisions and instantly see the results of those decisions.  The ability to recreate the scenario allows the learner to practice this decision-making skill. Better decisions in healthcare result in better healthcare.

References

1  Angry Birds [Internet]. Finland: Rovio Entertainment Ltd. Accessed 2012 Oct. 16. 

2  Caillois R. Man, Play and Games. University of Illinois Press: 2001. pp. 9-10. Accessed on 2012 Nov 26. 

3  Galagan P. From Pie in the Sky to the Palm of Your Hand: The Proliferation of Devices Spurs More Mobile Learning. T+D [serial online]. March 2012;66(3):29-31. Accessed 2012 Oct 11.

4  Kalman F. Social Media: Learning's New Ecosystem. Chief Learning Officer [serial online]. August 2012;11(8):42-45. Accessed 2012 Oct 11.

5  Gaming in Healthcare. Digitome Corporation. Accessed on 2012 Nov 26.

6  Re-Mission Characters. HopeLab, A Part of the Omidyar Group. Accessed on 2012 Nov 26.

7  Re-Mission For Clinicians. HopeLab, A Part of the Omidyar Group. Accessed on 2012 Nov 26.

8  Kato PM, Cole SW, Bradlyn AS, Pollock BH. A Video Game Improves Behavioral Outcomes in Adolescents and Young Adults WithCancer: A Randomized Trial. Pediatrics 2008; 122:2 e305-e317.

Role Modeling: The Forgotten Influence

by Ashley Janis, Pharm.D., PGY1 Pharmacy Practice Resident, the Johns Hopkins Hospital

The role of an educator, in the classroom and in practice, is to foster learning and serve as a role model.  Role modeling can be defined as teaching by example and influencing people in an oftentimes unintentional, unaware, informal, and episodic manner.¹ Thus, we all serve as role models for learners in our field through our routine actions.  Role modeling has often been referred to as the “hidden curriculum” of professional education as we often lack understanding regarding the influence role modeling has on learners.¹ Students learn behaviors that appear successful to them in light of their personal goals and rewards.  This is a foundational principle of social learning theory and how role models exert influence on others.

In a study published in 1997, researchers at the McGill University School of Medicine examined opinions of fourth year medical students using a questionnaire.³  Ninety percent of the responders identified one or more role models during their training.³ Many (35%) indicated that resident physicians were the most influential role models during the clinical portion of their academic training.² This finding demonstrates that pharmacy residents have a profound effect on student pharmacists.  As pharmacy residents, we have frequent interactions with students.  It may be easy to forget that we have an obligation to be a positive model of pharmacy practice.

Several common factors were consistently ranked high when students selected role models: personality, clinical skills and competence, teaching abilities.² Interestingly, position, academic rank, research experience, and publications were less important.² This finding suggests that is it not just the well-established, published, infamous leaders who are revered as models.  Instead, professionals of all age and rank may be influential.

Role models were not only important in helping students develop their knowledge and skill but 57% of students claimed their role model influenced their decision regarding their clinical specialty for residency training.²  Thus, the potential impact of a role model is very significant and can shape and inspire a career. 

While role models often influence learners in positive ways, it is important to discuss the potential for a negative impact.  In a study surveying students at the University of Texas Medical Branch in Galveston, the professional behavior of faculty and residents was examined.⁴  The authors found that the preceptors scored lowest on the following behaviors:  1) use of constructive criticism instead of backbiting about peers, and 2) consulting others when they lack the required knowledge.⁴  Prior research noted that students find bad-mouthing others as the most unprofessional behavior of faculty.⁴ Making negative comments about a specialty may discourage or decrease recruitment into that field.¹  And, it might incite pessimistic attitudes towards a learner’s chosen profession.¹  As we are emerging leaders and role models for future generations of pharmacists, we must hold ourselves to higher standards.  Negatively discussing colleagues sets a poor standard for ourselves and may also encourage bad habits.  In order to cultivate positive relationships between disciplines, we must refrain from voicing negative personal opinions in workplace conversations. 

To become positive role models, we must understand how our behavior affects others.  “Silent modeling is inadequate as a strategy.”¹ Where do we begin?  Role models must pay attention to their individual acts, encourage teamwork, and support others in their growth and development.⁵   Ideal role models inspire and teach by example.  The key is to be self-aware and self-critical.⁶

In order to change our behavior, we need to have the desire to improve and the insight to identify our strengths and weaknesses.⁶ Being self-critical of our current positive and negative actions in the workplace, allows us to develop personal improvement plans.  Self-reflection has two forms: “reflection-in-action,” thinking about changing the experience while it is underway, and “reflection-on-action,” critically evaluating an experience once it has passed.¹ Both are valuable tools to encourage change, and learner evaluations are a key source to identify areas of potential improvement.  Encourage your learners to critically evaluate you as a preceptor.  Skills to evaluate might include your ability to encourage teamwork and solve challenging problems with composure.  This may not be on the standard evaluation form, but it is appropriate to ask learners to evaluate you as a role model and as a source of clinical knowledge.  As you achieve positive marks, add new professional goals for learners to evaluate.  In this way, you have used your self-reflection and created a process to evolve and grow as a model.

Learners must learn to “talk the talk, and walk the walk.”¹ In this dynamic teaching method, role models talk through activities, explain their thought process, and allow for learners to discuss their own ideas and methods.¹ In this coaching method, students engage in the actions of their model, and receive verbal feedback.  For example, a preceptor on rounds may have a student observe the first day to familiarize with the experience.  After rounds, this preceptor can break down their thought process for recommendations by working through a patient with their learner.  In the following days, students learn how to model the appropriate behavior by presenting recommendations to both their preceptor and team, receiving feedback and constructive comments all the while.  We must set expectations.  If we fail to set appropriate guidelines for behavior, we have no basis for constructive criticism and students may feel lost without guidance.

Think back to the people who had a positive influence on your development and career choices.  Let their strengths serve as guide in your career.  When we become the person to be emulated, we have a profound effect on others.

References:

1.  Kenny NP, Mann KV, MacLeod H. Rolemodeling in physicians’ professional formation” reconsidering an essential butuntapped educational strategy. Academic Medicine 2003; 78: 1203-1209.

2.  Asghari F, Fard NN, Atabaki A. Are weproper role models for students? Interns’ perception of faculty and residents’professional behavior. Postgrad Med J. 2011;87:519-523.

3.  Wright S, Wong A, Newill C. The impact ofrole models on medical students. J Gen Intern Med. 1997; 12: 53-56.

4.  Szauter K, Williams B, Ainsworth MA, et al. Student perceptions of the professional behavior of faculty physicians. MedEduc Online. 2003; 8: 17.

5.  Macaulay S. Are you a good role model? Think:Cranfield. Feb 2010. Accessed 24 Nov 2012. 

6.  Ray S. Role Models. BMJ Careers. 13 Mar 2010. Accessed 24 Nov 2012.