Co-Learning: Students and Faculty Learning Together

by Victoria Goodman, PharmD, PGY1 Community Pharmacy Practice Resident, University of Mississippi School of Pharmacy

As someone who graduated from a professional degree program and returned from the workforce to complete a PGY-1 pharmacy residency, I feel there were few opportunities to truly collaborate with my professors/preceptors until after graduation. There were set roles; I was the student, and they were the teachers. This dynamic was emulated throughout schooling at most institutions. It felt like there was a stark divide between the faculty and students. But upon graduation, students are expected to flip a switch, spring into their professional role, and even teach others.

This style of teaching and learning, where there are strict roles and responsibilities, is common in many fields, including the health professions. The typical class consists of a faculty educator standing and delivering a lengthy presentation that the students are expected to commit to memory. Information flows in one direction to students as they attempt to absorb as much as possible. Unfortunately, this is not the most effective method of retaining knowledge. In recent years, many courses have incorporated active learning strategies.  This is certainly an improvement but can we improve the learning process by building more connections between our educators and students? One potential technique is a concept called co-learning.

Co-learning is the act of grouping individuals to share the workload of a given learning task or share perspectives in a conversation. Group members learn from each other's unique insight and provide a mechanism for each participant to be accountable for contributing to the learning process.¹

The concept of co-learning is not new, but the practice of co-learning among educators and students is underutilized.^2,3,4 When including the educator in the co-learning group, the teaching strategy is similar to Socratic teaching with students and teachers engaged in dialogue and learning from one another. The educator is not the only person speaking or delivering knowledge; instead, students are encouraged to pose questions and further the conversation.

The Cornell University's Center for Teaching Innovation webpage on Collaborative Learning details the benefits of co-learning between faculty and students.  This includes building rapport, improving faculty-student relations as well as increasing retention rates, experience, idea sharing, and organizational involvement.^2,3 All of which lead to more meaningful learning experiences and strengthen the program.

Rapport Building/Deepening Connections. The opportunity is provided for students and educators to interact in a learning setting that opens doors. The traditional roles can be disbanded, allowing for new bonds to be forged. This is called “flattening the hierarchy” of the power differential between students and teachers.²

Increased Frequency and Quality of Faculty-Student Interactions.  Once the lines of communication are paved, this allows for more frequent and higher-quality interactions between the students and educator. Talking about areas of uncertainty are more likely to be discussed and this increases the confidence in both learners and teachers alike.²

Improved Retention Rate.  The practice of nurturing positive relations between students and educators will naturally begin to build positive and uplifting morale throughout the institution. Having a more understanding and embracing work/school environment will help each member of the institution to feel a higher sense of belonging and value within the program.

Sharing Ideas and Perspectives.  Through open and honest communication, everyone will have the opportunity to share the perspective they have on the situation or subject matter.^2,3

Greater Organizational Involvement. Exposing students to professional organizations through the perspective lens of the faculty member will help the learner gain a better understanding and appreciation for these organizations during their tenure and post-graduate.^2,3 Serving alongside each other would be less of a foreign idea and more of an ushering experience.³

Here are some helpful ideas a teacher can use to foster a co-learning model. Activities aimed at increasing social awareness, cultural competency, and connectedness often work well.⁴ Activities such as storytelling to get to know each member, role-playing to gain an understanding of diversity within the group, and then debriefing at the end of each activity to explore the perspectives about the activity itself.⁴

Another activity might involve one member of the group interviewing another member to complete a survey on socio-demographic information.⁴ The other members of the co-learning team can be assigned as observers of the interaction. The purpose of this is to demonstrate support, empathy, and cultural sensitivity. If it’s not possible to divide students into small groups, each with an educator as a participant, the practice and observation activity could be performed on a larger scale with larger classes. This activity will require members of co-learning teams to interact and analyze information in real-time to come together as a group to decide. Group members engage in open discussion and respect one another’s perspectives.

Dialogue and shared decision-making activities, which include the teacher as a group participant, are ideal - allowing greater time and fostering intimate connections within the group. Experiential learning is where co-learning between students and preceptors often occurs.  Using a similar model in the classroom, teachers and students can discuss and grapple with real problems that don’t have easy solutions, making learning relevant, meaningful, and transformative.

