What to Consider Before Beginning Graduate
Education: A Pilot Study
F. Scott Imus, CRNA, MSN
Shari Burns, CRNA, EdD
The literature supports a general theme that college
students lack metacognitive awareness about learning, which leads to poor examination performance
and ultimately high attrition rates. However, the literature emphasizes that when college students receive
instruction about learning, examination performance
goes up and attrition goes down.
This pilot study focused on a specific subset of
learners: graduate students in a nurse anesthesia program. Given new evidence-based wellness approaches
to learning, the nurse anesthesia program conducted
a descriptive study aimed at exploring student perceptions. The study goals were to provide students with
evidence-based information about wellness factors
that influence learning. The book The New Science of
Learning by Doyle and Zakrajsek (Stylus Publishing,
A
growing body of literature about the neuroscience of learning identifies a gap between
what students believe are successful learning
strategies and what new research offers.1-5
On matriculation into a nurse anesthesia
program, students quickly realize that they need to acquire
new learning skills because of the increased demands of
graduate education. The challenge is severe for some students and results in lower grades and occasionally failure.
Some students are dismissed from the program because
of multiple failures. The students’ frustration and anxiety
result not because they lack the ability, but because they
are not aware of learning strategies needed to succeed
academically.
Doyle and Zakrajsek offer substantive evidence regarding new learning approaches for college students. Their
book The New Science of Learning is a little more than 130
pages synthesizing the newest research about how the
brain best learns, along with concise and effective tools
on how to employ successful wellness-based learning
strategies.6 Doyle and Zakrajsek’s work identifies 4 main
areas that students should consider to optimize learning:
sleep, nutrition, exercise, and hydration. The evidence
clearly indicates that a relationship exists between academic success and attention to sleep, nutrition, exercise,
and hydration. In fact, the science shows specifically how
each element influences learning. Traditionally, learning
strategies focus on specific study skills. Rather, initial
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2013) was used to provide students with neuroscience evidence about learning that might assist their
transition to graduate school. The book was mailed
to 34 student registered nurse anesthetists before
matriculation. An 8-item Likert-style online survey
evaluated the students’ perceptions of the book along
with identifying any changes the students made in
anticipation of starting the rigorous nurse anesthesia
program. The study demonstrated that student registered nurse anesthetists could benefit from instruction
about wellness approaches that enhance learning
before matriculation. Additionally, the study provided
the framework for future research.
Keywords: Academic success, learning strategies,
metacognitive awareness, neuroscience.
attention to the science of sleep, nutrition, exercise, and
hydration may positively influence the student registered
nurse anesthetist’s (SRNA’s) approach to learning from
the start of the graduate program.
Given the new evidence linking sleep, nutrition, hydration, and exercise to learning, the nurse anesthesia
program at our institution conducted a prospective descriptive study aimed at exploring student perceptions
of newly acquired knowledge about learning. The goal
of the study was twofold: (1) provide students with
evidence-based learning strategies for promoting academic success and (2) identify how reading the book by
Doyle and Zakrajsek influenced the students’ approach to
graduate education. This was the first attempt at discerning students’ perceptions of learning strategies using the
latest evidence. Ultimately, the nurse anesthesia program
hopes to foster academic success and decrease attrition.
Literature Review
The literature contains numerous articles addressing the
flawed, faulty evaluations that students offer regarding
their learning and study behaviors.1-5 However, a notable
gap exists regarding the possible benefit to SRNAs who
proactively receive information about the science of learning. Although this is a unique population of graduate
students, the current pilot study addressed specific learning habits of these students. It can no longer be presumed
that students are prepared with effective learning strate-
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gies because they are graduate students and have accomplished both professional and previous academic success.
Raichlen and Polk7 noted in their study that aerobic
exercise has the ability to generate, protect, and increase
the placidity of the brain along with developing intellect.
Despite the well-documented benefits of aerobic exercise, Pauline8 indicated a need for exercise promotion
in higher education due to the lack of physical activity
among this group. Walker9 offered confirmation that
sleep plays a major part in the processes of learning and
memory development. Buboltz et al10 verified that virtually 90% of higher education students reported some
type of sleep deficit. Norman11 reported the importance
of staying well hydrated for ideal brain performance and
noted how slight dehydration can affect overall learning
capability. Furthermore, Norman stated that a healthy
diet is vital to the development of neurotransmitters
that form the communication between brain cells, which
are imperative for learning to take place. Additionally,
Florence et al12 established a clear relationship between
overall diet quality and academic success.
