February 22, 2013

Habits of Mind

by Janessa Smith, Pharm.D., PGY1 Pharmacy Practice Resident, The Johns Hopkins Hospital

How do we learn? What allows us to retain new information and have it available in the future? Is learning driven by external stimuli in the environment or is it dependent on internal processes within the learner? These are the questions that drive theorists to explore the mysterious world of educational psychology.  Some of the fundamental theories of learning include social learning, constructivism, and behaviorism attempt to answer some of these questions.  And new understandings are emerging all the time.  A relatively new concept called “habits of mind” has been described and it’s taking the world of education by storm.

First described by Arthur L. Costa, Ed.D and Bena Kallick, PhD, habits of mind (HOM) are specific behaviors that intelligent humans employ when confronted with problems in which the resolution is not immediately known.1 These 16 habits (defined in Table 1) attempt to explain how behavior and learning are intertwined and dependent on one another. Costa and Kallick suggests that each time these behaviors are employed, “the effects of their use are reflected upon, evaluated, modified and carried forth to future applications.” This ability is what they define as intelligence in humans, which is a distinct concept from cognitive ability. The pair believes that intelligence is not just about having information but knowing how to use the information to act in specific situations based on previous experience. This concept applies to both academic and non-academic situations.

         Table 1
Habit of Mind
Managing Impulsivity
Taking the time to deliberate before acting.
Listening with Understanding and Empathy
Making the effort to perceive another person’s perspective.
Thinking Flexibly
Considering Options and Changing Perspectives.
Striving for Accuracy
Setting high standards and finding ways to improve.
Persevering in a task to completion and not giving up.
Thinking about one’s thinking. Being aware of how thoughts, feelings and actions affect others.
Questioning and Problem Posing
Findings problems to solve, seeking data and answers.
Applying Past Knowledge to New Situations
Accessing prior knowledge and applying that knowledge to new contexts.
Thinking and Communicating with Clarity and Precision
Striving for accuracy in oral and written communications.
Gathering Data Through all Senses
Paying attention to the world around through taste, touch, smell, hearing and sight.
Creating, Imagining and Innovating
Generating new and novel ideas.
Responding with Wonderment and Awe
Being intrigued by the mystery in the world.
Taking Responsible Risks
Living on the edge of one’s competence.
Finding Humor
Enjoying the incongruous and unexpected. Being able to laugh at oneself.
Thinking Interdependently
Being able to work and learn as a team.
Remaining Open to Continuous Learning
Resisting complacency in learning and admitting when one does not know.
  Adapted from Campbell4

I find this to be a very intriguing concept of how intelligent people utilize their knowledge. Prior to reading about HOM, I believed, as most people do, that intelligence was driven by how much knowledge one has and the ability of that person to retrieve that knowledge. This new concept suggests that deeper processes are important.  It’s not simply a matter of storage and retrieval. While Costa and Kallick introduced me to the HOM concept, it wasn’t until reading an excerpt from How Children Succeed: Grit, Curiosity, and the Hidden Power of Character by Paul Tough that I began to fully understand that this concept transcends the classroom.2 In his book, Tough describes how one’s character is a stronger predictor of life success than cognitive ability. He provides a number of examples to illustrate this point, the most striking being “The Perry Preschool Project”, a sociology experiment that began in the mid-1960s in an industrial town west of Detroit. This study randomly assigned three- and four-year old children into either an intervention or a control group. The intervention group was enrolled in Perry Preschool, a two-year, high-quality preschool program. The control group was not. The initial intent of the project was to evaluate the effect of Perry Preschool on the children’s IQ – a measure of intelligence. The initial results of this experiment showed that those that attended Perry Preschool performed better on cognitive tests but the difference between the groups diminished by the time they reached the third grade. Interestingly, when evaluating the long terms results, those children that attended Perry Preschool were more likely to be “successful” in life. They were more likely to graduate from high school, to be employed at age twenty-seven, and to be earning a higher salary at age forty when compared to the control group.

