By Jen Schmitz, RN, MSN
A few years ago in one of my NCLEX® review classes, I looked over to see a student furiously taking down notes. At our first break, I checked in with her and she asked to copy down all the class questions with the answer choices. It seems this student thought the best way for success was to memorize the Kaplan questions and answers as if they held the key to passing the NCLEX. The student and I discussed that these exact questions would not be on the NCLEX exam, but similar questions that test your ability to make clinical judgments will be. My prescription: put down the pencil and interact in class.
I have seen this situation play out in other classrooms with a quick flash of a smartphone camera capturing ‘critical data’ or a student that tries to apply a rule when judgment is what is required. Students want to memorize facts.
So then it should not come as a surprise when Time magazine’s headline ran with “1 in 4 Americans Apparently Unaware the Earth Orbits the Sun.” The subheading reads: “They must have been sick the day this was taught in school.” I would argue most of them learned that fact, but it was never contextualized. But what we find is that memorized facts that are not contextualized remain difficult to retrieve when most needed.
Blowing the cover off of people’s lack of factual knowledge is not new. The documentary “A Private Universe,” asked Harvard faculty, students and alumni to explain why it is warm in the summer yet cold in the winter. The vast majority got it wrong, explaining that the Earth was closer to the Sun in summer when in fact the opposite holds true.
John Edward Huth, a professor of physics at Harvard, wrote about this in a piece for the New York Times last July and noted that the errors were a result of retrieving pieces of what they had previously learned and not what they could perceive themselves. Huth continues to say that a farmer with no formal education would be better adept at answering the question:
But a Neolithic farmer might cast his arm in an arc across the sky and explain that the sun was low in the winter and high in the summer. The farmer’s explanation would be perfectly correct, rooted in experience.
In the documentary you can see the sun beaming down from high in the sky, and had the students given their surroundings some thought, the answer would have been obvious. And yet for them, like many people, the cause of the seasons has been reduced to some disembodied nugget of information we’re taught in school, divorced from our daily lives.
In a way, we can create our own meanings: our own private frameworks to link events. Too often in the modern era, we rely on guardians to interpret events for us, and they’re too happy to step in and tell us what something “means.”
Arguably, we continue to be guardians in educating nurses. The challenges in providing ample and high quality clinical experiences for our students impact our goals as well. But, we have also collectively made great changes in teaching nursing students to develop clinical judgment, to prioritize and to use contextualization in approaching care of a unique patient.
I like to view the example of the Neolithic farmer as akin to the expert nurse, who in the course of assessing her patient, is able to pick up and respond to critical cues that speak to the patient’s condition. Much of this learning is ‘on the job.’ But there are still some missed opportunities to help students use the clues around them to create that personal framework that will lead to sound judgment making.
As we continue to educate, we should ask, “Are we teaching the cues? And are we optimizing the experiences whereby knowledge becomes intrinsically known?
