What is “Deep Learning”?

Let’s take a closer look at deep learning. Because it’s something that relates to the concept of critical thinking. You might have heard various definitions of critical thinking. Some of them can be very nebulous, difficult to understand. You even wonder how well the person who developed that definition of critical thinking is critically thinking at the time. But it’s actually a very basic very fundamental concept. There are three elements in critical thinking. And if we can focus our students activities on those three elements, so that they truly engage in critical thinking. They’re learning will be as deep as possible. That’s really our goal. First step in critical thinking is analysis. To examine information. Take a close look at the information.

See how it relates to various pieces of information. See how relates to what we already know. And be able to understand what that information reflects. The second step in critical thinking, in addition to examining or analyzing the information, is to evaluate the information to assess its usefulness. How relevant is the information to what we’re trying to accomplish. Is the information legitimate? Is a good or bad? How effectively can we apply it? So it involves executing some level of value judgment on the information. Then the third step, putting all that together, the analysis and the evaluation. The third step in of critical thinking is to form a conclusion or an inference to infer. Perhaps forming an hypothesis of what it means.

But it ultimately means either forming a conclusion or making a decision about this information. So, we want to engage students in activities. That will cause them to analyze the information they’re dealing with, to evaluate the usefulness of that information. And then to make decisions. To make decisions themselves. We want to be telling them the decisions they should make. That would shortcut the process of their own deep processing of information that causes them to develop deep learning that they’ll be able to apply in the future and retain for a prolonged period of time. The levels of cognition in Bloom’s taxonomy clearly illustrate the same concept of critical thinking.

The lower levels of Bloom’s taxonomy involved just basic remembering facts or understanding the meaning of facts. But if that’s the extent of the students knowledge, not much that the student can do with that. In order to apply knowledge in terms of patient care or pharmacy practice setting. The student has to be able to understand how to apply that information. And then the three highest levels, analysis, evaluation and creating closely correspond to the three elements of critical thinking. Be able to analyze information, evaluate information informed influences or conclusions about that information. When we form a conclusion and since we’re creating a new concept. So we want students to be engaged in the higher levels of thinking, the higher order of cognition.

But in order to do that, we can’t ignore the fact that they need a solid foundation of knowledge and understanding to begin with. The idea of a rotation is to reinforce that foundational knowledge. Not necessarily to focus entirely on expanding it though. That would normally be a part of the experience. But the students spend three years on campus, learning in the classroom. That’s when they should be developing the bulk of their remembering and understanding. It’s the clinical rotation in the advanced practice experience rotation. When they should develop the skills to apply what they’ve learned in a variety of ways and expand their understanding to the deeper levels.

So, it’s the critical thinking elements of cognitive learning that we should be most concerned about in a rotation. The guaranteed preceptor technique number

two that I’d like to share with you is: “ask, don’t tell”. This simply implies that the students don’t need to be lectured to by the preceptors. They’ve already spent years and years, thousands of hours sitting through lectures on campus. The idea of a rotation is to apply what they learn, rather than listen to more lectures one-on-one for a preceptor. So as tempting as it may be to share your knowledge with students, to sit down with them and explain how they should be taking care of patients. Or to explained how they should be engaged in certain type of pharmacy operation. We have to resist that temptation and focus more on asking the students.

To figure out how they would engage a patient care situation or how they would see themselves applying their knowledge rather than telling them what to do. So, my first suggestion here is to refrain from engaging in mini-lectures one-on-one with your students. They don’t need you to teach them. They need you to help them learn on their own. And that’s done by simply asking them questions. Probing questions to get them to think about what it is you want them to learn. And a good precepting skill is to ask the type of questions that guide them consistently in the direction of what you want them to learn.

By posing deep probing questions, we can get them to think critically, which obviously is a very valuable element of an effective rotation. Now carrying that a step further. The third technique for preceptors that

I guarantee to be effective is: “tell me why.” In other words, we don’t want to just focus on not giving them information and asking them to provide information. But we also want to constantly probe them to explain themselves at a deeper level. We should constantly be asking them why. Why do you feel that? why did you come to that decision? Why did you use this information? As opposed to different information? Why do you have that evaluation of your information? So we want to request that students to explain the rationale behind all the decisions that they make. All the conclusions that they come to. Why do they feel that way? And lastly we want them to dig deeper.

So we want to ask deep probing questions that caused them to explain it deeper and deeper level. What it is there they are expressing to us. One thing that’s very important about this. I’ve shown this on the slide is to not allow students to simply quote clinical guidelines. This is becoming an alarming process and pharmacy practice, where pharmacists are engaged in learning, the latest guidelines, and in place in great importance on understanding what the latest guidelines are and they’re imposing that same expectation on students. Implying that students need to stay on top of guidelines and memorize those guidelines. The point I’m trying to make here is not the guidelines are a bad thing.

Students should be familiar with guidelines, but they should know much more than what the guidelines state. The student can simply regurgitate guidelines that have been published. It doesn’t necessarily mean that the student really understand what those guidelines represent. The preceptor should constantly probe students. If a guideline says to use a certain drug in a certain situation, why do you think the guidelines say that? The fourth guaranteed preceptor technique is automatic recall. Automatic recall is a very simple process. When you approach a red light you’re driving a car, you don’t have to stop and think to yourself. Gee! I’m going to have to stop. I better put my foot on the brake and press down on the brake pedal.

It’s an automatic process. You see the red light. You know it means to stop and and you take appropriate action. Students should have the same level of automaticity when it comes to basic critical, factual information that you want them to learn in the rotation. For example, if you want students to know that a serum creatinine 2.5 is high and it weren’t some consideration about the dosing of drugs. Make them memorized the therapeutic range of creatinin. Rather than have them struggle, trying to recall what that range is when they encounter serum creatinine values.

So the suggestion here is extract that information you want them to know core, and ask them to memorize it separately, and then quiz them on that information repetitively over the rotation. It’s almost like providing a storage disk that they can put inside their brain that the information that you want them to have. The rationale is that they have that information, they won’t waste energy trying to recall that information when you want them to use it rather than struggle recalling. To identify key information that students should be able to recall effortlessly require them to recall it by using multiple memory quizzes. And I emphasize the word we call here, because it doesn’t mean recognize.

We wouldn’t want to use a multiple-choice quiz to find out of students can recall the information we want them to know automatically. We want to use a fill-in-the-blank quiz which would be much more straightforward and require the student to truly recall the information.