The Benefit of Student-Generated Questions

by Theresa Brush, Pharm.D., PGY-1 Pharmacy Practice Resident, Suburban Hospital

How many times have you sat in a classroom and had an instructor ask, “Do you have any questions?” What follows, most often, is silence. The silence does not necessarily indicate a lack of interest by students, but they may feel uncomfortable asking questions or have not sufficiently digested the information in order to even ask one. A possible solution to this problem has been explored — student generated questions.

Questions are such an integral part learning.  Indeed, “the act of asking questions and the consequent search for answers is key to active learning.”¹ Student-generated questions are exactly as the name implies; students create their own questions regarding the subject matter and this, in turn, directs their learning.

But how can we help students create good questions?  One of the methods that has been successfully used to develop student-generated questions is called the Question Formulation Technique (QFT).² The QFT is a step-by-step process that helps students learn how to produce their own questions, improve them, and strategize how to use them. This six-step process includes:

1. The Teacher Designs the Question Focus

• The teacher presents a Question Focus in the form of a statement, visual, or auditory stimulus that focuses and attracts student attention. This focus is not in the form of a question but rather a prompt from which students develop questions.

2. Students Brainstorm Questions

• Working in small groups, students brainstorm and record lots of questions. Students produce as many questions as they can.  They should not stop to discuss, judge, or answer any of the questions.  The questions should be written down exactly as stated.  Any statements should be changed into questions.

3. Students Improve Their Questions

• Students then improve their questions by categorizing them into one of two categories:  open-ended and close-ended.  At this point the teacher should have a discussion about the advantages and disadvantages of both types. Students are then asked to change at least one of their open-ended questions into a closed-ended question.  And vice versa. This step furthers students’ understanding of how the phrasing of questions can affect the depth, quality, and value of the answer.

4. Students Prioritize Their Questions

• The teacher then offers criteria or guidelines for selecting questions. For example, the criteria may be, “Choose the three questions you want to explore further.” Students then select their priority questions based on the criteria.

5. Students and Teachers Decide on Next Steps

• Students and teachers decide together on how to use the questions. For instance, the questions may be used to stimulate discussion during the next class.

6. Students Reflect on What They Have Learned

• The teacher reviews the steps of the QTC and has students reflect on what they have learned through the process.

This method of having students develop their own questions encourages them to go deeper into their thinking and (hopefully) develop a new thirst for learning.² One study demonstrated the impact of student-generated questions on learning.³ In an undergraduate psychology course, students were given the opportunity to earn extra credit by submitting questions to the instructor concerning the material covered in class the previous week. The questions could be regarding concepts that were unclear, additional information the student would like to explore, or how the issue applies to other courses or relates to other concepts. The performance of students who developed questions was compared to students who did not write questions. The results demonstrated that the slope of improvement in performance on the exams was directly proportional to the number of questions generated. These results provide some evidence regarding the effectiveness of student-generated questioning to motivate learning and promote deeper understanding.

Not only have student-generated questions helped improve students’ understanding of course material, but student-generated questions can be used to evaluate and assess students’ learning. Instructors can use student-generated questions to construct multiple-choice examinations and open-ended essay questions.⁴ Learning activities that involve student-generated questions help students shift from merely acquiring knowledge (from the teacher) to learning knowledge (self-directed learning), increasing their confidence about the subject matter, and promoting more diverse and flexible thinking.⁵  However, student-generated assessment questions have been criticized because it forces students to focus their attention on finding details in the material around which they can construct questions.  This may limit their understanding of the material and they may not comprehend “the big picture.” If a teacher uses this technique, awareness of this criticism should force the instructor to use a set of parameters for students to follow when creating questions.  Moreover, students should be encouraged to give feedback on how to improve the use of this technique.

Techniques to improve student-generated questions can be used to enhance class participation and engagement as well as to construct evaluations and assessments. This QFT is a great tool for instructors to have within their toolbox and promotes deeper learning.

References:

1. Chin C. Student-Generated Questions: Encouraging Inquisitive Minds in Learning Science. Teaching and Learning [Internet]. 2002 Jun [cited 2016 Feb 3];23(1):59-67.

1. Rothstein D, Santana Luz. Teaching Student to Ask Their Own Questions [Internet]. Cambridge (MA):Harvard Education Letter; 2011 Sep [cited 2016 Feb 3].

1. Berry JW, Chew SL. Improving Learning Through Interventions of Student-Generated Questions and Concept Maps. Teaching of Psychology. 2008;35:305-312.