At its heart, this experiment was an evaluation of two different teaching models.3 Investigators compared the Direct Instruction Model — a traditional teaching model where teachers directly teach students and reward them for correct answers — to the High/Scope model where teachers set up the daily routine but allow children to plan, do, and review their own activities.  Thus students engaged in active learning — individually, in small groups, and as whole-class groups. This model of instruction ties in directly with the HOM. It allows learners to use each of the 16 HOM in their daily learning and demonstrates that this teaching model can improve educational performance at a young age and has long-term impact in terms of success in the learner’s personal life.

Additionally, Tough attributed the difference between the two groups to the development of “noncognitive skills” in the Perry Preschool group. These skills were a sum of behaviors that were observed and recorded over the decades among the two groups. The schools tracked “personal behavior” which included how often the students swore, lied, stole, or were absent or late to school. They also recorded behaviors of “social development” which tracked characteristics such as curiosity and peer relationships.  Students in the intervention group performed much better.  Thus the High/Scope teaching model likely facilitated the development of many of the HOM such as Managing Impulsivity, Responding with Wonderment and Awe and Applying Past Knowledge to New Situations.

The HOM complement the traditional and widely accepted educational theories that explain how people learn. They rely on the same fundamental concepts of these more traditional theories, but provide an explanation of how intelligent people use knowledge and add an element of accountability and responsibility.  John Campbell, faculty at Central Queensland University in Australia, describes the parallels between HOM and other learning theories, including constructivism and social learning theory.4 He explains that in order to construct knowledge, learners must reflect, plan and evaluate (i.e. Metacognition) as well as use senses to gather data from their surroundings (i.e. Gathering Data through all Senses). Additionally, he explains that constructivism emphasizes the use of group interaction (i.e. Thinking Interdependently) and active rather than passive learning (i.e. Questioning and Posing Problems, Managing Impulsivity).  Campbell compares the three aspects of social learning (observation, language and self-talk) with HOM, explaining that “self-talk” corresponds with Managing Impulsivity and Metacognition, “language” relates to Thinking and Communicating with Clarity and Precision andobservation” is demonstrated by Gathering Data through all Senses.

While still a relatively new concept, I believe the HOM have the potential to significantly influence the way we educate children and adults. By incorporating the HOM into learning exercises, educators can enhance what is learned and improve its application to other situations in life. After all, the purpose of education is to provide a structured environment where learners develop in all domains of their lives:  academically, personally, and professionally.

1.  Costa AL, Kallick B. Describing 16 Habits of Mind. [Internet]. [cited 2013 Feb 3].
2.  Tough P. How Children Succeed: Grit, Curiosity, and the Hidden Power of Character. Boston: Houghton Mifflin Harcourt; 2012.
3.  Schweinhar LL, Montie J, Xiang Z, et al. The High/Scope Perry Preschool Study ThroughAge 40: Summary, Conclusions and Frequently Asked Questions. Ypsilanti, MI. High/Scope Press. 2005 by High/Scope® Educational Research Foundation. [cited 2013 Feb 20].
4.  Campbell J. Theorising Habits of Mind as a Framework for Learning. Proceedings of the Australian Association from Research in Education Conference, Adelaide, South Australia. [Internet].  [cited 2013 Feb 3].

February 21, 2013

How Can Educators Cultivate Creativity?

by Lizhi Liang, Ph.D., Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

If you were to ask “Do you think you are a creative person?”, how often would you expect people to answer “Yes, I am.”  Not many.  What differentiates a creative person from a non-creative person?  Were we born with creativity but somehow lost it as we grew older? If so, whom should we blame? Can we save or restore our creativity? We will be educating future generations, thus it is important for us to answer these questions and try to find solutions.

