Team-Based Learning to Improve Learning Outcomes in a Therapeutics Course Sequence

Objective. To compare the effectiveness of team-based learning (TBL) to that of traditional lectures on learning outcomes in a therapeutics course sequence.Design. A revised TBL curriculum was implemented in a therapeutic course sequence. Multiple choice and essay questions identical to those used to test third-year students (P3) taught using a traditional lecture format were administered to the second-year pharmacy students (P2) taught using the new TBL format.Assessment. One hundred thirty-one multiple-choice questions were evaluated; 79 tested recall of knowledge and 52 tested higher level, application of knowledge. For the recall questions, students taught through traditional lectures scored significantly higher compared to the TBL students (88%±12% vs 82%±16%, p=0.01). For the questions assessing application of knowledge, no differences were seen between teaching pedagogies (81%±16% vs 77%±20%, p=0.24). Scores on essay questions and the number of students who achieved 100% were also similar between groups.Conclusion. Transition to a TBL format from a traditional lecture-based pedagogy allowed P2 students to perform at a similar level as students with an additional year of pharmacy education on application of knowledge type questions. However, P3 students outperformed P2 students regarding recall type questions and overall. Further assessment of long-term learning outcomes is needed to determine if TBL produces more persistent learning and improved application in clinical settings.     

Pharmacy Students’ Perception of an Elective Course on Evidence-based Learning Strategies

Objective. To examine pharmacy students’ perceptions of an elective course on evidence-based learning strategies.Methods. Pre- and post-course survey questionnaires were administered to students who enrolled in an elective course, to determine the learning strategies they used prior to course attendance, track their use of evidence-based learning strategies and observance of healthy lifestyle habits, and assess their perception of the course. A written assignment was given that required students to reflect on the learning outcomes that resulted from their application of evidence-based learning strategies. Mean scores on the pre- and post-course survey were analyzed using a general linear model repeated measures test.Results. The 59 students in this study predominantly used less-effective strategies (eg, re-reading and re-writing of notes) prior to taking the course. They reported increased use of evidence-based learning strategies, particularly retrieval practice and elaboration, and practice of healthy lifestyle habits (ie, enough sleep, exercise, good nutrition) after course completion. Students believed that using the above learning strategies improved their learning and memory and performance on graded assessments, among other benefits. Students had a positive perception of the course.Conclusion. The elective course was associated with increased use of effective learning strategies, adoption of healthy lifestyle practices that aid learning, and increased appreciation for evidence-based learning strategies by the students. Future studies are needed to examine actual learning outcomes and barriers to implementation of evidence-based learning techniques.     

A Global Health Elective Course in a PharmD Curriculum

Objective. To describe the design, development, and the first 4 implementations of a Global Health elective course intended to prepare pharmacy students pursue global health careers and to evaluate student perceptions of the instructional techniques used and of skills developed during the course.Design. Following the blended curriculum model used at Touro College of Pharmacy, the Global Health course combined team-based learning (TBL) sessions in class, out-of-class team projects, and online self-directed learning with classroom teaching and discussion sessions.Assessment. Student performance was assessed with TBL sessions, team projects, and class presentations, online quizzes, and final examinations. A precourse and postcourse survey showed improvement in global health knowledge and attitudes, and in the perception of pharmacists’ role and career opportunities in global health. Significant improvement in skills applicable to global health work was reported and students rated highly the instructional techniques, value, and relevance of the course.Conclusion. The Global Health elective course is on track to achieve its intended goal of equipping pharmacy students with the requisite knowledge and applicable skills to pursue global health careers and opportunities. After taking this course, students have gone on to pursue global field experiences.     

An Elective Course on Postgraduate Residency Training

Objective. To develop, implement, and assess the impact of an elective course for pharmacy students on postgraduate pharmacy residency training.Design. An elective course on residency training was developed using short lectures, group discussions, and active-learning strategies, such as small-group exercises, mock match, and mock interview.Assessment. Students were asked to self-assess their understanding and abilities related to residency training at the beginning and end of the semester based on course objectives. The median post-semester responses increased for all objectives compared to baseline (p<0.05).Conclusion. A residency elective using a variety of teaching methods increased student knowledge and confidence in their skills regarding residency training.     

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.     