Happy Learning.

References

1. Co-learning in education works wonders for future generations [Internet]. Inventionland Education. 2018 [cited 2023 Mar 26].
2. Haddock L, Rivera J, O'Brien B. Learning together: Co-learning among faculty and trainees in the clinical workspace. Acad Med 2023; 98 (2): 228-236.
3. Collaborative Learning [Internet]. Center for Teaching Innovation, Cornell University. teaching.cornell.edu. [cited 2023 Mar 23]
4. Nguyen-Truong CKY, Fritz RL, Lee J, Lau C, Le C, Kim J, et al. Interactive co-learning for research engagement and education (I-coree) curriculum to build capacity between community partners and academic researchers. Asian Pac Isl Nurs J 3(4):126–38.

The Advantages and Disadvantages of Social Media in Learning Environments

by Chelsea Watts, PharmD , PGY1 Community Pharmacy Resident, Mississippi State Department of Health

Social media has had a significant impact on our society. In January 2023, there were 4.76 billion social media users.  That’s nearly 60% of the total global population.¹ Regardless of individual socio-demographics, nearly everyone is connected through social media. Social media platforms allow users to create and share ideas with people from all walks of life through photo and video sharing, blog postings, short-form communications, and more. Although social media was not created for educational purposes, it has infiltrated learning environments and this has led to research to determine the positive and negative aspects of social media use.

BetterYou, a digital wellness platform, identified five areas of a student’s life affected, in some cases positively but also negatively, by social media:²

• Social well-being:  The fear of missing out (FOMO) and setting unrealistic life goals can create social isolation.
• Emotional well-being:  Seeking validation through likes and peer approval creates a mental strain on students to meet certain expectations.  
• Academic well-being:  Social media is a major distraction and can lead to poor academic performance. Another cause is lack of sleep due to late-night browsing.
• Peer connection:  Students can stay in touch with their support system and build relationships with people who share common interests.  
• Spreading the word: The latest news or announcements can be shared on a larger scale.  

The use of social media can negatively affect students’ social, emotional, and academic well-being, whereas connection with peers and communication about professionally related opportunities might be advantageous.

Networking is a key component of professional development. There are many avenues available to network. Building a successful network includes meeting people in different settings, even virtually. Social media platforms, such as LinkedIn, allow students to create digital portfolios and share them with peers, potential employers, and others they may not have the opportunity to interact with in person. I believe it is important to equate engagement with connections. For example, if I create a post on Facebook or Twitter about a professionally related topic, the engagement (likes, comments, and reshares) I receive may reach someone with a similar interest.

One drawback to social media engagement is echo chambers. Most social media feeds conform to the user’s perspectives and beliefs, which limits interactions from those with opposing opinions. Students should be encouraged to apply critical thinking skills in their social media use. Questioning the information, confirming sources, and analyzing for bias are ways students can learn how to use social media platforms thoughtfully and maximize their engagement.

Improving students’ communication skills is another potential advantage of using social media. On many platforms, a user is limited by a maximum word (or character) count. Twitter, for example, has a 280-character limit for each “tweet.” Therefore, the user must be precise with their word choices in order to communicate their ideas effectively and coherently. To develop this skill, teachers could create an assignment requiring students to develop thoughtful responses to a question prompt or case scenario. The students would formulate their responses as a “tweet”. After creating the post, students can interact with other peers’ responses. This skill can be transferred to written communication skills in a professional setting. One study that examined the impact of Facebook on undergraduate students’ writing skills found that active participation in online discussions improved the content and organization of their written communications.³ The authors also concluded that the social media platform enabled students to learn in a stress-free environment and from peers through collaborative learning.³ 

Although there are some advantages to using social media in higher education, educators must be aware of the negative effects of social media. Students can become easily distracted and excessive social media use can have a negative impact on student’s mental health. Distractions created by social media can be classified as internal or external cues.⁴ Mind wandering to social media platforms when completing learning assignments or tasks is considered an internal distraction.⁴ External factors come from the environment. An example of an external factor is receiving a social media notification that inclines the student to stop the task.