1. Pittenger AL, Lounsbery JL. Student-Generated Questions to Assess Learning in an Online Orientation to Pharmacy Course. American Journal of Pharmaceutical Education. 2011;75(5) Article 94.

1. Yu FY. Scaffolding student-generated questions: Design and development of a customizable online learning system. Computers in Human Behavior. 2009;25:1129-1138.

Breaking Down the Barriers that Hinder Class Participation

by Teyrra Crawford, Doctor of Pharmacy Candidate 2018, University of Maryland School of Pharmacy

“Show of hands. How many students think the answer is choice A.”

As instructors work to incorporate review questions and checkpoints in their presentations, many students decline to participate out of a fear of being wrong.¹ The lecturer is unaware of their students’ gaps in understanding the material and students miss opportunities for clarity out of fear of saying the “wrong” thing.

So how can we bridge the gap? How can instructors encourage students to be open and engaged during class discussions and when review questions are posed?  By creating a classroom that is psychologically safe – that’s how. The concept of psychological safety, simply stated, is the idea of “feeling safe”² in the situation or environment. This is not about physical safety (although that may be a factor), it is more about the student’s comfort in sharing their thoughts without fear of being attacked or judged by their peers or the instructor. But the fear of being wrong is not the only barrier. In addition, students need to know their input is appreciated and, regardless of a difference of opinion, respected.

Let’s revisit the example about asking the students to select the correct choice for a checkpoint question:

Several students raise their hands for the various answer choices: A, B, and C. While the students still have their hands raised for answer choice C the instructor points to one of those students and asks her to explain how she arrived at that answer choice.

Depending upon the age of the students/participants as well as the content, this type of “on the spot” attention may invoke anxiety or withdrawal from the student (from a behaviorist perspective) as well as others (from a social learning perspective). The goal in creating a psychologically safe classroom environment based on mutual respect and openness, as well as providing a variety of opportunities for meaningful participation that results in learning success. By establishing a culture within the classroom that fosters active participation and engagement by the students, it will lay the basis for a classroom that is psychologically safe.

Understanding that every student learns differently based on personality and experience, “putting someone on the spot” may be counterproductive and make the student feel less “safe.”³ But fear not instructors — all is not lost! There are several strategies that can be employed to inspire students to actively participate. Instead of students raising their hands, if they have access to electronic devices, they can submit their answer choices through a polling system via the internet, or using software and devices designed to increase interaction. Classroom response devices and online polling, test student knowledge and providing a way to share the results while maintaining a level of anonymity. These classroom aids (like ActivClassroom, iClicker, RW poll) can be used to teach and reinforce concepts throughout the course while still tracking the individual progress and challenges of the individual student. Such technology has been integrated at Ron Clark Academy Middle School⁴, a school that focuses on making learning fun and effective for students. It can also be used in health professional education!  In a comparative study conducted between 2008 and 2009 at an Indian medical school, clicker technology was used during lecture activities and the researchers measured it’s impact on test scores. The results showed that test scores and retention up to 12 weeks after the course were both higher in the group that used clickers.⁵

Due to budget restrictions, using such tools may not be an option. However there are other ways in which instructors can cultivate an environment where students enjoy sharing. Instead of simply stating that a student is “right” or “wrong”, open the response to the entire class for feedback. In an article published on Education Week’s website, an instructor discusses the strategy of “sticking with the student” that she learned from the book, The Skillful Teacher.⁶ In the article, McCaffrey suggests how to engage the student after a less than optimal answer is given without making the student feel like he was on the hot seat. The instructor has to be conscious of their own body language and tone when responding. Additionally, when responding to answers, the instructor should praise the student’s thinking, while encouraging them to think a little more about the answer.  Sometimes the instructor should reword the question to help the students explore the concepts more deeply. Another strategy she suggests using is “turn and talk” session. Using this strategy, students have an opportunity to discuss their responses with peers before having to provide individual responses to the teacher.  This relieves some of the immediate pressure from one student while actively engaging thought and participation from the rest of the class.⁷ Instructors can incorporate “get to know me” exercises so that students may become more at ease with their peers.

While different tools help to engage students, the fundamental component of building a psychologically safe classroom is consistency.⁸ For example, let’s say students have been allowed to turn in homework two days late without penalty. Let’s assume, mid-way through the course, a student turns in an assignment a day late and receives a zero. Such inconsistency incites anxiety in students and can destabilize that feeling of “safety” in the classroom. Once standards are set in place, they should stay in place.  Or if changes must be made, adequate explanation for the change should be provided to support consistency and trust between the students and the instructor.

