Responsibility: Can it be Taught?

By: Emeri D. Potter, Pharm.D., PGY2 Ambulatory Care Pharmacy Resident, VA Maryland Health Care System

This past June, towards the end of my PGY1 Pharmacy Practice Residency, I had an administrative rotation at the Veterans Affairs (VA) Central Office. My preceptor posed a question to me: “Can you teach pharmacists accountability and responsibility?” My preceptor told me it would not be an easy question to answer.

I wondered, “What exactly is responsibility in pharmacy?” A responsibility is a duty for which you can be held liable.¹  Although the willingness to accept a responsibility ultimately resides within the individual, it does not alter the expectation.  Nonetheless, although responsibility exists, it can be a challenge to teach someone to feel responsible.  Pharmacy has changed in the last few decades.  Rather than concentrating primarily on chemistry, compounding, and dispensing, pharmacy now takes a more patient-centered approach.  Pharmacists today have a new set of responsibilities, in addition to the traditional ones.  As the profession is becoming more “patient-centered”, pharmacists make decisions and recommendations to improve patient care in addition to dispensing.  Some pharmacists may not feel comfortable in this new role depending on their training.  The management of patients requires us to consider what is optimal for the patient in terms of adherence, cost, and quality of life as well as what’s recommended by various practice guidelines.

After a comprehensive search, I did not find any data or research regarding how to teach responsibility to pharmacists. However, I did find a useful review that offers guidance on teaching responsibility to medical students.²  I believe this review can be extrapolated to pharmacy training.  Here are some of the best practices that are discussed in the article.   First, educational objectives relating to professional responsibilities should be included in each year of the pharmacy curriculum. It should be longitudinal, rather than a single elective or course.  Responsibilities can be taught in didactic format but, second, should also be taught during practice-based experiences.  For instance, a pharmacy student can be taught in a lecture about the responsibilities of a pharmacist in a hypertension clinic. This can be reinforced during an experiential rotation and/or health fair, where the student has to take and record blood pressures, and provide medication counseling.  The connection between both the didactic and professional experiences should be clear to both the faculty and students.  Evaluations by students and faculty are a key part of gauging whether the connection between didactic and experiential learning have been made.²

In pharmacy school, I listened to lectures and took exams relating to pharmacy laws, morals, and ethics. However, ”what students learn is not confined to what they learn in the classroom setting.”¹ These topics were reinforced during my pharmacy practice experiences in school, where I believe social learning and constructivism were the most common educational themes.  In addition, group discussions and class debates about topics such as Plan B were also helpful.  I learned a lot about myself and how to handle sensitive situations.  At the conclusion of these exercises, the faculty and students debriefed, exchanging feedback and evaluations.  I realize now that the process of accepting new responsibilities did not end at the conclusion of pharmacy school and will continue throughout my career.

I feel that I have learned more about responsibility since starting my PGY2 Ambulatory Care Pharmacy Residency.  As a student and a PGY1 resident, I did a lot of observing.  I was more passive.  In my PGY2 residency, I am expected to order laboratory tests and recommend changes in drug therapy.  I must take full responsibility for my actions based on the results.  In the past, when I made recommendations to practitioners, the ultimate responsibility was still theirs.

As pharmacy moves towards the Pharmacy Practice Model Initiative (PPMI) ³, taking responsibility will become increasingly important and it must be taught throughout the pharmacy curriculum. PPMI is an initiative from the American Society of Health-System Pharmacists (ASHP).  The goal of PPMI is to “significantly improve the health and safety of patients by capitalizing on pharmacists’ unique knowledge of the medication-use system, and professional acumen as direct patient care providers.”³ The pharmacy profession is more specialized and additional training is required to meet our new responsibilities.  Pharmacy practice is undergoing a mutation and I think everyone must be ready to adapt.

References

1.  Jacono BJ, Jacono JJ. A holistic approach to teaching responsibility and accountability. Nurse Educator. 1995;20(10):20-23.

2.  Faulkner LR, McCurdy RL. Teaching medical students social responsibility: the right thing to do. Acad Med. 2000 Apr;75(4):346-350.

3.  Hertig J. New practitioners and the pharmacy practice model initiative: our opportunity to define the future. Am J Health-Syst Pharm. 2011 Jun;15(68):1074-1076.

