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.     

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.     

A Team-Based Learning Course on Nutrition and Lifestyle Modification

Objective. To create, implement, and evaluate an elective team-based learning (TBL) course on nutrition and lifestyle modification for pharmacy students.Design. An elective course with 15 contact hours was developed for second-year pharmacy students based on the principles of TBL. Student knowledge gained and satisfaction with the course were measured.Assessment. Sixty-two students completed the course. Knowledge about nutrition and lifestyle modification was significantly improved by completing the course (59% and 91%, respectively, p=<0.001). The satisfaction survey instrument had a response rate of 97%, and the majority of students (>85%) responded favorably to the TBL components.Conclusion. An elective course using TBL effectively delivered course content while teaching students communication and teamwork skills. The course was well received by students.     

Physical assessment experience in a problem-based learning course

Objective. To evaluate the impact of a physical-assessment learning experience implemented in the problem-based learning (PBL) format of the third year of a doctor of pharmacy (PharmD) program.Design. Students enrolled in a PBL course completed survey instruments to measure knowledge and confidence before and after participating in the learning experience. A simulation stethoscope was used to teach students abnormal pulmonary and cardiovascular sounds in 1-hour sessions for each of 12 PBL groups.Assessment. The 92 students enrolled in the PBL course completed pre- and post-experience survey instruments. Students’ scores on knowledge questions increased significantly (p < 0.0001) from 40.4% ± 11.4% at baseline to 62.5% ± 13.7% and 63.1 ± 11.6%, respectively, on the 2 sets of post-experience questions. Students scored a median of 3 or 4 on a 5-point Likert scale after a learning experience on questions measuring confidence.Conclusion. Use of a simulation stethoscope in a physical-assessment learning experience increased pharmacy students’ knowledge in performing pulmonary and cardiovascular assessment techniques.     

Assessment of manual blood pressure and heart rate measurement skills of pharmacy students: a follow-up investigation

Objectives

To evaluate the impact of a laboratory course on the manual blood pressure (BP) and heart rate (HR) measurement skills of pharmacy students.

Methods

After 1 lecture and 1 laboratory session on vital sign technique, pharmacy students enrolled in a patient assessment laboratory course were randomly paired with a classmate and manually measured the classmate''s BP and HR. Within 2 minutes, the BP and HR were measured by an Omron 711-AC automatic monitor. The same assessment procedures with manual and automatic measurements were repeated near the end of the laboratory course. Student skills were also evaluated through direct observation by faculty members.

Results

Student and machine measurements of systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR significantly correlated at the final assessment (r = 0.92, 0.83, and 0.91 respectively; p < 0.001 for each. The proportion of student and device values agreeing to within 5 units (mmHg and beats-per-minute) at baseline versus at the final assessment significantly improved from 38% to 67% for SBP, 51% to 77% for DBP, and 52% to 79% for HR (p < 0.001 for each). The percentage of students correctly performing all 13 AHA endorsed steps for BP measurement improved significantly from 4.6% to 75.6% (p < 0.001).

Conclusions

Significant improvement and the attainment of competency in manual vital signs measurement were demonstrated by pharmacy students after 11 weeks of skill rehearsal in a laboratory course.     

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     

Student and Faculty Perceptions of Lecture Recording in a Doctor of Pharmacy Curriculum

Objective. To describe students’ and faculty members’ perceptions of the impact of lecture recording in a doctor of pharmacy (PharmD) curriculum.Methods. Second- and third-year pharmacy students and faculty members completed an anonymous survey instrument regarding their perceptions of lecture recording with 2 classroom lecture capture software programs, Camtasia Studio and Wimba Classroom.Results. Most students (82%) responded that Camtasia was very helpful and almost half (49%) responded that Wimba Classroom was helpful (p<0.001). Forty-six percent of the students reported being more likely to miss a class that was recorded; however, few students (10%) reported using recordings as a substitute for attending class. The most common concern of faculty members was decreased student attendance (27%).Conclusion. Pharmacy students consider lecture recordings beneficial, and they use the recordings primarily to review the lecture. While faculty members reported concerns with decreased attendance, few students reported using recordings as an alternative to class attendance.     

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.     

Patient Simulation to Demonstrate Students�� Competency in Core Domain Abilities Prior to Beginning Advanced Pharmacy Practice Experiences

Objective. To implement a simulation-based introductory pharmacy practice experience (IPPE) and determine its effectiveness in assessing pharmacy students’ core domain abilities prior to beginning advanced pharmacy practice experience (APPE). Design. A 60-hour IPPE that used simulation-based techniques to provide clinical experiences was implemented. Twenty-eight students were enrolled in this simulation IPPE, while 60 were enrolled in hospital and specialty IPPEs within the region.Assessment. The IPPE assessed 10 out of 11 of the pre-APPE core domain abilities, and on the practical examination, 67% of students passed compared to 52% of students in the control group. Students performed better on all 6 knowledge quizzes after completing the simulation IPPE. Based on scores on the Perception of Preparedness to Perform (PREP) survey, students felt more prepared regarding “technical” aspects after completing the simulation experience (p<0.001). Ninety-six percent of the respondents agreed with the statement “I am more aware of medication errors after this IPPE.”Conclusion. Simulation is an effective method for assessing the pre-APPE abilities of pharmacy students, preparing them for real clinical encounters, and for making them more aware of medication errors and other patient safety issues.     