Some points to remember:

1. Set the tone, be clear of what expectations are, and be consistent!
2. Provide a variety of opportunities for students to participate and show what they know!
3. Do some research and prepare activities in advance to maximize outcomes, minimize confusion, and reduce stress.
4. HAVE FUN!!  Your enthusiasm will rub off on your learners!

****Please share your comments and experiences with establishing and thriving a psychologically safe classroom!****

References

1.    Schreiner CS. Handbook of research on assessment technologies, methods, and applications in higher education. Hershey, PA: Information Science Reference; 2009. p. 53-57.

2.    Preisler J. Being Safe vs. Feeling Safe [Internet]. Fosteringperspectives.org. 2016 [cited 2016 Feb 1].

3.    Nilson L. Teaching at its best. Bolton, MA: Anker Pub. Co.; 2003. p. 129-131.

4.    YouTube. The Ron Clark Academy ActivClassroom - Top Ten Ways [Internet]. 2016 [cited 2016 Feb 1].

5.    Datta R, Datta K, Venkatesh M. Evaluation of interactive teaching for undergraduate medical students using a classroom interactive response system in India. Medical Journal Armed Forces India. 2015;71(3):239-245.

6.    McCaffrey B. Sticking With Students: Responding Effectively to Incorrect Answers [Internet]. Education Week Teacher. 2014 [cited 2016 Feb 10].

7.    Phillips M. Creating an Emotionally Healthy Classroom Environment [Internet]. Edutopia. 2014 [cited 2016 Jan 31].

8.    Coetzee M, Jansen C. Emotional intelligence in the classroom. Cape Town: Juta; 2007. p. 31-32.

9.    Jordan R, Lin Foo M, Hooley R. Science engineering - McGraw Center - Princeton University [Internet]. Princeton.edu. 2010 [cited 2016 Feb 1].

Mastering the Fundamentals of Precepting

by Sahil Sheth, Pharm.D., PGY-1 Pharmacy Practice Resident, Suburban Hospital

Residency training is a unique experience in the life of pharmacists. They are expected to demonstrate and develop clinical knowledge, organizational skills, and interpersonal communication while practicing pharmacy for the first time.¹ Therefore, effective teaching in this setting is essential. It requires flexibility, time commitment, and devotion to the resident. Preceptors need to address the resident’s desires as well as have flexible teaching methods and approaches.² This can be difficult because many preceptors are new to their roles and are developing their teaching skills. In one recent study, thirty percent of pharmacists indicated that they have been a preceptor for less than two years and over fifty percent had been a preceptor for less than five years.³ Using appropriate preparation techniques, effective teaching methods, and honest feedback strategies can help alleviate potential problems between preceptors and their trainees. Moreover, implementing these fundamentals can help the resident succeed.

Preparation and planning are key components of a successful practice-based teaching and learning experience. At the beginning of the clinical experience, preceptors should meet with the resident to discuss the resident's learning style, learning goals, and career aspirations so that the experience can be tailored to meet the resident’s needs. For example, a critical care preceptor can tailor major presentations such as journal clubs and patient cases in infectious diseases for a resident who is interested in applying to a PGY-2 Infectious Diseases residency. In addition to tailoring the rotation to residents’ interests, preceptors should outline day-to-day activities as well as longitudinal projects that the resident is expected to complete by the end of the experience. For instance, the preceptor can create a flow sheet outlining pre-rounding, discharge counseling, and follow-up tasks that needed to be completed each day. As a result, there is no miscommunication regarding the daily requirements and expectations.

Preceptors should teach critical thinking skills so that the resident becomes a detective able to gather relevant evidence, reflect on the information gathered, and manage patient interactions and follow-up.⁴  This can be done using different teaching styles. The two general preceptor approaches are the “sink or swim” method and the “manipulated structure” method.⁴ In the “sink or swim” method, the resident is assigned a panel of patients and is expected to manage those patients independently with no visible support from the preceptor.⁴ This includes pre-rounding on patients, attending interprofessional care rounds, performing medication reconciliations, and following up with interventions. There is minimal support from the preceptor besides providing “back up.” The “manipulated structure” approach involves selection of patients accompanied by preceptor consultations before and after interprofessional patient care rounds.⁴ Using this teaching strategy, the preceptor’s determines what the appropriate patient volume and complexity is based on the resident’s current level of skill and future developmental needs. There are several important factors that influence the selection of teaching approaches, but the most important factor is the resident’s prior experience. New residents (in July and August) will likely flounder if the “sink or swim” method is used, whereas residents in the final half of the residency year will likely thrive and appreciate the independence. It is important to select an approach that best fits the resident’s current skills and to conservatively advance the level of independence.

