Anticipating Difficult Situations in Experiential Learning

by Kaitlin Pruskowski, Pharm.D., PGY1 Pharmacy Practice Resident, Johns Hopkins Bayview Medical Center

Inevitably, all preceptors will be faced with difficult teaching situations in the experiential learning setting.  Both the teacher’s and the student’s skills and expectations can contribute to these difficult situations.  Lack of motivation, either on the student’s or preceptor’s part, can play a big part in a difficult teaching situation.  In addition, not understanding generational differences and expectations can lead to problems.

Teacher-specific factors that can make teaching difficult include poor teaching skills, lack of experience, and not being well-prepared to supervise students.¹  Student-specific factors include lack of effective communication skills, poor baseline-knowledge, and lack of ‘real world’ skills.  Because students lack real-world experience, they may question a preceptor’s recommendations.  When this occurs, it may be helpful to direct the student toward the evidence on which the recommendation is based.  Additionally, mismatched teaching and learning styles, personal insecurities, and life events may contribute to difficult teaching situations.¹

Lack of motivation may also be a significant contributor.  A student may lack internal motivation and is only motivated by external factors (i.e., grades).  Because the learner may not be interested in the subject matter, she may only be willing to do the minimum work required.  Her actions and body language may reflect this.  The student may be tardy, not prepared, or not willing to participate during patient care rounds or group meetings.  Similarly, a preceptor may not be motivated to teach his student.  The preceptor may not make time to meet with students and may not provide clear instructions about what is required.

Generational differences can also play a role in difficult learning situations.  Today, there can be up to three or four generations sharing a common workplace.²  Each generation has its own unique attitudes with regard to work, work-life balance, and respecting authority.  The ‘Baby Boomers’ tend to be ‘workaholics’ and work until they achieve the goals they have set for themselves.  They usually work to please their managers and coworkers.  Members of ‘Generation X’ tend to be self-reliant and are focused on building their resume.  Most are usually very knowledgeable about technology and how it can be used to improve the workplace.  ‘Generation Y’ value life-long learning and like problems-solving.  They are often dependent on technology and are comfortable participating in virtual meetings and communities.  With all of the technology available to them, they expect their preceptors to be available 24/7 to address questions or concerns.  If a preceptor and learner are of different generations, issues may arise due to these differences in values and expectations.²

So how can you prevent difficult teaching situations?  During the orientation period, teachers need to clearly define their expectations, including rotation schedule, workload, and interactions with the medical team.  The teacher/preceptor should know the school or program’s expectations of its learners; chances are that the learner has already received some instruction about these expectations – but it is up to the teacher to reiterate these to the student or resident, along with any rotation-specific requirements the teacher may have.³

Despite clearly stating the expectations in the beginning of the rotation, teachers may face problems as the rotation progresses.  Be sure to address these issues early! If the teacher ignores them, they will worsen with time.  Ask the student about what is going on.  When talking with the learner, it is important to stay calm and give objective feedback.  Be specific about what was observed and what the student can do to improve.

Hewson and Little conducted a survey of medical residents to see which feedback techniques were the most and least helpful.⁴  Feedback that was non-judgmental and based on observations was found to be significantly more helpful than disparaging comments that were not tied to specific events.  It is important to elicit the learners’ ideas and to offered suggestions for improvement.

Based on their findings, the authors developed a model for giving effective feedback.⁴  First, the learner should be given some ‘warning’ that the teacher like to give some feedback and to schedule a time to talk about it.  Next, the learner should be asked to do a self-assessment.  The student should identify what he does well and the areas in which he should improve.  Then, the teacher/preceptor can give feedback as to what the learner is doing well and what he can do to improve.  As a team, the teacher and learner should develop a plan for improvement.  The session should end with a follow-up plan developed by both the teacher and the student.

After meeting with a student and discussing difficult learning issues, the situation may not improve or may get worse.  When this happens, it is time to contact the school or program director.  Program administrators know that not every student is ‘perfect’ and that the teacher may encounter an especially difficult student from time to time.  The school needs to get involve and they are prepared to help if an especially difficult situation arises.

References

1. Langlois JP and Thach S. Managing the difficult learning situation. Family Medicine. 2000;32:307-309.
2. Ginsburg DB. Teaching across the generations: Challenges and opportunities for preceptors. Presentation given at The University of Texas at Austin College of Pharmacy. Austin, TX.
3. Langlois JP and Thach S. Preventing the difficult learning situation. Family Medicine. 2000;32:232-234.
4. Hewson MG and Little ML. Giving feedback in medical education: Verification of recommended techniques. J Gen Intern Med. 1998;13:111-116.

