September 23, 2009

Student Absenteeism

by Lauren Hynicka - Assistant Professor, University of Maryland School of Pharmacy

The branch campus is becoming ever more popular in higher education. As a result, lectures are recorded for students at the distance campus to view asynchronously and often students on the "main" campus also have access. The University of Maryland School of Pharmacy recently started its own branch campus at Shady Grove. I have heard during my short time here that there has been a decline in student attendance since the adoption of the recorded lecture. [Editor's Note: Dr. Hynicka joined our faculty in August 2009]

Over the past several weeks, we have been discussing teaching and learning styles. I was curious to see if I could find any information that might give me a clue as to the types of students who would be more apt to be absent from lectures and what if anything could be done to encourage attendance. In my search I found an article by Westrick and colleagues entitled, “Factors influencing pharmacy students’ attendance decisions in large lectures.” (Citation: Westrick SC, Helms KL, McDonough SK, Breland ML. Am J Pharm Educ 2009; 73: 1-9).

The authors introduce the topic by identifying the reasons why educators should be concerned about absenteeism in the classroom. Negative impacts on both academic performance as well as professional development were identified as two major consequences of student absenteeism. In order to better delineate strategies to improve student attendance at classes, a study was conducted at the Auburn University School of Pharmacy. The study consisted of a two step process - the first step was to develop a survey instrument. All students were invited to participate in a discussion on student absenteeism. They were asked to identify reasons to attend and not to attend classes. Following the generation of this list, the students ranked the reasons based on how much they agreed or disagreed. In addition to student generated ideas about absenteeism, a literature search revealed two research studies evaluating similar research questions. A compilation of these sources lead to the generation of the survey instrument.

A cross-sectional survey was disseminated to 131 second-year pharmacy students via email. Students were asked to identify the number of times they were absent from 3 courses: integrated pharmaceutical sciences, management, and pharmaceutics. Demographic information was also collected. Finally, students were asked rate 14 reasons to attend class and 22 reasons not to attend class. Students were asked to use the following scale: main reason, moderately important reason, minor reason, or not a reason.

A total of 98 (75%) students responded. Three-quarters of the students were female and unmarried. Prior education was split down the middle, with half of the students earning prior college degrees. The majority of the students was not working during school and lived less than 10 minutes from campus. The average age was 23 with a cumulative GPA of 3.0. Student reports of absenteeism were highest in the pharmaceutics course with 38% of students reporting 11 or more absences and lowest in the management course with 100% of student reporting ≤ 2 absences. When analyzing the effect of student characteristics on absenteeism there were no statistically significant differences in the pharmaceutics or management courses. In the integrated pharmaceutical sciences course students were more likely to miss more classes if they lived more than 10 minutes from campus (p=0.04) and paid for their own education (p=0.04).

The main reasons to attend or not to attend class varied based on the course. A resounding reason to attend class (common to all courses) was the desire to take notes and to hear what the instructor considered important to know. In the management course a strong motivator for student attendance was the implementation of pop quizzes and activities that would impact student grades, with 97.7% of students reporting this as a reason to attend class. In terms of reasons not to attend class, students stated they would skip class if they were sick, they were studying or working on an assignment for another course, and the material was available from another source. These reasons were common to all three courses.

One thing I have gleaned from this article is that awarding credit (or points toward the student’s grade) for attending class is a strong incentive. I also think one of the students' justification for not attending class - the need to study or work for other courses - is an interesting one. In pharmacy education we have the unique advantage in that our students are taking essentially the same classes and we (the teachers and administrators) have access to their schedules. While I recognize that developing time management skills is important, perhaps we (the faculty and administration) are doing a disservice to ourselves and our students by not exploring better ways to schedule course-related activities that would enable more students to complete assignments, study for tests, and attend class.