The neuroscience research regarding the wellness
elements that foster learning represents only one aspect
to learning strategies. Other literature emphasizes the
complex learning requirements characteristic of higher
education.13-22 Although a full review of the literature is
beyond the scope of the current pilot study, meaningful
studies are included to emphasize the importance of learning strategies for SRNAs. Sansgiry and colleagues18 noted
that a high level of academic performance may well be correlated to effective learning and improved study strategies.
Furthermore, to excel in academics at the university,
it is essential to learn how to study effectively.18 Rowles23
posited that while some students do possess this knowledge, most students do not, simply because they have
had no formal training on the subject. Some students
believe that they can learn everything they need from the
professor, and subsequently they lack the resourcefulness needed to seek learning strategies.23 Another belief
that restricts students’ range of learning strategies is that
expertise can be achieved exclusively through traditional means as rote learning.3,5 Butler et al5 found that
metacognitive inaccuracies can ascend from dependence
on prompts such as familiarity or fluency that may not
indicate whether something is learned. For example, if
students test themselves at a reasonable interval from
learning, they can discern whether they can produce the
material when it is needed. If they do not quiz themselves
but merely continue to restudy, the material may seem
fluent and easy, but they may not be able to retrieve it
after a delay. An important responsibility in educating
SRNAs is imparting a commitment to lifelong learning so
they will be able to maintain and expand their knowledge
and skills to better serve patients, the profession, and
society as a whole. Burchard and Swerdzewski17 recog-
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nized that students with better metacognitive skills are
theoretically more proficient at higher-level processing,
inferring better academic achievement. It is the charge
of faculty to place more responsibility for learning on
SRNAs as they advance through rigorous curricula.
Research revealed that the learning strategies a student
embraces will affect the quality of learning attained.21
Tuckman15 showed that college students who received
training about learning and study skills had a significant
increase in their grade point average (GPA). Fleming16
was able to demonstrate that education on study strategy
increases examination performance and that teaching
these strategies can have long-lasting effects that will
pay dividends over time. It is imperative that faculty
members place substantial importance on educating students about how to develop healthier study strategies for
overall improvement in academic performance. Schools
may consider holding seminars or workshops to enhance
study strategies.18
A vast amount of literature incorporates 2 main
themes: (1) students are unaware of how the brain best
learns and (2) integrating students’ knowledge into the
curriculum improves GPA and decreases attrition.
Methods
Following approval by the Midwestern University institutional review board, a prospective descriptive survey
of 34 SRNAs matriculating in June 2014 was conducted.
The Doyle and Zakrajsek6 book was mailed to all students accepted to the program during the first week of
May 2014, with a request to read the book before matriculation in June 2014. The book accompanied the program’s welcome letter. On the first day of class, an email
invitation to participate in the study using an online
survey link was sent to the first-year class. A follow-up
email was sent 1 week later.
An 8-item Likert style online survey evaluated the students’ perception of the book and identified any changes
the students made in their approach to learning (Figure
1). The survey was designed by Doyle and Zakrajsek6 for
use with undergraduate students and was modified for
this pilot study with permission from the authors. The
survey addressed any benefits the student received from
reading the book as well as any personal habits that the
student changed as a result of the strategies offered in the
book. Completion of the survey was voluntary. Cohort
data were analyzed using descriptive statistics and were
tabulated. There were no individual identifiers. The data
were securely stored in the Nurse Anesthesia Program
office at Midwestern University in Glendale, Arizona.
Results
Surveys were returned by 97% of the students (33 of
34). Thirty (90%) of the students stated that they had
no formal training about learning. When asked if the
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1.Have you had any formal training about learning how to
learn?
• Yes
• No
2.How helpful would it be to know how your brain learns in
order to be successful in a nurse anesthesia program?
• Very helpful
• Helpful
• Somewhat helpful
• Not helpful
3. Do you know how you learn best?
• Yes, significantly
• Yes, somewhat
• No
4. Have you attended a prior graduate program?
• Yes
• No
5.How many learning strategies do you apply when learning
new material?
• 0-1
• 2-3
• 4-5
• 6-7
6. Did you read the book The New Science of Learning?
• Yes (Please continue with the survey)
• No (Please discontinue the survey)
7.How would you best describe The New Science of Learning
in improving your understanding of how your brain learns
best?
• Very helpful
• Helpful
• Somewhat helpful
• Not helpful
• No response
8.Did reading this book cause you to change your sleep patterns so that you obtained more sleep on a regular basis?
• Already had good sleep patterns
• Yes, significantly
• Yes, somewhat
• No change
• No response
9.Did reading this book cause you to change your exercise
patterns so that you exercised more on a regular basis?