You Can Get All A’s and Still Flunk Life

by Christine Puschak, PharmD, PGY2 Cardiology Pharmacy Practice Resident, University of Maryland School of Pharmacy

        

Take a moment to think about what is required to lead a “successful” life. Is it knowledge, luck, hard work? How about self-awareness and relationships?¹  Success in life often requires all these.  It is our job, as educators, to help students achieve success: in the classroom, in the program, and in their lives. Many of us focus on teaching content-specific material to increase students’ factual knowledge and problem solving skills. However, have you ever thought about increasing students’ self-awareness and relationship management skills?

Emotional Intelligence^1,2

Daniel Goleman describes emotional intelligence (EI) as a flexible, intangible concept.² EI is comprised of four major cornerstones: self-awareness, self-management, social awareness, and relationship management (see Table 1). The four cornerstones allow us to work through a situation by evaluating ourselves and effectively interacting with those around us. These skills focus on recognition and regulation of emotions. EI helps build stronger relationships and success at work by empowering others and leading change. It is a skill required by health care workers as they need to effectively communicate with patients and create a plan that meets a patient’s goals. Healthcare providers must be attuned to the emotions and motivations of their patients and co-workers as they address complex issues. Empathy helps providers understand their patients in a way that improves decision-making.

TABLE 1 – The Cornerstones of Emotional Intelligence

	Self	Social
Recognition	Self-Awareness ·  Emotional self-awareness ·  Accurate self-assessment ·  Self-confidence	Social-Awareness ·  Empathy ·  Organizational awareness ·  Service orientation
Regulation	Self-Management ·  Self-control ·  Transparency ·  Adaptability ·  Achievement drive ·  Initiative	Relationship Management ·  Inspirational leadership ·  Developing others ·  Influence ·  Change catalyst ·  Conflict management ·  Building bonds ·  Teamwork & collaboration

Most of us acquire these skills through experience and practice, but how do we teach learners to be emotionally intelligent?  Can it even be taught?

Measurement¹

Before we can teach EI, we have to determine if there is a way to measure these skills. Drs. Bradberry and Greaves developed the EI Appraisal questionnaire  — a survey to quickly and accurately assess one’s emotional intelligence quotient (EQ).¹ This assessment tool is based on the four major cornerstones of EI. It has shown strong reliability through validation studies. In addition to this test, there are currently nine other assessment tools to determine a person’s EQ, all varying in complexity and utility. The details of each assessment can be found at http://www.eiconsortium.org.

Can I Improve my EQ?¹

While our intelligence quotient (IQ) is considered to be rigid and remains relatively unchanged throughout life, EQ often increases with age and experience. Improving your EQ is something that you work on regularly. A change can often be seen within a few months with a measurable difference in EQ score often occurring in three to six months. The key to successful developing your EQ is to start small and work on it incrementally. A person should choose one of the four cornerstones and work to improve that area before moving to another. It is beneficial to first identify which cornerstone requires the most development. The EI surveys and assessments can help one identifying these areas. To increase EQ, it requires self-management and a specific action plans. Ultimately, the responsibility is the learner’s.  Personal growth requires a conscious effort and constant practice.

How Do I Teach EI?

To help learners improve their EQ, a teacher must be aware and cognizant of the skills required for emotional intelligence. If teachers are not aware of or do not understand EI, they can not effectively nurture the development of EI skills in their learners. EI can be built through self-reflection and relationships with others. Thus, teachers must first build their own EQ! Once mastered, there are numerous ways of incorporating the skills into your instruction. Activities to raise awareness of the cornerstones of EI are available in print and electronic media.⁴

EI skill development exercises increase EQ scores.  In one study, third year medical students were assigned to a seven month EI training program which included individual reflections and group activities.⁵  A second group of medical students who participate in the study did NOT participate in the EI training program.  The group assigned to the EI program had a substantial increase in mean EQ over time while the comparator group actually had a slight decrease. Although an increase in EQ was observed, the benefits remain unclear. The study reported only changes in the EQ score, which is merely a surrogate marker, and did not follow-up with participant over time.   It would useful to know if the EI program participants did better during their 4^th year practice experiences, more likely to match with the first preference for residency training, and if their patients and co-workers believed their were more competent (when compared to those who did not complete the EI program). Clearly we need more data to document the impact of EI training on outcomes.

