Team-based Learning to Promote the Development of Metacognitive Awareness and Monitoring in Pharmacy Students

Objective. To evaluate the metacognitive abilities of pharmacy students and determine whether introducing the concept along with team-based learning (TBL) enhances metacognition.Methods. Pharmacy students completed a Metacognitive Awareness Inventory (MAI) and a low-stakes pretest during the first class that evaluated students’ knowledge about the therapeutic concepts that would be taught through TBL. The same questions were administered on the comprehensive final examination for the course. For each of the course assessments, students were asked to indicate their understanding of the topic and predict their performance. Actual performance was measured as a result of each assessment.Results. The pre-MAI composite score was 77.3%. Scores significantly improved by the end of the course to 84.6%. There were significant differences in both declarative knowledge and conditional knowledge when evaluating performance groups. Students in the middle performance group demonstrated the greatest ability to predict their performance on the final examination. Though these were not significant, students in the low group overestimated their performance, while students in the high group underestimated their performance. Baseline grade point average was the only factor predictive of the final examination score and the final course grade.Conclusion. Pedagogies such as TBL may support development of metacognitive skills in pharmacy students. However, intentional guidance provided by an instructor is required to improve pharmacy students’ regulation of cognition skills.     

Enhancing Team-Based Active Learning Through Hands-On Experience With Nicotine Replacement Therapy

Objectives. To enhance tobacco cessation active-learning in an ambulatory care elective course by adding hands-on experience with nicotine replacement therapy to a team-based learning (TBL) session.Design. A hands-on experience that included students chewing a piece of nicotine gum was added to a TBL class session. Student pairs used a skills checklist to evaluate and give peer feedback on appropriate counseling and gum use.Assessment. Students’ scores on a tobacco cessation examination were higher than those of students enrolled in the previous course in which TBL alone had been used. Based on pre- and post-experience survey responses, students’ perceptions regarding their abilities to provide tobacco cessation counseling improved. Subjective student comments regarding the experience were positive.Conclusion. Participating in a TBL session that incorporated hands-on experience with nicotine gum in an ambulatory care elective course increased students’ confidence in their ability to provide tobacco cessation counseling and provided a unique perspective on the product’s characteristics.     

A Concept Mapping Activity to Enhance Pharmacy Students’ Metacognition and Comprehension of Fundamental Disease State Knowledge

Objective. To examine the impact of pre-class concept mapping activities on pharmacy students'' ability to self-assess their degree of foundational disease state knowledge and predict their pre-class quiz performance.Methods. Second year pharmacy students in a problem-based learning course were responsible for self-directed learning of foundational knowledge for 14 disease states. After completing their independent pre-class reading, students worked in groups to create concept maps for which feedback was provided for four laboratory sessions, worked in groups to create concept maps but received no formal feedback for three laboratory sessions, and did not engage in any formal group activity for seven laboratory sessions. The day following each session, prior to the formal in-class discussion, students were asked to predict the number of questions they could answer correctly on a quiz covering foundational knowledge and then completed the quiz. Quiz performance was compared based on the three conditions, and bias and absolute bias were calculated to evaluate students’ metacognitive skills.Results. There was no difference in pharmacy students’ metacognition based on the conditions, as reflected by inaccuracy between predicted and actual quiz scores. However, when students had engaged in concept mapping the previous day, their quiz performance was significantly higher than when they had not.Conclusion. Concept mapping did not improve pharmacy students’ metacognitive skills but did have a small effect on their quiz performance. More research is needed to tease apart the roles of concept mapping, group activity, and feedback in altering pharmacy students’ quiz performance and metacognitive skills.     

A Training Program for Pharmacy Students on Providing Diabetes Care

Objective. To compare second- and third-year pharmacy students’ competence, attitudes, and self-confidence in providing diabetes care before and after completing a hand-on diabetes training program and to determine if the program had an impact on students’ attitude and self-confidence based on their year in the curriculum.Design. The program included classroom lectures and hands-on learning sessions in 5 facets of diabetes care. Pre- and post-test instruments measured students’ competence, attitudes, and confidence in diabetes care.Assessment. Students’ competence and the mean overall confidence score significantly improved after completing the program, while mean overall attitude score did not. Third-year students had significantly higher confidence scores than did second-year students on both pre- and post-program tests. No significant difference was found for attitude scores between second- and third-year students.Conclusion. The hands-on learning program was an effective approach to training pharmacy students in diabetes care, improving both their competence and confidence.     