Comparing Effectiveness of High-Fidelity Human Patient Simulation vs Case-Based Learning in Pharmacy Education

Objective. To determine whether human patient simulation (HPS) is superior to case-based learning (CBL) in teaching diabetic ketoacidosis (DKA) and thyroid storm (TS) to pharmacy students.Design. In this cross-over, open-label, single center, randomized control trial, final-year undergraduate pharmacy students enrolled in an applied therapeutics course were randomized to HPS or CBL groups. Pretest, posttest, knowledge retention tests, and satisfaction survey were administered to students.Assessment. One hundred seventy-four students participated in this study. The effect sizes attributable to HPS were larger than CBL in both cases. HPS groups performed significantly better in posttest and knowledge retention test compared to CBL groups pertaining to TS case (p<0.05). Students expressed high levels of satisfaction with HPS sessions.Conclusion. HPS was superior to CBL in teaching DKA and TS to final-year undergraduate pharmacy students.     

Incorporating Active-Learning Techniques and Competency Assessment into a Critical Care Elective Course

Objective. To design, implement, and measure the effectiveness of a critical care elective course for second-year students in a 3-year accelerated doctor of pharmacy (PharmD) program.Design. A critical care elective course was developed that used active-learning techniques, including cooperative learning and group presentations, to deliver content on critical care topics. Group presentations had to include a disease state overview, practice guidelines, and clinical recommendations, and were evaluated by course faculty members and peers.Assessment. Students’ mean scores on a 20-question critical-care competency assessment administered before and after the course improved by 11% (p < 0.05). Course evaluations and comments were positive.Conclusion. A critical care elective course resulted in significantly improved competency in critical care and was well-received by students.     

An Elective Course on Landmark Trials to Improve Pharmacy Students' Literature Evaluation and Therapeutic Application Skills

Objectives

To determine the impact of a landmark trials elective course on pharmacy students'' attitudes toward evidence-based medicine, students'' comfort with technical concepts used in drug literature, and students'' perceptions of accessibility of PubMed from home computers.

Design

An elective course which gave third-year pharmacy students the opportunity to discuss landmark trials in primary care and reinforced skills in applying evidence from the primary literature to support therapeutic recommendations was design and implemented. The impact of the course was evaluated via a pre- and postcourse questionnaire administered during 3 consecutive course offerings.

Assessment

Overall, students had positive attitudes toward evidence-based medicine before taking the course (97.5% positive or somewhat positive) and these attitudes were unchanged postcourse (p = 0.74). Though 97.6% (n = 40) of students had Internet access at home, only 68.3% (n = 28) indicated having PubMed access at home. The course increased self-assessed comfort with technical concepts used in literature evaluation including random assignment (p < 0.01), placebo-controlled (p < 0.01), and intention-to-treat (p = 0.02).

Conclusion

An elective course on landmark trials allowed third-year pharmacy students to increase their comfort level with literature evaluation and reinforced their positive attitudes toward the use of evidence-based medicine in pharmacy practice.     

Performance of Pharmacy Students in a Communications Course Delivered Online During the COVID-19 Pandemic

Objective. To examine pharmacy student readiness, reception, and performance in a communications course during the COVID-19 pandemic and to compare that with the performance of students who completed the same course in person the previous year.Methods. First-year Doctor of Pharmacy students (2020 cohort) enrolled in a professional communications course completed pre- and post-course surveys regarding their readiness for and changes in perception of online learning. Student learning was assessed using midterm and final examination grades. These grades were then compared with those of students who had completed the same course in person (on campus) the previous year (2019 cohort).Results. Students’ preference for face-to-face instruction decreased from the pre-course to the post-course survey as indicated by responses made using a five-point Likert-scale (difference in means = −1.59; p < .05). Their comfort level with online learning increased (difference in means = +0.38, p < .05) by the end of the course. Students did not perceive any appreciable changes in rapport with the instructor by the end of the study. Course performance of students in the online cohort did not differ significantly from that of the 2019 cohort (p>.05).Conclusion. This study demonstrated that first year PharmD students were already somewhat prepared for online learning when they began a communication course, with further adjustment occurring as the quarter progressed. Remote online learning did not seem to impact pharmacy student learning in this communications course conducted during the COVID-19 crisis.     

