Early in my teaching career, if a PA student approached me about struggling to perform well in class or on tests, my best response was a simple encouragement to study harder. But this advice doesn’t always prove useful to students who are trying their best to learn without success; studying more isn’t the answer in these situations.
Instead, I’ve learned students need guidance about how to more effectively learn. The volume and pace of knowledge acquisition in PA school is far beyond what most PA students have ever experienced. As a teacher, figuring out how to best guide these struggling students is a challenge that may seem daunting at first.
Almost thirty years ago, I was responsible for tutoring and remediating students who were at risk. Without any data analysis, we rarely knew who was truly at risk and who wasn’t. Most students at the time who struggled with clinical medicine often went on to fail the End of Rotation Exams (EOREs). I tried several different methods with students, emphasizing a focus on key concepts rather than trying to absorb the entire volume of information. I felt a moral imperative to provide assistance to stressed PA students.
Discovering New Strategies to Help Struggling Students
A new study technique I used began showing promising results; after several years, I had finally found something effective. The strategy was incredibly simple: I asked each advisee to construct a 1-1.5-page written note on each disease topic on the NCCPA blueprint. I developed a template, shown below, by using the NCCPA task areas. I knew I was onto something special when previously struggling students were displaying amazing results; virtually every student passed the EOREs on their second attempt.
Pertinent historical findings/clinical symptoms
Pertinent physical exam findings
Surgical management (when applicable)
Emergency management (when applicable)
In 1998, I reviewed the literature to see if and how this learning approach could be improved. At this time, learner-centered strategies were emerging. It made perfect sense about the application of these methods.
Why Use Learner-Centered Strategies?
Students usually want to know what is most important to learn; certainly, in PA school, the amount of information provided is quite overwhelming. Oftentimes, the student will focus on learning only what is necessary, retaining the info long enough to pass the next exam. While exam success is important, the ultimate goal of PA educators is to graduate skilled and knowledgeable practitioners.
Basic Principles of Learner-Centered Strategies
Learner-centered strategies are based on the principle that the student is at the center of the learning experience, not the teacher. How students learn is, therefore, of utmost importance. As students use the learning system, they will achieve practice in learner-centered methods. Students will construct a basic template of the most pertinent information related to each disease item learned during the program. This process allows the students to not only create their own framework of knowledge but also allows the framework to be repeatedly utilized and connected as the program progresses. This theoretical construct is based upon the metacognitive framework. It reinforces that students will learn the basic framework of each disease process on the NCCPA blueprint that you can modulate depending upon the individual and unique features of your PA curriculum. Once the students have learned the basic framework, they can more effectively connect these concepts in the clinical phase of training.
The American Psychological Association’s (APA) Five Principles of Learner-Centered Education
This learning system was developed based on an educational construct that began in the early 90s called Learner-Centered Education. Other names used in the literature include student-centered education and learning-centered education. The authors fully embraced this process through their years of experience in PA education and through their doctoral study and research. The APA developed a framework of learner-centered principles. In the following section, several of these principles will be outlined, and a brief rationale will be given about the value of embracing these principles.
Nature of Learning Process
The learning of complex subject matter is most effective when it is an intentional process of constructing meaning through information and experience. This learning system is vastly different than any previous review text written for PA students. In most review books for PANCE preparation, students are given information to read and a series of test questions to practice. In this system, students must engage in their learning process, they must construct knowledge from the plethora of material that they are given and place this into a context that they can understand. They, in essence, construct their own knowledge by learning how to ascertain what is most important to learn from the medical literature. This also connects with the principle that by using multiple learning styles, including visual, kinesthetic, auditory, and so forth, the learner can maximize the learning process.
Goals of Learning Process
The successful learner over time and with support and instructional guidance can create a meaningful coherent representation of knowledge. Learners who lack development in efficient learner-centered skills can be mentored to eventually demonstrate significant improvement in a short period of time.
Construction of Knowledge
One of the key principles of this educational product is a belief that students have one or more key learning styles. One way of discovering the learning styles of students is by using a learning-style inventory. One such inventory, developed by Neil Fleming, is called VARK (visual, aural, read/write, kinesthetic). The system can be used to maximize learning strategies depending upon the student’s predominate learning style. By administering their learning-style instrument, students can gain insight about why the construction of knowledge is essential for deeper learning. This process can educate students about how using the visual, auditory, and kinesthetic learning styles will reinforce key concepts.
In 2006, I embarked upon a three-year study to see how implementation of this learning system could result in global enhancement of student outcomes. All students were required to construct high impact notes (HINs) on a specific number of clinical medicine topics during the first year. In addition, students created an HINs portfolio during the clinical year as they reviewed all topics on the blueprint. Fully implementing the system resulted in a dramatic increase in first-time taker pass rates. The class prior to implementation had an 83% first-time taker pass rate. In the three years after implementation, the first-time taker pass rate was 96% in 2006, 97% in 2007 and 97% in 2008. The results of this action research was captured in the 2008 article in the Journal of PA Education.
In 2011, FA Davis published this system in the book Classroom to Clinic Study System: Personal Professor for Clinical Rotations and PANCE.
During my journey as a PA educator, the most rewarding aspect has always been seeing light bulb come on in students who are struggling. This is why I focused much of my research on topics related to student success. The method of the HIN has been adopted in many programs throughout the country. It is simple to implement, and the results are remarkable. Hopefully, using methods such as these will improve PA educator strategies for helping struggling students. Perhaps you will develop another innovative method to enhance learning. For me, it was the hundreds of students I worked with who taught me about how to help future generations of PA students.