Active-learning implementation in an advanced elective course on infectious diseases

Objectives. To describe the development, implementation, and assessment of an advanced elective course on infectious diseases using active-learning strategies.Design. Pedagogy for active learning was incorporated by means of mini-lecture, journal club, and debate with follow-up discussion. Forty-eight students were enrolled in this 4-week elective course, in which 30% of course time was allocated for active-learning exercises. All activities were fundamentally designed as a stepwise approach in complementing each active-learning exercise.Assessment. Achievement of the course learning objectives was assessed using a 5-point Likert scale survey instrument. Students’ awareness of the significance of antimicrobial resistance was improved (p ≤ 0.05). Students’ ability to critically evaluate the infectious-disease literature and its application in informed clinical judgments was also enhanced through these active-learning exercises (p ≤ 0.05). Students agreed that active learning should be part of the pharmacy curriculum and that active-learning exercises improved their critical-thinking, literature-evaluation, and self-learning skills.Conclusion. An elective course using active-learning strategies allowed students to combine information gained from the evaluation of infectious-disease literature, critical thinking, and informed clinical judgment. This blended approach ultimately resulted in an increased knowledge and awareness of infectious diseases.     

Promotion of Self-directed Learning Using Virtual Patient Cases

Objective. To assess the effectiveness of virtual patient cases to promote self-directed learning (SDL) in a required advanced therapeutics course.Design. Virtual patient software based on a branched-narrative decision-making model was used to create complex patient case simulations to replace lecture-based instruction. Within each simulation, students used SDL principles to learn course objectives, apply their knowledge through clinical recommendations, and assess their progress through patient outcomes and faculty feedback linked to their individual decisions. Group discussions followed each virtual patient case to provide further interpretation, clarification, and clinical perspective.Assessments. Students found the simulated patient cases to be organized (90%), enjoyable (82%), intellectually challenging (97%), and valuable to their understanding of course content (91%). Students further indicated that completion of the virtual patient cases prior to class permitted better use of class time (78%) and promoted SDL (84%). When assessment questions regarding material on postoperative nausea and vomiting were compared, no difference in scores were found between the students who attended the lecture on the material in 2011 (control group) and those who completed the virtual patient case on the material in 2012 (intervention group).Conclusion. Completion of virtual patient cases, designed to replace lectures and promote SDL, was overwhelmingly supported by students and proved to be as effective as traditional teaching methods.     

Patient simulation software to augment an advanced pharmaceutics course

Objective

To implement and assess the effectiveness of adding a pharmaceutical care simulation program to an advanced therapeutics course.

Design

PharmaCAL (University of Pittsburgh), a software program that uses a branched-outcome decision making model, was used to create patient simulations to augment lectures given in the course. In each simulation, students were presented with a challenge, given choices, and then provided with consequences specific to their choices.

Assessments

A survey was administered at the end of the course and students indicated the simulations were enjoyable (92%), easy to use (90%), stimulated interest in critically ill patients (82%), and allowed for application of lecture material (91%). A 5-item presimulation and postsimulation test on the anemia simulation was administered to assess learning. Students answered significantly more questions correctly on the postsimulation test than on the presimulation test (p < 0.001). Seventy-eight percent of students answered the same 5 questions correctly on the final examination.

Conclusion

Patient simulation software that used a branched-outcome decision model was an effective supplement to class lectures in an advanced pharmaceutics course and was well-received by pharmacy students.     

An Introductory Review Module For an Anti-Infectives Therapeutics Course

Objective. To determine whether an introductory review module using a hybrid-learning approach helped students learn infectious disease management in an anti-infectives therapeutics course.Design. An introductory module consisting of an online pharmacology review, pre-class assignment, 2 classroom lectures, and 1 case-based lecture was developed and implemented.Assessment. Among the 110 students who completed pre- and post-tests on the material covered, average scores increased from 71% to 83% (p<0.0001). Performance on knowledge-based question improved for 8 out of 10 questions (p<0.05) and student confidence increased from the first lecture to completion of the module (p<0.001 for all comparisons). Of the 129 students who completed an evaluation of the introductory module, 98% strongly agreed or agreed that the content was essential for course success.Conclusion. The addition of an introductory module using a hybrid-learning approach to review and solidify concepts of medical microbiology and pharmacology provided the foundation necessary for success in an infectious diseases module.     

