Preparing for a Renaissance in pharmacy education: the need, opportunity, and capacity for change

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.

Successful implementation of Medical Education Faculty Development Project at Saint George University of Beirut in the immediate post triple blow to Beirut

Background

The aim of this study is to explore the efficacy of the Faculty Development Program (FDP) implemented at the Saint George University of Beirut-Faculty of Medicine (SGUB FM) under exceptional circumstances as the triple blow to Beirut.

Methods

The Faculty Development, directed towards a cohort of 35 faculty members, is composed of two major components: methodology of teaching and techniques of assessment. The Kirkpatrick's assessment model, in combination with a specifically designed psychological questionnaire, were chosen to assess the effectiveness of the faculty development initiative.

Results

Results of the different questionnaires were interpreted individually, then through the lens of the psychological questionnaire. A majority of faculty (55%) were significantly affected psychologically by Beirut's triple blow and 77% of all participants found the workshops to be of excellent quality (Kirkpatrick's Level I). Moreover, Kirkpatrick's level II results yielded a 76% mean percentage of correct answers to post-workshops MCQs and a significant improvement in the mean results of the self-assessment questionnaires, administered before and after each workshop. Results also show that the more a trainee is psychologically affected, the less he/she performs as evidenced by a decrease in the satisfaction rate as well as in the score of the cognitive MCQs and of the self-assessment questionnaires.

Conclusions

This study was able to highlight that significant learning can occur amidst exceptional circumstances like the Beirut triple blow and administration should invest in professional growth to retain its faculty.

Lecture Capture Is the New Standard of Practice in Pharmacy Education

The desire and need for remote access to education dramatically increased during the COVID-19 pandemic. As higher education struggles to find its "new normal," pharmacy programs have begun to review changes and approaches to decide which should be continued. This Commentary advocates that the use of lecture capture as an instructional delivery strategy, is no longer just a supplement to learning, but is now a standard of practice in health professions education. Lecture capture creates equity for students by providing additional opportunities to review material. Students may be balancing schoolwork with a job, caring for their children, or fulfilling other obligations. Lecture capture allows students to acquire information at lower levels of Bloom's taxonomy at a time that fits into their schedule, at a pace appropriate for them, and in a method that may better suit their learning needs. Students entering pharmacy school at this time have learned from audio/video media (eg, YouTube, Ted Talks, podcasts) and nontraditional educational competitors (eg, Khan Academy, Coursera, MasterClass). Students have become accustomed to learning via media technology and regularly do so in their everyday lives. Students desire lecture capture as it provides an opportunity to review unclear, complicated, or missed concepts as part of the studying process. Though its use is flexible, like any tool, lecture capture should not be used for all situations. Benefits and disadvantages of lecture capture for students, faculty, and institutions are described herein.

Preceptor Perceptions of Pharmacy Student Performance Before and After a Curriculum Transformation

Objective. To explore preceptors' perceptions about the performance of undergraduate pharmacy students during experiential placements in Australia, before and after curricular transformation.Methods. Using a semi-structured approach, we interviewed 26 preceptors who had recently supervised students who took part in the transformed curriculum and students from the previous curriculum. A directed content analysis approach was used to analyze the transcripts.Results. Preceptors described students from the transformed curriculum as having improved professional skills, behaviors, and attitudes and as having an increased ability to perform clinical activities compared to students of the previous curriculum. Preceptors also perceived that students in the transformed curriculum had improved clinical knowledge and knowledge application. They less frequently expressed that students in the transformed curriculum had lower-than-expected knowledge levels.Conclusion. The results of this study suggest that curricular transformation with a focus on skill-based and active learning can improve the performance of pharmacy students in terms of their professional behaviors and attitudes, skills, knowledge, and clinical abilities, as perceived by preceptors.

Exploring the Experiences of Pharmacy Students and Their Transition to Online Learning during COVID-19

Due to the heavy focus on development of communication skills, compounding laboratories and many practical workshops, undertaking a registerable pharmacist qualification in an online format is typically not an option for students. COVID-19 presented on-campus pharmacy students with the opportunity to experience online learning. The aim of this study was to explore the experiences of on-campus pharmacy students who were required to move their studies to online learning during the COVID-19 pandemic. An interpretive phenomenological methodology was adopted, and semi-structured interviews were conducted with pharmacy students who were originally enrolled in on-campus learning and had to transition to online learning. Data were analyzed using a hermeneutic phenomenological approach whereby themes were identified to aid in the development of the phenomena guided by 'lived experience'. Seven interviews were conducted with pharmacy students. Four emergent themes resulted from the interviews: (1) life as an on-campus pharmacy student, (2) preconceived ideas of online learning, (3) learning differences as an online pharmacy student and (4) the future of online pharmacy programs. Students were initially hesitant to transition to online learning due to preconceived ideas and expectations that may have tainted their overall experience. Pharmacy students preferred face-to-face learning due to their sociable personality and heavy dependence on peer and teacher support. All participants reported that they preferred face-to-face learning and acknowledged that fully online programs were not suited to their learning style or to the discipline of pharmacy. After their experience of online learning, participants believed that there was a place for online learning components in pharmacy courses. Lectures and some discussion workshops could be delivered online, but some aspects, such as compounding; dispensing; counselling; and demonstration of medication delivery devices, such as asthma inhalers and injectable diabetes products, should be delivered on campus.

