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.     

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.     

Active-learning assignments to integrate basic science and clinical course material

Objective

To develop, implement, and evaluate active-learning exercises requiring the integration and application of pathophysiology, medicinal chemistry, pharmacology, and therapeutics knowledge of osteoarthritis and rheumatoid arthritis to formulate therapeutic recommendations for patients with musculoskeletal disorders.

Design

Two team-based case study exercises, one evaluating a patient with osteoarthritis and the second, a patient with rheumatoid arthritis, were developed, incorporating material and questions from pathophysiology, medicinal chemistry, pharmacology, and therapeutics. The learning assignments were implemented in a required pharmacotherapy module.

Assessment

Student learning was evaluated using performance on the team-based case study exercises and on 2 examinations. A standard student course evaluation was used to assess students'' impressions of the learning activity. The mean student grades for the osteoarthritis and rheumatoid arthritis activities were 9.1 and 8.9, respectively, on a 10-point scale. The majority of students indicated that the learning exercises were more than adequate to excellent in helping students learn.

Conclusion

The addition of active-learning activities was successful in teaching pharmacy students the knowledge needed to formulate therapeutic recommendations for patients with musculoskeletal disorders.     

A multi-instructor, team-based, active-learning exercise to integrate basic and clinical sciences content

Objectives. To introduce a multiple-instructor, team-based, active-learning exercise to promote the integration of basic sciences (pathophysiology, pharmacology, and medicinal chemistry) and clinical sciences in a doctor of pharmacy curriculum.Design. A team-based learning activity that involved pre-class reading assignments, individual-and team-answered multiple-choice questions, and evaluation and discussion of a clinical case, was designed, implemented, and moderated by 3 faculty members from the pharmaceutical sciences and pharmacy practice departments.Assessment. Student performance was assessed using a multiple-choice examination, an individual readiness assurance test (IRAT), a team readiness assurance test (TRAT), and a subjective, objective, assessment, and plan (SOAP) note. Student attitudes were assessed using a pre- and post-exercise survey instrument. Students’ understanding of possible correct treatment strategies for depression improved. Students were appreciative of this true integration of basic sciences knowledge in a pharmacotherapy course and to have faculty members from both disciplines present to answer questions. Mean student score on the on depression module for the examination was 80.4%, indicating mastery of the content.Conclusions. An exercise led by multiple instructors improved student perceptions of the importance of team-based teaching. Integrated teaching and learning may be achieved when instructors from multiple disciplines work together in the classroom using proven team-based, active-learning exercises.     

Flipping Content to Improve Student Examination Performance in a Pharmacogenomics Course

Objective. To develop, implement, and evaluate active learning in a flipped class to improve student examination performance in the genetic foundations of pharmacogenomics.Design. The flipped classroom model was adopted in which a guided-inquiry learning activity was developed and conducted to complement recorded, previously viewed didactic lectures. The activity was constructed to focus on critical thinking and application of core principles of genetic crosses and pedigree analysis. A combination of independent work and active discussion with volunteer and guided student response provided student-facilitator interaction.Assessment. Student learning was evaluated by comparing pretest and posttest formative assessment results and by the comparison of prior years’ examination performance on a subset of content for which no flipped classroom learning activities occurred. There was no significant difference between examination scores between the flipped classroom and previous approaches. An item-by-item analysis of the content reflected a significant change in performance on questions addressed in the flipped classroom exercise.Conclusion. The flipped class instructional model in this project included active-learning activities and formative assessments that provided students spaced and repetitive curricular engagement. The intervention transformed the classroom interactions of faculty members and students and contributed to improved student examination performance.     

A case-based toxicology elective course to enhance student learning in pharmacotherapy

Objective. To assess the impact of a case-based toxicology elective course on student learning in related required courses and student performance on the Pharmacy Curriculum Outcomes Assessment (PCOA) examination.Design. A case-based clinical toxicology elective course that contained topics from 2 required courses, Pharmacology III and Pharmacotherapy II, was offered in the spring 2009 to second- and third-year pharmacy students.Assessment. Scores on the Toxicology subsection of the PCOA of students enrolled in the elective were higher than those of students not enrolled (91.3% ± 4.1 vs. 67.2% ± 5.7). Enrollment in the elective was related to increased examination scores among Pharmacotherapy II students (89.5% ± 2.0 vs. 83.9% ± 1.8). Students indicated on course survey instruments that they were satisfied with the new elective offering.Conclusions. A toxicology elective provided a clinically relevant, active-learning experience for pharmacy students that addressed a curricular need within the college and increased examination scores.     