Theoretically, all health professions, including pharmacists, would benefit from EI skill development and a higher EQ.  Health professional interact with patients and these interactions require trust and effective communication.  I believe that EI skills are best taught through communication-type labs. By making the students aware of their EQ score prior to lab, learners can improve their EI skills by developing self-awareness and working through various patient case scenarios and healthcare situations. Reflective exercises related to uncomfortable interactions — such as an angry patient or a competitive classmate  — may also help learners develop their EQ.  These exercises are intended to help them to acknowledge their thoughts, control their emotions, and think about others. These exercises may help to decrease school-related stress as they learn to assess and adjust their emotions.  EI exercise can also help learners work more effectively with others in the classroom and beyond.

EI is not a skill that can be developed overnight. With the encouragement of emotionally intelligent teachers, students can hone their skills and improve their own EQ, which may enhance their chances of success, both personally and professionally.

References:

1. Bradberry T and Greaves J. The emotional intelligencequick book: everything you need to know to put your EQ to work. New York: Fireside; 2005.
2. Goleman D. Emotional intelligence: why it can matter morethan IQ. New York: Bantam Books; 1997.
3. Daniel Goleman’s five components of emotional intelligence [Internet]. 2009 Feb 9. [cited 2014 Sept 22].
4. Lynn AB. The emotional intelligence activity book: 50activities for promoting EQ at work. New York: Amacom; 2002.
5. Fletcher I, Leadbetter P, Curran, et al. A pilot study assessing emotional intelligence training and communication skills with third year medical students. Patient Education and Counseling. 2009;76:376-9.

Mobile Devices in the Classroom: What’s Your Policy?

by Benjamin Laliberte, Pharm.D., PGY-1 Pharmacy Practice Resident, University of Maryland Medical Center

Ten years ago, the Boston Globe reported that less than 5% of colleges across the United States required students to purchase personal computers.¹  In 2014, things have changed dramatically — 67% of students have two to four mobile devices connected to their campus wireless network.² In the classroom, 94% of students are now utilizing some sort of mobile technology!

From one perspective, the push to use wireless technology in the classroom is due, in part, to the increasing use of computers and technology in our everyday lives, coupled with the need to provide students the skills to succeed in a “technology-dependent” world.^1,2 Moreover, teachers are simply responding to changes in social norms. When companies like Apple, HP, and Samsung roll out new gadgets, everyone seems to jump in line to purchase the latest invention! The integration of classwork with technology can produce interactive, hands-on learning that increases student engagement.  And it provides opportunities for educators to introduce innovative teaching techniques.^1-3 On the other hand, it may just be an easier way to deliver content and go (or not to go) to class.

Numerous studies have evaluated the benefits of laptop use in the classroom. One study was conducted at the United States Military Academy in West Point with 527 college freshmen enrolled in ten general psychology classes.³  Six classes served as a control group that did not use laptops and four classes incorporated laptops into classroom activities.  Students used laptops to prepared presentations and share information using a first generation Dropbox. After seven exams, students in the laptop classes had significantly higher scores when compared to the no laptop group (86.8% vs. 83.5%; p<0 .05)

Similarly, a recent study at the University of Michigan, involving nearly 600 students, examined the benefits of a homegrown, web-based software called LectureTools.  Half of the students were given access to LectureTools on their laptops and half were not.⁴ This interactive program allowed students to ask questions during lectures, take notes, draw on PowerPoint slides, quickly rate the professor’s slides, and review the lecture again after class. At the conclusion of the semester-long study, survey results demonstrated that students in the LectureTools group had self-reported increases in attentiveness (37% vs. 25%), engagement (60% vs. 39%), and learning (53% vs. 40%) when compared to the students who did not have this tool available to them.