A Scoping Review of Active-Learning Strategies for Teaching Social Determinants of Health in Pharmacy

Objective. To review current conceptualizations and measurements of active-learning education within Doctor of Pharmacy degree programs as it pertains to social determinants of health (SDOH) and to determine the gaps and limitations in available literature. A secondary objective was to assess simulation-based educational methods related to SDOH in pharmacy.Findings. Sixteen articles were eligible for inclusion. Many simulation-based and non-simulation-based teaching strategies are described. The majority of articles included active-learning activities related to social/community context and health/health care, the other three 3 social determinants of health domains: education, economic stability, and neighborhood/built community, were not equally addressed. In the studies included in this review, schools and colleges of pharmacy did not appear to not be integrating all five components of SDOH into active learning curricula. The sparsity of literature and lack of diversity in published types of simulated experiences and assessments may suggest there is room for innovation in this area.Summary. More research is needed in order to fully characterize conceptualizations of social determinants of health in Doctor of Pharmacy degree programs in order to ensure students are provided with a full understanding of the SDOH factors that affect patient outcomes.

Pharmacy Education Crosses the Rubicon

The pandemic caused by the novel coronavirus identified in 2019 (COVID-19) has resulted in seismic changes throughout society. Accordingly, academia has been forced to adapt. Changes across all aspects of teaching and instruction have occurred. Students have departed campuses and prospects of their return remain unclear. The Academy, which is generally reluctant to change, has been forced to make rapid adjustments. Among other issues, pharmacy schools and colleges have been forced to mitigate changes to experiential education. Tremendous resources and energy have been invested to actuate the changes that have occurred. In many ways, the disruptions forced upon pharmacy education may usher in a new normal. The likelihood for even a partial return to the customary way of doing things appears increasingly unlikely.

Evaluation of an intervention to support the development of clinical problem solving skills during a hospital-based experiential learning program for South African pharmacy students

INTRODUCTION

Final year pharmacy students at the Nelson Mandela University described feeling unprepared for the complexities of clinical reasoning and problem solving during the hospital-based experiential learning program (ELP). The fifteen week ELP is part of the third Pharmacology and Therapeutics module taken in the final year of the four year Bachelor of Pharmacy (BPharm) degree program. An intervention, in the form of supplementary academic support sessions, was implemented during the ELP. The aim of the research was to evaluate the intervention from the perspectives of the students' experience as well as academic performance in the ELP.

METHODS

A mixed-methods approach using a quasi-experimental, intervention-based design was employed. Final year students in Year 1 (control cohort) completed the ELP as usual without additional academic support. In the consecutive academic year (Year 2), the intervention cohort completed the ELP that was enhanced with the intervention. Student feedback provided qualitative data, while quantitative data in the form of assessment marks were used as a measure of academic performance.

RESULTS

The students' experience of the intervention was overwhelming positive and provided evidence that the students felt better prepared for patient case analysis as a result of the intervention. A small but significant improvement in academic performance in the ELP was also seen.

CONCLUSIONS

The intervention, using a modified team based learning (TBL) approach developed from student-identified needs, was successfully implemented and provided a means of enhancing the development of problem solving and clinical reasoning skills during the ELP, through additional academic support sessions.

Pharmacy Students Perceptions of Their Distance Online Learning Experience During the COVID-19 Pandemic: A Cross-Sectional Survey Study

INTRODUCTION

The COVID-19 pandemic imposed dramatic changes on educational practices worldwide. Many universities and schools have moved into the delivery of their courses and educational programs utilizing fully electronic online modes. This study aims to evaluate the pharmacy student distance online learning experience during the COVID-19 pandemic.

METHODS

A cross-sectional survey was utilized where a 3-domain survey questionnaire focused on preparedness, attitude and barriers was distributed to students at the time of conclusion of the semester. Each domain consists of multiple questions that made up a score that reflects their preparedness, attitude as well as barriers relevant to distance online learning experience. The survey was voluntarily, and all data were collected and recorded via google forms with maintaining anonymity.

RESULTS

The response rate was about 75% (n = 309). The results' analysis revealed no gender differences in any of these domains. However, there were some variable responses among different educational levels. The average preparedness score was 32.8 ± 7.2 (Max 45), the average attitude score was 66.8 ± 16.6 (Max 105), and the average barrier score was 43.6 ± 12.0 (Max 75). There was statistical significance difference in both preparedness score and attitude scores between different professional years (P-value <.05). However, there was no difference in barrier scores among all professional years. The results indicated that about 61.4% of the students agreed on that college of pharmacy was well-prepared and ready for the online education during the emerging COVID-19 pandemic with complete transition into online education. The results also indicated that 49.2% of the students showed positive attitude toward the provided online learning. The results indicated that about 34% of the students identify some barriers toward the provided online learning. Finally, there were strong association between the need for training on how to receive online courses and preparedness and barriers scores.

DISCUSSION AND CONCLUSION

E-learning experience pose challenges and presents opportunities during emergency situations. The need for training for students and faculty was highly associated with the preparedness and barriers domains rather than the infrastructure or computer literacy, so the school can improve their experience by addressing these needs.

