Using Artifacts and Qualitative Methodology to Explore Pharmacy Students’ Learning Practices

Study Practices

The majority of participants brought along objects that represented study or revision practices. For many of them, colored pens, sticky notes, mind maps, and summary notes were the objects that represented learning. One student considered his colored pens an essential tool for him (Table 2, quote 1) and described how the practice of color-coding different aspects of a subject made it a lot easier to understand. Another explained that color coding made everything more manageable and that it allowed her to visualize things with colors and in her own writing (Table 2, quote 2). Published assessment criteria was the artifact that represented study for another student who said she used these to help her focus on what she needed to learn (Table 2, quote 3). Two participants brought diaries as objects that represented their organizing practices. Being organized and prepared was really important to one student (Table 2, quote 3). For another student who described her motivation as coming from friends and family, the diary represented a link with the world outside her studies (Table 2, quote 5). For several participants, the objects chosen represented particular spaces that they associated with their learning. For one, the silent study area in the library was the place where she always studied, whereas another brought a pair of ear plugs to represent how she needed silence as a precondition for effective studying. One participant discussed how she and a friend had developed a practice of each learning a different half of a subject really well and then taking turns teaching each other the remaining topics. Another discussed how she and her friend “talk it all out” once they had created their individual mind maps or note cards and that they had developed this practice while studying together during a previous course (Table 2, quote 6). Several participants brought iPods and music as artifacts that represented learning for them and explained that they played music while studying. One student had discovered while preparing for high school examinations that the practice of listening to music while studying helped her to learn (Table 2, quote 7). She found that she was listening to specific albums when studying different subjects and realized that she now always associated those songs with a particular subject and recognized the soothing and emotional effect that music had on her (Table 2, quote 8). Another student had different playlists on her iPod (with different genres of music) for listening to while studying various subjects and she found this motivated her to study.

Rituals Associated with Learning and Studying

Several participants identified specific “rituals” that they associated with their learning. In most cases, the students had not been aware of these rituals prior to being invited to the interview.

One participant only used the desk in his bedroom for studying and it had to be completely clear to enable him to become really focused. On probing further, he reflected that he only used his desk for assessments, which he linked with examinations, and he compared this ritual to a different practice he had when working on other types of assignments (Table 3, quote 1). He also admitted he had not realized this practice before considering what to bring to the interview.

Another participant brought objects that she felt she could not do without when studying. She felt she could not take an examination without her green pen and said she always wrote out the question in green at the start of the examination (Table 3, quote 2). She reflected that this was her way of focusing on reading the question and explained that this was a strategy that she developed early on in high school. One student only ate nuts when he was studying and another only ate mints during examination time, often using them as a mini reward for accomplishing a goal while studying (Table 3, quote 3). A student who had brought her iPod as an object described how having music on while studying had become like a ritual for her (Table 3, quote 4).

A more mature student brought his old calculator, which he had bought when he had first studied in the 1970s, and described it as an amulet which he had always had with him. He said the calculator summed up his whole educational life. He described how, when he started to get distracted or lose faith in things, he looked at his “trusty friend,” the calculator, and knew he would get through the difficulties (Table 3, quote 5). He also laughed about no longer being able to read the data card without his reading glasses.

Coffee was an artifact that represented learning for several participants but held several different meanings for them. Some saw the practice of drinking coffee with friends as a ritual or distraction associated with studying for examinations (Table 3, quote 6).

Pharmacy Knowledge

Five participants brought along their copy of the British National Formulary (BNF)⁴¹ as an artifact that represented learning as a pharmacy student. One described it as her “trusty old BNF” and felt that it would represent learning for the rest of her life (Table 4, quote 1). For the second student, the BNF was a more negative representation of what was not a very good kind of learning. For her the BNF represented knowledge she acquired only by rote learning, which she did not enjoy (Table 4, quote 2). For the third student, the BNF represented a condensed source of information which she found useful in learning about drugs, while also recognizing that the black and white text was less useful than a summary textbook which used color to categorize, linking to her practice of using color. The fourth student brought the BNF to represent books in general, explaining that he used books a lot in learning, with the BNF being the text he currently used the most (Table 4, quote 3). The last student used the BNF to represent how her learning had progressed during her studies. Now in her final year, she relied much less on it as a source of information than she had earlier in her studies (Table 4, quote 4).