Evaluation of an Injection Training and Certification Program for Pharmacy Students

Objective. To evaluate an injection training and certification program for third-year (P3) pharmacy students, and to measure the impact of students’ administration of immunizations at an influenza clinic on their knowledge, skills, and competence in immunization.Design. A repeated measures design was used to assess students’ injection skills across the injection training and certification program and the influenza clinic. A repeated measures design was also used to evaluate students’ self-reported knowledge, experience, and confidence.Assessment. Postcertification and during influenza clinic comparisons showed significant improvement in students’ knowledge, experience, and confidence after taking part in the influenza clinic. University staff members and students indicated in a survey that they were satisfied with the clinic services provided by pharmacy students.Conclusion. The injection training and certification program and the university influenza clinic were effective in enhancing and fostering student skills development.     

Design and Implementation of a Laboratory-Based Drug Design and Synthesis Advanced Pharmacy Practice Experience

Objective. To provide students with an opportunity to participate in medicinal chemistry research within the doctor of pharmacy (PharmD) curriculum.Design. We designed and implemented a 3-course sequence in drug design or drug synthesis for pharmacy students consisting of a 1-month advanced elective followed by two 1-month research advanced pharmacy practice experiences (APPEs). To maximize student involvement, this 3-course sequence was offered to third-year and fourth-year students twice per calendar year.Assessment. Students were evaluated based on their commitment to the project’s success, productivity, and professionalism. Students also evaluated the course sequence using a 14-item course evaluation rubric. Student feedback was overwhelmingly positive. Students found the experience to be a valuable component of their pharmacy curriculum.Conclusion. We successfully designed and implemented a 3-course research sequence that allows PharmD students in the traditional 4-year program to participate in drug design and synthesis research. Students report the sequence enhanced their critical-thinking and problem-solving skills and helped them develop as independent learners. Based on the success achieved with this sequence, efforts are underway to develop research APPEs in other areas of the pharmaceutical sciences.     

Using Best-Worst Choice Methodology in a Survey of Pharmacists Regarding Pharmacy Practice Skills Teaching

Objective. To conduct a survey of practicing pharmacists in which best-worst choice methodology was used to prioritize pharmacy practice skills for inclusion in a pharmacy curriculum in New Zealand.Methods. A literature search and review of pharmacy curricula were conducted, and the findings were used to develop a best-worst choice survey instrument regarding inclusion of pharmacy practice skills in the pharmacy curriculum. The survey was sent to registered pharmacists and intern pharmacists in New Zealand. Participants were asked to prioritize 16 skills in terms of their importance and relevance to pharmacy practice.Results. Of the 3836 pharmacists invited to participate in the survey, 388 completed the questionnaire. Comprehensive chronic disease management, specialty medications, and medicines use review were the top three prioritized skills. Injections, independent prescribing, and specialty compounding were the skills ranked as having the lowest priority. The pharmacists’ gender, age, practice setting, and ethnicity all influenced their skill prioritization. The pharmacists emphasized skills required in their current practice but deemphasized some skills that were emerging professional responsibilities.Conclusion. If curricular reform is to include new skills that are largely unfamiliar to or deemed unimportant by practicing pharmacists, quality assurance of students’ experiential education will be needed. Furthermore, preceptor education about changing expectations for pharmacy graduates’ skill sets must be adequately developed and implemented to ensure that preceptors provide students with opportunities to practice the full range of skills they will need in practice and provide them with accurate assessment and helpful feedback.     

A Three-Year Reflective Writing Program as Part of Introductory Pharmacy Practice Experiences

Objectives. To implement and evaluate a 3-year reflective writing program incorporated into introductory pharmacy practice experiences (IPPEs) in the first- through third-year of a doctor of pharmacy (PharmD) program.Design. Reflective writing was integrated into 6 IPPE courses to develop students’ lifelong learning skills. In their writing, students were required to self-assess their performance in patient care activities, identify and describe how they would incorporate learning opportunities, and then evaluate their progress. Practitioners, faculty members, and fourth-year PharmD students served as writing preceptors.Assessment. The success of the writing program was assessed by reviewing class performance and surveying writing preceptor’s opinions regarding the student’s achievement of program objectives. Class pass rates averaged greater than 99% over the 8 years of the program and the large majority of the writing preceptors reported that student learning objectives were met. A support pool of 99 writing preceptors was created.Conclusions. A 3-year reflective writing program improved pharmacy students’ reflection and reflective writing skills.     