Pharmacy students' preferences for various types of simulated patients

Objective

To evaluate pharmacy students'' preferences for various types of simulated patients.

Methods

Second-professional year (P2) pharmacy students participated in 7 learning activities that used simulated patients including community volunteers, College administrative staff, course instructors, and student peers. Students ranked each simulated patient type according to believability, skill development, and preference using a 5-point Likert scale.

Results

One-hundred seven of 155 students (69%) completed the survey instrument. Students preferred community volunteers as simulated patients (mean rank 1.39), followed by peers (2.22), instructors (2.63), and staff members (2.81) (p < 0.001). Greater than 89% agreed or strongly agreed that their work with simulated patients prepared them for actual patients, with community volunteers receiving the highest ratings (p < 0.03).

Conclusions

Although pharmacy students found value in interactions will all types of simulated patients, they preferred community volunteers over staff members and their peers. Future scholarship should explore the relationship among simulated patient types and student learning outcomes.Key words: simulated patient, survey, practice laboratory     

Team-based Learning in Therapeutics Workshop Sessions

Objectives

To implement team-based learning in the workshop portion of a pathophysiology and therapeutics sequence of courses to promote integration of concepts across the pharmacy curriculum, provide a consistent problem-solving approach to patient care, and determine the impact on student perceptions of professionalism and teamwork.

Design

Team-based learning was incorporated into the workshop portion of 3 of 6 pathophysiology and therapeutics courses. Assignments that promoted team-building and application of key concepts were created.

Assessment

Readiness assurance tests were used to assess individual and team understanding of course materials. Students consistently scored 20% higher on team assessments compared with individual assessments. Mean professionalism and teamwork scores were significantly higher after implementation of team-based learning; however, this improvement was not considered educationally significant. Approximately 91% of students felt team-based learning improved understanding of course materials and 93% of students felt teamwork should continue in workshops.

Conclusion

Team-based learning is an effective teaching method to ensure a consistent approach to problem-solving and curriculum integration in workshop sessions for a pathophysiology and therapeutics course sequence.     

A Virtual Patient Software Program to Improve Pharmacy Student Learning in a Comprehensive Disease Management Course

Objective. To implement and assess the impact of a virtual patient pilot program on pharmacy students’ clinical competence skills.Design. Pharmacy students completed interactive software-based patient case scenarios embedded with drug-therapy problems as part of a course requirement at the end of their third year.Assessment. Assessments included drug-therapy problem competency achievement, performance on a pretest and posttest, and pilot evaluation survey instrument. Significant improvements in students’ posttest scores demonstrated advancement of clinical skills involving drug-therapy problem solving. Students agreed that completing the pilot program improved their chronic disease management skills and the program summarized the course series well.Conclusion. Using virtual patient technology allowed for assessment of student competencies and improved learning outcomes.     

A Technology-Enhanced Patient Case Workshop

Objectives

To assess the impact of technology-based changes on student learning, skill development, and satisfaction in a patient-case workshop.

Design

A new workshop format for a course was adopted over a 3-year period. Students received and completed patient cases and obtained immediate performance feedback in class instead of preparing the case prior to class and waiting for instructors to grade and return their cases. The cases were designed and accessed via an online course management system.

Assessment

Student satisfaction was measured using end-of-course surveys. The impact of the technology-based changes on student learning, problem-solving, and critical-thinking skills was measured and compared between the 2 different course formats by assessing changes in examination responses. Three advantages to the new format were reported: real-life format in terms of time constraint for responses, a team learning environment, and expedient grading and feedback. Students overwhelmingly agreed that the new format should be continued. Students'' examination scores improved significantly under the new format.

Conclusion

The change in delivery of patient-case workshops to an online, real-time system was well accepted and resulted in enhanced learning, critical thinking, and problem-solving skills.     