 

Multiple Intelligences in the Classroom

by Lara Groetzinger, PharmD, PGY1 Pharmacy Practice Resident, Johns Hopkins Bayview Medical Center

The theory of Multiple Intelligences (MI) was introduced by Dr. Howard Gardner in 1983.  In his book Frames of Mind, he proposes a novel view of what the concept of “intelligence” entails.¹ This broadened perspective consists of eight different intelligences that humans are capable of possessing. These include: linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, interpersonal, intrapersonal, and the naturalist intelligence. Dr. Thomas Armstrong takes this concept a step farther and applies it to teaching. In his book Multiple Intelligences in the Classroom, he describes how Gardner’s theory can be applied to education.²
 
Armstrong explores each type of intelligence in depth, and offers different ways to approach each intellect. He proposes forty teaching strategies, five for each of the eight intelligences. For example, a student who possesses linguistic intelligence has the capacity to use words effectively, whether orally or written. Armstrong recommends a different way to bring out the linguistic learner in every student. These techniques include storytelling, brainstorming, tape recording, journal writing, and publishing.  The student who has logical-mathematical intelligence holds the ability to use numbers and reasoning with sensitivity to logical patterns and relationships. For this type of learner, Armstrong offers approaches beyond the traditional use of calculations and numbers. These include classifications, Socratic questioning, heuristics, and science thinking. For those learners who are spatial or picture smart, Armstrong suggests visualization, color cues, picture metaphors, idea sketching, and graphic symbols as ways of teaching toward this particular intelligence.

If someone possesses interpersonal intelligence, he or she has the ability to perceive and make distinctions in the moods, intentions, and feelings of other people. For this, the five strategies Armstrong promotes include peer sharing, people sculptures, cooperative groups, board games, and simulations. For the learner who is music smart, tactics such as rhythms/ songs/ raps/ chants, discographies, supermemory music, musical concepts, and mood music are proposed. Intrapersonal intelligence is seen in someone who has self-knowledge and can adapt on the basis of that knowledge. For this student, Armstrong suggests methods such as one minute reflection periods, personal connections, ‘choice time’, feeling-toned movements, and goal-setting movements.

The use of the MI-direct teaching strategies in the classroom is relevant to the Educational Theory and Practice course because it provides another approach to the education of adult learners, including pharmacy students. Some pharmacy educators written about their experiences incorporating multiple intelligences theory into their courses.³ An article entitled Effective Teaching and Learning Strategies emphasizes that there is a difference between learning styles and MI, but stresses that implications for teaching are the same. The author further highlights the importance of teaching in a variety ways including laboratories, simulations, and games, in addition to didactic lectures and problem sets.

As adult educators, we can incorporate the theory of MI into how we teach by using Armstrong's innovative methods in our classroom.  For example, many pharmacy students possess linguistic intelligence. For those that are not as strong in this area, one way to teach to them would be using Armstrong's strategy of journal writing. This could be done by suggesting that every student keep an ongoing record of one thing new they learn each day. This also incorporates intrapersonal intelligence because the students are encouraged to reflect.  The teaching of students with spatial intellect can be accomplished by using colors, symbols, and drawings in a lecture.  Examples include categorizing different classes of drugs by colors, or perhaps showing a picture to depict a mechanism of action for an antagonist using an "X" symbol to represent the receptors that it inhibits. Another example is to have the students draw the steps of how and where the drug works. The possibilities are numerous.

For the music smart student, one could incorporate a rhyme or song with a mnemonic for remembering all the drugs in a therapeutic class or the steps of the Krebs Cycle. This goes beyond pure memorization and allows for a different approach to learning material often perceived as dry or boring. Since students with interpersonal intelligence are smart around other people, small group sessions are a great way to teach to this strength, as well as bring out the interpersonal intelligence in every student. These are just a few examples of how Armstrong’s suggested teaching methods can be applied to pharmacy education.  While it is not feasible to incorporate all strategies to reach all types of intelligences into a lecture, employing a few of these approaches throughout a course may be advantageous.

The conventional teaching ways have traditionally been highly weighted toward the linguistic and logical-mathematical intelligences. Even though textbooks and lectures are important, broadening these instructional methods in order to appeal to other intelligences is ultimately the best strategy. We all possess the eight intelligences – but we each have strengths in some intelligences more than others.  This should be considered when preparing a lecture, topic discussion, or any learning activity. Armstrong proposes multiple ways of teaching to each of the eight intelligences. As educators, we should adopt these strategies, and use them in our own classrooms.

References:

1.  Gardner, H. Frames of mind: the theory of multiple intelligences. 3^rd ed. New York, NY: Basic Books; 2011.
2.  Armstrong, T. Multiple intelligences in the classroom. 3rd ed. Alexandria, VA:  Association for Supervision and Curriculum Development; 2009.
3.  Brandt ,B. Effective teaching and learning strategies. Pharmacotherapy. 2000; 20: 307S–316S.

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).