Toward a pharmacy curriculum theory: spiral integration for pharmacy education

Advancing Pharmacy Education by Moving From Sequenced "Integration" to True Curricular Integration

OBJECTIVES

Traditional pharmacy education focuses on teaching content, which is affectionately known as "silos". Each topic area or discipline includes a course or an individual class session designed to impart knowledge, skills, or abilities needed for the student pharmacist to become a practice-ready, team-ready pharmacist. With expanding content and educational standards, there have been calls to simplify and streamline content. Truly "integrated" curricula (sequenced, coordinated, and collaboratively taught) where silos are removed to foster student integrative learning and build connections across disciplines (foundational, clinical, and social or administrative sciences) could be one such approach. Thus, the objectives of this integrative review are to provide recommendations for decreasing curriculum overload by moving to truly integrated curricula, explore integrated approaches, discuss challenges and barriers, and propose next steps for creating integrated curricula that decrease content overload.

FINDINGS

Although there are different approaches to curricular integration, most curricular integration occurs through sequenced courses or integrated cases. In order to truly streamline content and foster connections across disciplines, integration must move beyond simply sequencing of content to content that includes all the disciplines taught seamlessly. When taught together, curricular integration offers the opportunity to cover medication classes quickly and efficiently with multiple opportunities for reinforcement.

SUMMARY

There remains limited data and examples of these types of true integration approaches. Thus, it is important for the Academy to determine if the integration of content improves curricular outcomes, positively affects students' learning, and addresses curriculum overload by increasing efficiency and streamlining curricula.

A New Vision of Teaching Clinical Pharmacology and Therapeutics for Undergraduate Medical Students

For many years, clinical pharmacology (CP) has been taught at schools of medicine via traditional methods including classic lectures and experimental sessions. The explosion of scientific knowledge and the availability of many treatment options have necessitated the development of new strategies for pharmacology teaching and learning. Applying information learnt in real-life situations has become more important than finding information that is readily available in many places. The newly implemented reformed curriculum at Umm Al Qura University - Faculty of Medicine (UQUMED) is a student-centred, competency-based curriculum with enhanced integration across the disciplines. Teachers and students have a great responsibility in updating the curriculum. The "Use of Medicine" (UofM) vertical module is part of this reformed curriculum that focuses on key principles, a core list of medications, the vertical and horizontal integration of subjects, the knowledge application to real case situations, enhanced critical thinking and self-learning. It emphasizes rational prescribing, safe medical practice and excellence in teaching CP and therapeutics. The adoption of newer and innovative teaching and assessment methods and the training of faculty/staff can help to refresh CP education. One challenge in CP education is that teachers are shifting from acting as information providers to acting as facilitators so that students become life-long learners. The assessment of our reformed curriculum uses several valid reliable tools to evaluate the achieved skills and competencies. This manuscript describes the transformational changes in CP education at UQU up to the development and implementation of the UofM vertical module as part of the reformed UQUMED curriculum. Continuous updates in CP education are critical for rational, safe, and affordable medication prescribing for better patient care.

Development of Professional Attributes through Integration of Science and Practice at First-Year Pharmacy Level

The design, implementation and evaluation of a year 1 pharmacy-integrated learning component, using the World Health Organisation’s (WHO) analgesic ladder as a scaffold for case-based learning, is described. A novel aspect of the integrated component is the mapping of the cases to the national Core Competency Framework (CCF) for Pharmacists in Ireland and to the school’s own cross-cutting curricular integration themes. The integrated cases were student led and delivered through peer-to-peer teaching for 68 first-year pharmacy students. The integrated cases mapped strongly to three of the CCF’s domains, namely, personal skills, organisation and management skills and supply of medicines. With regard to the school’s curricular integrative themes, the cases mapped strongly to the curricular integration themes of professionalism and communications; medicines sourcing, production and use; and safe and rational use of medicines. Highlights from an anonymous online student survey were the recognition by students of the importance of core science knowledge for practice, the enabling of integrated learning and the suitability of the integrated component for entry-level. While a majority of students were found to favour individual work over group work, future iterations will need to consider a greater degree of group work with a view to reducing the volume of content and time required to complete the cases.