The Impact of Blended Learning on Student Performance in a Cardiovascular Pharmacotherapy Course

Objective. To examine student engagement with, perception of, and performance resulting from blended learning for venous thromboembolism in a required cardiovascular pharmacotherapy course for second-year students.Design. In 2013, key foundational content was packaged into an interactive online module for students to access prior to coming to class; class time was dedicated to active-learning exercises.Assessment. Students who accessed all online module segments participated in more in class clicker questions (p=0.043) and performed better on the examination (p=0.023). There was no difference in clicker participation or examination performance based on time of module access (prior to or after class). The majority of participants agreed or strongly agreed that foundational content learned prior to class, applied activities during class, and content-related questions in the online module greatly enhanced learning.Conclusion. This study highlights the importance of integrating online modules with classroom learning and the role of blended learning in improving academic performance.     

Comparison of Patient Simulation Methods Used in a Physical Assessment Course

Objective. To determine whether there is a difference in student pharmacists’ learning or satisfaction when standardized patients or manikins are used to teach physical assessment.Design. Third-year student pharmacists were randomized to learn physical assessment (cardiac and pulmonary examinations) using either a standardized patient or a manikin.Assessment. Performance scores on the final examination and satisfaction with the learning method were compared between groups. Eighty and 74 student pharmacists completed the cardiac and pulmonary examinations, respectively. There was no difference in performance scores between student pharmacists who were trained using manikins vs standardized patients (93.8% vs. 93.5%, p=0.81). Student pharmacists who were trained using manikins indicated that they would have probably learned to perform cardiac and pulmonary examinations better had they been taught using standardized patients (p<0.001) and that they were less satisfied with their method of learning (p=0.04).Conclusions. Training using standardized patients and manikins are equally effective methods of learning physical assessment, but student pharmacists preferred using standardized patients.     

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.     

Simulated medication therapy management activities in a pharmacotherapy laboratory course

Objective. To measure the impact of medication therapy management (MTM) learning activities on students’ confidence and intention to provide MTM using the Theory of Planned Behavior.Design. An MTM curriculum combining lecture instruction and active-learning strategies was incorporated into a required pharmacotherapy laboratory course.Assessment. A validated survey instrument was developed to evaluate student confidence and intent to engage in MTM services using the domains comprising the Theory of Planned Behavior. Confidence scores improved significantly from baseline for all items (p < 0.00), including identification of billable services, documentation, and electronic billing. Mean scores improved significantly for all Theory of Planned Behavior items within the constructs of perceived behavioral control and subjective norms (p < 0.05). At baseline, 42% of students agreed or strongly agreed that they had knowledge and skills to provide MTM. This percentage increased to 82% following completion of the laboratory activities.Conclusion. Implementation of simulated MTM activities in a pharmacotherapy laboratory significantly increased knowledge scores, confidence measures, and scores on Theory of Planned Behavior constructs related to perceived behavioral control and subjective norms. Despite these improvements, intention to engage in future MTM services remained unchanged.     

Advanced Screencasting With Embedded Assessments in Pathophysiology and Therapeutics Course Modules

Objective. To implement and assess the effectiveness of a hybrid learning model using advanced screencasting with embedded assessments in pathophysiology and therapeutics modules.Design. Two pathophysiology and therapeutics course modules on viral hepatitis and the clinical pharmacokinetics of aminoglycosides were chosen for study. The preclass portion of the hybrid model involved student completion of interactive e-lectures that were created with the use of advanced screencasting and included embedded assessments. Students viewed the e-lectures and completed the assessment questions prior to in-class lecture.Assessment. Preimplementation and postimplementation test scores were compared and student survey data were analyzed. Test scores improved significantly and students’ perceptions of the learning method were favorable. Test scores improved most significantly on higher-level Bloom’s taxonomy questions.Conclusion. A hybrid model that used advanced screencasting with embedded assessments offered a novel method to afford students active-learning opportunities to progress to higher cognitive domains of learning.     

Virtual patients and problem-based learning in advanced therapeutics

Objective

To enhance student learning of a complex therapeutic concept through the incorporation of 2 case-based, active-learning strategies with lecture in a required advanced therapeutics course.

