R-E-S-P-E-C-T Find Out What it Means to Me

By: Theresa Carboni, Pharm.D. PGY-1 Pharmacy Practice Resident, Baltimore VA Medical Center

I remember the day I received my acceptance letter to pharmacy school. “This was it!”  I told myself.  With the letter in hand, I was now well on my way to achieving my goal of becoming a pharmacist.  As I prepared to move 500 miles away, sacrifice 4 years of my life, and pull out a loan the size of a mortgage, I never thought I’d have to earn the respect of my professors (and future colleagues). I had been accepted to the school.  If I were unqualified, I wouldn’t be here, right? Well, on the very first day, I was quickly put in my place by one of my professors.  After I tried to clarify some of the course requirements, he stated, “You will do exactly what I say. Once you have your license in hand, then maybe I will consider what you have to say.”  This incident and a few similar situations, set the tone for the next 4 years with that professor.  And, unfortunately, with a few others too. Based of this experience, I wanted to understand the impact that respect between teacher and student has on learning.

Respect is defined as a state of honor or esteem wherein there is a demonstrated willingness to show consideration or appreciation.¹  Respect is an important component of professionalism.²  A professional shows respect for patients and their families, peers, and other healthcare professionals.   Key documents in the pharmacy literature define the standards by which pharmacists and pharmacy students should demonstrate professional behavior and attitudes. These documents include the Code of Ethics for Pharmacists, Pledge of Professionalism, and Oath of a Pharmacist.²   The word respect is literally written into our professional codes of conduct, the standards by which both pharmacists and pharmacy students should live up to.  Shouldn’t these codes of conduct apply to the interactions between students and teachers in (and outside) the classroom?

Indeed, respect is clearly important and a requirement within the  standards for pharmacy education. According to the Accreditation Council for Pharmacy Education (ACPE) 2007 Standards for the Professional Degree Program in Pharmacy (Standard No. 25: Faculty and Staff – Qualitative Factors), “The college or school must have qualified faculty and staff who, individually and collectively, are committed to its mission and goals and respect their colleagues and students.”³ Additionally, it goes on to state that [faculty] “should provide strategies to develop consistent socialization, leadership, and professionalism in students throughout the curriculum.”³ If faculty are required to respect students and to ensure that students uphold the standards of professionalism, then it seems imperative that it be effectively demonstrated by everyone in the academic community (administrators, faculty, staff, and students).

If respect is important, how can teachers effectively demonstrated it?  What does respect look like?  In his book “What the Best College Teachers Do”, Kenneth Bain devotes an entire chapter on how the best teachers treat their students.⁴  He goes on to describe how the best teachers display an investment in their students. Moreover, the best teachers have a strong sense of trust in their students by believing that students want to learn, and assume, until proven otherwise, that they can.  Above all, the best teachers treat their students with simple decency.  Teachers should treat students in the same manner they would treat a colleague - with fairness, compassion, and concern.  Bain observed that the best teachers incorporated this approach into everything they did – including what they taught, how they taught, and even how they evaluated students. In other words, the best teachers did not use their power to bend students to their will but rather attempted to build common ground based on trust, decency, and respect for what each other brought to the classroom experience.⁴

Pharmacists and pharmacy students are bound by our Code of Ethics⁵ “to respect the values and abilities of colleagues and other health care professionals.” Since we commit as professionals to uphold these standards, I feel it is imperative we start when a student enters pharmacy school  … and not wait until graduation.

References:

1. Webster’s Dictionary for word respect. Accessed on December 15, 2010.

2. Hammer DP. Professional attitudes and behaviors: the “A’s and B’s” of professionalism. Am J Pharm Educ 2000; 64: 455-464

3. Accreditation Council for Pharmacy Education: Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Available at: http://www.acpeaccredit.org/pdf/ACPE_ Revised_ PharmD_ Standards_ Adopted_Jan152006.pdf. Accessed on December 15, 2010.