Learning Outcomes and Student Preferences with Flipped vs Lecture/Case Teaching Model in a Block Curriculum

Objective. To assess the impact of using a flipped classroom instructional approach on Doctor of Pharmacy (PharmD) students' learning outcomes and instructional preferences in a pharmacotherapy course within a block curriculum. Methods. Select topics in a gastrointestinal and liver pharmacotherapy course were taught using a flipped classroom method that required students to view lecture modules and respond to self-assessment questions prior to class. Classroom time included quizzes, application exercises, and discussion. The following year, teaching of these topics was switched back to a lecture/case format, and different topics were taught in the flipped classroom format, Student performance under each teaching method was examined, and student preferences and study habits were collected via a survey administered before and after experiencing the flipped classroom. Results. Combined mean formal assessment scores were higher for all four topics taught using the flipped classroom format compared to the lecture/case format. This pattern persisted when topics were examined individually, except for scores on one review topic. Survey responses reflected acknowledgement by about half of the students that the flipped format was more beneficial than traditional methods, but they still clearly preferred live lectures over prerecorded lectures. The majority of students reported that the amount of preparation time required for the flipped classroom was appropriate and that they had a positive or neutral experience with the flipped classroom overall. Conclusion. This study supports use of the flipped classroom method for teaching standard pharmacotherapy topics within a block curriculum, but underscores some of the resistance expressed by students despite understanding the potential benefits of the flipped format.

Assessing Students' Satisfaction with a Redesigned Pharmacology Course Series

Objective. To describe the revision of a pharmacology course series taught over three quarters within a Doctor of Pharmacy (PharmD) curriculum and assess changes in students' attitudes toward and performance after the revision. Methods. Based in part on students' dissatisfaction regarding a pharmacology course series, a course director was hired and tasked with teaching a major portion of the course content, rewriting course examinations, and facilitating active learning in the course series. Course evaluations and examination scores of students who completed the course series after the implementation of the redesigned curriculum (classes of 2015 and 2016) were assessed and compared with those of students who completed the course before the revisions were made (classes of 2013 and 2014). Results. Qualitative analysis of second-year pharmacy student evaluations identified a lack of integration and coordination within the pharmacology course sequence. Poor examination quality and the absence of active teaching methods were other frequently described shortcomings of the pharmacology curriculum. Course evaluations dramatically improved after shortcomings were addressed and students' performance in the subsequent therapeutics course also increased significantly. Conclusion. Adding additional structure to and oversight for a pharmacology course series by adding a course director improved student satisfaction with the course and improved performance in the subsequent therapeutics course. This study highlights the importance of a well-designed pharmacology curriculum for continued success in core courses in the PharmD curriculum.

Conducting and presenting qualitative research in pharmacy education

SITUATION

The evolution of practices in healthcare and the content and delivery of pharmacy education have generated new challenges for practitioners and academicians. Fittingly, pharmacy education research in the academic setting has grown rapidly to provide innovative solutions to these challenges. One approach for addressing these challenges includes the collection and analysis of qualitative research (QR). Though a useful methodological tool, many pharmacy educators are not trained to appropriately conduct QR and present the findings of their work.

METHODOLOGICAL LITERATURE REVIEW

QR offers many advantages for pharmacy education researchers. However, prior to delving into QR projects it is important to understand the key distinctions of the approach, role of the researcher, and the significance of situating the study so that the research question, data collection techniques, and analysis procedures are aligned.

RECOMMENDATIONS

We provide recommendations for several key components for conducting QR, articulating the process, and presenting and contextualizing the findings.

IMPLICATIONS

This article serves as a primer on QR methods, offering relevant background information, ways to apply this approach in pharmacy education research, and recommendations for presenting qualitative findings. Employing rigorous qualitative approaches in pharmacy education and appropriately presenting the procedures and findings will increase the visibility of QR and provide an opportunity for scholars to become familiar with the approach.

Redesigning a Pharmacology Course to Promote Active Learning

Objective. To incorporate active-learning sessions into a lecture-based pharmacology course, assess the impact on student learning and attitudes, and address commonly perceived barriers to implementing active learning. Methods. Prior to the redesign, the course met twice a week for 75 minutes. As part of the redesign, the two weekly lecture sessions were reduced to 50 minutes each. Additionally, students were assigned to one of three sections that met separately once a week for a 50-minute recitation session in which they applied course concepts to cases, problems, and situations. Data from the two years before the redesign and two years after it were assessed. Results. Students' average course grade increased 2.5% after the redesign. Average ratings of the course and instructor on student evaluations each increased significantly (around 0.3 points on a 5-point scale). Conclusion. Student knowledge and performance in a pharmacology course increased when a portion of the time previously devoted to lecture was replaced with an active-learning session. This experience can serve as a blueprint for how to convert a lecture-only course into a hybrid lecture and recitation model.