In addition to effective preparation and use of appropriate teaching methods, providing constructive feedback is essential to the resident-preceptor relationship. It is important for preceptors to provide ongoing feedback to residents – not just during the midpoint and final evaluation.¹ Moreover, feedback should always be done in a manner that helps the resident to perform better in the future.¹ Detailed and specific examples can help residents understand their strengths and weaknesses. For example, saying “You were lackluster today” is not sufficient. Instead, a more complete explanation like “Your medication reconciliation was incomplete for 5 out of the 10 patients that you followed today.  Be sure to ask about over the counter medication use in the future” is constructive. Preceptors can also conclude feedback sessions by asking the resident to reflect on the lessons learned.  This can help residents refocus and renew their efforts to perform better in the future.⁴

It is imperative for preceptors to prepare for the arrival of residents (and students), to use effective teaching methods, and to provide honest but constructive feedback. Developing a framework with these fundamental principles in mind will make the teaching and learning experience better for everyone. The roles and responsibilities of preceptors may differ, but the basic skills and teaching approaches are the same.

References

1. Anderegg SV, Christenson JC, Padgett CP. An accelerated, practice-based model for fostering precepting skills in pharmacy residents. Hosp Pharm. 2014;49(8):713-6.
2. Vaughn L, Baker R. Teaching in the medical setting: balancing teaching styles, learning styles and teaching methods. Med Teach. 2001;23(6):610-612.
3. Hartzler ML, Ballentine JE, Kauflin MJ. Results of a survey to assess residency preceptor development methods and precepting challenges. Am J Health Syst Pharm. 2015;72(15):1305-14.
4. Burns C, Beauchesne M, Ryan-krause P, Sawin K. Mastering the preceptor role: challenges of clinical teaching. J Pediatr Health Care. 2006;20(3):172-83.

Teaching From Your Strengths

by Jane Kim, Pharm.D., PGY1 Pharmacy Practice Resident, Kaiser-Permanente Mid-Atlantic

 “What are your strengths and weaknesses?” is a common interview question. Employers ask this question not to identify what the candidate brings to the table, but rather to see if the candidate has an awareness of his or her own unique strengths and weaknesses. When given the opportunity to focus on one’s strengths, individuals are six times more likely to be engaged in their jobs and three times more likely to have an excellent quality of life.¹ As an educator, leveraging your strengths to enhance student performance will not only benefit you in becoming a more effective teacher, but will advance your students’ skills and knowledge as well.

You cannot be anything you want to be –

but you can be a lot more of who you already are.

– Tom Rath, StrengthsFinder 2.0

A powerful tool that identifies an individual’s potential for building strengths is the Gallup Organization’s Clifton StrengthsFinder questionnaire. Created by educational psychologist Don Clifton and Gallup, StrengthFinder characterizes 34 strengths that describe what people do well (Theme Quick Reference Card). By completing an assessment consisting of 177 questions, your top five strengths and the areas with the greatest potential to develop are identified. The strengths philosophy states that individuals will benefit more by building on their talents rather than spending the same amount of time correcting their weaknesses.²

What is a strength? A strength is the ability to provide consistent, near-perfect performance in a given activity. By investing skills and knowledge in a “natural” talent, it becomes a strength.¹ By having an awareness of your strengths, you can apply them to develop your teaching philosophy and style, and subsequently build aspects of the instructional design process such as preparation, instructional methods, presentations, and evaluations around your strengths. Strengths-based education involves intentionally discovering one’s own strengths as well as students’ strengths and applying them systematically to teach effectively.³ For example, one of my top five strengths is “Context,” meaning I like to create a framework and to put facts into perspective. An enjoyable lesson for me would involve breaking down a patient case and presenting the key points in the context of the case. Not only would it be enjoyable, it would be easier for me to teach with real-life illustrations rather than lecturing about a disease state with no relevant examples. Applying your unique strengths will allow you to create an environment for learning that taps into all of your greatest potential. In addition to using your strengths in the teaching process, actively modeling your strengths is a lesson in itself.³ Albert Bandura’s social learning theory states that complex behaviors can be produced only through the influence of models.⁴ Another strength of mine is “Analytical” — meaning I am methodical and rational in the way I think through things. If I can teach using my analytical strengths, students will be more likely to appreciate the importance of facts, data, and details in assessing a problem.

