Differentiated Instruction

by Cynthia Uche, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

The recognition that all students do not learn in the same paves the way for differentiated instruction, or DI. DI is a type of instruction that is inclusive of different types of learners.^1,2,3 DI addresses the varying learning styles of students within the classroom.^1,2,3 Each student has different learning preferences and the aim of DI is to create options for the delivery of a lesson. This method of instruction is a form of multimodal learning and it is often applied in today’s classrooms. DI is part of the standard to which teachers and instructors are assessed.^4,5 Students’ needs, motivations, and abilities are varied, therefore, part of the instructor’s task is to construct lessons that address each student’s needs. DI principles are based on the idea of multiple intelligences, completing tasks/activities that are socially relevant to the student, along with incorporation of visual, auditory, and kinesthetic learning methods into each lesson.^1,3,5

Image from:  https://loorducation.wordpress.com/edu-605-differentiated-instruction/

Establishing clear objectives is the first step. In order to deliver content well, the content must be relevant to the students. Choosing a variety of instructional methods is the key to applying the DI method. For example, use of visual aids and textbooks for visual learners and incorporation of note taking for the tactile learners.^1,5 Another important component of DI is addressing the learning environment. The learning environment needs to be safe and encourage learning. Rewarding students’ for effort, despite less than perfect performance, is important in establishing a safe learning environment.

After the delivery of content, instructors may use DI to allow students the option of showing mastery of the content based on their learning style.^1,2 Kinesthetic learners may build a model and describe its relevance to the topic. Visual learners may wish to create a PowerPoint presentation or a graphic organizer that explains the assigned topic. Auditory learners may wish to deliver an oral report. Finally, learners who prefer to write may compose a written report based on the assigned content.^1,3 Assessing effectiveness throughout each lesson, is an important aspect of DI.  The infusion of formative and summative assessments during and following delivery of the lesson are great ways to assess student learning and progress. Multiple-choice questions that assess the students’ level of comprehension of the topic can be administered during and at the end of the lesson. In many classrooms, the instructor can employ student response software such as “clickers”, raising hands to indicated answer choices, or through traditional paper and pencil questions. Research has shown that DI is effective for learners of different cognitive abilities.¹ The availability of options motivates students to take responsibility for their learning.^1,4 One study found that student grouping based on learning styles improved collaborative learning.⁶ The accessibility of different options of assignments may better serve the students, if they work collaboratively, in groups, based on their similar learning styles.

With the expansion of course delivery to online classrooms, the application of DI methods to online learners is also important. Students enrolled in online courses have the same varied needs, experiences, intelligences, and learning styles as those enrolled in courses held in traditional classrooms.

In the online classroom, utilizing multimedia can help an instructor to differentiate the content, process, and outcomes. Interactive activities that foster cooperative learning, with shared ideas and open discussions among students, especially through online chat forums, are great tools for learning.² According to the DI model, direct instruction and inquiry-based learning should also be incorporated into lessons.¹ There needs to be a balance between all of these methods, no one method should be utilized more than the others.^4,5 For instance, in a course that is delivered in a 50 minute period, direct instruction may comprise only 10-15 minutes of that period. After which, the instructor can then segue into other forms of instruction, such as inquiry-based learning. DI model encourages student-centered learning over instructor-led learning.⁵ This method inspires student investment and accountability for learning.¹

As with any method of instruction, there are pros and cons of DI. DI requires a great deal of planning.¹ More time is spent adjusting delivery of a lesson after formative assessment indicates that the delivery is less than optimal. Professional development needs to be dedicated to assisting instructors learn how to apply DI methods to their classes. Ultimately, the success of DI that has been observed in the traditional classrooms can be translated to online classes.

References

1. Weselby C. What Is Differentiated Instruction, Examples of Strategies [Internet]. Concordia University: Teaching Strategies; 2014 Oct 1 [cited 2016 Mar 5].
2. Hampel R, Stickler U. The use of videoconferencing to support multimodal interaction in an online language classroom. ReCALL. 2012; 2:116-137.
3. Clayton K, Blumberg F, Auid DP. The relationship between motivation, learning strategies and choice of environment whether traditional or including an online component.  Br J Educ Tech. 2010;3: 349-64.
4. Landrum T, McDuffie K. Learning styles in the age of differentiated instruction. Exceptionality. 2010;18:6-17.
5. Tomlinson CA. The Differentiated Classroom: Responding to the Needs of All Learners [Internet]. Association for Supervision and Curriculum Development; 1999 [cited on 2016 Mar 5].
6. Alfonseca E, Carro RM, et al. The impact of learning styles on student grouping for collaborative learning: A case study. User Modeling & User-Adapted Interaction 2006;16:377.

Knowledge Dimensions: Factual, Conceptual, Procedural, and Metacognitive

by Tara Bastawrous, PharmD., PGY-1 Pharmacy Practice Resident at Kaiser Permanente of the Mid-Atlantic States.

Personally, I learn the best through questions and answer. I appreciate professors and preceptors who take the time to make study guides and cases where I need to find the answers in the reading materials. I enjoy preceptors asking me questions because — although it may be intimidating or nerve racking when I do not know the answer immediately — searching for the answers makes me remember the concept. In searching for answers, I am able to make connections and relate the information to previously learned material. I learn best through questions and plan to use this excellent teaching and learning tool with students I will precept in the future.

