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.     

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.     

Incremental Development of an Integrated Assessment Method for the Professional Curriculum

Objective. To incrementally create and embed biannual integrated knowledge and skills examinations into final examinations of the pharmacy practice courses offered in the first 3 years of the pharmacy curriculum that would account for 10% of each course’s final course grade.Design. An ad hoc integrated examination committee was formed and tasked with addressing 4 key questions. Integrated examination committees for the first, second, and third years of the curriculum were established and tasked with identifying the most pertinent skills and knowledge-based content from each required course in the curriculum, developing measurable objectives addressing the pertinent content, and creating or revising multiple-choice and performance-based questions derived from integrated examination objectives. An Integrated Examination Review Committee evaluated all test questions, objectives, and student performance on each question, and revised the objectives and questions as needed for the following year’s iteration. Eight performance objectives for the examinations were measured.Assessment. All 8 performance objectives were achieved. Sixty-four percent of the college’s faculty members participated in the integrated examination process, improving the quality of the examination. The incremental development and implementation of the examinations over a 3-year period minimized the burden on faculty time while engaging them in the process. Student understanding of expectations for knowledge and skill retention in the curriculum also improved.Conclusions. Development of biannual integrated examinations in the first 3 years of the classroom curriculum enhanced the college’s culture of assessment and addressed accreditation guidelines for formative and summative assessment of students’ knowledge and skills. The course will continue to be refined each year.     

Pharmacy Students’ Ability to Think About Thinking

Objective. To investigate students’ metacognitive skills to distinguish what they know from what they do not know, to assess students’ prediction of performance on a summative examination, and to compare student-identified incorrect questions with actual examination performance in order to improve exam quality.Methods. Students completed a test-taking questionnaire identifying items perceived to be incorrect and rating their test-taking ability.Results. Higher performing students evidenced better metacognitive skills by more accurately identifying incorrect items on the exam. Most students (86%) underpredicted their performance on the summative examination (actual=73.6 ± 7.1 versus predicted=63.7 ± 10.5, p<0.05). Student responses helped refine items and resulted in examination changes.Conclusion. Metacognition is important to the development of life-long learning in pharmacy students. Students able to monitor what they know and what they do not know can improve their performance.     

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.     

Resilience and First-Year Pharmacy Students’ Academic Performance in a Pharmacy Math Course

Objective. The purpose of this study was to examine the relationship between academic resilience and academic success in Doctor of Pharmacy (PharmD) students.Methods. A cross-sectional survey using the Academic Pharmacy Resilience Scale (APRS-16) was conducted in two cohorts of first year pharmacy (P1) students (n = 374) during fall orientation in 2019 and 2020. The following data were also collected from student records: demographics, pre-pharmacy grade point average (GPA), Pharmacy Math outcome (passing or failing the course), and Pharmacy Math final numerical grade. Academic success was defined as achieving a passing grade in a Pharmacy Math course. Correlational, multiple logistic regression, and multiple linear regression analysis were conducted.Results. The survey response rate was 98.1%, and approximately 95% of participants passed Pharmacy Math. No significant correlations were found between Pharmacy Math final pass/fail outcome or Pharmacy Math final numerical grade and APRS-16 overall and subscale scores. In multiple logistic regression, neither pre-pharmacy GPA nor APRS overall scale or subscale scores were significantly associated with final Pharmacy Math outcome (passing/failing). In multiple linear regression, pre-pharmacy GPA was significantly associated with Pharmacy Math final numerical grade, but APRS-16 overall score and subscale scores were not.Conclusion. First-year pharmacy students’ performance in Pharmacy Math was not influenced by academic resilience. Studies like this one examining the relationship between pharmacy students’ resilience and academic performance are lacking. Future studies should assess whether academic resilience may affect performance in other courses as well as performance in the PharmD curriculum.     

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.     

Student Knowledge and Confidence in an Elective Clinical Toxicology Course Using Active-Learning Techniques

Objective. To measure changes in students’ knowledge and confidence scores after completing an elective clinical toxicology course in an accelerated doctor of pharmacy (PharmD) program.Design. Various active-learning techniques were used to create a learner-centered environment. Approximately two-thirds of the course used student-led presentations. Some of those not presenting were assigned to be evaluators, responsible for asking the presenter a question or writing quiz questions based on the presented material. Other learner-centered activities included weekly quizzes and discussions at the conclusion of each presented topic.Assessment. A test instrument designed to measure students’ knowledge and associated level of confidence on each item was administered at the beginning and end of the course. Students’ knowledge and confidence scores increased significantly from pretest to posttest.Conclusions. Students’ increased confidence and knowledge scores were well correlated after course completion, indicating students were better able to self-assess these areas. These findings suggest that confidence could be an additional measure of students'' metacognitive skill development.     