Impact of Novel Active-Learning Approaches Through iBooks and Gamification in a Reformatted Pharmacy Course

Objective. To compare pharmacy students' assessment and evaluation ratings of a newly formatted nonprescription products course that used innovative technology and gaming to that for a traditional nonprescription products course. Methods. Examination scores and course evaluations of students who completed the traditional course on nonprescription products were analyzed and compared with those of students who completed a revised course on nonprescription products that used teaching techniques in educational technology. Results. Students in the traditional course significantly outperformed those in the comparator group in eight nonprescription categories on examinations, while students in the new course significantly outperformed those in the comparator group in four categories. Students in the new course outperformed those in the traditional course in two additional examination categories, however these were not significant. Almost all students in both courses agreed or strongly agreed with each course evaluation item, including those items where use of gamification and iBooks were most likely considered. Conclusion. Improvements in student examination performance and course satisfaction may not be immediately seen in a course in which new teaching techniques using educational technology including gamification and iBooks are introduced.

Curricular Reform in Pharmacy Education Through the Lens of the Flexner Report of 1910

Abraham Flexner's 1910 report on medical education in the United States (US) and Canada propelled medical training forward into a contemporary renaissance. The report heralded many seismic changes that still resonate within medical and health professions education throughout the US. Today several factors are accelerating curricular reform within pharmacy education, including but not limited to accreditation standards, technologic advances, and student diversity. Despite the fact that Flexner's report is now over a century old, many of his observations and recommendations regarding education are as pertinent and timely today as they were in 1910. This commentary will discuss and reflect upon curricular reform in pharmacy education as it contrasts with some of the observations, findings, and recommendations of Flexner's 1910 report.

Improved Learning Outcomes After Flipping a Therapeutics Module: Results of a Controlled Trial

PURPOSE

To evaluate the impact on learning outcomes of flipping a pain management module in a doctor of pharmacy curriculum.

METHOD

In a required first-professional-year pharmacology and therapeutics course at the University of Maryland School of Pharmacy, the pain therapeutics content of the pain management module was flipped. This redesign transformed the module from a largely lecture-based, instructor-centered model to a learner-centered model that included a variety of preclass activities and in-class active learning exercises. In spring 2015, the module was taught using the traditional model; in spring 2016, it was taught using the flipped model. The same end-of-module objective structured clinical exam (OSCE) and multiple-choice exam were administered in 2015 to the traditional cohort (TC; n = 156) and in 2016 to the flipped cohort (FC; n = 162). Cohort performance was compared.

RESULTS

Learning outcomes improved significantly in the FC: The mean OSCE score improved by 12.33/100 points (P < .0001; 95% CI 10.28-14.38; effect size 1.33), and performance on the multiple-choice exam's therapeutics content improved by 5.07 percentage points (P < .0001; 95% CI 2.56-7.59; effect size 0.45). Student performance on exam items assessing higher cognitive levels significantly improved under the flipped model. Grade distribution on both exams shifted, with significantly more FC students earning an A or B and significantly fewer earning a D or F compared with TC students.

CONCLUSIONS

Student performance on knowledge- and skill-based assessments improved significantly after flipping the therapeutics content of a pain management module.

Identifying perceptions of academic reform in pharmacy using a four-frame organizational change model

BACKGROUND

In an ever-changing environment, pharmacy education is in the race to catch up and excel to produce competent pharmacists. Examining academic institutions, including schools of pharmacy, their internal systems and framework, it seems appropriate to view these institutions using multiple lenses. Bolman and Deal conceptualized a method to examine organizations using four constructs (structural, human resource, political, and symbolic). The Eastern Mediterranean Region (EMR), with deep-rooted pharmacy education and practice was the setting for this research.

OBJECTIVES

To explore factors affecting academic reform in undergraduate pharmacy education in the EMR from stakeholders' and students' perspectives; and to apply Bolman and Deal's four-frame organizational change model to explore how these issues might be viewed.

METHODS

A multiple-method approach was employed and involved collecting, analyzing and integrating qualitative semi-structured interview data with open-ended questions in a survey. Cross-sector stakeholder sample from various EMR countries was recruited and interviewed. Final year pharmacy students from one school of pharmacy in Jordan were surveyed.

RESULTS

Emergent themes were indicative that academic reform was addressed by all frames of the Bolman and Deal model. Structural and political frames received substantial weighing pointing to the importance of curricular reform, collaboration and leadership. A need for skillful and role-model teaching academic staff was highlighted, and in harmony with the human resource frame. Issues within the symbolic frame were readily apparent in the data and spanned the other three frames in relation to heritage, customs and cultural barriers.

CONCLUSIONS

Issues pertinent to academic reform in pharmacy were presented. Viewing change in pharmacy schools from multiple perspectives highlighted the need for structural changes to pharmacy programs, human resource management, political will, leadership, and collaboration. The importance of understanding cultural aspects of organizations is critical as it is these that provide identity to any organization and help reformers better manage change.

Curriculum renewal: Alignment of introductory pharmacy practice experiences with didactic course content

BACKGROUND AND PURPOSE

The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) used the opportunity of curriculum renewal to integrate knowledge and skills learned from didactic courses into the introductory pharmacy practice experiences (IPPEs) occurring simultaneously. This paper describes and evaluates the meaningful application of course content into IPPEs, and evaluates the success using qualitative feedback.

EDUCATIONAL ACTIVITY AND SETTING

Students entering the renewed curriculum starting in fall 2012 were provided a list of pharmacy skills and activities from didactic course directors that reinforced course content for that semester. The skills and activities were to be completed during the students' IPPE visits in the community or health systems settings, depending on the program year and semester.