Despite these promising results and the increased use of classroom-based technology, it is common for students to become distracted and wander into cyberspace.^1-4  In the University of Michigan study, 75% of students in both groups used their laptops for non-course-related tasks, including 35% for social networking and email.⁴ A survey of law students at three institutions located at geographical diverse areas of the country found that 96% of respondents used their laptops for note taking, but 71% were simultaneously surfing the internet during class.⁵ While many students take advantage of the available internet access to supplement classroom material, others are abusing the privilege, which can be distracting to those around them.^4,5

A 2006 study observed 137 college students in one college general psychology class that permitted laptop use.⁶  Sixty four percent of the students used their laptop during at least one class period. During class, 81% of the students admitted to checking their email, 43% browsed the Internet, and 25% reported playing games on their computer.  Not surprisingly, there was a negative association between student performance in the class and laptop use (p=0.024). Not only were the students who reported using their laptop in class performing poorer on exams, there was a self-reported decreased attention to lectures (p<0 .01)

Pharmacists and other health care providers often pride themselves in being effective multitaskers. But did you know self-proclaimed multitaskers may actually be worse at multitasking?^7,8  One study found that self-proclaimed multitaskers, such those students who actively using laptops during class, performed worse on cognitive memory tasks than students who preferred to focus on a single assignment.⁶  According to a paper on work-memory capabilities, human ability to multitask and “juggle facts” is limited to seven units. There appears to be a “switching time cost” that occurs when changing your attention, say, back and forth between facebook and a professor giving a lecture.⁷ Whereas it would normally take two seconds to repeat a single task, balancing two such tasks at the same time may actually take upwards of twenty seconds! Remember that all-nighter in college? Fatigue, in addition to anxiety and other emotional disturbances lessen our ability to multitask and process information efficiently.

Technology is here to stay. It has been shown that laptops can have a positive effect on attention and learning, if used appropriately.^1,3,4,9  Our job as instructors is to ensure laptops and other mobile computing devices are not a barrier to our students’ learning.¹ Successful teachers will be able to merge effective teaching methods with technology and social media to enhance student learning and comprehension. How? Well, here are a few tips:⁸

• Develop a technology use policy. This is a syllabus “must have” so students know your classroom etiquette rules. Are students with laptops and tablet devices allowed to sit in the front two rows?  Or do you have a “laptop/tablet free” zone?
• Develop in-class activities for students to accomplish using their laptops, tablets, and smartphones. Small group activities, such as patient cases or database research are great ways to engage students.
• Transforming technology into “audience response systems.” This may include tools like LectureTools or social media such as Twitter for students to ask in-class questions and share articles.  In doing so, you have a better shot at limiting technology use to course-related tasks.

References:

1. Russell J. Laptops required at 3 state colleges. The Boston Globe. 30 Aug. 2004.
2. Weldon D. BYOD now a fact of life for majority of college students. FierceMobileIT. 8 May 2014.
3. Efaw J, Hampton S, Martinez S, Smith S. Miracle or Menace: Teaching and Learning with Laptop Computers in the Classroom. Educause Quarterly. 2004;3:10-18.
4. Zhu E, Kaplan M, Dershimer RC, Bergom I. Use of Laptops in the Classroom: Research and Best Practices. CRLT Occasional Paper. 2011;30:1-6.
5. Mazzie LA. Is a Laptop-Free Zone the Answer to the Laptop Debate? Marquette University Law School Faculty Blog. 27 Oct. 2008.
6. Fried CB. In-class laptop use and its effects on student learning. Computers & education. 2008;50(3):906-914.
7. Glenn, D. Divided Attention. The Chronicle of Higher Education. 28 Feb. 2010.
8. Research on In-Class Use of Laptops and Other Devices: Effects on Students’ Learning and Attention. The Teaching Center Journal. 23 Apr. 2013.
9. Penuel WR. Implementation and Effects Of One-to-One Computing Initiatives: A Research Synthesis. Journal of Research on Technology in Education. 2006;38(3):329-348.

VARK – Know Your Style

By Vicky Shah, Pharm.D., PGY-1 Pharmacy Practice Resident, Suburban Hospital

Developing good study habits as a student is extremely important in order to obtain the knowledge required in school as well as life. To be an effective student, it is imperative that students understand how they learn. The VARK questionnaire is a sixteen-question survey that can assist students do exactly that.¹ Whether the questionnaire truly assesses a student’s best method for learning or simply reflects what method he/she currently uses is controversial.²

VARK is an acronym that represents the different categories of preferred sensory methods for learning: V (Visual), A (Auditory), R (Read/Write) and K (Kinesthetic). In completing the VARK questionnaire and identifying how one best learns, a student could then identify how to get the most out of studying. No one particular style is better than another.² In fact, very rarely do individuals learn by one method alone. There are a few lucky individuals who learn equally through ALL sensory methods; they fall into a category called “multimodal” learners.^1,2

Visual!    

