Distance Education in Healthcare Degree Programs

by Maureen Jones, M.S., Pharm.D., PGY-1 Pharmacy Practice Resident, Carroll Hospital Center

Distance Education has been defined as “the separation of educator and learner in time and space.”¹  Among advanced healthcare degrees, nursing², dental hygienist³, public health⁴ and Doctor of Pharmacy degrees^5-6 can currently be completed through distance education programs. Many (perhaps most) traditional healthcare degree programs incorporate aspects of distance learning into their curricula as well.^7-8  But what kind of evidence do we have evaluating the quality of distance education to traditional methods?  Should we celebrate distance education as an equal (or better!) alternative to traditional methods of instruction?  Or should we reject it?  The answer: we have data (but perhaps not enough) and it’s mostly positive.

Nursing programs have by far the most data on distance education.  One systematic review on the effectiveness of tele-education in nursing and medical education found that there was no significant difference in overall knowledge gain between face-to-face instruction and videoconferencing.⁹  Another study evaluating the effect of learning environment in a graduate nursing program found that there were no significant differences in final course grades or the student’s perceived learning between online versus traditional face-to-face classes.  The authors emphasized that it was the “quality of instruction [that was] more important than the medium by which the course content was delivered.”¹⁰

There has also been research on distance learning in the dental sciences. For example, traditional classroom versus e-learning in infection control education for first year dental hygienist students showed that both methods of teaching were comparable based on knowledge assessments and a competency based exam (CBE).  The researchers concluded either method could be used depending on school preference and resources.  It is true that the traditional face-to-face group performed significantly better on a multiple choice exam (mean score=86.8 vs. 82.8 p=0.011), however the difference was not deemed to be a “practical” difference as both group’s mean scores were passing.  Regarding the CBE, there was no significant difference in the pass rate in each pathway.¹¹  Many Dental Schools offer distance education courses in their curriculum. The University of Missouri-Kansas City School of Dentistry conducted a pilot program whereby the school’s pharmacology course, which was previously taught by the University’s School of Pharmacy, was transitioned to an online course taught by dental school faculty.  The pilot study showed student grades in the online cohort were similar to grades in previous year’s.  Additionally, the dental school was able retain a highly qualified professor who would have otherwise sought employment elsewhere.⁷

Pharmacy Schools have researched distance education strategies as well.  Creighton University is the only school of pharmacy that has a distance learning pathway for some students in their entry-level Doctor of Pharmacy degree program.  Many schools now have hybrid pathways and satellite campuses. One particular school of pharmacy that has two satellite campuses evaluated student performance in a pharmacotherapeutics class taught synchronously between the campuses. Over the course of five years, there was no significant difference between the final grades of students attending each campus.¹²

While the academic aspects of online education are very positive, there are potential negatives associated with distance learning: namely students potentially feeling isolated, both from other students and professors, as well as technological frustrations.  In two separate studies, students in an online dental terminology class and students in an online Doctor of Nursing program both cited feelings of isolation and disconnectedness as drawbacks to distance learning.^13-14 However, students overwhelmingly thought the benefits of distance education (convenience, access, good school-life balance) outweighed this drawback.¹⁴ Additionally, students and faculty can feel frustrations towards the technology needed for distance learning.  These may be from slow download speeds, dropped internet connections, or the lack of information technology (IT) support from the school.¹³ Practical ways that educators can overcome these shortcomings include utilizing synchronous online chat discussions or assigning group projects to help students feel more connected, promptly answering student emails and phone calls, preparing back-up plans for activities in the event of a technological failure, and making certain there is adequate IT support available during synchronous online events.  Practical ways that students can address potential negativities include utilizing social media outside of class time to become more connected to classmates and obtaining high-quality, reliable internet service.

While some individuals may still hold certain negative perceptions about distance education, the evidence shows that well-designed instruction delivered at a distance is equally effective as traditional teaching methods in educating our future healthcare providers.

References

1. Du S, Liu Z, Liu S, Yin H, Xu G, Zhang H and Wang A Web-based distance learning for nurse education: a systematic review. Nurse Educ Perspect. 2011;32:406-10.
2. US News. The Best On-line education programs in 2014. Accessed 2/25/2014.
3. American Dental Hygienists Association. List of on-line Master’s of Dental Hygiene programs. Accessed 2/25/2014.
4. Davis MV, Sollecito WA and Williamson W. Examining the Impact of a Distance Education MPH Program: A One-Year Follow-Up Survery of Graduates. J Public Health Management Practice. 2004;10:556-563.
5. Lenz TL, Monaghan MS, Wilson AF, Tilleman JA, Jones RA and Hayes MM. Using Performance Based Assessments to Evaluate Parity Between Campus and Distance Education Pathway. Am J Pharm Educ 2006;70: Article 90.
6. The Non-Traditional Doctor of Pharmacy Pathway. The Bernard J. Dunn School of Pharmacy at Shenandoah University. Accessed 3/4/2014.
7. Gadbury-Amyot CC and Brockman WG. Transition of a Traditional Pharmacology Course for Dental Students to an Online Delivery Format: a pilot project. J of Dental Educ. 2011;75:633-45.
8. Haney M, Silvestri S, Van Dillen C, Ralls G and Papa L. A Comparison of Tele-Education Versus Conventional Lectures in Wound Care Knowledge and Skill Acquisition. J Telemed Telecare. 2012;18:79-81.
9. Chipps J, Brysiewicz P and Mars M. A Systematic Review of the Effectiveness of Videoconference-based Tele-education for Medicaland Nursing Education. Worldviews Evid. Based Nurs. 2012;9:78-87.
10. Wells M and Dellinger AB. The Effect of Type of Learning Environment on Perceived Learning Among Graduate Nursing Students. Nurs. Educ. Perspect. 2011;32:406-10.
11. Garland KV. E-learning vs. Classroom Instruction in Infection Control in a Dental Hygiene Program. J of Dent Educ. 2010;74:637-643
12. Steinburg M. and Morin AK. Academic Performance in a Pharmacotherapeutics Course Sequence Taught Synchronously on Two Campuses Using Distance Education Technology. Am J Pharm Educ. 2011;75:Article 150.
13. Grimes EB. Student Perceptions of an Online Dental Terminology Course. J of Dent Educ. 2002;66:100-107.
14. Halter MJ, Kleiner C and Hess RF. The Experience of Nursing Students in an Online Doctoral Program in Nursing: A Phenomenological Study. Int. J of Nurs Studies. 2006;43:99-105.