Motivation for Learning

Several participants brought along objects that represented where their motivation for learning came from, and this was a strong theme in the data. An important motivator for many participants was their family. Four of them brought a photograph of their family, which they said they often pinned up above their study area to keep them focused. For some participants, the motivational phenomenon was the love and support that their family provided, which helped when they were struggling with their studies (Table 5, quote 1). For others, it was remembering the sacrifices their family had made to send them to university that kept them motivated (Table 5, quote 2). One participant described a very close relationship with her parents and sisters and felt that she did not want to let them down.

One student described the motivational effect that a particular song had on him, and brought along a picture of his iTunes (Apple, Cupertino, CA) page showing how often he played the song as compared to other songs (Table 5, quote 3).

A majority of participants described social interaction and peer support with friends as a major motivating factor in their learning. Participants represented social interaction with various objects: a photo of friends, a photo of a rugby ball and bottle of champagne, a cell phone or a photo of their Facebook page. Those who brought a cell phone or Facebook page, felt it represented the practice of keeping in contact with their peers while they were studying and that such contact kept them both motivated and focused. One student always had her phone on silent on her desk and the other always had Facebook open on his laptop while studying (Table 5, quote 4).

One student represented social interaction and peer support with a photo of her friends, explaining that she learns a lot from other people. She and some of the other participants explained how supportive they found working as part of a self-selected group of motivated students, where they would compare their responses to case studies in problem-based learning. One participant commented how she would text friends to gauge their progress and described this practice of using friends’ progress as a security blanket to motivate her in studying. She appeared to be using this as a yardstick to measure her relative speed of learning.

Coffee featured heavily in a number of participants’ discussions about their study practices. For some, as described earlier, coffee was bound up with ritual practices, while for others, it was an important way of creating distinct phases of time. One student used coffee as a goal to motivate herself (Table 5, quote 5). Others recognized the “pharmacological” effect of coffee, ie, the caffeine kept them going during intense periods of study. One student described the social aspect of having a coffee with peers, but for her, the coffee also represented the financial pressures associated with being a student. The local coffee shop sold a cup of carryout coffee at a discounted rate before 10.30 am, and this student had brought a cup with her to the interview (Table 5, quote 6).

For another participant, the picture of a rugby ball and champagne bottle not only represented social interaction but also a way that he used sports as a goal to keep him focused on learning (Table 5, quote 7). Creating goals and markers of achievement were also important to other participants. For example, one student brought her “achievements folder,” which contained all of her school certificates and awards, and explained how this gave her confidence to persevere. Another student brought a university transcript letter to represent her goals. One of the participants brought a desktop stress toy to represent how “super stressful” the pharmacy course was and how much work she felt she needed to do, but also to represent how much doing well was important to her.

For some participants, an important motivation for studying was the future. In particular, one student reflected on his future earning capacity as a professional and represented this with his wallet (Table 5, quote 8). Another likewise felt that one of his main motivators was wanting to be comfortable financially to allow him to have a family. The mature student who had had a number of years career experience as a scientist before commencing studies in pharmacy, brought his Royal Society of Chemistry membership card to represent achievement as well as identity and belonging. Belonging to a professional body or organization did not feature in any of the other participants’ interviews. Participants did not identify feeling part of a professional community as a motivator. Professional identity was only explicitly expressed in the mature student’s case and, even then, it did not relate to a professional identity as a pharmacist but to his previous career as a chemist.

