Any course in ethics demands a high degree of student engagement and discussion as students wrestle with ethical dilemmas presented in case studies and real-life situations. Without discussion, an ethics class becomes a lecture on ethical systems and viewpoints from which students must infer their own positions from values that might not align with their moral outlook.
When I first began teaching a health ethics course in the School of Pharmacy at the University of Mississippi, small enrollments allowed for plenty of discussion among the students. We held formal debates and tackled one “big idea” each semester. In the spring semester of 2010, we took on the Affordable Care Act, which was being debated in Congress and was passed into law during spring break. During subsequent semesters, we analyzed and debated sex education, the ACA birth control mandate, pharmacies’ role in state executions, and the expansion of Medicaid.
These types of collaborative, low-stakes activities have proven an effective way for students to identify their values and biases as well as understand how they shape outcomes when applied to both theoretical and real ethical scenarios.
High enrollment, low engagement
As class enrollments grew, I divided the class into more sections, teaching two in the spring semester and two in the fall semester. Despite the expansion of sections, classes were still too large for discussion. Because of this, I fell back on the lecture format, but the classes felt stagnant and attendance levels dropped as students discovered they could learn most of the essential information from the lecture notes I posted online.
In 2015, I experimented with a hybrid model in which I divided a large class into two sections that met once a week and then had students working through online activities during their “off” times. Unfortunately, I was never sure whether students were actually doing the readings, watching the videos, and completing the case studies and other interactive activities. In fact, during class discussions, I found myself giving mini-lectures for the benefit of students who clearly had not done the readings and thus could not make meaningful contributions to the discussions.
In 2016, I replaced the online components of the class with adaptive learning courseware. The courseware allows students to track their progress in each lesson and it quizzes them following each mini-lesson to allow them to practice retention and retrieval of the content. I noticed improved levels of student engagement in discussions after introducing adaptive courseware.
This year, I took it a step further and made a New Year’s resolution to stop lecturing in class. Now, instead of listening to a lecture, students analyze case studies, work through ethics dilemmas, and complete ethics surveys in teams of three. Teams report out at the end of class, keeping them on task and also generating discussion and questions about case details, legal issues, and ethical principles. Once they realized I was not going to lecture, which they tend to equate with teaching, students overwhelmingly preferred this model of learning. Another benefit of the small groups is that students no longer worry about expressing a controversial opinion or risking embarrassment through ignorance or error in front of the entire class. They are relaxed and open to learning, despite some of the controversial topics being tackled.
Expectations versus reality
It’s important to note that my expectations of what active learning should look like have not always matched the reality, making it necessary for me to adjust how I facilitate the class.
I expected to see and hear students loudly debating each other, but they tend to work with their heads in their devices, talking online in the shared Google doc. It is up to me to engage with student teams and to nudge them into engaging with each other.
I expected students to be far more tech savvy than they are. They have trouble cutting and pasting images, saving Word documents as PDFs, and using Google’s collaboration apps, Google Docs and Google Drive. It became necessary to provide instructions to students to perform the technological functions necessary for completing class activities.
I expected activities to take much longer than they actually do. This has an upside in that I see now there is time to bring the class together at the end of an activity to report out to each other what they discovered in doing the activity.
I expected students would naturally connect the activities they complete with their team in class to the learning and activities they complete on their own, but this is not always the case. I now spend a few minutes before each class explaining the connection between the adaptive courseware content and the class activity.
Finally, I expected to feel ill at ease not lecturing all the time, but I enjoy not being the main focal point in the class. It is a subtle but important message to students that they are the ones who must do the work of learning rather than me doing the work of teaching.
Students enjoy the new format of the class. Does that mean they are learning? The adaptive courseware measures student knowledge of the course content, and by that measure, yes, students are learning. More than 90 percent of the class achieves a 90 percent mastery level for each learning module.
Nevertheless, learning content is not the same as learning concepts. In their collaborative and individual writing, I am encouraged by students wrestling with the material. However, too few apply the concepts from the courseware to these activities.
The class is not perfect, but it is better. With each iteration of the class, I am taking note of what works and what does not. In the end, that is enough for me, because education is not about getting it right the first time, but recognizing errors and self-correcting. I include my students in the process of improving the class. If all they take away from Health Ethics is the understanding that education is a process and that it is OK to be good enough while striving for excellence, they will have learned the most important lesson of all.
Patricia O’Sullivan is the manager of the Personalized Learning and Adaptive Teaching Opportunities Program and an adjunct instructor of ethics, pharmacy administration at the University of Mississippi.
Photo courtesy of Patricia O’Sullivan and her students at the University of Mississippi.