There is  a growing concern for students’ mental well-being because social media has deviated from its initial purpose of bringing users together. The authors of a study published in 2021 concluded that emotional investment in social media is correlated with a significant increase in anxiety and depression in university students.⁵ The emotional attachment can lead to disappointment due to the desire to acquire materialistic things and unrealistic lifestyles. It is, therefore, important for students and educators to use social media platforms with intention. Being intentional includes restricting in-class use for educational purposes, setting a goal before each use, and creating an allotted time spent on social media.

I believe the advantages of social media use in learning environments outweigh the disadvantages. When used properly, social media can facilitate professional networking and improve communication skills. Since social media platforms have an enormous impact on daily life, using these platforms in educationally oriented and intentional ways would be beneficial for students.

References:

1. Global Social Media Statistics - DataReportal – global digital insights [Internet]. DataReportal. [cited 2023Feb14].
2. Zwart H. Effect of social media on college students. BetterYou. [cited 2023Feb14].
3. Shahzadi A, Kausar G. Using Social Media to Improve Students’ English Writing Skills: A Mixed Method Study. J Res Social Sci 2020; 8(1):124-140
4. Koessmeier C, Büttner OB. Why are we distracted by social media? distraction situations and strategies, reasons for distraction, and individual differences. Frontiers in Psychology. 2021;12:Article 711416.
5. Alsunni AA, Latif R. Higher emotional investment in social media is related to anxiety and depression in university students. Journal of Taibah University Medical Sciences. 2021;16(2):247–52. 

Does Working in Groups Result in Higher Academic Performance?

by Joshua Chang, PharmD, PGY1 Pharmacy Practice Resident, Magnolia Regional Health Center

Students often face different study environments and styles when preparing for exams. The debate regarding the benefits of group studying compared to studying alone remains an ongoing discussion.  Which ensures students achieve optimum learning (and exam scores)? From personal experience, studying in groups has several advantages, including retention of information, opportunities to clarify ambiguous topics, and teaching others while simultaneously solidifying one’s knowledge.  Collaborating in groups can be constructive when students are assigned a rigorous assignment that requires critical thinking and planning to execute it efficiently.

Unfortunately, working in groups has several pitfalls, such as the difficulty in arranging times for the group to gather.  This is especially true when group members are heavily involved with organizations, work, and family obligations. The number of participants in the group also is a factor. As the number of students in a group increases, distractions (such as mobile devices) and engaging in side conversations can hinder progress.  Research sheds some light on when individual vs. group study might work best.

In 2015 qualitative study performed at five Universities in Pakistan, the investigators conducted group interviews using a semi-structured questionnaire.  They found that approximately 30% of the students leaned towards individual study. This group of students emphasized that individual study allows them to remain in focus, achieving maximum concentration, which strengthens their confidence to solve difficult assignments and be less dependent on others. Additionally, these students believed that group study was too time-consuming and would only do group study when directed by the instructor. The second group, which consisted of 10% of the student population, preferred group study. They believed that it allowed them to share their knowledge, express their thought process, and assist each other when completing difficult assignments. The most important factor for favoring group study was the increase in motivation to study and the assistance that weaker students gained when working in groups.¹

Interestingly, the largest population of students (60%) took advantage of both styles of study. They asserted that both are equally important for enhancing their learning. They state that every member of the group possesses a different perception and view on the material and group study facilitates the sharing of different ideas.  On the other hand, individual study allows for fewer distractions and the freedom to plan one’s study session. Students in this study emphasized that a group size of no more than 5 students was key to effective group work. An excessive number of members limits the opportunity for students to speak, participate, and contribute frequently.  It is important to take into consideration that this study was conducted at five different Universities with varying curricula – but they were not structured to promote either individual study or group study.¹

In a 2014 case study that focused a Collaborative Learning Environment among 122 university students enrolled in an Engineering and Molecular Biology program explored group work versus individual work. The study recorded each student’s performance for 3 different course assignments over one semester. The study utilized a software called Moodle that allowed for file sharing and synchronous group work.  Using this technology, the instructors were able to monitor each student’s actions in real-time. Each individual student’s work was color-coded to differentiate participation and involvement as they completed assignments.²

