Poetry in teaching pharmacology: Exploring the possibilities.

OBJECTIVES: To explore poetry as a tool for active learning in linking knowledge and affective domains and to find if correlating learning with imagination can be used in "assessment for learning."
MATERIALS AND METHODS: After taking a conventional lecture on Asthma, a creative writing assignment in the form of poetry writing was given to the students. Different triggers were given to the students to channelize their thought pattern in a given direction that was linked to specific areas of academic relevance. Students were asked to reflect on this learning experience and the faculty was asked to evaluate the student assignment on a 5-point Likert scale.
RESULTS: Most student groups scored well in the "overall assessment" of creative assignments and were rated as good or fair by the faculty. Students reflections were very informative and revealed that more than 90% of the students liked the exercise and many were too exuberant and liberal with emotional reactions that breathed positive. Around 5% students found the exercise average and another 5% found it very childish.
CONCLUSION: Poetry writing turned out to be like a simulation exercise that linked academic knowledge, creativity, and the affective domain in an assumed scenario, rehearsed in free locales of mind. The metaphorical transition embedded in its subtle creation helped assess deeper understanding of the subject and the logical sequence of thought pattern.

Poetry writing can be a good exercise for the students. It is a reflection of their ability to correlate learning with real-life situations in a methodological sequence. Conventional methods sometimes may fail linking all in a single thread, but poetry complements as well as supplements the learning, making learning more holistic. Hence, it is a flexible tool in the hands of academicians and clinicians alike.[123]

Poetry gives more freedom of expression as it is free from norms, codes, and conventions that often govern the structured learning pattern. It is here that it gives a whiff of relief, a freedom for in-depth exploration to those who wish to use language and verses as a media for expressing.[4] These tasks not only enable students to understand some of the varied real life applications of classroom teaching but also act as a reinforcer to establish a new memory circuit.[567]

Students often find problems in memorizing pharmacology as they find that facts often evaporate with the wink of the eye. The hard facts that need to be memorized appear monotonous after a while and the attention span waivers. Engaging students in activities that involve students in group activities and inspire both creativity and recall, at the same time, as in poetry writing, can help generate more interest in the subject.[56] If we give interesting cues and initiate active search soon after the lecture or teaching–learning activity, the context in the cues thus designed can shift focus from passive to active learning and lead to meaningful learning of relevant facts that may otherwise be soon forgotten. Hence, this study was done with the aim to encourage active learning among students through introduction of creative writing assignments during the formative assessment.

Materials and Methods

The study was undertaken after taking due ethical clearance from the Institutional Ethical Committee. The teaching hours allotted to the Department of Pharmacology in the annual MBBS calendar of the institute were utilized for this purpose. Asthma was initially taught in two interactive lectures. Creative writing scenarios were then prepared, validated, and pilot-tested through E-mail group discussion. Necessary modifications were made after validation.

One-hundred and twenty students participated in the study. The students were divided into small groups of 10 each, and poetry writing assignments were given in the form of creative writing scenarios/triggers.[8] A total of six triggers were used as shown in Table 1. Each trigger was allotted to two groups of ten students each. The assignments were assessed on a 5-point Likert scale to derive an overall impression, based on three major criteria which were validated through E-mail discussions.

Table 1

Triggers used for poetry writing in asthma

Students were informally sensitized toward reflection writing and asked to write reflections in a given printed format of “What Happened”, “So What,” and “What next”. Poetry writing was followed by sensitizing students on how to write reflections where students reflected on the entire learning experience.

Results

Poetry writing added some color and fun to the exhaustive learning challenges and brought about a climate of change. Six different triggers were used to give direction to the student imagination [Table 1]. These triggers were aimed at focusing on different areas of concern not only in Pharmacology but also in linking it with etiopathogenesis as in trigger 1, therapeutics and special drug delivery systems as in trigger 2 and 3, adverse drug effects, drug toxicity, and drug–drug interactions as in trigger 4 and 5, and status asthmatics as in Trigger 6. The cue, “It was spring time, the flowers were blooming, Teddy bear, the rug, mite, Food” was used with an intent to see how students link allergic response with therapeutic options.

Faculty assessment and feedback revealed that ~70% faculty rated the poetry as good and ~30% as fair on a 5-point Likert scale (Excellent, Good, Can’t say, Fair, and Poor), based on three point criteria which were used for the overall assessment. This three-point criterion took into consideration the points as follows: (1) Clarity on the given topic and the written communication of the same, (2) extent of understanding of the topic by the student, (3) basic concept grabbed based on lecture objectives. Students’ emotional reactions were mostly positive as was evident in their reflections where they wrote “poetry was fun”, “I liked the creative way of teaching”, “helped me a lot to learn and recollect”. However, 5% of students reported the entire exercise as kiddish, another 5% found the exercise average, and two students found it exhaustive [Table 2] as evident in the statement “Helped memorize better, but exhaustive”. All data were qualitatively analyzed.