4. Bain K. What the Best College Teachers Do. Harvard University Press. Cambridge, Massachusetts.

5. Code of Ethics for Pharmacists. American Pharmacists Association. 1994 

Pick Me! I Was a Pharmacy Technician

by Kasey Dumas, Pharm.D., PGY1 Pharmacy Practice Resident, Sibley Memorial Hospital 

Many universities consider previous pharmacy work experience to be a predictor of better academic performance in pharmacy school.  Attesting to this fact is that some pharmacy schools include information on their websites implying that work experience may enhance an applicant’s chance of acceptance.  For example, the University of Maryland School of Pharmacy website states, “Work experience is not required for admission.  However, it can show commitment to the field of pharmacy or can demonstrate the well-roundedness of an applicant.”¹ The Virginia Commonwealth University’s School of Pharmacy website states that previous work experience is not required but, “exposure to pharmacy practice is desirable” and “ideally, successful candidates have some exposure to the health care system and patient care involvement.”²  This is a interesting hypothesis, but what needs to be tested is whether previous pharmacy-related work experience results in improved academic outcomes.

A study conducted in April 2010 at the Touro University College of Pharamacy evaluated the impact of previous pharmacy work experience on academic success.  This study was looking at both academic and clinical performance.  A survey was used to determine the type and quantity of pharmacy work experience.  The survey results from 206 responding students were then correlated with grade point average (GPA), high-stakes examination grades, and advanced pharmacy practice experience (APPE) grades.  The researchers also stratified the data by student demographics.  The results of this study showed no difference in academic performance between students with previous work experience and those without previous work experience.³ 

Unfortunately, the results of this study may not be generalizable to other pharmacy schools (or health professional disciplines).  The average age of respondents in the Touro study was 26 years in respondents with no work experience and 27.3 years in respondents with work experience.  Some institutions accept students immediately from high school into 6-year programs.  Thus, the effects of work experience may be different if the average age is much younger (or older).  Also, assessment strategies and grading methodologies differ between institutions.  Finally, surveys in general have poor response rates and may not accurately represent the entire student body.

One explanation as to why work experience does not translate into better academic outcomes is that working as a technician or intern teaches you technical skills, but not clinical skills, which are now the focus of pharmacy curriculums.³  Although academic performance does not appear to be effected by work experience, previous experience in a pharmacy may indicate that a perspective student is more sure of their future and may be more dedicate to the profession.^1,2  In the future, it may be beneficial for researchers to examine other benefits that previous work experience may confer.

Previous work experience may be a useful way to select between students and it may predict some other desirable attribute(s).  In my experience, working as a pharmacy technician made me more confident when I entered pharmacy school, more certain that I had made the best career choice, and made studying for many of the technical aspects easier, such as learning brand and generic names of medications.  Also, during my clinical experiences, I was already comfortable interacting with members of the pharmacy team and speaking with physicians and nurses.

In conclusion, although experience has not been shown to improve academic performance, other benefits may be afforded to students (and the schools that accept them) who have previous work experience.  I believe that universities should continue to use previous work experience as one the criteria to select applicants but we need further studies to better understand how previous pharmacy-related experience impacts short and long-term outcomes.

References

1.      University of Maryland School of Pharmacy.  PharmD Admissions: Prerequisites.  Accessed: Dec 2010.

2.      Virginia Commonwealth University School of Pharmacy.  Pharm. D. Program FAQ: Academic info.  Accessed: Dec 2010.

3.      Mar E, Barnett MJ, Tang TTL, Sasaki-Hill D, Kuperberg JR, Knapp K.  Impact of previous pharmacy work experience on pharmacy school academic performance.  American Journal of Pharmaceutical Education.  2010; 74 (3): Article 42.