Students who are visual learners need to make a few adjustments while they are in class to understand the material. Visual learners, perhaps more than other students, need to attend lecture or procure a copy of the handout.  It can be helpful for visual learners to imagine the words on a slide or highlight and underline key words on the handout for added emphasis. Visual learners experience things with their eyes, such as watching the teacher’s body language and facial expressions to fully understand what’s being presented. They prefer to sit near the front of the class and prefer to see pictures and graphs rather than wordy explanations. Diagrams, illustrations and interactive whiteboards further assist the visual learners.^{3, 4}

As a teacher, we can do plenty of things to ensure that our visual learners have everything they need. We can provide visuals aides, such as graphs or pictures, coupled with words on slides. There is nothing wrong with repeating the same information if you are presenting it differently, such as pictures and words. If the teacher’s preferred method of teaching is through paragraphs on the slides or handouts, try to highlight or underline key words or color code items of importance to help visual learners. ^{3, 4}

Auditory!             

Auditory students prefer learning through discussions, talking through topics, and listening to others explain the material. These individuals use the tone and pitch of a person’s speech to interpret emotion. Students who learn through auditory methods usually listen during lecture rather than diligently take notes. If they try to multitask, they may miss an important message.^{3, 4}

In order to help students who learn through auditory means, teachers need to understand that they cannot just show a slide and say “know this slide.” For students who learn best through hearing, they need to explain their slides so the students can fully understand the information. Teachers can encourage group learning and should allow students to tape record the lecture for further review.^{3, 4} The act of merely reading an abbreviated version of the material presented can be quite effective for an auditory learner.

Read/Write!                 

Individuals who learn through reading and writing benefit from taking notes, sometimes multiple times.  This can be done by simply rewriting the same thing over and over, or by rewording the material in a different way. Rewriting the notes using different words can help a student understand the concept rather than just memorizing a series of words. Students are encouraged to review their notes every day to ensure continuous absorption of the information. They can also organize graphs into statements rather than trying to be too visual.^{3, 4} Most read/write learners are also have visual or kinesthetic learning tendencies.

Teachers can assist students who learn by read/write by providing additional resources for students to consult for further explanation regarding the topic.  Teachers may need to slow down a bit to ensure that students who learn through reading/writing have sufficient time to write notes during class.^{3, 4}

Kinesthetic!         

Students who are kinesthetic learners prefer a more hands-on approach. They tend to learn by learning by “doing” something. They like to physically experience the topic, rather than just reading about it, hearing about it, or watching someone else. Many of these students tend to thrive during clinical rotations as they have the opportunity to put their knowledge to use. Hands on experiences are the best method for these students, but they can become distracted by their need for movement and must learn to control this urge or use it for their benefit.^{3, 4}

Teachers can assist by providing opportunities outside the classroom that benefit these students. Lab practicals and clinical experiences allow these students to “do” what they’ve told about in the classroom.  This helps them to understand better than a traditional written exam. Teachers can try to include brief group exercises interspersed throughout their lectures where students can practice counseling or medication preparation in the classroom.^{3, 4}

The VARK questionnaire benefits students by providing them with information on their learning style and preferences. This tool benefits teachers by reminding them that each student is an individual and learns in a different way. By understanding the different ways through which learning occurs, teachers can reach more students and help foster stronger teacher-student relationships.⁵

References:

1. Fleming N. VARK -- A Guide to Learning Styles. VARK-LEARN Limited, 1987. Web. 10 Sept. 2014.
2. Fleming N and Baume D. Learning Styles Again: VARKING up the Right Tree!" Educational Developments 2006; 7: 4-7.
3. Cherry K. What Are the 4 VARK Learning Styles? About. About Education, n.d. Web. 10 Sept. 2014.
4. VARK: Learning Styles: Visual, Auditory, Read/Write, Kinesthetic. Southwestern Community College. Web. 10 Sept. 2014.
5. Fleming N. I'm Different; Not Dumb. Modes of Presentation (VARK) in the Tertiary Classroom. Research and Development in Higher Education, Proceedings of the 1995 Annual Conference of the Higher Education and Research Development Society of Australasia (HERDSA). HERDSA, 1995; 308-13. Web. 10 Sept. 2014.