The Impact of Problem-Solving Feedback on Team-Based Learning Case Responses

Objective. To determine the amount and type of feedback needed to improve pharmacy students’ problem-solving skills using team-based learning (TBL) and a problem-solving rubric.Methods. A problem-solving rubric was developed to assess the ability of pharmacy students’ to prioritize, organize, and defend the best and alternative options on TBL cases The study involved 3 groups of pharmacy students: second-year students in a cardiology class who received no feedback (control group), third-year students in an endocrinology class who received written feedback only, and third-year students in an endocrinology class who received written and verbal feedback. Students worked in groups on all TBL cases except the first and last one (beginning and end of course), which students completed independently as it served as a pretest and posttest.Results. Significant improvements were seen in the ability of the third-year students who received verbal and written feedback to prioritize the information presented in the case and in their total score on the problem-solving rubric.Conclusion. Providing pharmacy students with written and verbal explanations may help them improve their problem-solving skills overall. During verbal feedback, faculty members can provide more examples of how to improve and can field questions if needed.     

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.     

Use of Virtual Patients in an Advanced Therapeutics Pharmacy Course to Promote Active,Patient-Centered Learning

Objective. To assess student satisfaction and learning of course objectives following the integration of virtual patient cases designed to promote active, patient-centered learning in an advanced therapeutics pharmacy course.Design. A dynamic virtual patient platform that incorporated a branched-narrative, decision-making teaching model was used in an advanced therapeutics course to supplement lecture content.Assessment. Presimulation and postsimulation tests were used to assess student learning. The use of virtual patients significantly enhanced student learning for both higher- and lower-level test questions (p<0.001 and p=0.01, respectively). Students agreed or strongly agreed that the virtual patient cases provided an effective way to learn (72%), were enjoyable (69%), and were appropriate in content (80%), and that more should be incorporated (59%).Conclusion. The use of virtual patients in an advanced therapeutics practicum effectively promoted active, patient-centered learning; engaged students in an interactive and dynamic educational technology; encouraged teamwork; enhanced higher-level student learning; and improved student satisfaction in the course.     

Self-Efficacy and Self-Esteem in Third-Year Pharmacy Students

Objective. To identify the experiential and demographic factors affecting the self-efficacy and self-esteem of third-year pharmacy (P3) students.Methods. A 25-item survey that included the Rosenberg Self-Esteem Scale and the General Self-Efficacy Scale, as well as types and length of pharmacy practice experiences and demographic information was administered to doctor of pharmacy (PharmD) students from 5 schools of pharmacy in New England at the completion of their P3 year.Results. The survey response rate was approximately 50% of the total target population (399/820). Students with a grade point average (GPA)≥3.0 demonstrated a higher significant effect from unpaid introductory pharmacy practice experiences (IPPEs) on their self-efficacy scores (p<0.05) compared to students with lower GPAs. Students who had completed more than the required amount of pharmacy experiences had higher levels of self-efficacy and self-esteem (p<0.05). Ethnicity also was related to students’ levels of self-efficacy and self-esteem.Conclusion. Self-efficacy and self-esteem are two important factors in pharmacy practice. Colleges and schools of pharmacy should ensure that students complete enough practice experiences, beyond the minimum of 300 IPPE hours, as one way to improve their self-efficacy and self-esteem.     

Implementation of an Accelerated Physical Examination Course in a Doctor of Pharmacy Program

Objective. To describe the implementation of a 1-day accelerated physical examination course for a doctor of pharmacy program and to evaluate pharmacy students’ knowledge, attitudes, and confidence in performing physical examination.Design. Using a flipped teaching approach, course coordinators collaborated with a physician faculty member to design and develop the objectives of the course. Knowledge, attitude, and confidence survey questions were administered before and after the practical laboratory.Assessment. Following the practical laboratory, knowledge improved by 8.3% (p<0.0001). Students’ perceived ability and confidence to perform a physical examination significantly improved (p<0.0001). A majority of students responded that reviewing the training video (81.3%) and reading material (67.4%) prior to the practical laboratory was helpful in learning the physical examination.Conclusion. An accelerated physical examination course using a flipped teaching approach was successful in improving students’ knowledge of, attitudes about, and confidence in using physical examination skills in pharmacy practice.     