Social Networking and Professional Education

By Nicole Hahn, Pharm.D., PGY2 Ambulatory Care Pharmacy Practice Resident, University of Maryland

There is no doubt that the popularity of social media sites has boomed in the last few years and with it has come new ways to communicate to and among students.  The London School of Business and Finance Global M.B.A. decided to capitalize on the success of Facebook by using the site as a vehicle to advertise their online M.B.A. program.  Students will be able to sign up for the program just as they join any other group by sharing their name, profile picture, Facebook ID, and list of friends.  Short (15 minute) online video presentations, Facebook discussions, and case study materials are provided for each course.  Unique to this program is the way in which tuition is paid.  Students have free access to all of the online study and collaboration tools and only pay when they want to take exams.   Similarly to other Facebook groups, students post comments on each other’s “walls” and this mechanism is used to provide feedback about courses.

As instructors, we are encouraged to recognize the different learning styles and preferences of our students.  And we should strive to structure our lesson plans to incorporate all of them.  What we sometimes fall short in accomplishing is appealing to what our students’ interests are.  It is amazing how people can remember every single word to a song on the radio they haven’t heard in years but struggle to remember concepts from a lecture they sat through just yesterday.  Or a student athlete who struggles in the classroom due to a learning disability but as the quarterback of his team, remembers and calls every offensive play.   So what is the difference described in these two examples?  A favorite song, a passion for playing a sport are activities that these individuals enjoy doing.

Today people of all ages enjoy keeping up with friends and family on social networking sites such as Facebook.  The online M.B.A. program at The London School of Business and Finance combines a social networking conduit with scholarly activity – joining an activity people enjoy doing to one they may struggle to motivate themselves to accomplish.  One of the most important steps in developing a lesson, course, or degree program is providing feedback.  Constructive feedback is very important for a teacher and being able to “post” on Facebook is a great incentive to get students to actually write meaningful feedback.  Educators in this program discovered that students began posting feedback without even prompting them to do so.

As we look ahead and postulate how online social networking can be applied to ourselves as educators, we should do so with caution.  There exists a very thin line in managing your own personal life and your professional career when using sites such as Twitter, Facebook, and MySpace.  It takes some effort to prevent these two lives from crossing one another, but it is not impossible.  When used effectively, social networking sites may be appealing and useful to both to the educator and the learner.

Reference

Guttenplan DD. (2010 Nov 28). Poking, Tagging and Now Landing an M.B.A. The New York Times (New York, NY). 

A Different Small Group Learning Method - POGIL

by Amy Nathanson, Pharm.D., PGY1 Community Pharmacy Practice Resident, University of Maryland School of Pharmacy

Small group learning with an active component is incorporated in many curricula today. Have you been in a class where you had small group breakout sessions to discuss a case or apply learned concepts?  Many of us would answer yes.  Have you been enrolled in a course which was taught exclusively using a small group learning method?  Likely fewer would say yes.  Have you heard of or been enrolled in a process-oriented guided-inquiry learning (POGIL) course?

POGIL is a student-centered small group method of education.  The goal of this educational method is geared to develop the learner’s critical thinking and communication skills while keeping the student actively engaged in the learning process.  Students work in teams of four.  Using course materials and equipped with “guided” questions from the instructor, students explore an idea, (hopefully) grasp a concept, and then apply it.¹  The instructor’s role is to serve as a facilitator and, therefore, will not answer questions if s/he believes the students have enough information to come to a conclusion.²

This method of learning was initially developed for science courses and was prompted by an understanding the needs of industrial employers.³  A survey was conducted and concluded that “employers would like chemistry-trained employees whose education includes greater preparation in communication, team skills, relating applications to scientific principles, and problem solving, without sacrificing thorough preparation in basic science concepts and experimental skills.”³

I am fortunate to have participated in a POGIL course taught by one of the founders of this methdology.  It was an introduction to chemistry course taught at Franklin & Marshall College.  Reflecting back on the course, I remember it was very different from the typical lecture-base courses and, at the time, only a few courses were taught in this manner.  I enjoyed working with other students and remember favoring certain roles over others.  As a group we taught ourselves the key concepts of chemistry.