The study highlighted various models of collaboration that played a vital role in each group’s progress. Some groups engaged in real-time collaboration, having their members work simultaneously alongside one another from start to end, while other groups utilized a self-paced model, having their members work individually at their leisure. The frequency of contribution was a key factor. Some students only contributed once, while other students would review their colleague’s work, improving and editing the composition. Another factor was the effort and quality of work. Groups that were dominated by one student had performance scores ranging from 55% to 100%. The wide gap in scores for these groups is likely attributable to the quality of work from that single member.  Groups with 4 to 6 members that divided the work but had low-level contributions generally had a narrower span of scores - from 70% to 90%.  However, the study did not report data regarding large groups with higher-contributing work to have an appropriate comparison.²

One important aspect that the study focused on was assessing each student’s individual performance and using that score to predict an expected group performance score. They found that the group performance score, on average, was much higher than the predicted group score and higher than the mean individual performance scores. The study was not able to study groups larger than 5 students and the three assignments used for analysis were not explicitly open for review. The type of subject, level of difficulty, familiarity, and time commitment needed for the assignments are unknown. Overall, the study asserts that the defining factor for higher performance is not merely the size of a group but the level of contribution.²

There are advantages and disadvantages to both group and individual study. Although we may think that study habits are binary, research shows that both strategies can be beneficial, and academic performance may be related to one’s preferences. In my opinion, specific assignments that mimic real-life tasks where a practitioner acts independently should be done individually. Measuring a student’s growth is also more feasible when analyzing individual work. A student may prefer studying and working alone but being in a group offers several benefits and can also be useful for mimicking those real-world tasks done by groups of people.

References:

1. Kandhro, S. (2015). Impact of Group-Study and Self-Study on Learning Abilities of Students at the University Level. Case Studies Journal 2015; 4(2).
2. Cen L, Ruta D, Powell L, and Ng J. Learning alone or in a group — an empirical case study of the collaborative learning patterns and their impact on student grades. 2014 International Conference on Interactive Collaborative Learning (ICL).

Do NAPLEX or MPJE Preparatory Courses Improve Pass Rates?

by Jacey Gossett, PharmD, PGY1 Pharmacy Practice Resident, Baptist Memorial Hospital North Mississippi

As a recent pharmacy school graduate, I took the National Pharmacy Licensure Exam (NAPLEX) and the Multi-state Pharmacy Jurisprudence Exam (MPJE). A hot topic of conversation among my classmates is the pass rates on these exams.  Being a “good” student who earned A’s and B’s throughout pharmacy school, I expected the NAPLEX to be something that I would be able to easily pass — boy, was I wrong! To my, my friends, and my family’s surprise, I received a “FAIL” on my first NAPLEX attempt. The word FAIL staring me in the face that day last June was a major kick in the gut. Since I passed my MPJE shortly after graduation in May, I thought the NAPLEX would be a similar outcome. Luckily, in July, I received a “PASS” on my second NAPLEX attempt.

It was shocking to me, but I was not the only one from my graduating class that had to retake the NAPLEX.  How in the world had we made our way through pharmacy school just to receive a big fat “FAIL” when taking our boards? Our school and the professors certainly did everything they could to push us toward success on our boards. We had a year-long NAPLEX prep course that ran concurrently with our advanced pharmacy practice experiences (APPE).  We were given various assignments to “ensure” that we were preparing ourselves for these challenging exams. We had multiple practice exams to give us experience. In December of my P4 year, I scored 69 on my first practice NAPLEX. Although this is not a “passing” score, I felt I was on the right track as I was just getting deeper into my studying. In the spring of my P4 year, I took another practice exam and brought my score up to 73.  I was improving but I recognized that had more studying to do.

There have been multiple studies published in recent years examining factors that might help students be successful on their board exams. One cross-sectional study sought to describe the characteristics of NAPLEX preparation programs currently offered by schools of pharmacy and the correlation between program characteristics and first-attempt pass rates. Fifty-eight Pharm D programs completed an online survey about their NAPLEX preparation programs. A majority (86%) of schools indicated they offered a NAPLEX prep program. But offering a NAPLEX prep program was not associated with higher first-attempt pass rates. Some concerns raised by the authors of the paper included student workload (e.g., balancing the demands of a prep program during APPEs) and the faculty workload associated with delivering these programs.¹