A Quality IPPE Institutional Experience

by Teresa Elsobky, Pharm.D., PGY2 Psychiatric Pharmacy Resident, University of Maryland School of Pharmacy

Introductory Pharmacy Practice Experiences (IPPE) are a requirement designed to be a pharmacy student’s first structured experience with direct patient care in a health care setting.¹  They provide transitional experiential activities and active learning opportunities for students to apply lessons learned in the classroom in the “real world.”² As a pharmacy student, I had to complete two IPPEs: a 40-hour IPPE community experience and an 80-hour IPPE institutional experience. My IPPE institutional rotation experience, in particular, stands out in my mind. During this rotation, I did not have a chance to participate in the medication use process in its entirety – from when a prescriber writes a medication order to when the medication is administered to the patient.  While I mastered the task of stocking a Pyxis^® machine, I did not understand why these specific medications were made available or how to prevent medication errors from occurring. During that introductory experience, I never entered a medication order into the hospital’s health information system.  It wasn’t until my advanced pharmacy practice experience (APPE) during a institutional rotation that I learned about the medication use process.

Image from: http://www.pharmacy.arizona.edu/programs/rotations

An IPPE institutional rotation can be conducted in many ways, but the goals and objectives should be clear and similar across all Doctor of Pharmacy curricula. According to the Accreditation Council for Pharmacy Education (ACPE), an IPPE rotation should “continue in a progressive manner leading to entry into the advanced pharmacy practice experiences.”3  IPPE rotations should be appropriately designed in order to prepare students for the direct patient care activities that occur during advanced rotations. In 2009, a task force of the American Association of Colleges of Pharmacy (AACP) developed a nationally defined set of IPPE competencies that these competencies should be mastered prior to APPEs.⁴ These competencies included the following broad categories: processing and documenting prescriptions/drug orders; understanding professional norms and behaving in a professional manner; understanding dosage forms/devices and how their use should be communicated to patients; and assisting patients with self care.⁴  These competencies were established to help schools and preceptors create valuable IPPE rotations with clear goals, objectives, and activities.

After looking at several different institutions’ IPPE rotation syllabi, here are some general goals and objectives that I believe should be achieved during an IPPE: participating in pharmacy operations in a role similar to the pharmacist’s,⁵ observing an interprofessional team,⁵ explaining the roles and responsibilities of every pharmacy staff member,⁶ and identifying personal learning needs by participating in a continuing professional development process.⁶

How will a pharmacy student accomplish these objectives?  What activities can the preceptor arrange to aid in the successful completion of these goals?  Preceptors can not spend every moment with their students during the rotation, but they should facilitate the necessary tasks to make it a fulfilling experience.¹ Certain activities that will help achieve the rotation goals include:⁶ being involved in the preparation and dispensing of oral, topical, and intravenous medications; observing the medication use process (understanding how orders are written and delivered to the pharmacy, shadowing a pharmacist as he/she inputs and verifies medication orders, and seeing how the patient receives the medication after the order has been processed); attending Pharmacy & Therapeutics Committee meetings; helping to maintain patients’ medication profiles; assisting the pharmacist report an Adverse Drug Reaction (ADR); formulating an alternative drug selection when a drug-drug interaction exists; communicating verbally and in writing with various healthcare disciplines and patients; formulating a timely response to drug information questions from hospital staff members; and utilizing resources (efficiently!) to look up answers to drug information questions.

Creating a quality IPPE institutional rotation is important and vital to pharmacy students’ professional growth, as this is the first structured experience with patient care.   Schools/Colleges of Pharmacy and preceptors should focus on setting realistic goals and designing fulfilling experiences during these rotations that will enable students to accomplish these goals. The recommendations set forth by the AACP Task Force for IPPE rotations should be used as a resource⁴ and every student should be expected to master these competencies before advancing to APPE rotations.

References

1. Owle C, Lawrence S. IntroductoryPharmacy Practice Experiences: What Students Should Expect [Internet]. Southern Pines (NC): Coastal Research Group; 2011 Dec 14.
2. Chisholm M, DiPiro J, Fagan S. An Innovative Introductory Pharmacy Practice Experience Model. Am J Pharm Educ. 2003; 67:171-8.
3. American Council on Pharmacy Education Standards 2007. Accessed March 9, 2014
4. Task Force on IPPE Competencies, American Association of Colleges of Pharmacy (ACCP). Report to: Board of Directors 2009 May.
5. Ackman M, Mysak T. Structuring an Early Clinical Experience for Pharmacy Students: Lessons Learned from the Hospital Perspective. Can J Hosp Pharm 2009;62:320-5.
6. Eshelman School of Pharmacy (University of North Carolina). Rotation workbook to: IPPE pharmacy students (University of North Carolina Eshelman School of Pharmacy). 2013.