Pharmacy Students’ Performance and Perceptions in a Flipped Teaching Pilot on Cardiac Arrhythmias

Objective. To implement the flipped teaching method in a 3-class pilot on cardiac arrhythmias and to assess the impact of the intervention on academic performance and student perceptions.Design. An intervention group of 101 first-year pharmacy students, who took the class with the flipped teaching method, were supplied with prerecorded lectures prior to their 3 classes (1 class in each of the following subjects: basic sciences, pharmacology, and therapeutics) on cardiac arrhythmias. Class time was focused on active-learning and case-based exercises. Students then took a final examination that included questions on cardiac arrhythmias. The examination scores of the intervention group were compared to scores of the Spring 2011 control group of 105 first-year students who took the class with traditional teaching methods. An online survey was conducted to assess student feedback from the intervention group.Assessment. The mean examination scores of the intervention group were significantly higher than the mean examination scores of the control group for the cardiac arrhythmia classes in pharmacology (with 89.6 ± 2.0% vs 56.8 ± 2.2%, respectively) and therapeutics (89.2 ± 1.4% vs 73.7 ± 2.1%, respectively). The survey indicated higher student satisfaction for flipped classes with highly rated learning objectives, recordings, and in-class activities.Conclusion. Use of the flipped teaching method in a 3-class pilot on cardiac arrhythmias improved examination scores for 2 of the 3 classes (pharmacology and therapeutics). Student satisfaction was influenced by the quality of the learning objectives, prerecorded lectures, and inclass active-learning activities.     

An Innovative Seminar Course in Business Etiquette for Pharmacy Graduate Students

Objectives. To develop and implement a seminar course for graduate students in the social and administrative pharmaceutical sciences to enhance knowledge and confidence with respect their abilities to demonstrate appropriate business etiquette.Design. A 1-credit graduate seminar course was designed based on learner-centered constructivist theory and application of Fink’s Taxonomy for Significant Learning.Assessment. Eleven students participated in the spring 2011 seminar course presentations and activities. Students completed pre- and post-assessment instruments, which included knowledge and attitudinal questions. Formative and summative assessments showed gains in student knowledge, perceived skills, and confidence based on observation and student-reported outcomes.Conclusion. Graduate student reaction to the course was overwhelmingly positive. The etiquette course has potential application in doctor of pharmacy education, other graduate disciplines, undergraduate education, and continuing professional development.     

Student Performance in a Pharmacotherapy Oncology Module Before and After Flipping the Classroom

Objective. To determine if a flipped classroom improved student examination performance in a pharmacotherapy oncology module.Design. Third-year pharmacy students in 2012 experienced the oncology module as interactive lectures with optional case studies as supplemental homework. In 2013, students experienced the same content in a primarily flipped classroom. Students were instructed to watch vodcasts (video podcasts) before in-class case studies but were not held accountable (ie, quizzed) for preclass preparation. Examination questions were identical in both cohorts. Performance on examination questions was compared between the two cohorts using analysis of covariance (ANCOVA), with prior academic performance variables (grade point average [GPA]) as covariates.Assessment. The students who experienced the flipped classroom approach performed poorer on examination questions than the cohort who experienced interactive lecture, with previous GPA used as a covariate.Conclusion. A flipped classroom does not necessarily improve student performance. Further research is needed to determine optimal classroom flipping techniques.     

Incorporating a diabetes certificate program in a pharmacy curriculum

Objective. To determine student competency and confidence in the provision of diabetes care and satisfaction with incorporation of the American Pharmacist Association/American Association of Diabetes Educators (APhA/AADE) diabetes certificate program into the required doctor of pharmacy (PharmD) curriculum.Design. Material from the diabetes certificate program was incorporated longitudinally into the third-year curriculum skills laboratory courses. Educational techniques used included self-study modules with case questions, lectures using the program’s slides and live seminar materials, and active-learning techniques including instructor-led modeling and role-playing exercises, small group activities, objective structured learning exercises (OSLE) using standardized patients, and a week-long diabetes simulation.Evaluation. Students achieved a 100% pass rate on a diabetes certificate program examination and earned a mean score of 71.8 out of 100 points on a medication therapy management (MTM) objective structured clinical examination (OSCE). A student survey demonstrated high student confidence in their ability to provide diabetes care (mean scores 4.2 to 4.8) and satisfaction with the program (mean scores 4.5 to 4.8).Conclusion. Longitudinal integration of a nationally recognized diabetes certificate program into the required PharmD curriculum produced satisfied students competent in providing diabetes pharmaceutical care.     