Does self-reflection and peer-assessment improve Saudi pharmacy students’ academic performance and metacognitive skills?

Background: The patient-centered focus of clinical pharmacy practice which demands nuanced application of specialized knowledge and skills targeted to meeting patient-specific therapeutic needs warrant that the training strategy used for PharmD graduates must empower with the ability to use the higher level cognitive processes and critical thinking effectively in service delivery. However, the historical disposition to learning in the Middle East and among Saudi students appeared heavily focused on rote memorization and recall of memorized facts. Objectives: To assess the impact of active pedagogic strategies such as self-reflection and peer assessment on pharmacy students’ academic performance and metacognitive skills, and evaluate students’ feedback on the impact of these active pedagogic strategies on their overall learning experience. Method: An exploratory prospective cohort study was conducted among 4th year students at the College of Clinical Pharmacy, King Faisal University, Saudi Arabia to assess the impact of self-reflection and peer-assessment in a semester-wide assessment tasks in two compulsory first semester 4th year courses (Therapeutics-3 and Pharmacoeconomics). An end-of-course evaluation survey with a pre-tested 5-item open-ended questionnaire was also conducted to evaluate students’ feedback on the impact of active pedagogic strategies on their overall learning experience. Result: Male students (study group) constituted 40.7% of the cohort while 59.3% were females (control group) with mean ± SD age of 23.2 ± 5.6 and 22.1 ± 4.9 years respectively. The mean ± SD scores for quizzes, mid-term and final exams, and the overall percentage pass were significantly higher in the study group for both courses (P < 0.001). The majority of the students in the study group opined that the exposure to active pedagogic strategies enabled them to improve their use of critical thinking, facilitated deeper engagement with their learning and improved their clinical decision-making and discussion skills. Conclusion: The use of active pedagogic strategies such as self-reflection and peer-assessment appeared to significantly improve examination performance, facilitate deep and constructive engagement with learning and fostered students’ confidence in the use of critical thinking and clinical decision-making.     

A Multiyear Analysis of Team-Based Learning in a Pharmacotherapeutics Course

Objectives. To evaluate the impact of team-based learning (TBL) in a pharmacotherapeutics course on pharmacy students’ ratings of faculty instructors and the course, and to assess students’ performance after implementation of team-taught TBL.Design. Teaching methodology in a pharmacotherapeutics course was changed from a lecture with recitation approach in 2 semesters of a 6 credit-hour course to a TBL framework in a 3-semester 3+4+5 credit hour course. The distribution of faculty of instruction was changed from 4 faculty members per week to 1 faculty per 1-credit-hour module. TBL consisted of preclass study preparation, readiness assurance (Individual Readiness Assessment Test and Group Readiness Assessment Test), and in-class application exercises requiring simultaneous team responses.Assessment. Retrospective analysis of student ratings of faculty and instructional methods was conducted for the 2 years pre-TBL and 4 years during TBL. Final course grades were evaluated during the same time period. Student ratings showed progressive improvements over 4 years after the introduction of team-based learning. When aggregated, ratings in the “excellent teacher” category were unchanged with TBL compared to pre-TBL. Improvements in faculty instructor approaches to teaching were noted during TBL. Group grades were consistently higher than individual grades, and aggregate course grades were similar to those prior to TBL implementation.Conclusion. Implementation of TBL in a pharmacotherapeutics course series demonstrated the value of team performance over individual performance, indicated positive student perceptions of teaching approaches by course faculty, and resulted in comparable student performance in final course grades compared to the previous teaching method.     

Teaching and Learning Health Literacy in a Doctor of Pharmacy Program

Objective. To evaluate the impact of health literacy (HL) activities incorporated into a required, first professional year (P1), patient-centered communication course on pharmacy students’ knowledge, abilities, confidence, and attitudes related to HL.Design. Integrated, active-learning HL activities were incorporated into the course. Students’ knowledge and abilities were assessed with course evaluations. Students’ knowledge, confidence levels, and attitudes were evaluated by a precourse and postcourse survey. Third professional year (P3) students who did not complete HL activities were also surveyed.Assessment. Almost all students “met” or “exceeded” expectations (the top 2 levels of achievement on the objective structured clinical examination (OSCE) grading rubrics) on HL course evaluations. Survey results showed significant improvement in P1 students’ knowledge, confidence, and attitudes related to HL after completing the course. First year students (postcourse) rated their confidence levels and attitudes higher than P3 students.Conclusion. The use of integrated, active-learning activities is effective at improving P1 pharmacy students’ knowledge, abilities, confidence levels, and attitudes related to HL.     