• Already exercised regularly
• Yes, added significant exercise to my life
• Yes, added some exercise to my life
• No change
• No response
10.Did reading this book cause you to change your hydration
patterns so that you drank more fluids/water on a regular
basis?
• Already kept well hydrated
• Yes, added significant water to my diet
• Yes, added some water to my diet
• No change
• No response
11.Did reading this book cause you to change your diet (food
intake) patterns so that you had a more balanced diet?
• Already had a balanced diet
• Yes, significantly improved my diet
• Yes, somewhat improved my diet
• No change
• No response
12.Did you change the way you study to bring it into more
harmony with how the book says your brain learns?
• Yes, made significant changes
• Yes, made some changes
• No change
• No response
13.Would you recommend this book be read by all nurse
anesthesia students?
• Yes, very important for them to read
• No, not necessary for them to read
• No response
14.Please write an overall evaluation of the book’s helpfulness or failings to improve your learning, study habits, and
memory.
Figure 1. Survey About The New Science of Learning 6
students thought it would be helpful to know how their
brains learn, 85% (28 of 33) indicated that the information would be very helpful and 15% (n = 5) thought the
information would be helpful or somewhat helpful. Only
9%, or 3, of the students reported that they had attended
a prior graduate program. When asked how many learning strategies the students applied when learning new
material, 78% (n = 26) indicated that they used 2 to 3
methods, which included modification of sleep, exercise,
diet, or water intake (Figure 2).
Of the sample, 90% (30 of 33) read The New Science
of Learning.6 Of those who read the book, 28 found it
helpful or very helpful. Two students found the book
somewhat helpful. Only 3 (9%) of the students had
formal training about learning (Figure 3).
When the students were asked whether they knew
how they learned best, 24% (n = 8) reported that they understood how they learned best, 70% (n = 23) somewhat
knew about how they learned, and 6% (n = 2) reported
no knowledge about how they learned. Of the students,
73% (n = 24) reported that they had made a change to
their sleep patterns so that they would obtain more sleep
on a regular basis. Twelve (37%) of the students added
exercise, and 18 (56%) of the cohort changed their hydration patterns such as regularly drinking more water
and other fluids. Nearly three-fourths (74%; n = 24)
made no changes to their diet, and 36% (n = 12) made
some changes to improve their diet.
Of this cohort, 96% of the students (n = 32) changed
the way they studied, mirroring how the book says the
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Figure 2. Number of Learning Strategies Used by
Student Registered Nurse Anesthetists
Figure 3. Students’ Perception of the Book’s 6
Usefulness
Figure 4. Sleep Patterns of Student Registered Nurse
Anesthetists
Figure 5. Exercise Patterns of Student Registered
Nurse Anesthetists
Figure 6. Hydration of Student Registered Nurse
Anesthetists
Figure 7. Diet of Student Registered Nurse
Anesthetists
brain learns. Notably, 100% of the graduate students recommended the book by Doyle and Zakrajsek for future
graduate students in nurse anesthesia (Figures 4-7).
When asked to give an overall evaluation of the book’s
helpfulness or failing to improve learning, study habits,
and memory, students shared multiple comments, as
shown in the Table.
The findings of this study established a clear association between providing information about the neuroscience of learning, specifically sleep, nutrition, hydration,
and exercise in an effort to optimize learning for SRNAs
at the onset of the rigorous curriculum. Moreover, the
study demonstrated the willingness for the SRNAs to
align behaviors and adopt evidence-based strategies that
may improve academic performance. The results of this
research correlate well with the previously unpublished
results that Doyle and Zakrajsek6 described when giving
a similar survey to undergraduate students. This correlation alongside the literature substantiates the positive
influence that students acquire when offered knowledge
Discussion
“I’m sorry that it has taken me this long to learn how to learn.
This information would have been helpful earlier in my academic studies.” This comment from an SRNA emphasized
the purpose of the pilot study.
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•Good information, easy read.
•It helped with incorporation of all senses while learning and learning at short intervals too.
•Helped make changes in study habits along with reinforcing the need for a change in food and sleep habits
•The book says it all!! Great tool for those people who read it and applied it.
•I feel that it gives me confidence that I can learn anything if I incorporate the principles in the book.
•I was happy to have received a book that would explain the learning process better. I was never taught how to learn, so I am
trying to use some of these strategies when studying. It offered up some theories and new ways of thinking that I was previously
unaware of.
