All nursing educators are responsible for using current, evidence-based teaching/learning strategies to achieve educational outcomes. How those teaching/learning strategies are used is at the core of how well students achieve what they need to learn. Merely using a teaching/learning strategy does not guarantee learning. A current approach to teaching in nursing education involves using active learning strategies. A possible misconception is that if active learning strategies are used, then learning automatically occurs. However, the "devil is in the detail." Using only active learning (such as with the flipped classroom) does not always equate to learning. The "why" behind the "what" must always be considered. Faculty should ask themselves why they are using a particular teaching/learning strategy. That is, strategies should have a purpose, and that purpose should link to a course learning outcome. Remember, it's all about the outcomes!

One current approach for active learning in the classroom is the "flipped classroom."1 The purpose of the flipped classroom is to engage students in higher-level thinking than is possible with lecture. Students first complete focused, lower cognitive level activities as preclass assignments. Those activities serve as the basis for what is actively processed in the classroom. The planning of these active learning strategies must take into consideration not only content but also cognitive level. Consider the following example.

You are working with a group of students in an advanced adult health course. The lesson objective is: Predict and manage potential complications when caring for adult patients with acute, unstable conditions.

Students work in small groups to address this lesson objective. The students in the first group are presented with a disease process such as acute asthma or myocardial infarction. They are asked to identify the potential complications that can occur and interventions to prevent or manage those complications. The students are merely presented with the medical diagnosis, then asked to recall the information they learned. This represents the knowledge or remembering level of Bloom's taxonomy.

A second group of students is provided with 2 case scenarios, preferably patients with whom they are familiar through previously experienced unfolding case studies. Students apply decision making to the individual patient situations taking into account prescribed medications, preexisting conditions, clinical manifestations, age, gender, and other personal information. The students respond by providing the same information as the first group but expanded on it by considering the individual patient situation.This is also known as contextual learning. Potential complications that may occur within the context of each patient include additional possible complications based on the nuances of the patient's situation. This approach more closely resembles real practice and requires a higher level of thinking to sort through information for each specific patient. The thinking required is now at the analyzing level of Bloom's taxonomy.

Both of these are examples of using active learning strategies. However, the second scenario puts the students in the role of the nurse in a situation that resembles the real-world practice of nursing. That scenario is more representative of an active learning strategy that advances thinking. Students must be guided in this contextual thinking to improve patient outcomes.2

Always consider the "why" behind the "what." Identify the level of thinking that is the goal of the classroom session. This is the why behind the what. If it requires remembering, then use the first active learning strategy. If it is analyzing, then use the second approach.

Merely using a strategy does not in itself advance thinking or learning. Select strategies because they support the learning outcomes. Never use a strategy merely because it is expected. Always ask yourself, "Why?" Always teach with a purpose.

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