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.     

Test-Enhanced Learning in an Immunology and Infectious Disease Medicinal Chemistry/Pharmacology Course

Objective. To develop a series of active-learning modules that would improve pharmacy students’ performance on summative assessments.Design. A series of optional online active-learning modules containing questions with multiple formats for topics in a first-year (P1) course was created using a test-enhanced learning approach. A subset of module questions was modified and included on summative assessments.Assessment. Student performance on module questions improved with repeated attempts and was predictive of student performance on summative assessments. Performance on examination questions was higher for students with access to modules than for those without access to modules. Module use appeared to have the most impact on low performing students.Conclusion. Test-enhanced learning modules with immediate feedback provide pharmacy students with a learning tool that improves student performance on summative assessments and also may improve metacognitive and test-taking skills.     

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 Antimicrobial Stewardship

Objective. To implement an antimicrobial stewardship (AS) elective course for second-year and third-year pharmacy students and to assess its impact on students’ perceptions regarding the application of AS principles.Design. A 2-credit elective course focusing on principles of AS incorporated prelecture didactic recordings with primary literature and guideline-based reading assignments, in-class active-learning group work and student-led presentations, and student-generated examination items.Assessment. Perceptions were assessed by precourse and postcourse survey items. Graded course assessments included completion of preclass assignments (readings, prerecorded lecture and writing assessment items), in-class active participation and group presentations, a midpoint examination, and a final examination.Conclusion. An AS-themed elective course in a doctor of pharmacy curriculum incorporating preclass, self-directed learning and in-class group-based active-learning strategies positively impacted students’ perceived understanding of AS strategies.     

Modification of a Pharmacokinetics Course Design to Improve Student Performance

Objective. To determine if the addition of weekly quizzes or reducing the number of faculty members teaching improved third-year (P3) pharmacy students’ final grades in a clinical pharmacokinetics course.Design. Four sections of a pharmacokinetics and pharmacodynamics course were divided according to the number of faculty members teaching the course and the administration of weekly quizzes. Two sections were taught by 6 faculty members and 2 were taught by 3 faculty members. Also, 1 section in each group received weekly quizzes, creating a 2-by-2 design.Assessment. The performance of the 201 P3 students enrolled in the course was assessed by comparing the average of 3 examination grades while excluding quiz grades. The mean final grade of classes in which quizzes were not administered was lower than that for classes in which quizzes were administered (p=0.019). The mean final grade in classes taught by 3 faculty members vs 6 faculty members was higher, but not significantly. A positive significant correlation existed between performance in a prerequisite biopharmaceutics class and this advanced class.Conclusion. Making minor modifications to the delivery of a course, such as number of quizzes administered and number of faculty members teaching the course, had a positive impact on student performance. Grades in a prerequisite course may enable earlier identification of students at risk of poor performance in advanced courses.     

Integration of physical assessment within a pathophysiology course for pharmacy

Objective. To determine first-year pharmacy students’ analysis, confidence, and knowledge of patient physical assessment integrated within a pathophysiology curriculum.Design. A prospective quasi-experimental study using validated pre- and post-surveys and follow-up examinations was conducted to objectively assess the confidence and knowledge of pharmacy students’ physical assessment skills.Assessment. Students’ perceived ability to perform physical assessment techniques improved. Topic mastery was demonstrated by a final comprehensive examination with a composite student class score of 83%.Conclusion. First-year pharmacy students demonstrated acquisition of patient physical assessment skills when integrated into a pathophysiology course.     

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 Solid Organ Transplant Elective Course for Pharmacy Students

Objective. To develop and implement a solid organ transplant elective course for second- and third-year pharmacy students, and assess its impact on students’ knowledge in the management of medications, adverse effects, and complications in organ transplantation patients.Design. Topics related to the care of solid organ transplant patients were covered in depth. Students were required to complete a group presentation focusing on common infectious disease topics encountered in solid organ transplant patients.Assessment. Students’ solid organ transplantation knowledge was assessed using examinations quizzes, a group presentation, and class participation. With an average class grade of 87%, students demonstrated knowledge of the course material. Most students felt that their knowledge increased significantly with regard to the course objectives.Conclusion. Students who completed the elective course significantly improved their confidence and knowledge regarding solid organ transplantation, felt more prepared than their peers who did not complete the course, and became open to exploring careers or residencies in this area.