Relative to the student reasons to attend class it is interesting to note that one is an intrinsic characteristic of the learner (a desire to take notes) and the other is a quality related to how the teacher presents the material (emphasizing what’s important). While the authors were not able to delineate which students were more likely to miss class based on demographic characteristics, I would argue that the authors failed to collect some important information. I believe information about the students’ learning style, perhaps by using an inventory such as Kolb’s learning style indicator, would have been helpful . This might have provided additional insight into student responses to the survey and may be helpful for instructors to design learning activities for large groups that would entice more students to attend. Instructors are the other piece to the equation of classroom attendance and yet this crucial stakeholder was not surveyed in this study.

I think that this study could be used as a tool for faculty development. Having faculty members participate in a similar survey to see what biases / beliefs they have as it relates to student absenteeism would add an interesting dimension. Taking this a step further I would like to see faculty members complete an inventory to identify their teaching style. A better understanding of their own teaching tendencies will allow faculty members to see what areas they should strive to develop to better meet the needs of their students.

[Editor’s Commentary: Should we force, coerce, or bribe students to attend lectures (e.g. take attendance, administer pop quizzes, give attendance points)? Is there any evidence that attendance (per se) improves outcomes? If students perform equally well (or perhaps better) on assessments and exams when they skip class, what is the incentive to attend? From the student’s perspective, if the benefits of not attending outweigh the potential consequences, being absent is a simple benefit-risk decision. Does absenteeism bother us (the faculty) because it reflects badly on us (the faculty)? Does it annoy us because its boring talking to a bunch of empty seats? Are we failing to measure and assess important aspects of learning that best occur during face-to-face encounters with and between students? Or are students simply making rational decisions about how best to use their time? Food for thought. S.H.]

April 11, 2008

From Avatars to Yugma: Exploring Technologies

American College of Clinical Pharmacy (ACCP)

Spring Forum Meeting 2008

From Avatars to Yugma: Exploring Electronic Technologies to Teach
Facilitators: Donna Huynh and Stuart T. Haines

The following is a summary of the discussions of the participants at the ACCP Spring Forum Meeting held in Phoenix, Arizona on Sunday, April 3, 2008. This information was generated from a series of BRAINSTORMING activities regarding the potential uses, advantages, and disadvantages of various electronic technologies that could be employed during the teaching and learning process. As a brainstorming activity, the potential uses, advantages, and disadvantages outlined below may not be complete, accurate, or appropriate. Moreover, concepts are not fully described and require the reader to draw his/her own conclusion or interpretations.

The facilitators are NOT advocating for the use of these technologies and it should be recognized that any new technology requires a substantial commitment on the part of the users (instructors and students) to learn how to use the technology in an appropriate manner. While these technologies clearly have some potential benefits and may enable some forms of instruction that might not otherwise be possible, the facilitators STRONGLY recommend that technology should only be used when other methods are less likely to help the students to achieve the intended outcomes. In other words, technology should only be used when it is believed to be the best way to accomplish the instructional objectives.

Individuals who participated in the ACCP Program are free to download and use this information for whatever purpose they desire ... but if used for a scholarly or commercial endeavor, appropriate recognition of the facilitators should be given.

Avatars and Virtual Stimulations

Potential Uses

  • Orient students to a patient's room in a hospital or long-term facility
  • Observe mediation errors/communications
  • Simulate emergeny or "code" situations
  • Physical assessment of abnormalities
  • Ensuring students see all types of patients, disease states
  • Interprofessional scenarios (e.g. pharmacist-physician, pharmacist-nurse)
  • Anatomy/visual physiology
  • Structure Activity Relationships (visualize drug/receptor bindings)
  • Sim-pharmacy
  • Patient counseling
  • Ethics (making a decision and seeing the outcomes)
  • Experiencing adverse drug interactions
  • Demonstrating sterile technique
  • Dealing with patients with communication barriers (e.g. non-English speaking, hearing impairments)
  • Virtual hospital rounds

  • Able to stimulate rare situations
  • Fun
  • Great prequel to "real" experiences
  • Practice whenever they want (and as many times they want)
  • Resource sparing (no need to pay for actors)
  • Real time quizzing with formative feedback
  • Active learning
  • Good for visual learners
  • Can develop scenarios based on student responses (layering)
  • Standardized assessment
  • Modeling of communication skills
  • Simulated labs for basic science courses
  • Self-learning
  • Less inhibition to interact