In a retrospective study, investigators compared NAPLEX scores (n=150) to several factors that might predict performance. The investigators found that the NAPLEX score was most strongly correlated with pharmacy GPA (r=0.66) and Pre-NAPLEX score (r=0.45) but also race/ethnicity, Pharmacy College Admission Test (PCAT) composite score and section scores, undergraduate GPA, undergraduate science GPA, and on-time graduation.²

In another retrospective study, the correlation between preparatory testing and other factors were compared to performance on the MPJE. This analysis showed that the Pre-MPJE scores failed to predict whether a student would pass the MPJE but a student’s performance in the pharmacy law course did.³

As you can see from the results of these studies, there is no clear correlation between prep courses and the odds of passing either the NAPLEX or MPJE. Therefore, simply having such courses available does not ensure success.  Thus, it is truly up to individuals to ensure that they are using prep courses, practice exams, and other resources to fully prepare themselves. It is difficult to find a quick and easy fix to improving first-time pass rates for board exams. There are many “tips and tricks” on the Internet. These “tips and tricks” seem to be consistent with things students have likely heard during pharmacy school – things like having a study plan, taking practice tests, creating self-testing materials, working with a study group, getting plenty of sleep, and not cramming.

Spaced repetition is a study technique that involves reviewing and recalling information at optimal spacing intervals until that information is deeply learned. This technique has students review materials, repeatedly, over a long period of time. Research has clearly shown that spacing out repeated encounters with material over time provides superior long-term retention.  Self-testing coupled with spaced repetition amplifies the benefits.⁴

As I’ve learned, it’s important to study and prepare for the MPJE and NAPLEX well in advance. I was able to pass my MPJE solely on the material learned during our pharmacy law course and our professor was very clear about how hard and tricky the exam could be. I was able to pass my NAPLEX on the second try by realizing my areas of weakness. I used the same study strategies, but by being more self-aware of my weaknesses I was better prepared for my second attempt. Perhaps the best approach is to help students figure out what they do not know and then encourage them to use effective evidence-based study techniques.

There are several evidence-based learning and studying techniques, like spaced repetition, that can be used to enhance a student’s recall of information, but it is truly up to the student to “take the bull by the horns” and get the studying done. Students need to know very early in their pharmacy school journey just how hard these exams can be.

References

1. Fiano K, Attarabeen O, Augustine J, et al. Association between Naplex Preparation Program Characteristics and First-Time Pass Rates. Am J Pharm Education 2022; 86(6): Article 8760.
2. Chisholm-Burns M, Spivey C, Byrd D, McDonough S, Phelps S. Examining the Association between the NAPLEX, Pre-NAPLEX, and Pre- and Post-admission Factors. Am J Pharm Education 2017; 81(5): Article 86.
3. Havrda D, Hall E, Spivey C, et al. Examining Preparatory Testing and Other Factors Associated With Performance on the Multistate Pharmacy Jurisprudence Examination. Am J Pharm Education 2022; 86(7): Article 8774.
4. Kang S. Spaced Repetition Promotes Efficient and Effective Learning. Policy Insights from the Behavioral and Brain Sciences(PIBBS) 2016; 3 (1): 12-19.

Resilience Training in Healthcare to Meet the Needs of Learners and Practitioners

by Lori Emory, PharmD, PGY1 Pharmacy Practice Resident, Mississippi State Department of Health Pharmacy 

Resilience is the ability to “bounce back” from challenges — to learn and grow from setbacks. An individual’s resilience is built up over the course of their life and is shaped by their actions taken prior to, during, and after difficult and often stressful situations.^1,2  

Stress is a natural response by the body to physical and mental challenges. While stress can be a motivating factor that prompts us to try new things as we face new challenges, too much stress over a prolonged period of time is unhealthy and can lead to anxiety and burnout. Anxiety is an overreaction to stress experienced from performing “ordinary” daily activities which can lead to significant impairment. Burnout is a diminished ability to respond to stressors and can lead to anhedonia and depression.^1,3 

In healthcare, providers are responsible for the well-being of numerous patients. Chronic stress – often unavoidable in healthcare – puts health professionals at a higher risk for developing anxiety or burnout, which, in turn, results in less than optimal care and increases the risk of errors and poor patient outcomes.^1,3,4 Thus, resilience strategies, often techniques learned from previous stressful situations, help providers meet new challenges.⁵ 