After discussing various small group teaching methods during the Educational Theory and Practice course, I have been reflecting on my experiences in this course and how it is unique.  POGIL utilizes carefully crafted learning materials to provide information to students systematically with leading questions to promote critical thinking to arrive at the best conclusion.  In each small group students have defined roles and responsibility that rotate weekly.  The roles include:

Manager- delegates responsibilities and keeps team focused, resolves disputes and ensures full member participation

Recorder- writes up group answers to turn in

Spokesperson/presenter- presents report to class

Analyst/reflector- identifies strategies and methods for problem solving, identifies positive attributes of the team

Every student is expected to learn the material on a daily basis and ensure that all group members have learned it too.

Unlike other small group learning environments such as Problem Based Learning (PBL), POGIL is more structured.  Every member of the group has an assigned role.  PBL is less structured and requires more independence of each student.¹ There are never lectures in a POGIL course, whereas occasionally there is a lecture in a PBL course.

This method of learning is rewarding to students because it actively engages them in the learning process. It’s more rewarding to the instructors as well because there is constant feedback from students.  Instructors have greater awareness of how the class is doing by getting this feedback.⁴

In my pharmacy education at University of Maryland we have small group case-based learning activities.  These cases often included leading questions to encourage critical thinking and further application of knowledge and guidelines of disease states and therapies.  However, the groups were often too large, consisting of 10-12 students, making it difficult to effectively work as a team.  And as is typical with most group work, certain people become the leaders or “managers” for every session, and other members of the group assumed roles that they were naturally comfortable with.  This is a problem that POGIL addresses by creating small working groups and assigning student roles.

These small group learning activities take a substantial time commitment from instructors and more effort on the part of the student too.  This likely explains why small group facilitated learning is not commonplace.  However there is a place for this methodology and I believe it can be used more in pharmacy education.  The skills POGIL works to enhance are necessary skills in pharmacy:  communication and team work with patients and other health professionals are critical skills that every pharmacist should master. 

References

1. Eberlein T, Kampmeier J, Minderhout V, Moog RS, Platt T, Varma-Nelson P, White HB.  Pedagogies of Engagement in Science: A Comparison of PBL, POGIL and PLTL. BAMBED. 2008; 36(4):262-73. 

2. POGIL Guided Inquiry Classroom [Internet]. Lancaster: Franklin & Marshall College. The POGIL Project. C2010 [Cited 2010 Nov 19]

3. Hanson DM. Instructor’s Guide to Process-Oriented Guided-Inquiry Learning. Lisle, IL: Pacific Crest. 2006. [Cited 2010 Nov 19] 

4. POGIL [Internet]. Lancaster: Franklin & Marshall College. The POGIL Project. C2010 [Cited 2010 Nov 17]

Interprofessional Education: Building a Bridge to Interprofessional Cooperation

By Susan Montenegro, Pharm.D., PGY1 Pharmacy Practice Resident, Union Memorial Hospital

Many schools boast having an “interprofessional culture,” which (apparently) they define as having more than one health professional school located on the same campus. But simply having schools across the street from each other, sharing a cafeteria, and hosting a few campus-wide social events, does not come close to building the relationships needed for optimal patient care. Many students in the health professions are taught a structured approach to managing a patient. So interprofessional education (IPE) shouldn’t be so difficult – should it? How can educators from different schools build bridges and encourage students to make the journey? How do we encourage the healthcare system to sustain these bridges?

I envision the answer to this question to be a three step process analogous to constructing a bridge to connect two places. Step 1 is putting together a blue print and building a structure.  As with any improvement process, first you need to put everything down on paper so everyone can see it. How will the bridge be built? Who will build it? Who will pay for it? Why is the bridge necessary? What are the benefits? A plan must be made and a proposal submitted to garner the support of the university, and secure the funds needed, to build the structure. Once these things are secured, those in charge of the project can begin to lay the foundations.