Design

A virtual patient session using a branched-outcome decision-making model and a problem-based learning (PBL) practica were developed from the course learning objectives for severe sepsis and septic shock. Following lecture of this material, students were required to complete the simulation session and attend the PBL.

Assessment

Student learning was assessed through review of examination scores, as well as quality and accuracy of the pharmaceutical care plan developed as part of the PBL. Satisfaction of the teaching format was assessed through a course evaluation survey. For questions pertaining to sepsis or septic shock on the final examination, the class average was 90%, despite an average of 76% on the examination as a whole. Class average for the pharmacuetical care plan was 90%. Sixty-three percent of students stated the simulation contributed to their learning, and 93% stated the PBL contributed to their learning.

Conclusion

Using a multifaceted teaching approach, combining active- and passive-learning strategies, was well received by students and fostered an effective learning environment.     

Enhancing an Introductory Pharmacy Practice Experience at free medical clinics

Objectives The aim of the study was to assess and improve first‐year student pharmacists' satisfaction and learning experience in a Student‐Run Free Medical Clinic Project (SFMCP) providing medical care to an underserved population. Methods Two consecutive classes of first‐year student pharmacists at the University of California San Diego (UCSD) Skaggs School of Pharmacy and Pharmaceutical Sciences participated in an Introductory Pharmacy Practice Experience (IPPE) at the UCSD SFMCP. This IPPE involved two inter‐professional evening free clinics which provide medical care to an underserved population and opportunities for healthcare professional training and service. Year 1 students completed a self‐assessment survey instrument and year 2 students completed the survey instrument plus a new competency checklist tool. Average scores from the self‐assessment survey instrument were compared between years 1 and 2. Key findings Initial survey results showed that students felt the SFMCP was worthwhile; however, they did not experience enough involvement in the patient assistance programme or non‐pharmacy‐related clinic activities. After the competency checklist tool implementation, overall student pharmacist satisfaction of the SFMCP IPPE remained high (88%), participation in identified weak areas improved and students agreed that the tool helped focus their clinic experience. Conclusions Areas of improvement were identified with the survey instrument and the competency checklist tool increased achievement of learning objectives. Overall, student pharmacists felt the SFMCP IPPE was a good learning experience. Practising pharmacists can employ these or similar tools in specific practice settings, to evaluate and help ensure that student pharmacists or interns are achieving applicable learning objectives.     

Integration of Problem-based Learning and Innovative Technology Into a Self-Care Course

Objective. To assess the integration of problem-based learning and technology into a self-care course.Design. Problem-based learning (PBL) activities were developed and implemented in place of lectures in a self-care course. Students used technology, such as computer-generated virtual patients and iPads, during the PBL sessions.Assessments. Students’ scores on post-case quizzes were higher than on pre-case quizzes used to assess baseline knowledge. Student satisfaction with problem-based learning and the use of technology in the course remained consistent throughout the semester.Conclusion. Integrating problem-based learning and technology into a self-care course enabled students to become active learners.     

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.     

Comparing team-based and mixed active-learning methods in an ambulatory care elective course

Objectives

To assess students'' performance and perceptions of team-based and mixed active-learning methods in 2 ambulatory care elective courses, and to describe faculty members'' perceptions of team-based learning.

Methods

Using the 2 teaching methods, students'' grades were compared. Students'' perceptions were assessed through 2 anonymous course evaluation instruments. Faculty members who taught courses using the team-based learning method were surveyed regarding their impressions of team-based learning.

Results

The ambulatory care course was offered to 64 students using team-based learning (n = 37) and mixed active learning (n = 27) formats. The mean quality points earned were 3.7 (team-based learning) and 3.3 (mixed active learning), p < 0.001. Course evaluations for both courses were favorable. All faculty members who used the team-based learning method reported that they would consider using team-based learning in another course.

Conclusions

Students were satisfied with both teaching methods; however, student grades were significantly higher in the team-based learning course. Faculty members recognized team-based learning as an effective teaching strategy for small-group active learning.     

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.