Multiple Interprofessional Education Activities Delivered Longitudinally Within a Required Clinical Assessment Course

Objective. To determine if the incorporation of multiple interprofessional educational (IPE) activities delivered as a longitudinal curriculum within a required clinical assessment course changed pharmacy students’ perceptions regarding interprofessional collaboration.Design. Seventy-one third-year pharmacy students participated in Clinical Assessment, a required applications-based course with a laboratory component. Nine separate IPE activities were embedded into the course longitudinally over the semester using various active-learning strategies and simulated patients. The IPE activities required student participation from medical, nursing, and physician assistant students.Assessment. Pharmacy students completed an 18-item validated survey instrument, the Interdisciplinary Education Perception Scale (IEPS), on the first (pre-survey) and last (post-survey) day of the course. After completing the course, scores improved on 16 of 18 survey items that measured pharmacy students’ perceptions of interprofessional collaboration.Conclusion. Incorporating multiple IPE activities longitudinally into a required clinical assessment course significantly changed pharmacy students’ perceptions of interprofessional collaboration.     

A Peer-Teaching Model to Reinforce Pharmacy Students’ Clinical Knowledge of Commonly Prescribed Medications

Objective. To implement and assess the effectiveness of a peer teaching series to increase third year Doctor of Pharmacy (PharmD) students’ knowledge of and confidence regarding commonly prescribed medications.Methods. All third-year pharmacy students (n=98) at a college of pharmacy were encouraged to participate in the RxReady peer teaching series prior to beginning their advanced pharmacy practice experiences. Each student in the class was assigned a drug to learn in-depth. Twenty-four of the students were randomly selected to provide peer teaching regarding a single medication. These students were required to meet with a faculty member to prepare for their presentation. Assessment methods included completion of pre- and post-intervention quizzes and anonymous surveys regarding the peer-teaching modality. Students also provided qualitative feedback on the series as part of a course survey.Results. Among the 96 students who completed the pre- and post-intervention quizzes, there was a mean increase of 15% (SD=11%) on the post-intervention quiz score compared to the pre-intervention quiz score. Ninety-two (96%) students achieved a higher score on the post-intervention quiz. There was no difference in mean percent change in scores between the pre-and post-intervention quiz for students who presented in class compared with students who did not present (17% [SD=10%] vs 15% [SD=11%], respectively). Student-reported confidence significantly improved across all drug knowledge categories. In each category, the median confidence score increased from 2 (somewhat confident) to 3 (moderately confident). The students’ qualitative feedback was generally positive, and they provided suggestions to improve the content and design of the RxReady peer teaching series.Conclusion. A peer teaching approach to reviewing drug information can assist in targeting gaps in PharmD students’ drug knowledge and help to build their confidence in their readiness to begin APPEs.     

A Pharmacotherapy Capstone Course to Advance Pharmacy Students�� Clinical Documentation Skills

Objective. To implement and assess the effectiveness of a capstone pharmacotherapy course designed to integrate in-class curriculum using patient cases and drug-information questions. The course was intended to improve third-year doctor of pharmacy (PharmD) students'' clinical documentation skills in preparation for beginning advanced pharmacy practice experiences (APPEs). Design. This 2-credit, semester-long course consisted of 6 patient cases and 12 drug-information questions posted electronically on an Internet-based medical chart, a public health presentation, a knowledge examination, and an objective standardized performance assessment. In class, students engaged in active-learning exercises and clinical problem-solving. Students worked outside of class in small groups to retrieve and discuss assigned articles and review medication information in preparation for in-class discussions.Assessment. A rubric was used to assess the patient cases and questions that students completed and submitted individually. Data for 4 consecutive course offerings (n=622) were then analyzed. A significant improvement was found in the “misplaced” but not the “missing” documentation ratings for both assessment and plan notes in the final assessment compared with baseline. In course evaluations, the majority of students agreed that the course integrated material across the curriculum (97%) and improved their clinical writing skills (80.5%).Conclusion. A capstone pharmacy course was successful in integrating and reviewing much of the material covered across the PharmD curriculum and in improving students’ clinical documentation skills.     