Creative individuals usually have unique characteristics such as independence, innovation, curiosity, confidence, and risk-taking behaviors.1  These are similar characteristics we often find among children. Try to imagine how many times you are amazed by the imagination of a child asking you questions that makes you think.  Picasso once said: “all kids are born to be artists”.2  We were all born with curiosity, creativity, and originality.  What happened during our maturation process that made many of us lose these traits?  Sir Kenneth Robinson once told a story about a little girl who seldom concentrated on anything, but one day she sat for a long period time drawing a picture of God.  The teacher asked her “what are you drawing”? She responded “I am drawing God.”  “But nobody knows what God looks like” replied the teacher.  And the girl answered confidently “they will in a minute.”2 What a smart and creative girl! This is not rare among kids. If you observe carefully, you will be surprised to see how creative these small creatures are. Why does this kind of creativity disappears as they grow up.  Is our educational system limiting or inhibiting creativity? Do teachers encourage or discourage creativity? Do teachers stifle curiosity of students by telling them to follow orders and adhere to norms? Do teachers teach subject matter based on what’s known rather exploring what’s unknown? Do teachers coercively influence students’ decision making? If you answered yes to any of these questions, then improvement is needed to preserve creativity among learners.

Here are a few things educators can do to foster creativity:

1.  Allow time for creative thinking3 
Teachers should try to avoid bombarding students with extraneous material. This will only encourage memorization and regurgitation. Good educators teach students the tools they need to solve problems. Like an old saying in China states: “It is much better to teach a hungry person how to fish than give him fish to eat.”   An individual needs to be innovative in order to thrive on his/her own.  Being able to think independently is an indispensable part of being creative and teachers can help students to cultivate their creative, independent thinking skills. If every teacher designed individual problems for students to solve problems on their own, it will convey the signal to students that thinking is a necessary ingredient of learning. And sooner or later, students will form a habit of thinking independently as a result of repetitive practice. 

2.   Be creative yourself3,4 
Some educators are resistant to change. They can teach the same material, use the same strategies, and ask the same questions throughout their entire teaching career.  In order to cultivate creativity in their students, teachers have to be creative themselves. For example, a teacher shouldn’t always provide detailed protocols in the lab and ask the students to follow each step. And teachers shouldn’t expect each student to come up with the same result.  Ask students to write their own protocol, design their own experiment, and analyze their own data. When the experimental results are not optimal, ask them to troubleshoot on their own and provide only the amount of guidance that is necessary. This way, not only will students feel more excited and challenged, but this will also promote self-discovery. 

3.  Reward creative ideas or products3,5 
Educators need to create an encouraging atmosphere in the class to promote student creativity. They need to let students know that creative ideas and products are welcomed. Otherwise, students may not be willing to share due to a lack of confidence and recognition. Rewards and encouragement are very important for learning, especially children. In students’ eyes, teachers are the authority and role models, so any words of encouragement from the teacher means a lot to them. One of my friends told me a story that affected him enormously. When he was little, he loved to read and always came up with “strange” ideas or questions. One day when he asked a question in class, his teacher humiliated him in front of the whole class by saying “you think you are smart by asking strange questions?” Those words hurt his self-confidence and he felt defeated for a long period of time.  He lost motivation to learn and became a very quiet student. Fortunately, as he grew up, he realized that it was not his fault, but rather an irresponsible teacher who did not appreciate his creativity. Later, he re-gained his confidence and became a very successful researcher. This example demonstrates how educators are powerful influences on students.  Creativity can only be cultivated in a proper environment.

  1. Black RA. 32 Traits of Creative People. Bridge Storage and Art Space company [internet]. 2010 Aug 25 [cited 2013 Feb 4].
  2. Robinson K. Do schools kill creativity? [Internet]. TED Conferences, LLC  (US); 2006 Jun [cited 2013 Feb 4]. Videocast: 19min.
  3. Sternberg RJ, Williams WM. How to Develop Student Creativity. Alexandria, VA: Association for Supervision and Curriculum Development, 1996. 52p
  4. Kashdan TB. 3 Ideas to Prevent Schools from Killing Creativity, Curiosity, and Critical Thinking. Psychology Today [internet]. 2011 May 11 [cited 2013 Feb 2].
  5. Taylor M. Do schools kill creativity? If so,what can we do about it? Parenting [internet].2012 July 12 [cited 2013 Feb 4].