  • Not "real" enough (not hands on, may not take it seriously)
  • Difficult to cover all possible scenarios
  • Access to internet
  • Different learning styles
  • Social isolation
  • May not work well for students with limited technology or physical disabilities
  • Decrease critical thinking
  • Assessment of student use
  • Have to follow a predefined path
  • Older students may not relate to technology
  • Too much like a game
  • Doesn't work well for information that is constantly changing
  • Requires students to be self-learners


Potential Uses
  • Developing a virtual journal club (students responsible for reviewing / critiquing assigned journals and posting summaries)
  • Developing disease specific webpage
  • Writing reflective journal entries for introductory or advanced practice experiences
  • Reporting about student organization activities (upcoming or past events)
  • Highlighting Lecture reflections (e.g. Most important points by the instructor)
  • Debate controversial issues
Wikis and/or Google Docs

Potential Uses
  • Writing SOAP notes or care plans as a group assignment
  • Responding to drug information requestions / writing drug information papers
  • Group work examing case studies - one group develops the cases ...and another group "solves" the case
  • Developing a peripheral "brain" or study guide - an approved "cheat sheet" that all students are allowed to use for an exam OR on clinical rotations
  • Facilitating small group or committee work
  • Scheduling / coordinating group work (Google Docs ... Spreadsheets)
  • Facilitate faculty collaboration on developing cases or other course materials
  • Student presentations (Google Docs ... Powerpoint)
  • Patient information leaflets
  • Drug information monographs
  • Setting up a budget for a community pharmacy (Google Docs .... Spreadsheet function)
  • Developing policies and procedures for organization or business
  • Developing a curriculum vitae or resume
  • Writing a scientific abstract or poster
  • Creating and facilitating the activities of interprofessional working teams
Blogs, Wikis, and Google Docs
  • Holds every one accountable for doing their share of the work ... you can track participation
  • You don't have to sign into a secondary academic site
  • Tools are available for free ... and readily available on the web
  • No additional software is required
  • Using these tools is pretty intuitive ... shallow learning curve
  • Enables group work over distance (anywhere in world with Internet access) and time (24/7)
  • Faculty can make comments/give feedback to students during the development process
  • Can see peer review comments made by students to one another
  • Information (student work) is unlikely to be lost ... stored on servers with MULTIPLE redundances
  • Shy students who might not contribute to face-to-face collaborations might contribute more in this environment
  • Reduces the need for paper (good for the environment!)
  • Reduces the need to e-mail assignments back and forth between collaborators
  • All collaborators can access the SAME document at any time
  • Social interactions / team work processes are different online; skill set that is needed for face-to-face collaborations won't be developed
  • Feedback is not as immediate as face-to-face communications
  • Open access/security/privacy issues (information is stored on distant server)
  • Blogger, Wiki, or Google Doc Sites may be blocked at some universities
  • Plagiarism issues (temptations may be greater; may be more difficult to police)
  • Written assignments (regardless of whether this technology is used) require more instructor's time to review and provide feedback
  • Do not facilitate the development of oral communication skills
  • Student may feel uncomfortable / inhibited knowing they are being monitored during the process
  • Students may make inappropriate comments (harder to manage inappropriate communications in on-line environment)
  • If work is used by other students (e.g. peripheral brain), information may not be accurate

Discussion Boards

Potential Uses

  • Creating a drug information discussion board and letting students from different practice sites answer them
  • Discuss patient cases among several groups
  • Post FAQs and other course mechanics (e.g. virtual office hours, daily updates)
  • Ethics debates
  • Journal club
  • Reflection activities (student answer a question from reading and have other students respond)
  • Stimulated patient interview (give minimal information related to a patient case and students need to post questions to ask patient)
  • Preparation for job/residency interviews
  • Cross campus student interactions on assignments
  • Discussion of group projects
  • Facilitate communication with students after they leave practice site
  • Problem based learning
  • Student moderating "online" discussion (e.g., post student's questions and let students answer them)