Training Malaysian Pharmacy Undergraduates with Knowledge and Skills on Smoking Cessation

Objective. To evaluate the feasibility of an online training module, Certified Smoking Cessation Service Provider (CSCSP), developed for practicing pharmacists to equip pharmacy students with knowledge necessary for smoking cessation counseling and to assess the changes in student knowledge and skills regarding smoking cessation following training.Design. Sixty third-year and 80 fourth-year pharmacy undergraduates (N=140) were given access to an online module, the main intervention in the study. Two linkable questionnaires were administered to assess students’ preintervention and postintervention knowledge. For the third-year students, an additional role-play training component was incorporated, and student skills were assessed during week 14 with an Objective Structured Clinical Examination (OSCE).Assessment. Preintervention and postintervention knowledge assessments were completed by 130 (92.8%) students. Sixty-six students scored above 50% for the knowledge component postintervention, compared to 13 at preintervention, demonstrating significant improvement (x2(1, N=130)=32, p=0.003). All third-year students completed the intervention, and 66.7% were able to counsel excellently for smoking cessation, scoring more than 80%.Conclusion. The CSCSP online module developed for practicing professionals was found suitable for equipping pharmacy undergraduates with knowledge on smoking cessation topics. The module, along with role-play training, also equipped students with knowledge and skills to provide smoking cessation counseling.     

Pharmacy Student Self-Perception of Weight and Relationship to Counseling Patients on Lifestyle Modification

Objective. To assess the accuracy of pharmacy students’ self-assessment of body mass index (BMI) and determine the relationship of this to comfort level in counseling patients regarding lifestyle modification.Methods. A prospective, observational, cohort study was conducted that included first-, second-, and third-year pharmacy students who had previously undergone training in BMI self-assessment. Data on students’ weight and height were collected and a survey that contained questions on self-perception of body weight and comfort with lifestyle counseling was conducted. Perceived BMI categories (underweight, normal, overweight, and obese) were then compared to actual calculated BMI to determine the accuracy of the student’s self-perception.Results. At baseline, participants’ accuracy in self-assessment of BMI was 74%, 73.3%, and 75.6% respectively, for first-, second-, and third-year students (p=0.911). Students accuracy increased but not significantly as they progressed through the curriculum (7.2% and 13.3%, respectively; p=0.470 and p=0.209). Neither accuracy in self-assessment of BMI nor students’ actual BMI significantly affected students’ comfort level with lifestyle modification counseling within healthy weight, overweight, or obese patient categories. However, as the patients’ BMI category increased, comfort level differences were observed among students of normal and overweight categories.Conclusion. Patients’ BMI category may be a significant barrier to pharmacy students’ comfort level in providing lifestyle modification counseling. This finding suggests the need to implement curriculum changes to better prepare students for lifestyle modification counseling.     

Pharmacy Student Perceptions and Preferences of In-person Versus Video-Recorded Evaluations in Skills-Based Courses

Objective. To determine pharmacy students’ preferences for and perceptions of in-person and video evaluations.Methods. A mixed methods survey was administered to 447 first-, second-, and third-year students enrolled in a public US Doctor of Pharmacy program. A survey instrument with 14 quantitative items and four qualitative items was used to measure student perceptions. Eight response choice items measured preferences. Paired t tests were used to compare students’ perceptions. Independent t tests were used to compare perceptions between students who experienced and had not experienced video evaluations. Two researchers performed thematic content analysis of the qualitative responses.Results. Students (n=444, 99.3% response rate) perceived in-person evaluations more positively for all items except nervousness. Students who experienced video technology felt significantly more positive about video evaluations than students who had little or no experience using video technology on nine items. The students who experienced video technology felt significantly less positive toward video evaluations in terms of quality (1.24 vs. 0.83) and amount (1.14 vs 0.77) of written feedback. Although students valued the interaction with a larger, more diverse pool of evaluators that was made possible by video evaluations, they did not view video technology as applicable to their future practice.Conclusion. Students viewed in-person evaluations significantly more positively than video evaluations. This effect was mitigated by greater exposure to video technology, suggesting that concerns regarding video evaluations are based on conjecture rather than experience. This study highlights the need to reduce the technological issues associated with video evaluations and improve the written feedback provided to students.     

