Are We Following Evidence-Based Education?

I started this academic year by paging through one of my favorite books, Brookfield’s Being a Critically Reflective Teacher.¹ This work helps me reflect on my experiences as an editor, faculty developer, and instructor. I reflected on how we ask our students and clinicians to practice evidence-based medicine. Within this model, data-derived evidence is complemented with experience. I then reflected on our educational system. Within the realms of education, our approach seems reversed. We seem to use our teaching experiences or instincts/intuition more than data-derived evidence. With the release of the new Center for the Advancement of Pharmacy Education (CAPE) Outcomes, increases in manuscript submissions to pharmacy education journals, and changes to numerous schools’ curricula, maybe it is time we reflect and be a little critical of ourselves. Are we truly following the tenets of evidence-based practice? The more correct question may be “How do we best educate the next generation of pharmacists?” But is the acquisition and appraisal of evidence there? I hope to challenge assumptions and practices and to suggest that we pause for a moment and think.

In research, we still compare the flipped classroom to lecture and flipped classes seem to win. Not a surprise, active learning works. How do flipped courses compare to high-structured active learning courses? In 2014, Jensen and Kummer compared a flipped classroom to an active learning course.² The results: no real difference in learning or attitudes. This is one of the few studies that directly compared the methodologies. Do we truly know if a flipped classroom is better for student learning than a well-structured active-learning course? Moreover, is the flipped class the best format for all courses, all instructors, and all students? What is the evidence to justify that position?

Part of the flipped classroom paradigm suggests we make videos for preclass preparation. Many of us may have stopped to ask why. Maybe it is because of the popularity of the Kahn Academy or an infatuation with TED Talks. Visual information combined with narration can be superior to verbal delivery alone (ie, the multimedia principle).³ However, visual information means figures and graphs accompany the narration—it is not text on the screen and narrated text (ie, the redundancy principle), which will hinder learning. In addition, it has been established that animated visuals (ie, video) uses more cognitive resources than static or still visuals (eg, pictures), so learning should be better with static media (ie, the static-media hypothesis) especially for novices.^4,5 Höffler and Leutner concluded that, in many cases, static pictures may suffice to learn simple facts and to gain a deeper understanding of the to be learned material.⁶ There are times and places where video may be better than static images but it is context specific and not a universal truth.^6,7 For video to be effective, it must be grounded in research-based theories about learning and instruction.⁶ Knowing the evidence can help determine the when, where, and how of building effective videos or reading material that may contain pictures.

Regardless of flipped-class or active-learning techniques, learning does not happen instantly. Often courses or curriculum cover a topic and move on or we teach a class on a topic and the only place students see the material again is during their pharmacy practice experiences. We must work with material often and in different contexts. Curricula are road maps for learning—building in scaffolding, providing opportunities to retrieve information from memory, applying or using that information, and receiving feedback. And more often than not, the only time students are asked to retrieve information from memory is on an examination even though retrieval is a key part of learning and we should do it often.^8,9 Students need more cumulative testing because they are learning foundational aspects of practice, not random facts and skills. As we engage in curriculum and course redesign, we should remember these things: build in opportunities to retrieve information, build cumulative knowledge and skills, scaffold, and provide feedback. This is what research supports.¹⁰

Finally, learning styles suggest students can only learn in certain ways. For example, a “visual” learner will learn more if visual material is used for instruction. In health care, we attempt to personalize medicine; that is, find the right dose of the right drug for the specific disease, administered at the right time. We attempt this for education too, and our gut says learning styles exist. However, matching instruction with learning style has no benefit.¹¹ In addition, assessments of learning styles are poor, often unreliable, or not validated.¹² We can identify learning preferences but that is all they might be: preferences. Despite the evidence, we hold onto this idea of learning styles. Regarding personalized instruction, the expertise reversal effect states that instructional methods affect learning in different ways depending upon the expertise of the learner.¹³ That is, what may work best for students with lower previous knowledge may not work, or may hinder, learning for students with more knowledge. So individualized instruction is helpful, but it should be based on skill level, not “learning style.”

I encourage those involved in the education mission to remember there is evidence to support or refute our choices; this evidence is not necessarily found in popular press books, newspapers, or the Internet. It is found in scholarly publications. The examples you may read may not be within pharmacy or even health science, but they are out there. “The truth is out there”.¹⁴ We must do our best to position students for the future and that requires being critically reflective and practicing evidence-based education.

• © 2015 American Association of Colleges of Pharmacy