  • Accessibility of information
  • Allow students to respond that otherwise wouldn't in the classroom
  • Time management
  • Serves different learning styles
  • Decrease number of emails
  • Allow time for student to think about answers
  • Secure because of limited access
  • Familiar technology
  • Can post links
  • Develop writing skills
  • Promote teamwork

  • Access to resources may be an issue
  • Copying/plagiarizing is easier to do
  • Reduce face to face conversations (lack of personal interactions)
  • May not serve those who learn in person
  • Lots of time to monitor for students and instructors
  • Uncomfortable with creating new threads instead of responding
  • Difficult to read long posts online
  • More difficult to search
  • Misinterpretation of written communication
  • Lurkers can hind
  • Cultural issues in the way we express things
  • Need many small groups
  • Not real time (no sense of urgency), loss of acuity
  • Loss of professionalism
  • Requires (sometimes elaborate) ground rules to guide participation

Digital Portfolios

Potential Uses
  • Collection of useful documents (and multimedia?) to support employment or residency applications
  • Student Portfolios - track assignments completed during a specific experiential rotation or during entire series of advanced practice rotations
  • Facilitate communication between students and their mentors and/or advisors throughout the learning process
  • Repository of faculty-student evaluations for the entire course of student's learning experiences in school
  • Residency portfolios
  • Tenure and promotion portfolios for faculty
  • Accreditation documents for schools and universities
  • Central repository easily accessible to the student, faculty, preceptors, and mentors
  • Environmentally friendly? (cut down on paper)
  • Less bulky (stored electronically)
  • Easily to search and reorganize
  • Potential legal issues / privacy concerns
  • Overwhelming amount of information
  • Engender apathy / limited creativity (only cut and paste existing documents)

Online Conferencing

Potential Uses
  • Student presentations / faculty lectures
  • Communicate with students at distant sites / at home / from a remote location (e.g. while attending a conference)
  • Development activities for preceptors
  • Enables committee / faculty interactions at distant sites / from a remote location
  • Lead small group discussions
  • Lead discussions with students at remote practice locations (e.g. during APPEs)
  • Office hours for faculty
  • Online exam review sessions (pre-exam or post-exam debriefing)
  • Mentoring meeting with students, faculty, mentoring when you can't meet face-to-face
  • Enable invited (national / international) experts to teach a class from a remote location
  • Participants can be located anywhere (in the state, country, or world) .... as long as they have Internet access
  • Allows participants to review material repeated
  • Cheaper than traveling to remote locations
  • Reduces travel time
  • Job satisfaction ... you can work from home!
  • Can reuse lecture that don't need updating
  • Eliminate excuses why students weren't able to attend class
  • No (smaller) physical space requirements .... don't need to build new classrooms or conference rooms

  • Must all be online at the same time (synchronous) [Facilitator note: sessions can be recorded and accessed later]
  • Participants can easily get distracted by other things in their environment (unlike classroom environment)
  • Interaction is not a rich as face-to-face interactions
  • Managing "classroom" environment is difficult - need to use new tools / methods to acknowledge and respond to students
  • Can't determine if the participants are paying attention
  • Disengages some participants (similar to teleconferences)
  • Connection speed ... requires high speed connect for video/audio to work well
  • May be more difficult to follow speaker, slides, and student chat ... all at the same time
  • Miss the subtle voice inflections or body language of the speaker

August 18, 2006

Teaching Excellence

An essay by Frances Wong
(Doctor of Pharmacy Student and former teacher)

After being a student for more than 18 years and a high school teacher for 3 years, I learned to view the profession TEACHING as a student and as a teacher. It does not mean I am an expert in analyzing this profession perfectly. It simply means that I think about teaching from two angles due to the different roles I have.

It is easy to ask a student to give some descriptions of an excellent teacher. Depending on the age/maturity/education levels of the students, the answers can range from sense of humor and caring to mastery of knowledge in subject and organization. Students see how a teacher delivers the “knowledge” but seldom sees how a teacher prepares a lesson.