FINDINGS

Students successfully completed course assignments during their IPPE course program. Not all activities could be completed as designed, and many required modification, including simulated experiences. Feedback from faculty and preceptor members of the school's experiential education committee demonstrated that these activities were valuable and improved learning of course material, but were challenging to implement.

DISCUSSION AND SUMMARY

A renewed curriculum that mapped course assignments for completion in experiential settings was successfully established, after some modifications. The program was modified at regular intervals to improve the ability of preceptors to complete these activities in their individual practice environment. A balance between the school providing guidance on what activities students should perform and allowing unstructured independent learning with the preceptor is needed for an optimal experience.

Practical Insights for the Pharmacist Educator on Student Engagement

Student engagement continues to be a point of emphasis in pharmacy education, yet there remains little data on tangible means to increase organic student engagement. This review attempts to better define student engagement, draws from educational theorists to emphasize the importance of student engagement, and provides the reader with practice philosophies that can be used across of variety of teaching settings to help develop an engaging learning environment.

Understanding students' readiness for interprofessional learning in an Asian context: a mixed-methods study

BACKGROUND

Healthcare is generally provided by various health professionals acting together. Unfortunately, poor communication and collaboration within such healthcare teams often prevent its members from actively engaging in collaborative decision-making. Interprofessional education (IPE) which prepares health professionals for their collaborative role in the healthcare system may partially address this problem. This study aimed to investigate: 1) students' readiness for IPE in an Asian context, 2) the most important factors influencing students' perceptions of IPE, 3) the reasons underlying such perceptions, and 4) the factors mitigating or promoting their sense of readiness.

METHODS

To identify students' perceptions of IPE, we administered the Readiness for Interprofessional Learning Scale (RIPLS) to 398 in approximately 470 students from a range of health professions (medicine, nursing, midwifery and dentistry). The questionnaire included factors that could potentially influence readiness for IPE as found in the literature (GPA, etc.). To enhance our understanding of the responses to the RIPLS and to explore the reasons underlying them, we conducted 4 mono-professional focus group discussions (FGDs). We ran a statistical analysis on the quantitative data, while performing a thematic content analysis of the qualitative data using ATLAS.ti (version 7).

RESULTS

Medical students seemed to be the most prepared for IPE. Students' perceptions of IPE were conditioned by the study programme they took, their GPA, intrinsic motivation and engagement in the student council connoting experience of working with students from different programmes. Focus groups further revealed that: 1) early exposure to clinical practice triggered both positive and negative perceptions of IPE and of its importance to learning communication and leadership skills, 2) medical students caused insecurity and disengagement in other students, 3) medical students felt pressured to be leaders, and 4) there was a need to clarify and understand each other's profession and the boundaries of one's own profession.

CONCLUSION

Students were generally favourable to IPE, appreciating the opportunity it offered them to hone their interprofessional leadership, collaboration and communication skills and to learn to address the problem of role blurring. Hence, we judge the Asian context ready to implement IPE, allowing health professions students in Asian countries to reap its benefits. The present study revealed several important reasons underlying students' positive and negative perceptions of IPE implementation which may be addressed during the interprofessional learning process.

Five heads are better than one: preliminary results of team-based learning in a communication disorders graduate course

BACKGROUND

Clinical problem-solving is fundamental to the role of the speech-language pathologist in both the diagnostic and treatment processes. The problem-solving often involves collaboration with clients and their families, supervisors, and other professionals. Considering the importance of cooperative problem-solving in the profession, graduate education in speech-language pathology should provide experiences to foster the development of these skills. One evidence-based pedagogical approach that directly targets these abilities is team-based learning (TBL). TBL is a small-group instructional method that focuses on students' in-class application of conceptual knowledge in solving complex problems that they will likely encounter in their future clinical careers.

AIMS

The purpose of this pilot study was to investigate the educational outcomes and students' perceptions of TBL in a communication disorders graduate course on speech and language-based learning disabilities.

METHODS & PROCEDURES

Nineteen graduate students (mean age = 26 years, SD = 4.93), divided into three groups of five students and one group of four students, who were enrolled in a required graduate course, participated by fulfilling the key components of TBL: individual student preparation; individual and team readiness assurance tests (iRATs and tRATs) that assessed preparedness to apply course content; and application activities that challenged teams to solve complex and authentic clinical problems using course material.

OUTCOMES & RESULTS

Performance on the tRATs was significantly higher than the individual students' scores on the iRATs (p < .001, Cohen's d = 4.08). Students generally reported favourable perceptions of TBL on an end-of-semester questionnaire. Qualitative analysis of responses to open-ended questions organized thematically indicated students' high satisfaction with application activities, discontent with the RATs, and recommendations for increased lecture in the TBL process.

CONCLUSIONS & IMPLICATIONS

The outcomes of this pilot study suggest the effectiveness of TBL as an instructional method that provides student teams with opportunities to apply course content in problem-solving activities followed by immediate feedback. This research also addresses the dearth of empirical information on how graduate programmes in speech-language pathology bridge students' didactic learning and clinical practice. Future studies should examine the utility of this approach in other courses within the field and with more heterogeneous student populations.