Patients with Language Barriers: Getting the Message Across

by Lubna Kousa Pharm.D., PGY1 Community Pharmacy Practice Resident, Johns Hopkins Home Care Group

The United States is notorious for its diversity. Over the past several decades the use of a language other than English at home has increased by 148 percent.1  The number of non-English speakers increased from 23.1 million in the 1980’s to 57.1 million in 2009.  This rapid change can be seen throughout the country, whether it’s a Chinese language television station or a road sign in Spanish, the linguistic diversity continues to evolve.

Language barriers are becoming progressively more challenging for the delivery of health care services. Given the heterogeneity of ethnic origins and the primary languages among these groups, individuals who have limited English proficiency have significant challenges when communicating with health care providers. Patients with poor communication skills have difficulty accessing care and conveying their health concerns to practitioners.  In many health care settings, there is a lack of interpreters. This often results in misdiagnosis, inappropriate treatments, and the delivery of suboptimal care.2  Moreover, patients with limited English proficiency report being less satisfied, less likely to understand medication instructions, and more likely to have problems adhering to their medication regimens.

But why should this be? It shouldn’t. We invest billions of dollars in systems and programs for providing medical care and finding cures for diseases.  Why can’t we invest resources in systems and programs for patients with language barriers?

As pharmacists, we are responsible for providing excellent care in order to achieve optimal outcomes for our patients and enhance their quality of care.  It is our mission to provide our patients with a level of comfort and an opportunity to be understood.  And we should communicate clearly with our patients so that we can arrive at the best decisions together.  Being a pharmacist isn’t about filling prescriptions for our patients, but creating a bond that enables us to ensure a positive outcome, regardless of any barriers. Whether the patient is in a hospital, outpatient clinic, or a community pharmacy, this process requires excellent communication between the patient and the pharmacist to ensure the quality and safety of drug therapy.3  Patients who don’t fully understand their treatments are less likely to follow-up, which in turn puts them at greater risk of being hospitalized or experiencing drug complications.  For example, patients with asthma are at greater risk of intubation if they fail to properly use their treatments.4

Using visual methods can help. Going to the drawing board, showing pictures, and drawing examples can paint a clearer picture for our patients.  If nothing else, it demonstrates the effort put forth to help them. Using plain language and avoiding technical jargon is a strategy for making written and oral information easier to understand.  Written materials can be referred to at a later time.  Printed instructions for patients that contain pictographs and photographs that demonstrate medication-use techniques can be very useful in this patient population.2 However, a better long-term solution to this problem is for our healthcare system to invest in a powerful interpreter service that is consistently available in order to facilitate optimal communication between providers and patients.  This will, in turn, improve patient satisfaction and safety.5,6

Despite ongoing efforts to increase awareness of communication difficulties in patients with limited English proficiency, health disparities continue to exist.  Our challenge as pharmacists involved in the direct care of patients is not only to provide medications, but create a welcoming environment that encourages them to seek care even when language barriers exist.  Our job is to build a system that can mitigate communicate problems and deliver the best possible care to diverse patient populations.

1.    Ortman JM. Language Projections: 2010 to 2020. Population Division, U.S. Census Bureau.  Accessed on January 28, 2013.
2.    Diamond LC and Jacobs EA. Let's not contribute to disparities: the best methods for teaching clinicians how to overcome language barriers to health care. J Gen Intern Med 2010;25 Suppl 2:S189-93. Accessed on January 28, 2013.
3.    Bubalo J, Clark R, Jiing S et al. Medication adherence:Pharmacist perspective.  J Am Pharm Assoc 2010;50: 394-406.  Accessed on January 30, 2013.
4.    Flores G, Laws MB, Mayo SJ, et al. Errors in medicalinterpretation and their potential clinical consequences in pediatric encounters. Pediatrics 2003;111:6-14.  Accessed on January 30, 2013.
5.    Flores G. Language Barriers toHealth Care in the United States. N Engl J Med 2006; 355:229-231. Accessed on January 30, 2013.
6.    Phokeo V and Hyman I. Provision of pharmaceutical care to patientswith limited English proficiency. Am J Health-Syst Pharm 2007; 64: 423-429Accessed on January 30, 2013.