An elective course on lifestyle modifications in pharmacotherapy

Objectives

Develop and implement a pharmacy course explaining basic lifestyle modification components and assess changes in student knowledge, skills, beliefs, and confidence after completing the course.

Design

A 2-credit hour elective course was offered to pharmacy students in which basic lifestyle modification components were applied to case-based patients with hypertension, dyslipidemia, diabetes mellitus, obesity, and metabolic syndrome in the pharmacy practice setting through comprehensive wellness programs. Knowledge, skills, beliefs, and confidence assessments were embedded into the course.

Assessment

There were significant improvements in students'' skills and confidence, and in most knowledge areas, but not in their beliefs regarding health behaviors.

Conclusion

Implementing an elective course on lifestyle modifications is an effective means of teaching students about wellness and disease prevention.     

An Elective Course in Aromatherapy Science

Objective. To evaluate the impact of an innovative team-taught elective course on second-year (P2) students’ knowledge and skills relating to the relationship between aromatherapy and pharmacy.Design. An Aromatherapy Science elective course was offered to P2 students in an accelerated doctor of pharmacy (PharmD) degree program and was designed to provide an elective course experience while focusing on active-learning skills such as group work, student-led presentations, and in-class activities. Lectures were designed to reinforce core curricular threads from the basic sciences within the pharmaceutical sciences department while highlighting key aromatherapy principles.Assessment. Course evaluations, grades, and student self-assessments were used to evaluate student fulfillment and knowledge gained. Students agreed this hands-on course integrated pharmaceutical science experiences, enriched their pharmacy education, and provided knowledge to enhance their confidence in describing essential oil uses, drug interactions, and key aromatherapy clinical implications.Conclusion. Students agreed this course prepared them to identify essential oil therapeutic uses and potential essential oil-drug interactions, and interpret literature. The introduction of aromatherapy principles to pharmacy students will prepare a new generation of healthcare professionals on the role of alternative medicines.     

Active-Learning Instruction on Emergency Contraception Counseling

Objective. To increase pharmacy students’ knowledge of and confidence in counseling patients regarding emergency contraception and to identify any barriers to counseling patients about emergency contraception.Design. Approximately 200 third-year pharmacy students participated in the Women’s Health Therapeutics workshop at Midwestern University Chicago College of Pharmacy. Students observed a 5-minute skit of a counseling session on emergency contraception and then were asked to pair up with a classmate and practice counseling each other regarding the use of emergency contraception following a checklist of key points.Assessment. One hundred eighty-nine students completed pre- and post-workshop survey instruments. Students’ knowledge scores increased from 86% to 93% (p<0.001). Approximately 25% of the students stated they were confident in counseling patients on emergency contraception before completing the active-learning exercise compared to 58.5% after (p<0.001). The most common barrier to counseling that students identified on the pre- and post-workshop survey was lack of knowledge.Conclusion. Participation in an active-learning exercise significantly increased pharmacy students’ knowledge of and confidence in counseling patients regarding emergency contraception and significantly reduced several barriers to counseling identified prior to participation.     

Impact of Student- Versus Instructor-Directed Case Discussions on Student Performance in a Pharmacotherapy Capstone Course

Objective. To evaluate the impact of incorporating student-directed (SD) vs instructor-directed (ID) active learning on student performance in a pharmacotherapy capstone course.Design. This 9-credit course was redesigned from exclusively ID case discussions to a format in which half were SD and half were ID. Student performance on evaluation questions derived from SD sessions was compared with that from ID sessions.Assessment. Overall, students (n=299) performed better on ID-session questions than on SD-session questions (78.7% vs 75.3%, correctly answered, respectively; p<0.001). For written evaluations, students performed better on ID-session questions than on SD-session questions (79.8% vs 73.9%, respectively; p<0.001). For verbal evaluations, students performed better on SD-session questions than on ID-session questions (79.5% vs 74.5%, respectively; p<0.001). After the course revision, student confidence regarding their ability to think critically, solve problems, make decisions, and pursue lifelong learning was high, and student and faculty feedback was positive.Conclusion. Student performance in a pharmacotherapy capstone course remained acceptable when a combination of SD and ID active learning was used, but the addition of SD learning did not translate to better performance on course evaluations.