Questions need to be properly constructed in order for students to gain the most out of the learning experience. They should not be asked to confuse or intimidate students, but rather to stimulate critical thinking and apply prior knowledge to the current concept. Students can effectively learn from answering questions, but their answers can also assist the teacher. Teachers are able to assess the student’s prior knowledge and based on  student’s responses can guide further instruction, choosing what to focus on and the level of difficulty.¹

Not only should questions be planned both in the classroom and at clinical practice experiences, but students should also be taught to ask questions. Students need to feel that they have the freedom to ask scholarly questions to gain better insight or clarity. Questions should provoke higher-level thinking, no matter the academic proficiency of the student, as this will help engage and motivate the student.²

Questions can be constructed based on the 4 knowledge dimensions: factual, conceptual, procedural, and metacognitive. Anderson and Krathwohl first developed these 4 dimensions, ranging from concrete to abstract.  Factual questions seek recall information from textbook, guidelines, or studies on the concept being asked. They ask about details from reliable, published data.  Students must remember specific, applicable information from various sources. Factual questions are asked to assess understanding and prompt analysis of a disease state, situation, or others work.¹ An example of a factual question might be “According to the American Diabetes Association, when should anti-diabetic medications be initiated in a patient?” By reviewing these essential facts, terminology, and details, the learner will be better prepared to solve a problem.³

Conceptual questions ask students to further describe the factual information, to become aware of the “interrelationships between the elements of a larger structure”. Learners are asked “why” — to explain their answer, providing the principles or theories that support their answers. These types of questions also help learners to classify elements into categories, further differentiating information and analyzing correlations to the pertinent subject matter.^1,3 An example of conceptual questions would be: “How are the American Diabetes Association and the American Association of Clinical Endocrinologists Guidelines for Diabetes similar and different?” Another conceptual question would be, “Why do the guidelines recommend against using insulin and sulfonylureas concomitantly?”

Procedural questions assess the learners’ ability to choose from well-established methods and select the most appropriate algorithm, technique, or criteria based on the particular situation.¹ An example of a procedural question would include: “Based on this patients A1C and fasting blood glucose level, which medications are recommended by the American Diabetes Association for initial therapy?” 

Studies have shown only about 20% of questions are procedural, with another 20% being higher level.² These types of questions help the learner apply their knowledge, skills, and techniques to problems in the pertinent subject matter.³

Metacognitive questions ask learners to reflect on experiences and identify possible areas of improvement. Metacognition is defined as “higher-order thinking that enables understanding, analysis, and control of one’s cognitive processes, especially when engaged in learning.”⁴  The learners’ answers to metacognitive questions help the teacher assess the learners’ personal motivations and values, which could help shape how the material is taught.¹ By “thinking about one’s own thinking” learners are able to approach problems utilizing their strengths and preferences, and examining their weaknesses.  An example of a metacognitive question would be: “Thinking back on the patient encounter, how well do you think you did? How do you think you could have improved your patient interviewing and counseling skills for future consults?” These questions also help train learners to use their knowledge strategically and reflectively when solving problems.³

In one study, the questions overwhelmingly (91.2%) asked by clinical teachers were lower level questions, with most being factual type. The authors state this may be because teachers have not been taught how, or the importance of, asking higher order questions.⁶

Higher-order questions promote higher-order thinking. Higher-order questions “causes cognitive processing and organization of information that’s builds more elaborate mental structures.” ² Teachers and preceptors should be taught to formulate higher-order questions to stimulate such thinking.

It has been shown that teachers mostly ask lower-level cognitive questions. Lower-level cognitive questions can hamper the learners’ ability to develop higher order critical thinking skills. These skills are important to allow students to practice recalling knowledge they have learned and applying them to new situations. Critical thinking is especially important when problem-solving and determining the best treatment for a patient based on various factors and barriers. By asking students questions in the factual, conceptual, procedural, and metacognitive domains of knowledge, they will be able to learn in a “full circle” and understanding the bigger picture.^1,2

References:

1. Tofade T, Elsner J, Haines ST. Best Practice Strategies for Effective Use of Questions as a Teaching Tool. Am J Pharm Educ 2013; 77 (7): Article 155.  Accessed February 15^th, 2016.
2. Saphier J, Haley-Speca M, Gower M. Dimensions of Questioning. The Skillful Teacher: Chapter 9: Action, MA. Research for Better Teaching, 2008; 208-214. Accessed February 16^th, 2016
3. Owen L. Anderson and Krathwohl-Understanding the New Version of Bloom’s Taxonomy. 2013. Accessed February 18^th, 2016
4. Metacognition defined by dictionary.reference.com
5. Gall M, Ward B, Berliner D, et al. Effects of questioning techniques and recitation on student learning. American Educational Research Journal. 1978; 15: 175-199
6. Sellapah S, Hussey T, Blackmore A, et al. The use of questioning strategies by clinical teachers. Journal of Advanced Nursing. 1998; 28: 142-148.