The Impact of Preceptor and Student Learning Styles on Experiential Performance Measures

Objectives. To identify preceptors’ and students’ learning styles to determine how these impact students’ performance on pharmacy practice experience assessments.Methods. Students and preceptors were asked to complete a validated Pharmacist’s Inventory of Learning Styles (PILS) questionnaire to identify dominant and secondary learning styles. The significance of “matched” and “unmatched” learning styles between students and preceptors was evaluated based on performance on both subjective and objective practice experience assessments.Results. Sixty-one percent of 67 preceptors and 57% of 72 students who participated reported “assimilator” as their dominant learning style. No differences were found between student and preceptor performance on evaluations, regardless of learning style match.Conclusion. Determination of learning styles may encourage preceptors to use teaching methods to challenge students during pharmacy practice experiences; however, this does not appear to impact student or preceptor performance.     

Viability of Virtual Skills-based Assessments Focused on Communication

Objective. To evaluate faculty and student perceptions of and performance on virtual skills-based assessments focused on communication compared to in-person assessments.Methods. In spring 2020, virtual skills-based assessments were conducted. After all assessments were completed, two 12-item questionnaires, one for students and one for the faculty members who conducted the assessment, were designed to assess perceptions of virtual skills-based assessments. The surveys were distributed via an online platform to second- and third-year (P2 and P3) pharmacy students and to faculty who had participated in a virtual skills-based assessment. Scores from the spring 2020 virtual skills-based assessment were compared to scores on the in-person skills-based assessment that took place in spring 2019.Results. Of the 19 faculty and 279 students invited to participate, 18 (94.7%) faculty and 241 (86.4%) students responded. The majority of faculty (88.9%) and students (63.5%) perceived the virtual skills-based assessments to be effective at simulating an interaction. However, only 33.3% of faculty and 28.6% of students preferred the virtual environment. There was not a significant difference in student performance between in-person and virtual assessments for patient consultation and SOAP note skills.Conclusion. Providing sufficient formative and summative feedback to pharmacy students is a challenge, particularly in the context of skills-based assessments. Students and faculty reported that the virtual assessment provided an opportunity for an appropriate assessment of student communication skills. However, a strong preference for using virtual skills-based assessments in the future was not observed.     

Vodcasts and Active-Learning Exercises in a “Flipped Classroom” Model of a Renal Pharmacotherapy Module

Objective. To implement a “flipped classroom” model for a renal pharmacotherapy topic module and assess the impact on pharmacy students’ performance and attitudes.Design. Students viewed vodcasts (video podcasts) of lectures prior to the scheduled class and then discussed interactive cases of patients with end-stage renal disease in class. A process-oriented guided inquiry learning (POGIL) activity was developed and implemented that complemented, summarized, and allowed for application of the material contained in the previously viewed lectures.Assessment. Students’ performance on the final examination significantly improved compared to performance of students the previous year who completed the same module in a traditional classroom setting. Students’ opinions of the POGIL activity and the flipped classroom instructional model were mostly positive.Conclusion. Implementing a flipped classroom model to teach a renal pharmacotherapy module resulted in improved student performance and favorable student perceptions about the instructional approach. Some of the factors that may have contributed to students’ improved scores included: student mediated contact with the course material prior to classes, benchmark and formative assessments administered during the module, and the interactive class activities.     

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.     

Correlation Between Active-Learning Coursework and Student Retention of Core Content During Advanced Pharmacy Practice Experiences

Objective. To implement an active-learning approach in a pharmacotherapy course sequence in the second year (P2) and third (P3) year of a doctor of pharmacy (PharmD) program and determine whether the pedagogical changes correlated with retention of core content in the fourth year (P4).Design. Class sessions were transitioned from slides-based lectures to discussion-based active-learning pedagogy.Assessment. A comprehensive examination was created and administered to assess student retention of therapeutic topics taught. Students demonstrated significantly improved overall scores on questions derived from the active-learning pedagogy used in Pharmacotherapy II and III compared to those derived from Pharmacotherapy I in which content was delivered by lecture.Conclusion. The use of active-learning strategies over lecture-based methods in pharmacotherapy courses resulted in higher retention of core content. Students’ performance in areas taught using the discussion-based methodology was superior to that which was taught using lecture-based slide presentations.     