Ways of Learning

Several participants brought along objects that represented how they learned. One student brought along a book on the cosmos to represent how he found enjoying a subject made it easier to learn, indicating that relevance, interest, and enthusiasm for a particular subject can impact on students’ learning (Table 6, quote 1). For two participants, both graduate entrants to pharmacy (which is not the norm in the UK), online resources and the practices involved in accessing these had a significant impact on the way that they learned on the course. One represented this with her USB stick and the other his portable hard drive. Both reflected on how internet technology and access to electronic resources differed significantly from their previous degree and made learning easier for them. Throughout the MPharm curriculum but particularly in the final year, there is a significant emphasis on learning materials and support being delivered online. Students work both individually and in groups on projects and case studies using a problem-based learning approach and are supported through discussion forums by academic staff members and external experts. Linking back to the social interaction practices described earlier, one of the graduate students found the online forums were really helpful to her in allowing her to post and move on from issues that she was struggling with (Table 6, quote 2). Another participant brought along two interesting pictures which represented how she learned. The first of these was a bath, which for her represented where she often had a “eureka moment,” the point at which everything about a pharmacy concept discussed in class suddenly made sense (Table 6, quote 3). For her, one interesting aspect of this was that she could not remember the specific instances of when this had happened, but simply remembered that it had occurred. The second picture she brought along was of a spider’s web, which she felt represented how she learned. The vertical strands were the knowledge she built, and the connecting strands represented her understanding of the connections between the knowledge.

Study Practices

The use of color and summary techniques described by participants may be a study practice indicating complexity reduction, which is the grouping of ideas together to increase clarity and reduce the complexity of the concepts being studied. Other studies^43,44 have explored how mind mapping can help in exploring relationships between concepts and in finding meaning. In this study, some participants described their motivation for mind mapping practices, which they believed to be effective for them. The strategies represented by color and notetaking in this study may indicate ordering and sense-making practices, where the participants categorized different threads, and it is the inter-relationship between participants and these artifacts which generates these practices, linking back to learning as dwelling.⁹ In contrast to the ordering practice represented by some participants, working towards published assessment criteria appeared to be one participant’s way of aligning herself with a pre-given order, using the criteria to define her own learning practices. This finding challenges the commonly held assumption that assessment measures learning but does not influence it.⁴⁵ The diaries brought by several students represent the multiple influences on students’ learning and links to Ingold’s conception of a life lived along the multiple lines of a meshwork.¹¹ These complex influences and “strands” of students’ learning practices may often be forgotten by those attempting to support students in their studies. Blocking out such noise and the possibility of distraction is a further example of a learning practice involving some form of complexity reduction. In other words, a strategy that serves to deliberately limit the meshwork or complexity of strands that might otherwise prevent sense-making from happening. Those participants who discussed working with others reflected on how the practice of peer learning seemed to work really well for them, allowing them all to contribute ideas, and strengthened all of their learning. Topping⁴⁶ defines peer learning as “acquisition of knowledge and skill through active helping and supporting among status equals or matched companions,” and this echoes the practices developed by participants in this study. Unlike those where a condition of effective learning appeared to involve a reduction in complexity, peer learning appears to multiply the relational complexity involved in the practices associated with their learning. Topping⁴⁶ refers to the “social and emotional gains” of peer learning, and this echoes strongly with some (but not all) participants’ experiences in this study.

Those participants who discussed music, recognized the soothing and emotional effect that music had on them, in some cases matching favorite music to more challenging topics. These various artifacts representing study techniques suggest that participants have developed study practices to suit their own way of learning, and these practices help them in managing the relational configuration and “meshworks”^10,11 surrounding them. Participants described how these practices had evolved throughout their educational life (in some cases, consciously, and in others, unconsciously). Most of the literature on student learning generalizes about learning practices without inquiring further into how, in practice, students carry these out. The practices discussed by participants in this study emphasize that learning is a far more complex, managed, and emergent set of practices than is usually acknowledged in the literature, and that “learning as dwelling”⁹ may be a helpful way of conceptualizing pharmacy students’ learning.