Limited Predictive Utility of Admissions Scores and Objective Structured Clinical Examinations for APPE Performance

OBJECTIVE

To examine the relationship between admissions, objective structured clinical examination (OSCE), and advanced pharmacy practice experience (APPE) scores.

METHODS

Admissions, OSCE, and APPE scores were collected for students who graduated from the doctor of pharmacy (PharmD) program in spring of 2012 and spring of 2013 (n=289). Pearson correlation was used to examine relationships between variables, and independent t test was used to compare mean scores between groups.

RESULTS

All relationships among admissions data (undergraduate grade point average, composite PCAT scores, and interview scores) and OSCE and APPE scores were weak, with the strongest association found between the final OSCE and ambulatory care APPEs. Students with low scores on the final OSCE performed lower than others on the acute care, ambulatory care, and community APPEs.

CONCLUSION

This study highlights the complexities of assessing student development of noncognitive professional skills over the course of a curriculum.

Student Preferences on Gaming Aspects for a Serious Game in Pharmacy Practice Education: A Cross-Sectional Study

BACKGROUND

Serious games are motivating and provide a safe environment for students to learn from their mistakes without experiencing any negative consequences from their actions. However, little is known about students' gaming preferences and the types of serious games they like to play for education.

OBJECTIVE

This study aims to determine the types of gaming aspects that students would like to play in a pharmacy-related serious game.

METHODS

A cross-sectional study was conducted using a self-administered survey, which obtained students' responses on their preferences regarding various gaming aspects (reward systems, game settings, storylines, viewing perspectives, and gaming styles) and for a hypothetical gaming scenario (authentic simulation or post-apocalyptic fantasy). Descriptive statistics, chi-square, and Fisher's exact tests were used for statistical analyses.

RESULTS

Response rate was 72.7% (497/684 undergraduates). The most popular game reward systems were unlocking mechanisms (112/497, 22.5%) and experience points (90/497, 18.1%). Most students preferred fantasy/medieval/mythic (253/497, 50.9%) and modern (117/497, 23.5%) settings, but lower year undergraduates preferred modern settings less than upper year seniors (47/236, 19.9% vs 70/242, 28.9%, P=.022). Almost one-third (147/497, 29.6%) preferred an adventurer storyline or an authentic pharmacy-related plot (119/497, 23.9%), and a collaborative game style was most preferred by the students (182/497, 36.6%). Three-dimensional game perspectives (270/497, 54.3%) were more popular than two-dimensional perspectives (221/497, 44.5%), especially among males than females (126/185, 68.1% vs 142/303, 46.9%, P<.001). In terms of choice for a pharmacy-related serious game, a post-apocalyptic fantasy game (scenario B, 287/497, 57.7%) was more popular than an authentic simulation game (scenario A, 209/497, 42.1%). More males preferred the post-apocalyptic fantasy scenario than females (129/187, 69.0% vs 155/306, 50.7%, P<.001).

CONCLUSIONS

In general, students want a three-dimensional, fantasy/medieval/mythic post-apocalyptic game, based on an adventurer storyline with an unlocking mechanism reward system. A balance between real-life and fantasy elements needs to be struck in order for the game to cater students towards health care practices.

Pharmacy students' performance and perceptions in a flipped teaching pilot on cardiac arrhythmias

OBJECTIVE

To implement the flipped teaching method in a 3-class pilot on cardiac arrhythmias and to assess the impact of the intervention on academic performance and student perceptions.

DESIGN

An intervention group of 101 first-year pharmacy students, who took the class with the flipped teaching method, were supplied with prerecorded lectures prior to their 3 classes (1 class in each of the following subjects: basic sciences, pharmacology, and therapeutics) on cardiac arrhythmias. Class time was focused on active-learning and case-based exercises. Students then took a final examination that included questions on cardiac arrhythmias. The examination scores of the intervention group were compared to scores of the Spring 2011 control group of 105 first-year students who took the class with traditional teaching methods. An online survey was conducted to assess student feedback from the intervention group.

ASSESSMENT

The mean examination scores of the intervention group were significantly higher than the mean examination scores of the control group for the cardiac arrhythmia classes in pharmacology (with 89.6 ± 2.0% vs 56.8 ± 2.2%, respectively) and therapeutics (89.2 ± 1.4% vs 73.7 ± 2.1%, respectively). The survey indicated higher student satisfaction for flipped classes with highly rated learning objectives, recordings, and in-class activities.

CONCLUSION

Use of the flipped teaching method in a 3-class pilot on cardiac arrhythmias improved examination scores for 2 of the 3 classes (pharmacology and therapeutics). Student satisfaction was influenced by the quality of the learning objectives, prerecorded lectures, and inclass active-learning activities.