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.     

Teaching physicians to address unhealthy alcohol use: a randomized controlled trial assessing the effect of a Web-based module on medical student performance

Background

The authors developed and evaluated an interactive, Web-based module to train medical students in screening and brief intervention (SBI) for unhealthy alcohol use.

Methods

First-year students were randomized to module versus lecture. Change in knowledge, attitudes, and confidence were compared. Performance was assessed by objective structured clinical examination (OSCE) and analyzed by intention to treat and treatment received.

Results

Of 141 consenting students, 64% (n = 90) completed an intervention (54% lecture vs. 70% Web assigned). Knowledge, confidence, and attitudes improved in both groups, with more improvement in Advise–Assist knowledge for Web students (14% vs. −3%, p = .003). Web students outperformed their lecture peers in both general communication (65% vs. 51% items well done, p = .004) and alcohol-specific tasks (54% vs. 41%, p = .021) on OSCE. Analysis by treatment received enhanced between-group differences.

Conclusion

Use of a Web-based module to teach SBI is associated with greater knowledge gain and skills performance compared with a lecture covering similar content. The module provides an efficient means for training in this area.     

Impact of online lecture-capture on student outcomes in a therapeutics course

Objectives

To examine the correlation between students accessing recorded lecture files (audio and slides) online and course grades and class attendance.

Methods

Second professional year (of 6-year program) students in a therapeutics course had access to recorded online lectures for 72 hours following live lectures. The number and duration of lecture accessions were compared to final course grades and class attendance. Course grades were compared to those of a historical control group. At the end of the semester, students completed a brief survey instrument regarding their use and perceptions of online lectures.

Results

No correlation was found between final course grades and the number of lecture accessions (r = 0.0014) or total number of minutes lectures were viewed (r = 0.033), nor between class attendance and minutes viewed (r = 0.2158). Students with access to recorded lectures outperformed the historical control group on the final examination (p < 0.002). Seventy-two percent of students reported no influence of online files on class attendance.

Conclusions

Posting lectures online did not affect student outcomes, but students did score higher on the final examination.     

Comparison of Learning Styles of Pharmacy Students and Faculty Members

Objectives. To compare dominant learning styles of pharmacy students and faculty members and between faculty members in different tracks.Methods. Gregorc Style Delineator (GSD) and Zubin’s Pharmacists’ Inventory of Learning Styles (PILS) were administered to students and faculty members at an urban, Midwestern college of pharmacy.Results. Based on responses from 299 students (classes of 2008, 2009, and 2010) and 59 faculty members, GSD styles were concrete sequential (48%), abstract sequential (18%), abstract random (13%), concrete random (13%), and multimodal (8%). With PILS, dominant styles were assimilator (47%) and converger (30%). There were no significant differences between faculty members and student learning styles nor across pharmacy student class years (p>0.05). Learning styles differed between men and women across both instruments (p<0.01), and between faculty members in tenure and clinical tracks for the GSD styles (p=0.01).Conclusion. Learning styles differed among respondents based on gender and faculty track.     

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.     

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.     

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.     

A Computer-based Module for Prescribing Error Instruction

Objective

To evaluate an instructional module''s effectiveness at changing third-year doctor of pharmacy (PharmD) students'' ability to identify and correct prescribing errors.

Design

Students were randomized into 2 groups. Using a computer-based module, group 1 completed worksheet A, watched a presentation on medication errors, and then completed worksheets B and C. Group 2 completed worksheets A and B, watched the presentation, and then completed worksheet C.

Assessment

Both groups scored a median 50% on worksheet A and 66.7% on worksheet C (p < 0.001). Median scores on worksheet B differed between groups (p = 0.0014). Group 1 viewed the presentation before completing worksheet B and scored 62.5%, while group 2 viewed the presentation after scoring 50% on worksheet B.

Conclusion

The module effectively taught pharmacy students to identify and correct prescribing errors.     

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.     

Comparison of Online Versus Classroom Delivery of an Immunization Elective Course

Objective. To compare performance and preferences of students who were randomly allocated to classroom or online sections of an elective course on immunization.Methods. Students were randomly assigned to either the classroom or online section. All course activities (lectures, quizzes, case discussions, vaccine administration, and final examination) were the same for both sections, except for the delivery of lecture material.Assessment. Students were surveyed on their preferences at the beginning and end of the semester. At the end of the semester, the majority of students in the classroom group preferred classroom or blended delivery while the majority of students in the online group preferred blended or online delivery (p<0.01). Student performance was compared at the end of the semester. There was no significant difference for any of the grades in the course between the 2 sections.Conclusion. There was no difference in student performance between the classroom and online sections, suggesting that online delivery is an effective way to teach students about immunization.