It is also easy to ask a teacher to give some descriptions of an excellent teacher. Depending on the age group/audiences’ education level/teaching subjects, the answers can range from well-prepared and detailed lesson plans to good communication skills and classroom management. Teachers also focus on the delivery method when presenting a lesson in a classroom but sometimes neglect what students really need in order to learn and how to truly evaluate and assess students’ learning.

An interesting collection of views on good teaching was presented by Ken Bain in the book: What the Best College Teachers Do. There were many great pedagogy methodologies that I strongly believe college educators can use to their benefits. However, Bain stresses the most important thing is not to focus on the methodologies; it is to look at the before, during and after of teaching so one can evaluate and enhance his/her teaching. A good educator starts by examining his/her teaching philosophy before the class even begins. A philosophy which bases teaching on helping students to make connections between new materials with one’s previous knowledge and not just focusing on the delivery. All teachers want to be good teachers, but it is how one perceives “teaching” and “learning” that structures the way they help their students to achieve the ultimate goal of the class – learning. With that in mind, a teacher then can go on to planning out how he/she wants to reach that goal. During the course teachers will encounter different “curve balls” in classes that require open-mindedness and adjustments which will allow students to maximize learning. Evaluation after the class then becomes the key to climbing up the ladder toward excellent teaching. To create a good learning environment, one needs to make the much needed preparation, lesson planning, and assessments while keeping both teachers and students in mind.

After examining “teaching” from different angles, I see that even though there are many differences between primary, secondary, and post-secondary/higher education teachers, one thing we all have in common is the power to shape and influence the minds of our future. This commonality is the most important reason that we need to have good teachers for all types of students in all parts of the world. As pharmacy educators, are you ready to take upon this challenge in being as good of a teacher as you can possibly be? Whenever you are ready, the students are waiting.

July 15, 2006

Learning to be an Expert

The development of expertise is a fascinating area of cognitive science. I recently read a well-written story in Scientific American (August 2006, Volume 295, Number 2) on this topic entitled "The Expert Mind" by Philip E. Ross. Unlike the commonly held belief that experts have some innate talent that enables them to advanced knowledge and skills in a particular field (e.g. physics, history, health care, sports, music, chess), expertise is acquired through hard work and practice (practice, practice, and more practice). For most individuals of average intelligence, expertise in any field can be rapidly acquired in childhood and early adulthood. Undoubtedly individuals acquire knowledge and skills in some fields more easily than others - perhaps due to their personal learning style, positive feedback from mentors/teachers/parents, as well as social conditioning. But expertise in any field is primarily acquired through years of study and taking on challenges that are just beyond one's current level of knowledge/skill (known as the zone of proximal development).

The implications are important because it means that expertise is acquired through purposeful activity - and it is not something that is innately inherent. Or is it? What do you think?

June 7, 2006

Paradox and Profound Truth

This photograph is of a truly majestic tree at the Morikami Museum and Japanese Garden in Delray Beach, Florida. As you can see, the tree is strong and healthy. It is a lovely and very full tree with numerous branches. It shaded me from the bright sun. Further, it has an impressive root system. Thankfully, the tree was perched on a pedestal – otherwise, I would have not been able to capture its beauty through its canopy of leaves. “Perched on a pedestal?” you may well be asking yourself. Yes, this magnificent tree is a mere 18 inches tall and is among the many trees in the Morikami bonsai collection. The bonsai tree is counter-intuitive to my (admittedly Western) understanding of what a tree is. How it is possible to grow and shape such small trees is beyond me. And yet, despite their short stature, they are just as beautiful, grand, and majestic as their full sized brethren.

In his book "The Courage to Teach" by Parker Palmer devotes an entire chapter to exploring truth and the profound truths revealed by paradox. The world is full of paradoxes and it is often through the exploration of paradox that great scientific, philosophical, and mathematical achievements are made. And Dr. Palmer contends that each of us must explore our own personal paradoxes in order to reach a fuller, deeper understanding of ourselves.