The flipped classroom: a course redesign to foster learning and engagement in a health professions school

Recent calls for educational reform highlight ongoing concerns about the ability of current curricula to equip aspiring health care professionals with the skills for success. Whereas a wide range of proposed solutions attempt to address apparent deficiencies in current educational models, a growing body of literature consistently points to the need to rethink the traditional in-class, lecture-based course model. One such proposal is the flipped classroom, in which content is offloaded for students to learn on their own, and class time is dedicated to engaging students in student-centered learning activities, like problem-based learning and inquiry-oriented strategies. In 2012, the authors flipped a required first-year pharmaceutics course at the University of North Carolina Eshelman School of Pharmacy. They offloaded all lectures to self-paced online videos and used class time to engage students in active learning exercises. In this article, the authors describe the philosophy and methodology used to redesign the Basic Pharmaceutics II course and outline the research they conducted to investigate the resulting outcomes. This article is intended to serve as a guide to instructors and educational programs seeking to develop, implement, and evaluate innovative and practical strategies to transform students' learning experience. As class attendance, students' learning, and the perceived value of this model all increased following participation in the flipped classroom, the authors conclude that this approach warrants careful consideration as educators aim to enhance learning, improve outcomes, and fully equip students to address 21st-century health care needs.

A roadmap for educational research in pharmacy

Educational research must play a critical role in informing practice and policy within pharmacy education. Understanding the educational environment and its impact on students, faculty members, and other stakeholders is imperative for improving outcomes and preparing pharmacy students to meet the needs of 21st century health care. To aid in the design and implementation of meaningful educational research within colleges and schools of pharmacy, this roadmap addresses philosophy and educational language; guidelines for the conduct of educational research; research design, including 4 approaches to defining, collecting, and analyzing educational data; measurement issues; ethical considerations; resources and tools; and the value of educational research in guiding curricular transformation.

Pharmacy student engagement, performance, and perception in a flipped satellite classroom

OBJECTIVE

To determine whether "flipping" a traditional basic pharmaceutics course delivered synchronously to 2 satellite campuses would improve student academic performance, engagement, and perception.

DESIGN

In 2012, the basic pharmaceutics course was flipped and delivered to 22 satellite students on 2 different campuses. Twenty-five condensed, recorded course lectures were placed on the course Web site for students to watch prior to class. Scheduled class periods were dedicated to participating in active-learning exercises. Students also completed 2 course projects, 3 midterm examinations, 8 graded quizzes, and a cumulative and comprehensive final examination.

ASSESSMENT

Results of a survey administered at the beginning and end of the flipped course in 2012 revealed an increase in students' support for learning content prior to class and using class time for more applied learning (p=0.01) and in the belief that learning key foundational content prior to coming to class greatly enhanced in-class learning (p=0.001). Significantly more students preferred the flipped classroom format after completing the course (89.5%) than before completing the course (34.6%). Course evaluation responses and final examination performance did not differ significantly for 2011 when the course was taught using a traditional format and the 2012 flipped-course format. Qualitative findings suggested that the flipped classroom promoted student empowerment, development, and engagement.

CONCLUSION

The flipped pharmacy classroom can enhance the quality of satellite students' experiences in a basic pharmaceutics course through thoughtful course design, enriched dialogue, and promotion of learner autonomy.

Team-based learning in pharmacy education

Instructors wanting to engage students in the classroom seek methods to augment the delivery of factual information and help students move from being passive recipients to active participants in their own learning. One such method that has gained interest is team-based learning. This method encourages students to be prepared before class and has students work in teams while in the classroom. Key benefits to this pedagogy are student engagement, improved communication skills, and enhanced critical-thinking abilities. In most cases, student satisfaction and academic performance are also noted. This paper reviews the fundamentals of team-based learning in pharmacy education and its implementation in the classroom. Literature reports from medical, nursing, and pharmacy programs are also discussed.

Redesign of a large lecture course into a small-group learning course

Objective. To describe the redesign of a large self-care course previously delivered in a traditional lecture format to a small-group case-based course.Design. Prereadings and study guides were used to facilitate students' independent learning prior to class. Large lecture classes were replaced with smaller group-based learning classes. This change in delivery format allowed students to spend the majority of class time conducting small-group learning activities, such as case studies to promote communication, problem solving, and interpersonal skills.Assessment. Changes in course delivery were assessed over a 2-year period by comparing students' grades and satisfaction ratings on course evaluations. A comparison of course evaluations between the class formats revealed that students were provided more opportunities to develop verbal communication skills and tackle and resolve unfamiliar problems in the revised course. The activities resulted in better overall course grades.Conclusions. Redesigning to a small-group discussion format for a self-care course can be accomplished by increasing student accountability for acquiring factual content outside the classroom. Compared with student experiences in the previous large lecture-based class, students in the smaller-class format reported a preference for working in teams and achieved significantly better academic grades with the new course format.

The use of virtual laboratories and other web-based tools in a drug assay course

OBJECTIVE

To determine students' perceptions of and performance in a drug assay laboratory course after the addition of Web-based multimedia tools.

DESIGN

Video modules and other Web-based tools to deliver instructions and emulate the laboratory set up for experiments were implemented in 2005 to improve student preparation for laboratory sessions and eliminate the need for graduate students to present instructions live.

ASSESSMENT

Data gathered from quizzes, final examinations, and post-course surveys administered over 6 years were analyzed. Students' scores on online quizzes after implementation of the virtual laboratories reflected improved student understanding and preparation. Students' perception of the course improved significantly after the introduction of the tools and the new teaching model.