Expanding voluntary active-learning opportunities for pharmacy students in a Respiratory Physiology Module

Objectives

To expand voluntary active-learning opportunities for bachelor of pharmacy students enrolled in a third-year human physiology and pharmacology course and determine whether the additional course components improved learning outcomes.

Design

Additional voluntary active-learning opportunities including a large-class tutorial, additional formative assessment, and an online discussion were added to the Respiratory Physiology Module of the course. Examination scores were compared with those from previous years. A questionnaire was administered to assess students'' perception of the active-learning components.

Assessment

Mean examination scores increased from 69.3% ± 24.4% in 2003 to 88.9% ± 13.4% in 2004 and 86.9% ± 17.6% in 2005, after the addition of the active-learning components. Students'' overall perception of the value of the active-learning activities was positive.

Summary

The addition of voluntary active-learning course components to a required pharmacy course resulted in improved student examination scores, and decreased failure rate, and were accomplished at low cost and with little additional staff time.     

Applying Organ Clearance Concepts in a Clinical Setting

Objective

To teach doctor of pharmacy (PharmD) students how to apply organ clearance concepts in a clinical setting in order to optimize dose management, select the right drug product, and promote better patient-centered care practices.

Design

A student-focused 5-hour topic entitled "Organ Clearance Concepts: Modeling and Clinical Applications" was developed and delivered to second-year PharmD students. Active-learning techniques, such as reading assignments and thought-provoking questions, and collaborative learning techniques, such as small groups, were used. Student learning was assessed using application cards and a minute paper.

Assessment

Overall student responses to topic presentation were overwhelmingly positive. The teaching strategies here discussed allowed students to play an active role in their own learning process and provided the necessary connection to keep them motivated, as mentioned in the application cards and minute paper assessments. Students scored an average of 88% on the examination given at the end of the course.

Conclusion

By incorporating active-learning and collaborative-learning techniques in presenting material on organ clearance concept, students gained a more thorough knowledge of dose management and drug-drug interactions than if the concepts had been presented using a traditional lecture format. This knowledge will help students in solving critical patient situations in a real-world context.     

An evidence-based medicine elective course to improve student performance in advanced pharmacy practice experiences

Objective

To implement and evaluate the impact of an elective evidence-based medicine (EBM) course on student performance during advanced pharmacy practice experiences (APPEs).

Design

A 2-hour elective course was implemented using active-learning techniques including case studies and problem-based learning, journal club simulations, and student-driven wiki pages. The small class size (15 students) encouraged independent student learning, allowing students to serve as the instructors and guest faculty members from a variety of disciplines to facilitate discussions.

Assessment

Pre- and posttests found that students improved on 83% of the core evidence-based medicine concepts evaluated. Fifty-four APPE preceptors were surveyed to compare the performance of students who had completed the EBM course prior to starting their APPEs with students who had not. Of the 38 (70%) who responded, the majority (86.9%) agreed that students who had completed the course had stronger skills in applying evidence-based medicine to patient care than other students. The 14 students who completed the elective also were surveyed after completing their APPEs and the 11 who responded agreed the class had improved their skills and provided confidence in using the medical literature.

Conclusions

The skill set acquired from this EBM course improved students'' performance in APPEs. Evidence-based medicine and literature search skills should receive more emphasis in the pharmacy curriculum.     

Training Malaysian Pharmacy Undergraduates with Knowledge and Skills on Smoking Cessation

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

Redesign and Evaluation of a Patient Assessment Course

Objectives

To redesign a patient assessment course using a structured instructional design process and evaluate student learning.

Design

Course coordinators collaborated with an instructional design and development expert to incorporate new pedagogical approaches (eg, Web-based self-tests), create new learning activities (eg, peer collaboration on worksheets, SOAP note writing), and develop grading rubrics.

Assessment

Formative and summative surveys were administered for student self-assessment and course evaluation. Seventy-six students (78%) completed the summative survey. The mean course grade was 91.8% ± 3.6%, with more than 75% of students reporting achievement of primary course learning objectives. All of the additional learning activities helped students meet the learning objectives with the exception of the written drug information response.

Conclusion

The use of a structured instructional design process to redesign a patient assessment course was successful in creating a curriculum that succeeded in teaching students the specified learning objectives. Other colleges and schools are encouraged to collaborate with an instructional design and development expert to improve the pharmacy curriculum.