Design and Implementation of an Integrated Competency-Focused Pharmacy Programme: A Case Report

This paper describes the design and implementation of elements of an integrated competency-focused pharmacy programme in the School of Pharmacy and Pharmaceutical Sciences (SoPPS), Trinity College Dublin (TCD), Ireland. Following a national review of pharmacy education and training in Ireland in 2010, and subsequent publication of legislation in 2014, the School has implemented a five-year integrated programme of pharmacy education and training, leading to the award of a Master's degree in Pharmacy (M. Pharm.). Curricular integration has been achieved by underpinning the new programme with a national competency framework for pharmacists and through the utilisation of curricular integration themes. Programme integration also encompasses embedded experiential learning placements in Years 2, 4 and 5 of the five-year programme. The new five-year integrated pharmacy programme, which commenced in 2015, replaced the 4 + 1 model of education and training where a four-year Bachelor's degree was followed by a one-year internship, which was a distinct and separate element of the students' training.

A scoping review of health professional curricula: Implications for developing integration in pharmacy

BACKGROUND

Integrated health professions curricula aim to produce graduates who are capable of meeting current and future healthcare needs. This is reflected in pharmacy education where integration is increasingly advocated by pharmacy regulators as the perceived optimal way of preparing students for registration as pharmacists. There is, however, no definition of integration. Integration can be described according to a model of horizontal, vertical or spiral integration. It can also be described by the themes used to integrate, such as a systems-based approach or by integrative teaching and learning approaches. The level of integration can also be described.

OBJECTIVE

This scoping review aimed to explore health professions education literature to inform the optimal design of integrated pharmacy curricula. This review asks: what is meant by integration in health professions curricula?

METHODS

The Arksey and O'Malley scoping review framework was utilised. Ovid MEDLINE, EMBASE, Scopus, Web of Science and ERIC were searched. Models of integration, themes for integration, integrative teaching and learning approaches, and level of integration were defined and supported data extraction.

RESULTS

There were 9696 records screened and of these 137 were included. The majority of studies (n = 88) described horizontal integration. Systems-based teaching (n = 56) was the most common theme reported. Various integrative teaching and learning approaches were described, including experiential (n = 43), case-based (n = 42) and problem-based (n = 38) learning. The majority of the curricula could be classified as levels 5-7 on Harden's ladder (n = 102). Perception outcomes were reported for 81 studies, and only 3 reported outcomes beyond perception. Reported outcomes were generally positive and included knowledge gains and increased motivation.

CONCLUSIONS

There is a need for integration to be explicitly defined by curriculum developers and researchers. Attention should be given to describing the model, theme, teaching and learning approach and level of integration. There remains a lack of evidence for integration.

Using Technology in Pharmacy Education: Pharmacy Student Performance and Perspectives When Visual Aids Are Integrated Into Learning

Objectives: The role of the pharmacist has evolved and continues to evolve. The traditional role of the dispenser has been replaced with a patient-centered profession. This requires integration and application of pharmaceutical knowledge and skills to solve patient therapeutic problems and advance patient care. Therefore, having evidence-based teaching strategies for learning within pharmaceutical sciences is essential. New and maturing technologies enable traditional principles of pharmaceutical science to be visualized. We aimed to explore pharmacy students' performance before and after visual aids for learning are integrated within pharmaceutical science teaching. Student's opinions and views of the visual aids were determined.

Methods: Students were taught about selected pharmaceutical science concepts at two time points; during the second teaching point, visual aids were introduced. Students' performance was compared before and after the implementation of visual aids using pre and post-quizzes. Alongside the post-quiz an evaluation was also completed by the students; a descriptive analysis was conducted for the Likert-type responses and an in-depth thematic analysis of the student's free-text questions was completed using an iterative process.

Results: Significant differences were seen between pre and post-quiz sessions for total score and questions that mapped to the revised-Bloom's taxonomy lower and higher categories. Student evaluation of the visual aids were positive. Interesting themes and subthemes emerged regarding the perspectives of pharmacy students to these visual aids. Students indicated visual aids made it easier to understand, compared to written or verbal explanations, and helped with the application of pharmaceutical science concepts. However, a minority of students reported that the visual aids were irrelevant, or they did not understand them.

Conclusion: Students had better performance after the introduction of, and favorable responses to, the visual aids. Visual aids were a beneficial tool in regards to understanding and application of complex concepts. Improvements can be made; tailoring accompanying descriptions and using more repetition.