The American College of Clinical Pharmacy (ACCP) released a White Paper on IPE which describes considerations relevant to IPE.¹  Fundamentally, it is important for students to understand the knowledge and skills that other members of the healthcare team possess. Students must also realize that different professions take different approaches to patient problems in terms of assessment and evaluation. The paper describes several examples of IPE models.  Each approach has its strengths and future IPE programs can be optimized by building on these examples.

Creighton University Medical Center in Omaha, Nebraska has a number of IPE initiatives.² Collaborative Care Seminars are held one half-day each semester and involve students in dentisty, medicine, nursing, occupational therapy, pharmacy, physical therapy, and social work.  During these seminars, students are encouraged to reflect on what their own profession’s contributes to patient care and how to work together and understand what other professions have to offer. The Medical Center also offers a clinical conference and grand rounds series during which case-based discussions are led by panelists from the various health professions. This allows students to learn and observe how to participate in similar discussions once they start clinical training.

Step 2 is convincing the students to take the journey across the bridge. Students will only make the journey if they understand the importance of arriving at the destination. Where are they going? Why are they being asked to cross into unknown territory and away from familiar and safe ground? What are the benefits?

Another example from Kings College in London involves pairing a fourth year pharmacy student and a third year medical student to work together.³  Both students are starting their clinical year of training, so they have similar amounts of clinical experience and knowledge of therapeutics. Each student pair is assigned a patient with the objective of obtaining a medical and medication history.  The student pair is then instructed to organize the information and present it to a group of faculty and students.  They are expected to summarize the patient problems, the rationale and appropriateness of the treatment regimen, and how to monitor the patient for efficacy and adverse effects.  The results of this activity have been positive, with the medical students learning how to be more proficient at collecting the medical history of a patient and the pharmacy students being more proficient at collecting and managing the patient’s medication history. This type of activity is promising to demonstrating to health professionals early during their training how to maximize patient care by relying on the strengths of different professions.

A post-course questionnaire administered after the student pair activity found that 95% of pharmacy and medical students agreed or strongly agreed that it was useful to learn with other disciplines; 88% agreed or strongly agreed that there were equal contributions from both students; and 83% agreed or strongly agreed that more sessions were needed.³  This data shows that, given the opportunity, students are willing to meet other professions half-way and see the benefit in doing so.

Step 3 is ensuring that the destination (on the other side of the bridge) exists ... developing and continuing to foster the types of working environments where recent graduates can continue to use the skills they learned during IPE. This may require more time to develop as it will require holistic support. Not all clinicians have experienced IPE and many may feel threatened by the changes it will require. However as more programs move in the direction of IPE and as more workplaces emphasize the importance of inter-professional teams, the bridge built by educators will become stronger, producing a brighter and more promising future to optimize patient care.

In 2001, the Institute of Medicine released a report addressing the gaps in health care in the U.S. and how to redesign the health system. Titled, “Crossing the Quality Chasm: A New Health System for the 21^st Century,” this report stated that health care needs to be safe, effective, patient-centered, timely, efficient, and equitable.⁴  Included in the report were 10 general principles meant to guide improvements to meet these health care needs. One principle, stated quite simply and directly, “Cooperation among clinicians is a priority.” Thus, it is clear that our healthcare system needs to move towards interprofessional cooperation and that IPE will play an important role in making that future a reality.

References

1.  American College of Clinical Pharmacy. ACCP white paper. Interprofessional education: principles and application. A framework for clinical pharmacy. Pharmacotherapy 2009; 29: 145e-164e. [Accessed September 26, 2010].

2.  Interprofessional Education. Creighton University Medical Center. [Accessed: November 22, 2010]

3.  Greene RJ, Cavell GF, Jackson SHD. Interprofessional clinical education of medical and pharmacy students. Medical Education. 1996;30:129-133.

4.  Institute of Medicine.  Crossing the Quality Chasm: A New Health System for the Twenty-first Century.  Washington, D.C.: National Academy Press, 2001.