November 23, 2010

What is the Target?

by Angela L. Bingham, Pharm.D., PGY1 Pharmacy Practice Resident, Johns Hopkins Hospital
What is the target?  To answer this question, student pharmacists must be given a clear description of what they should be able to do after completing a learning experience.  Regardless of the field of study, instructors should give their students explicit instructional objectives.
In the “Required and Elective Educational Outcomes, Goals, and Objectives for PGY1 Pharmacy Residency Programs,” the American Society of Health-System Pharmacists (ASHP) defines educational goals, educational objectives and instructional objectives.1  Educational goals are “broad sweeping statements of abilities.”  Achievement of educational goals is determined by assessing the learner’s ability to perform educational objectives.  Instructional objectives further narrow the focus by outlining the “knowledge and skills required for successful performance of the educational objective.”  Instructional objectives are helpful to educators and students by identifying areas for improvement to meet educational objectives.1
Beyond providing students direction, instructional objectives help improve quality and efficiency.  According to Dr. Louis Vontver, “Instructional objectives should delineate specifically what the student is expected to do or know in terms of the student’s ability to demonstrate his skill or knowledge.”2  Objectives can only be measured effectively if they are simple.3  Measurement of complex outcomes and goals can be problematic because of the multi-factorial nature of the assessment needed.  Instructional objectives narrow the focus and help control for variables.
The Accreditation Council for Pharmacy Education (ACPE) also highlights the importance of objectives to facilitate learning.  ACPE states, “specific criteria should be developed to enable faculty and students to assess progress midway through the experience and at its completion. Students should be provided the opportunity to demonstrate achievement of stated competencies as assessed through the use of reliable, validated criteria.”4
When I was a student pharmacist, I was involved in a project that examined the role of self-assessment tool to evaluate the value of instructional objectives.  During this research project, a self-assessment tool was constructed using educational objective and instructional objective statements from the “Required and Elective Educational Outcomes, Goals, and Objectives for PGY1 Pharmacy Residency Programs.”5  Students performed self-assessments using this tool and their responses were compared to scores assigned by the preceptor for educational objectives and instructional objectives.
Twenty 3rd-year Doctor of Pharmacy candidates participated in the study.5  When comparing students’ self-assessment to the preceptor’s scores on the educational objectives, students were more likely to rate themselves higher for “accurately assess the patient’s progress toward the therapeutic goal.”  A significant difference was also seen when comparing “display initiative in preventing, identifying, and resolving pharmacy-related patient-care problems.”  In contrast, using instructional objectives improved the accuracy of student self-assessment.  There was no significant difference between student and preceptor scores for any of the instructional objectives.
As a result of this research project I concluded that, in order for students to understand course expectations, course syllabi must clearly outline the knowledge and skills needed to meet the educational objectives.5  Providing instructional objectives to students enable self-directed learners to achieve desired expectations.5 The learner and preceptor share a mutual understanding of the knowledge and skills required to meet an educational objective. 5
In addition to giving students greater clarity, instructional objectives also aid the instructor.5  When the learner and instructor understand the expectations, confrontation may be avoided at the time of evaluation.5
In an experiment conducted at the University of Washington Hospital in Seattle, Washington, medical students completing nights on obstetric call were provided with specific instructional objectives.2  Medical students were issued a document outlining objectives prior to nights on call.2  The medical students were instructed to read the document several times before each scheduled night and again during on-call period.2  The following morning, the students were expected to demonstrate fulfillment of the objectives.  Before implementation of objectives, the performance of the medical students during morning rounds were “highly erratic.”  After instructional objectives were provided as well as some instruction on how to use them, the students performed much better.  They were often able to fulfill all of the expectations after only one night in the delivery room.  Beyond guiding medical students, the instructional objectives also prevented misunderstanding by other members of the health-care team by clarifying the students’ responsibilities.2
When educators provide instructional objectives, students are more likely to find the target.  Well-written instructional objectives enable self-directed learners to achieve desired expectations.  Also, instructors may find assessment easier when clear instructional objectives are available.  Thus, instructional objectives are vital tools to both educators and students.

1. Required and Elective Educational Outcomes, Goals, and Objectives for PGY1 Pharmacy Residency Programs. American Society of Health-System Pharmacists. 2008.  Available at:
RTP_PGY1GoalsObjectives.doc. Accessed November 15, 2010.  
2.  Vontver LA. A Use of Instructional Objectives To Increase Learning Efficiency. Journal of Medical Education. 1974;49:453-454. 
3.  Norman HG. Schmidt GR. Effectiveness of Problem-Based Learning Curricula: Theory, Practice, and Paper Darts. Medical Education. 2000; 34(9):721-728.
4.  Accreditation Council for Pharmacy Education: Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Available at: Revised_ PharmD_ Standards_ Adopted_Jan152006.pdf. Accessed November 15, 2010.
5.  Bingham AL, Hess MM. Self Assessment as a Tool to Evaluate the Value of Instructional Objectives. ACCP Annual Meeting. Anaheim, CA. October 18, 2009.

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