We teach who we are.

– Parker Palmer, The Courage to Teach

Similar to having an awareness of your own strengths will help you in your journey as an educator, helping students to discover their own strengths will facilitate their journey as learners. Engagement is a principle highly sought after by employers and educators. William Kahn defines personal engagement as “harnessing of organization members' selves to their work roles; in engagement, people employ and express themselves physically, cognitively, and emotionally during role performances.”⁵ Engagement can be assessed using well-validated Gallup Workplace Audit, of which one of the 12 items asks if employees have an opportunity to highlight their strengths.  In a meta-analysis of 198,514 employees in 36 companies, engagement combined with overall job satisfaction leads to positive business-unit performance outcomes such as profitability and productivity.⁶ If utilizing one’s strengths makes an employee more engaged, it can certainly do the same to promote student engagement. Through positive and specific feedback, creating an awareness of their strengths will give students a sense of confidence and self-efficacy.

Creating meaningful activities that allow for development of one’s strengths is a hallmark of strengths-based education. A study involving 1,250 students from five schools of pharmacy that used StrengthFinders 2.0 found that the top five themes among 99.5% of the students were one of the following: Achiever, Harmony, Learner, Responsibility, and Empathy.⁷ These results provide valuable insight in guiding educational activities for pharmacy students. To leverage this knowledge, pharmacy education should reinforce these strengths to develop exceptional pharmacists who are both empathetic and responsible to their patients. The University of Minnesota College of Pharmacy developed a strengths-based instructional program to enhance awareness of strengths, foster strengths-based decision making, and increase application of strengths by students. After completing the Clifton StrengthsFinder, students completed workshops, reflections, and participated in discussions related to strengths. During advanced practice professional experiences, pharmacists provided feedback on strengths activities for students. When asked if discussing strengths with the student helps to support the student's ability to identify a role in pharmacy aligned with his or her talents, 86% of pharmacists responded positively. When asked if strengths discussions helped to support the student's leadership development, 95% of pharmacists responded positively.⁸ If educators endeavor to identify students who do not possess certain qualities, pairing students with complementing strengths can be valuable strategy.

One’s strength is a combination of one’s talents, knowledge, experience, and skills. This strength should be cultivated and given much more attention than one’s shortcomings. Recognizing these strengths, applying them, and then reflecting on them will make for better educators and engaged learners.

Five Principles for Strengths-Based Education³

1. Measure strengths. Use an assessment to determine unique strengths to provide learners and educators an awareness of their skillsets.
2. Individualize the learning experience to each student. Help students apply their strengths to individual goals as part of the developmental process and provide feedback that emphasizes strengths. When possible, tailor teaching methods to meet student needs and interests.
3. Network with personal supporters of strength development.  Establish connections with friends, family members, and professionals who encourage excellence.  
4. Deliberately apply strengths in and out of the classroom. Create opportunities for students to showcase their strengths and guide students to utilize strengths independently.
5. Develop strengths through novel experiences or focused practices. Invest time and effort in new experiences to elevate skills and knowledge of existing strengths.

References

1. Rath T. StrengthsFinders 2.0. New York, NY: Gallup Press; 2007.
2. Asplund J, Lopez SJ, Hodges T, et. Al. The Clifton StrengthsFinder 2.0 Technical Report: Development and Validation. The Gallup Organization 2007. Available from: Accessed January 31, 2016.
3. Lopez SJ and Louis MC. The Principles of Strengths-Based Education. J Coll Char. 2009;10(4):1-8.
4. Bandura A. Social Learning Theory. New York, NY: General Learning Corporation; 1971.
5. Kahn WA. Psychological conditions of personal engagement and disengagement at work. Acad Manage J. 1990;33(4):692-724.
6. Harter JK, Schmidt FL, and Hayes TL. Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: a meta-analysis. J Appl Psychol. 2002;87(2)268-279.
7. Janke KK, Farris KB, Kelley KA, et al. StrengthsFinder signature themes of talent in doctor of pharmacy students in five midwestern pharmacy schools. Am J Pharm Educ. 2015;79(4): Article 49.
8. Janke KK, Traynor AP, and Sorensen TD. Refinement of strengths instruction in a pharmacy curriculum over eight years. Am J Pharm Educ. 2011; 75(3):Article 45.