Rituals Associated with Learning and Studying

Participants recognized their artifacts in the rituals they had come to associate with studying and used terms such as “always” (using green pen) and “only” (eating nuts or mints at examination time). They also expressed how emotionally attached they were to these ritual artifacts. There are similarities here with the unintended aspects of practice that Law has referred to as “collateral realities,” ie, “all those realities that get done along the way, unintentionally.”³⁴ In encouraging participants in this study to articulate and explain these practices, which they are doing along the way, incidentally, there was the opportunity to bring the material dimensions of their learning practices to the foreground and to acknowledge the significance of these practices. The idea of paying attention to what is being done unintentionally as a constitutive dimension of study practice is not addressed in the literature on studying or in “traditional” approaches on how to learn. Having an awareness of these seemingly insignificant aspects of individuals’ leaning may help those supporting students to enable them to develop successful learning practices. Interestingly, all the artifacts brought to the interviews represented positive learning practices, ie, things that participants believed helped promote their learning. This may have been because of the researcher’s dual role as researcher and tutor, ie, participants perceived they should bring something that helped them learn rather than something that distracted them from learning. This method may also be helpful in further research to identify practices that get in the way of students’ learning, eg, when a ritual no longer fulfils its purpose, or where a student has been unable to mobilize a strategy to aid their concentration.

Pharmacy Knowledge

The symbolism of the object of pharmacy’s knowledge, the drug or medicine, was an interesting finding, with some participants reflecting on this positively and some negatively. For the participant who had a negative representation of “not a very good kind of learning,” this was described as rote learning of facts. Western education practices have downplayed the role of rote learning, linking this to “surface learning” approaches to study,⁴⁷ which are not usually associated with learning for understanding. However, research conducted in Asia⁴⁸ exploring the paradox of high-performing Asian students who rely heavily on memorization has shown that understanding can be facilitated through memorizing. Kember⁴⁸ argues that rote-learning is not always as negative a practice as it is perceived to be in western culture, highlighting the complexity of the interplay in learning processes, memory, and understanding.⁴⁹ For the participant who relied less on her BNF as a source of information, this book represented a marker of transformation within her ongoing development as a pharmacy student. In his discussion of the relationship between pharmacy knowledge and professionalism, Waterfield⁵⁰ describes the difference between information (facts) and knowledge, which requires “complex assimilation, cross referencing, and analysis of many different types of information.” Participants use of the BNF may represent less reliance on information and more on integrated pharmaceutical knowledge practices, showing a level of professional development which could be anticipated in the final stages of the course that aligns with the development of practitioners ready for a rapidly changing professional practice. The participant’s representation of the BNF as “not a very good kind of learning” may represent a frustration with the fixed and factual “information” aspect of pharmacy knowledge rather than the “knowledge practices,” which she referred to positively at a later point in her interview.

Motivation for learning was a strong emergent theme in the data. Respondents recognized the relational and emotional effect these phenomena had on them and their learning practices. These affective dimensions of learning appeared to be a recurring theme with a number of participants. This has some similarity with the findings of Aggarwal and Bates⁵¹ in their study exploring the relationship between approaches to study and life-long learning attributes in pharmacy students, which identified “pressures” as an extrinsic motivator towards learning. They note familial, institutional, and personal pressures as important, but their use of the term “pressure” implies a negative emotional force distinct from the more positive emotional effect expressed by most participants in this study.

A majority of participants described social interaction and peer support with friends as a major motivating factor in their learning, again illustrating how study practices are always nested within a more complex relational nexus. Aggarwal and Bates⁵¹ describe competition as a motivator for learning in pharmacy students. They argue that competition with others can affect learning in both positive and negative ways, which resonates with findings in this study. Studying with peers and benchmarking by text message were related by participants in this study as being empowering and motivating experiences. This does not fit with Aggarwal and Bates’⁵¹ more negative conception of competition but instead linked back to the “social and emotional gains”⁴⁶ of peer learning.

Participants’ reflections on previous successes link to the literature around threshold concepts and troublesome knowledge and how some students manage to negotiate their difficulties while others do not. Land and colleagues⁵² describe a response from one of their respondents where “the next time she faced such troublesome knowledge, she asserted, she would ‘hang in there’ with greater confidence because she now knew she would eventually find a way of coming to understand.” In the case of participants in this study, their past achievements and their ability to get through struggles appeared to motivate them with the confidence to approach a new difficulty.

