Enhancing Student Knowledge of Diabetes through Virtual Choose Your Own Adventure Patient Case Format

Student Use of Digital Patient Cases May Improve Performance in a Pharmacy Cardiovascular Therapeutics Course

The use of digital patient cases (eCases) is associated with student-perceived improvements in learning. However, novel instructional tools must demonstrate measurable student benefits to justify ongoing use. This research sought to identify the impact of digital patient cases (eCases) on student performance in a PharmD cardiovascular course. Optional eCases for hypertension (HTN), venous thromboembolism (VTE), and acute heart failure (AHF) were incorporated into the course. Performance on the exams and course overall was compared between student cohorts based on eCase use. Aggregated data were analyzed by year. Additional analysis was performed for scores on exam items related to eCase content. From 2020 to 2022, a total of 322/562 students (57.3%) used any eCase. While there were no differences in 2020 and 2021, eCase users in 2022 had significantly higher course (83.6% vs. 79.7%, p = 0.002) and final exam scores (75.0% vs. 67.7%, p < 0.001) compared with non-users. VTE eCase users had higher scores on VTE exam items compared to non-users, but only in 2021. AHF eCase users received higher scores on AHF exam items compared to non-users in 2021 and 2022. Among certain cohorts, student eCase use was associated with improved performance, and the use of certain eCases showed differences in content-specific performance. The eCase is a promising instructional tool that warrants further investigation to determine best design elements for maximal effectiveness.

Choose Your Own Adventure to Enhance Hypertension, Heart Failure, and Insulin Management Skills

OBJECTIVE

Choose Your Own Adventure (CYOA) educational activities can be utilized in the classroom to simulate patient cases. The objective of this study was to evaluate changes in pharmacy student knowledge and confidence in hypertension, heart failure, and insulin management skills after completion of CYOA activities.

METHODS

Three CYOA activities were developed for 3 separate lectures in 2 pharmacy electives on topics of hypertension, heart failure, and insulin management. Two different online platforms were used for the activities. Before and after each activity, instructor-created surveys were administered to students to assess knowledge, confidence, and satisfaction.

RESULTS

Overall, 110 potential respondents completed at least 1 of the 3 activities between 2021 and 2023. Average knowledge and confidence improved for each disease-state individually and when combined as a whole. Satisfaction was high (>4.5/5) for all activities and no differences were seen between activity platforms.

CONCLUSION

The CYOA activities can be successfully implemented in Doctor of Pharmacy elective classrooms using a digital platform for a variety of disease states and skills. Knowledge and confidence were improved in each individual topic and overall. Students enjoyed this activity regardless of the platform. Validated surveys and follow-up assessments would be beneficial in the future to determine if knowledge gains are sustainable.

Effect of Choose-Your-Own-Adventure (CYOA) Activities on Pharmacy Student Knowledge

OBJECTIVE

Many strategies are used in pharmacy education to maintain student engagement through active learning. Gamification, such as the choose-your-own-adventure activity (CYOAA), is one such method. The purpose of this study was to assess improvement in clinical knowledge and retention after the implementation of CYOAA.

METHODS

Two CYOAAs were designed and implemented within second-year pharmacy courses. One activity was on venous thromboembolism (VTE) and the other on chronic obstructive pulmonary disease (COPD). Students completed a six question prequiz and postquiz for both activities mapped to core learning objectives and four similar but more difficult questions on corresponding exams. After the CYOAAs, the students completed a reflection and perceptions survey.

RESULTS

Seventy-five students completed the VTE CYOAA and 77 completed COPD CYOAA. Over the three time points, there was a significant decrease in the mean assessment scores on the VTE activity (68% to 65% to 40%) versus a significant and sustained increase in mean assessment scores on COPD (62% to 83% to 85%). Of the 36 and 33 students who completed the postsurvey, the majority agreed or strongly agreed that they preferred CYOAA to traditional cases and that the activities improved their knowledge, critical thinking skills, and confidence in clinical decision-making.

CONCLUSION

There was a mixed result in the mean assessment scores, with an increase seen with the COPD CYOAA and a decrease with VTE, as well as positive perceptions for VTE and COPD, indicating that this classroom innovation is well-liked and may improve knowledge outcomes.