There are conflicting feelings about resiliency training in healthcare.  Some have argued that resiliency training focuses too much on individuals by teaching them how to adapt to and cope with the ever-growing demands of the profession while letting institutions off the hook by failing to address poor working conditions, such as chronic understaffing and addressing hindrances.^2,4 While data supporting resilience training programs in healthcare are limited, results show participants generally appreciate learning about the tools they can use to become more resilient and like being part of a community where they can share experiences with fellow health professionals.^1,2 

Although self-care has been around for many years, resiliency training was introduced to me as a formal concept while applying for residency. Many residencies now offer resilience training as a required component of their program structure. Given that most pharmacy jobs provide little to no social support for new practitioners, I believe having resiliency training incorporated into the residency experience can be very beneficial. 

Several studies have examined the elements of resiliency training that participants generally believe are needed for it to be most beneficial:  

1. Focusing on the experience of health professionals and students is vital in a successful program. ^1,2,4,5,6  Healthcare workers are exposed to difficult human experiences while working with serious injuries, illnesses, and even death.^1,2,4,6 Participants in resiliency training programs discussed the need for training to be guided by another health professional with a shared understanding of the many challenges that come with working in healthcare.^1,2,6 

2. Sharing experiences in a positive and non-judgmental manner builds community among healthcare providers who often feel isolated.^1,2  Many providers report feeling isolated and a desire to participate in a community of peer support.¹ Program participants reported small group discussions allowed them to recognize their own behaviors better and learn from others’ real-world experiences.^1,6 Participants often report preferring voluntary attendance at these sessions as they felt it helped ensure that all participants would come in with an open mind about sharing experiences and learning to grow from difficult situations.^2,6  

3. Following up with participants helps turn new skills into daily practiced habits. While the initial training session(s) were often considered to be helpful by participants, programs that included follow-up reflection, allow participants to expand on the skills they learned and think about how they could use those skills in their daily lives. ^1,2,6 

4. All health professionals can benefit from these types of programs, regardless of their current level of experience. Even students at the beginning of their training are exposed to the difficult realities of a career working in healthcare, and serving people who are experiencing some of the greatest stress in their lives.^2,5 Promoting resiliency training programs during early didactic coursework or introductory practice experiences may provide key life-long skills that participants will benefit from long-term as they progress through training and into their professional lives.^2,6 Students particularly report benefits from training programs that are structured to provide insight into stressors that they may experience, during their training and in practice.^2,3,6  

Offering resiliency training led by experienced faculty members should be considered at all educational institutions that are preparing the next generation of health professionals. Resiliency training programs should be voluntary, such as course electives or extracurricular meetings, where all students can participate without feeling the need to give up other interests. Placing participants in small groups of 8-10 with a mix of learners at various levels and faculty with guided discussion prompts can foster natural mentorships and a sense of community within groups. Providing this kind of support early and often throughout the professional degree program can provide a safe space where genuine conversations can take place. Regularly obtaining feedback from participants is important to tailor these programs to meet the needs of students and faculty based on schedules and topics of interest.  

References: 

1. Epstein RM, Krasner MS. Physician Resilience: What It Means, Why It Matters, and How to Promote It. Academic Medicine 2013: 88(3):301-303.
2. Johnson J, Simms-Ellis R, Janes G, et al. Can we prepare healthcare professionals and students for involvement in stressful healthcare events? A mixed-methods evaluation of a resilience training intervention. BMC Health Serv Res 2020; 20: Article number 1094.
3. Fares J, Al Tabosh H, Stress AH, et al. Burnout and coping strategies in Preclinical Medical Students. N Am J Med Sci 2016; 8 (2):75-81.
4. Murthy VH. Confronting health worker burnout and well-being. N Eng J Med 2022;387(7):577–9.
5. Kunzler AM, Helmreich I, König J, et al. Psychological interventions to foster resilience in healthcare students. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD013684:7-43.
6. Bird A, Tomescu O, Oyola S, Houpy J, Anderson I, Pincavage A.A curriculum to teach resilience skills to medical students during clinical training. MedEdPORTAL 2020;16:10975.