•I thought the book brought up many valid points about how a person can help themselves to be successful at learning. Personally,
I realized that these things mentioned in the book were important to help your brain, but the research that is presented that backs
up the statements in the book helps to make a person realize how important sleep, exercise, being hydrated, and eating well are to
being a successful learner. The topic of being a growth learner or being open and willing to learn was very helpful, as your mindset
can affect how well you learn.
•The book was easy and enjoyable to read. It helped me to get back into the practice of studying after being out of school for 5
years. Also made me more at ease starting the program and made me feel like the staff cares about my success as a student.
•I’m sorry that it has taken me this long to learn how to learn. This information would have been helpful earlier in my academic
studies. It was very informative and I hate to admit that I am guilty of having more of [a] fixed mindset in my thinking. Now that I
am aware of that method of thinking, I will actively try to change it to be more of a growth mindset.
•Helped enforce prior good habits and introduced new ones all in an effort to help with effective studying. This book was a good read.
•Mindset to learn made me more aware and alert. Makes [it] more conducive to learn rather than mindless memorizing.
•This book is very helpful. It opens up so many new possibilities. More needs to be discussed on this topic due to the fast-paced
and large volume of information we must assimilate. There isn’t much time to adjust your learning style once you start the program,
but it has to be done in order to succeed. I think more learning strategies would be very helpful to learn before starting and
upon arrival at the program. I am very happy to have benefited from this book and will continue to incorporate more and more
information into my daily routine.
•Mostly this book validated what I already knew and did. I feel a lot less guilty about getting enough sleep and exercise after reading
the book!! That, in and of itself, is very helpful so that I’m not wasting energy thinking I shouldn’t be doing the things that are
necessary.
Table. What Students Shared About the Book
about how the brain learns best. The literature consistently shows a disparity between what students perceive
to be effective learning strategies and what the evidence
demonstrates. The current study demonstrated that same
disconnect in SRNAs.
Karpicke et al2 were able to demonstrate the metacognitive inaccuracies that students have about learning,
whereas research by Ryan and Glenn4 supports employing
learning strategies.4 Tuckman15 and Fleming16 established
in their research the significant difference in examination
scores and overall GPA of students who received some
form of training in learning strategies compared with those
who did not. The current study’s attempt at discerning
students’ perceptions of learning strategies using the latest
evidence proved beneficial, as one student described,
“[The book] helped me make changes in study habits
along with reinforcing the need for a change in food and
sleep habits”. These open-ended comments made by the
SRNAs shared a common theme. The book provided them
with an easy-to-read and easy-to-incorporate set of skills
that foster learning. Generally, the students noted that
the book increased their metacognitive awareness toward
evidence-based learning and study strategies.
Limitations exist in that this project examined one
cohort of SRNAs in one university. The study will need
to be replicated, perhaps with multiple programs to generate greater evidence for learning. Additionally, as new
students, the subjects may have felt the need to respond
positively to the book that was supplied by the program
in order to present a positive initial impression to the
faculty. Reliability and validity of the survey tool require
attention to be able to generalize findings to the larger
population. For this reason, the current study results
are not generalizable. Rather, this is an initial effort, a
descriptive pilot study that explores a new arena for positive approaches to learning for SRNAs.
The current study provides a solid foundation for
follow-up data on student performance and attrition.
Specifically, future research will examine a correlation
between evidence-based learning strategies and GPA as
well as attrition for this cohort of SRNAs. Universities
have already implemented programs and/or courses to
teach learning strategies with success.13,17 Future research may inform curricular innovation for nurse anesthesia education and possibly for graduate programs in
other disciplines.
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AUTHORS
F. Scott Imus, CRNA, MSN, is currently an assistant professor in the
Nurse Anesthesia Program at Midwestern University in Glendale, Arizona.
He received his MSN in 2008 from the University of North Carolina at
Greensboro and his CRNA in 2008 from Wake Forest University Baptist
Medical Center, Winston-Salem, North Carolina. He is currently pursuing
a Doctorate of Education at the University of Phoenix with a concentration
in the neuroscience of education. Email: [email protected].
Shari Burns, CRNA, EdD, is currently a professor and the director of
the Nurse Anesthesia Program at Midwestern University. She received her
MSN in 1981 from Loyola University of Chicago, her CRNA in 1990 from
the US Air Force Nurse Anesthetist Program, and her EdD in 2009 from
the University of Phoenix, where her dissertation focused on predicting
academic progression for student registered nurse anesthetists. Email:
[email protected].
DISCLOSURES
The authors have declared no financial relationships with any commercial
interest related to the content of this activity. The authors did not discuss
off-label use within the article.
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