Methods for Optimizing Student Pharmacist Learning of Clinical Note Writing

Objective. To investigate the effectiveness of using problem-solving and worked examples in teaching clinical note writing to Doctor of Pharmacy students.Methods. First year student pharmacists who were recruited to participate in the study first studied a worked example on generating a clinical note from a written patient case. Participants were then randomized either to study another worked example or to practice writing a clinical note from a written patient case. Embedded in each condition was problem variability (ie, participants encountered either a similar disease state as that in the initial worked example or a different disease state). The primary outcome was the combined performance on writing two clinical notes. Secondary outcomes included quiz performance on knowledge of the components of a clinical note and ability to transfer writing skills to a novel disease state.Results. Seventy-nine students completed the study. Participants who studied a worked example followed by problem-solving (WE-PS) practice performed better than participants who studied two worked examples (WE-WE) on clinical note writing. However, there was no difference in their respective knowledge as determined by quiz performance.Conclusion. Both worked examples and problem-solving facilitated students’ learning of the basic knowledge of clinical note writing. However, only problem-solving improved student pharmacists’ ability to apply that knowledge. While there were significant improvements in student pharmacists’ knowledge of the basics of clinical note writing, it is unclear how worked examples or problem-solving influence the clinical decision-making skills needed to write a clinical note.     

A diabetes self-management education class taught by pharmacy students

Objective. To assess the impact of pharmacy students teaching a diabetes self-management education (DSME) class on their competence and confidence in providing diabetes education.Design. Pharmacy students enrolled in a service-learning elective first observed pharmacy faculty members teaching a DSME class and then 4 weeks later organized and taught a DSME class to a different group of patients at a student-run free medical clinic.Assessment. Student performance as assessed by faculty members using a rubric was above average, with a mean score of 3.3 on a 4.0 scale. Overall, student confidence after teaching the group DSME class was significantly higher than before teaching the class.Conclusion. Organizing and teaching a DSME class improved third-year pharmacy students’ confidence and diabetes knowledge and skills, as well as provided a valuable service to patients at a free medical clinic.     

Pharmacy Students’ Ability to Identify Plagiarism After an Educational Intervention

Objective. To determine if an educational intervention in a doctor of pharmacy (PharmD) degree program increases pharmacy students’ ability to identify plagiarism.Methods. First-year (P1), second-year (P2), and third-year (P3) pharmacy students attended an education session during which types of plagiarism and methods for avoiding plagiarism were reviewed. Students completed a preintervention assessment immediately prior to the session and a postintervention assessment the following semester to measure their ability.Results. Two hundred fifty-two students completed both preintervention and postintervention assessments. There was a 4% increase from preintervention to postintervention in assessment scores for the overall student sample (p<0.05). The mean change was greatest for P1 and P2 students (5% and 4.8%, respectively).Conclusion. An educational intervention about plagiarism can significantly improve students’ ability to identify plagiarism.     

Pharmacy Students’ Perceptions and Performance on the Use of an Online Virtual Experience Tool for Practicing Objective Structured Clinical Examinations

Objective. To examine pharmacy students’ performance on and perceptions regarding the use of an interactive online tool for practicing to take objective structured clinical examinations (OSCEs).Methods. The Monash OSCE Virtual Experience (MOVE), an online module consisting of 20 pharmacy case scenarios with virtual patients, was piloted with final-year pharmacy students at Monash University campuses in Australia and Malaysia. A mixed methods approach that included reviewing user attempts and comparing grades, collecting student-administered questionnaires, and holding focus groups was used to examine students’ perception and performance.Results. More than 99% of all students attempted at least one online case scenario in preparation for their final in-person OSCE, and 81% attempted all 20 scenarios two or more times. Ninety percent of students at the Malaysia campus and 70% of students at the Australia campus reported that MOVE was a helpful study tool for their OSCE preparation. However, a raw comparison of user attempts and OSCE grades did not find a direct correlation between online module attempts and assessment grades. Self-administered questionnaire and focus group results indicated that MOVE prepared students for targeted and time-restricted history-taking and problem-solving skills. Overall, students perceived MOVE to be a useful learning tool and a less overwhelming learning experience than were face-to-face sessions. Nevertheless, students still preferred face-to-face OSCE practice with simulated patients over online practice with virtual patients.Conclusion. The Monash OSCE Virtual Experience was perceived by our students as a flexible and useful online learning aid in preparing for their final-year OSCE However, there was no direct correlation between online practice attempts and students’ exam grades.