CONCLUSIONS

Implementation of an active-learning model in a laboratory course led to improvement in students' educational experience and satisfaction. Additional benefits included improved resource use, student exposure to a variety of educational methods, and having a highly structured laboratory format that reduced inconsistencies in delivered instructions.

Use of online modules to enhance knowledge and skills application during an introductory pharmacy practice experience

OBJECTIVES

To implement and assess the effectiveness of online instructional modules to increase the consistency of learning outcomes related to students' patient-care practice knowledge and their skills application and confidence across introductory pharmacy practice experience (IPPE) sites.

DESIGN

Twenty online modules were created to provide uniform delivery of instructional content that complemented classroom instruction and to introduce students to common pharmacy-practice skills in the patient-care arena.

ASSESSMENT

Quantitative data were collected by means of a survey and pre- and post-module quizzes, which were completed by students to assess knowledge. More than 85% of students applied the IPPE skills. During the course, students' confidence increased significantly in all areas. For all but 1 of the 13 competencies, more than 70% of students agreed or strongly agreed that the competencies were met.

CONCLUSIONS

Online instructional modules in patient care can effectively increase students' knowledge, skills application, and confidence, and improve the consistency of achieving outcomes for instructional content and activities across diverse practice settings.

Intergroup peer assessment in problem-based learning tutorials for undergraduate pharmacy students

OBJECTIVE

To develop, implement, and evaluate a process of intergroup peer assessment and feedback using problem-based learning (PBL) tutorials.

METHODS

A peer-assessment process was used in a PBL tutorial setting for an integrated pharmacy practice course in which small groups of students graded each others' PBL case presentations and provided feedback in conjunction with facilitator assessment.

ASSESSMENT

Students' quantitative and qualitative perceptions of the peer assessment process were triangulated with facilitator feedback. Students became more engaged, confident, and motivated, and developed a range of self-directed, life-long learning skills. Students had mixed views regarding the fairness of the process and grade descriptors. Facilitators strongly supported the peer assessment process.

CONCLUSIONS

Peer assessment is an appropriate method to assess PBL skills and is endorsed by students as appropriate and useful.

A process-oriented guided inquiry approach to teaching medicinal chemistry

OBJECTIVE

To integrate process-oriented guided-inquiry learning (POGIL) team-based activities into a 1-semester medicinal chemistry course for doctor of pharmacy (PharmD) students and determine the outcomes.

DESIGN

Students in the fall 2007 section of the Medicinal Chemistry course were taught in a traditional teacher-centered manner, with the majority of class time spent on lectures and a few practice question sets. Students in the fall 2008 and fall 2009 sections of Medicinal Chemistry spent approximately 40% of class time in structured self-selected teams where they worked through guided-inquiry exercises to supplement the lecture material.

ASSESSMENT

The mean examination score of students in the guided-inquiry sections (fall 2008 and fall 2009) was almost 3 percentage points higher than that of students in the fall 2007 class (P < 0.05). Furthermore, the grade distribution shifted from a B-C centered distribution (fall 2007 class) to an A-B centered distribution (fall 2008 and fall 2009 classes).

CONCLUSIONS

The inclusion of the POGIL style team-based learning exercises improved grade outcomes for the students, encouraged active engagement with the material during class time, provided immediate feedback to the instructor regarding student-knowledge deficiencies, and created a classroom environment that was well received by students.

Pharmacy students' approaches to learning in undergraduate and graduate entry programs

OBJECTIVES

To compare longitudinal data with previous cross-sectional data regarding Australian undergraduate pharmacy students' approaches to learning, and explore the differences in approaches to learning between undergraduate and postgraduate cohorts.

METHODS

Longitudinal, repeated measures design using a validated self-report survey instrument were used to gather data.

RESULTS

Undergraduate students' preferences for meaning directed, undirected, and reproduction-directed approaches to learning displayed the same pattern across the 2 studies; however, application-directed scores increased significantly in the second half of the undergraduate degree program. Commencing postgraduate students' approaches to learning were similar to finishing undergraduate students, and this group was significantly more oriented towards meaning-directed learning compared to undergraduate students.

CONCLUSIONS

Pharmacy students' maturation in approach to their learning was evident and this bodes well for pharmacists' engaging in life-long learning and capacity to work in increasingly complex health settings.

Multi-faceted approach to improve learning in pharmacokinetics

OBJECTIVES

To integrate a series of educational strategies ranging from content delivery to assessment, including a change in philosophy regarding the use of in-class time, to enhance learning of pharmacokinetics.

METHODS

Several approaches were taken to develop a significant learning experience in the basic and clinical pharmacokinetics courses including games, a piloted multimedia module to offset content delivery and free-up class time, reflective writing, and an immediate feedback assessment. Games, a multimedia module, reflective writing assignments, and other innovative learning tools were incorporated into pharmacokinetics courses, as well as an assessment tool to provide immediate feedback.

RESULTS

Median examination scores did not improve following the incorporation of the teaching innovations; however, based on survey results, student satisfaction increased.

CONCLUSIONS

Already high median examination scores (>90% from historical controls) did not improve; however, the effectiveness of the innovations implemented, which included deep learning and critical thinking and communication skills, may be more accurately measured over the long term, eg, in performance in advanced pharmacy practice experiences.