Aligning with some participants’ reflections on their future, Langley and colleagues⁵³ identified motivation for the future in pharmacy students and observed motivational differences between male and female students with male students more “interested in opportunities for independence, through ownership [of a pharmacy] or self-employment.” Aggarwal and Bates⁵¹ identified the need to meet defined goals as set by themselves (intrinsic) or others, such as financial and employment prospects, as extrinsic motivators for pharmacy students’ learning. However, given that in this study students identified multiple forms of motivation, it is questionable whether it is helpful to create a simple binary opposition between external and internal motivators in this way. The students’ practices of studying would appear to be enmeshed within a broader set of negotiations than any simple categorization can capture.¹⁰ Notably, most participants in this study did not single out qualifying as a professional as a distinct goal but instead appeared more concerned with the immediate hurdle of passing examinations (another motivator identified by Aggarwal and Bates⁵¹) and on finishing their degrees. Belonging to the profession of pharmacy did not feature in any of the participants’ interviews. This may link to students not being positioned as members of a professional body at the time of the study.

Ways of Learning

The online learning practices reflected on by some participants form a significant part of current pedagogy. Many e-learning approaches to curriculum design are heavily influenced by a constructivist underpinning,⁵⁴ explained by Zhang et al.⁵⁵ as allowing learners to construct their own knowledge through “resource-rich, student-centered, and interactive learning”. This appears to have been online learning experience of participants in this study. The social interaction mediated by digital technology is one that is unique to the current generation of students. While previous generations may have met up for a break and to chat face-to-face in the library, the current generation often catch up online

The findings around the student who brought two interesting pictures representing how she learned raises some interesting questions for pharmacy educators. Her description of “eureka moments” links to the idea of threshold concepts,⁵⁶ with crossing the threshold likened to moving through a door into “enlightenment.” Land and colleagues⁵² argue that these thresholds are often characterized as highly significant moments when they occur, but that it is often difficult to “gaze backwards across thresholds and understand the conceptual difficulty” being experienced. This description appears to echo with this student’s experience.

In terms of the implications for pharmacy education, this study raises the issue that it would be useful to explore with students how their learning practices are nested within a broader socio-material “meshwork” and how acknowledging this can enable them to structure their practices more effectively. The findings of this study indicate that educators cannot prejudge the significance of these practices in advance and that looking at the role particular practices have within an individual students’ learning may be an important part of supporting students in their learning.

Limitations

The study had several strengths and limitations. Most of the participants in the study were in their final year of the MPharm curriculum, with only a small representation from students in other years. These participants were about to enter practice, and this timing more than likely had an impact on their views and practices, which is both a strength and limitation of the study. The researcher’s dual role as lecturer and researcher was both a strength and potential limitation and required reflexivity about the impact of this on the data. In common with Wallman and colleagues⁴² arguments, being close to the material and able to understand the “lingo and underpinning meaning” that the interviewees used contributed positively to the analysis. Things were said that they knew the researcher would implicitly understand but that an “outsider” would not have. In terms of the limitations of the researcher serving a dual role, where possible any negative impact of perceived power was reduced by the strategies previously described. Data saturation was reached during the analysis of the interviews. The method of analysis (using mind mapping) was a strength in analysing the artifacts; however, it became a limitation when analyzing other aspects of the data. The participants’ “voice” and narrative were lost by using this technique, so a different method was adopted which will be discussed elsewhere. The intention had been to conduct a final focus group with all participants after the interviews were completed to validate the interview findings and check the interpretations. Because of time constraints, this proved impossible to organize, which could be considered a limitation. However, throughout the project, the attempt to adopt DiCocco-Bloom and Crabtree’s integration of reciprocity into the creation of knowledge,³⁸ along with the use of artifacts and attending to participants’ “voice” in analysis accounted for any limitations that resulted from this change in methodology. The lack of one coherent theoretical perspective or philosophy underpinning the research could be argued to be a limitation; however, this could also be asserted as a strength in that it allowed multiple ways to view the same data, which led to new understandings.