Table 2

Their reflections

Discussion

New perspectives originated when students were given freedom to express and explore.[1] After having undergone the routine core training, the students were divided into small groups of 10 students each. Triggers in the form of a thought that can lead them to a given direction were given.[8] These themes acquired new colors as students painted their thought and began converting academic foci in their memories into verses. Although the effort was premature and since the students had no earlier experience in poetry writing, yet the transformation of academic theme into a real life situation made theory more viable on paper and in their hearts.[4] It triggered a memory aspect that could not have been triggered by a teacher alone. Poetry writing and preparing verses are entirely different aspects. We listen, but may not have our heart into it. Then, we create and we pour in our souls. It is this deep sense of involvement that is the beginning of greater things and creating new memory links.[910] Creative writing has been earlier reported to aid internalization of information and deep understanding of concepts in science.[1112] When combined with active imagination, this coherent understanding has led to meaningful learning as reported in numerous ‘haikus’ written for neurodegenerative disorders by a group of undergraduate students in Massachusetts, USA.[13]

Some students also reported poetry writing kiddish. However, the term kiddish brought a sigh of relief. All childlike things are synonymous with curiosity, and if we can strike curiosity, at least we have knocked at closed door in the fond hope that the door shall open. This variation can also be attributed to student personal preferences because learning styles differ as reported earlier by Mc Naughton.[12]

Unaccustomed to these exercises, they may not have taken an instant liking. The assignment was very new and came to them as a surprise. The reason can be that the students were more prepared for a serious multiple choice or problem-based routine test and hence found poetry writing kiddish. However, as we went through their assignments, we found that they were creative, expressive and could manage to fold relevant facts and wrap them up beautifully into poetry. Poetry is an expression of creativity and exposing students to humanities can hone the skills.[14] Poems lend themselves well to an ideal integrated platform that can be used to establish a connect between empathy, clinical, psychological, and factual aspects or to a focused discussion on a single aspect of a subject.[61315]

Sharing a poem was based on trigger-1, Table 1, and narrated in third person. The trigger here was “It was spring time, the flowers were blooming…. Teddy bear, the rug, mite, Food”.

Poetry helped us initiate focused thinking. The mention of Omalizumab after the steroid and the bronchodilator use, in “He had a teddy bear “reflects that order of preference of drug to be chosen was well understood, and was not misplaced during rhyming.[16] There was evidence of good sequencing of thoughts as we find that steroid, bronchodilator, and omalizumab follow the mention of “hypersensitivity” in the very same verse –”Dr. Krantikari said, his tracheobronchial tree was hypersensitive”. This points toward understanding of the concept in a logical sequence and correlation intact.[12] It has been reported earlier that poetry enhances critical thinking.[17]

The second poem “Who am I” written in the first person by the student group. It was based on another trigger [trigger-3, Table 1], namely, The difficult inhaler (types).

The metaphorical element contained in these lines points toward an evolved thinking:[4]

The precautions as well as the intensity of the opportunistic infection are well narrated through metaphorical diction in – ”will remind you of your sins”.

Quoting further:

Clearly mentions how spacers will need coordination and points toward difficulty in educating children regarding the correct use of inhalers. These translucent observations helped illustrate that connectivity was established between theory, its comprehension, and application.[13]

During this project, there were moments where we questioned the outcome and the utility of the entire exercise that seemed so abstract. As is true of most research, we needed to lend scores or grades to everything we did. There was a quotient of dilemma on how to assess if learning actually happened during poetry writing. Should we lend scores to poetry? And at one point of time, we did so. However, eventually, we concluded that in assessment for learning not all moments need to be treated as “decision moments”.

Another limitation of this study can arise during implementation, and hence it is imperative that the trigger must direct their creativity either toward strengthening theoretical base, or toward situations of future clinical applicability.[4]

Although the quality of writing was not rated either “excellent” or “very good” [Figure 1], yet on an average, the effort was remarkable, basic concept was grabbed and well as expressed. We found, as is true of open-ended questions, assignments such as these may pose a problem to those with a very scientific bend of mind and negligible inclination toward arts, those less accustomed to these experiments, and also who are not very expressive and lack a command over language. Besides, student preferences and learning styles differ.[13] However, objectively perceiving, we can say that considering that it was their first exposure to humanities in medical education, the effort was encouraging. The mention that “we realized learning can be fun”, “poem was awesome”, and “exhaustive” or “kiddish “for some shows a diversity in learning preferences.[4] Interestingly, positive remarks point toward the fact that attributes of affective domain were touched upon and expressed in words [Table 1] and may have acted as stress buster, as in reported earlier studies.[4] These strengths and limitations of poetry make it powerful tool, provided it is used skillfully because it is the mere skill that can help one convert disadvantages into advantages.[5]

Figure 1

Overall impression-creative writing, based on faculty feedback 71%

Conclusion

The richness of these student-generated creative projects indicates a need for reflective learning activities to be combined with subjective experiences, early in training. This shall open the window to clinical correlation. Although endeavors such as these need commitment, time, and self-motivation, once acknowledged for their potential benefits, they carry the promise to make students lifelong learners, confident, and self-reliant. However, the poetry must go on, even when rhymes are difficult for the sheer pleasure that it echoes harmony, resounds with knowledge, and changes perceptions.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.