A meta-narrative review of choose-your-own-adventure style patient case activities in pharmacy education

BACKGROUND

The objective of this review was to characterize the methods of delivery and assessment of Choose Your Own Adventure (CYOA)-style activities in pharmacy education. A secondary objective was to utilize available data to determine best practices for educators interested in developing similar activities.

METHODS

A meta-narrative approach according to the guidance of the RAMESES standards was used for this review. A broad literature search was conducted using PubMed and Embase. Studies published on the use of a CYOA-style patient case format in pharmacy education were identified and appraised individually for their relevance.

RESULTS

Thirteen studies from the pharmacy education literature were included in the review. Activities were delivered for 25 unique topics, largely in small groups during class via patient simulation or interactive data collection software. Overall, students have a positive perception of CYOA-style activities, with positive results regarding knowledge development and student engagement. The most commonly reported challenge to implementing CYOA-style patient case activities was the up-front time commitment to develop activities.

IMPLICATIONS

This review provides a snapshot of the small but expanding body of literature on CYOA-style patient case activities in pharmacy education. CYOA-style activities are recommended for expanded use in pharmacy education as the preponderance of studies that assessed knowledge development showed significant improvement in knowledge after participation in CYOA-style activities. Additionally, students have a positive perception of CYOA-style activities and reported that they were enjoyable, improved their confidence, and helped them learn course material.

Implementing a choose your own adventure activity to improve insulin decision making

INTRODUCTION

The objective of this educational activity was to evaluate the impact of a virtually simulated Choose Your Own Adventure (CYOA) activity on pharmacy student knowledge and confidence of insulin management.

METHODS

An online CYOA activity was created using TypeForm, version 2 (TypeForm SL) for a third-year pharmacy school diabetes elective with 16 enrollees over two course offerings. Through use of interactive storytelling, students used critical thinking skills to make decisions in six simulated patient's care including initiation, counseling, conversions, and titration of multiple types of insulin. Instructor-created surveys were administered to students before and after the activity to assess satisfaction, confidence, and knowledge.

RESULTS

Ten students (62.5%) completed the activity and both pre- and post-surveys. Average total scores on the five-question insulin knowledge quiz improved significantly from 46% to 68% (P = .02). High satisfaction scores were recorded for each item in the post-survey. Student confidence improved in all aspects related to insulin management (P < .001). No differences in knowledge, confidence, or satisfaction were found between students who completed the activity in an in-person vs. virtual classroom.

CONCLUSIONS

CYOA activities can be successfully implemented in an in-person and virtual pharmacy classroom using a digital platform. Students viewed the CYOA activity as an enjoyable, low-stakes learning tool to increase confidence in their decision making. This small study did find knowledge improvements, but further research is needed to fully establish the validity of the knowledge assessments and ensure knowledge gains are sustainable.

An innovative approach to teaching depression and anxiety medication management: Virtual choose your own adventure, psychiatry edition

Introduction

Rates of depression and anxiety continue to increase in the United States. It's important for pharmacy students to graduate knowledgeable and confident in treating these disorders. The purpose of this study was to evaluate whether a virtual active-learning exercise (choose your own adventure) is helpful in teaching students how to manage medications for depression and anxiety.

Methods

Third-year pharmacy students responded to preactivity questions and then worked on a single patient case in which the presenting problem is worsening depression and anxiety. Students worked in virtual groups of 4 to 5 to select 1 treatment among 5 multiple-choice options and documented the rationale for their choice. Each multiple-choice option led to a different follow-up case. After writing their assessment and plan, the instructor debriefed on therapeutic concepts from each follow-up case. Students then answered postactivity questions and participated in a voluntary survey consisting of 10 retrospective questions.

Results

Of 106 participants, 85 completed the survey (80.2% response rate). Most agreed that their understanding of treatment of depression and anxiety disorders increased following participation (92.9% strongly/somewhat agreed). This was supported by an increase in the percentage of correct responses on the knowledge questions (preactivity: 67.2%, n = 91; postactivity: 83.5%, n = 97; P = .01). Additionally, students reported their confidence in their understanding of depression and anxiety management increased following activity participation (93.0% strongly/somewhat agreed).

Discussion

The virtual active-learning exercise improved student knowledge and confidence in managing depression and anxiety treatments. Educators teaching depression and anxiety pharmacotherapy may consider implementing such activity into their lecture(s).