To Record or Not To Record

By David E. Zimmerman, Pharm.D., PGY1 Pharmacy Resident, The Johns Hopkins Hospital

The video recording of lectures was implemented during my P3 year at the Philadelphia College of Pharmacy. At first I did not see a need for the technology because I was one of the students who always went to class. But I felt that it might benefit some students to see and hear the lecture for a second time. It did not occur to me that students might routinely skip class and simply watch the recorded lecture online. This soon became the norm … and my class of approximately 220 dwindled to only 50-100 student during most lectures.

A recent article published in the American Journal of Pharmaceutical Education, the authors discussed the pros and cons of recording lectures.¹ Some of the proposed benefits include repeated exposure to lecture material, the capability of reaching students at satellite campuses, and re-purposing the videos for other uses. I believe the first point can be a significant benefit. Recording lectures is perfect for students who may need repeated exposure to the material or who missed a key concept. Moreover, there will always be times when a student cannot attend a lecture due to illness or an unexpected event.

The main disadvantage to using this technology is decreased student attendance. Would students come to class if they had the opportunity to watch lectures within the comfort of their own apartment or dorm room?  Many students won’t.  I saw this first hand at my college … but this need not happen. To “encourage” attendance, instructors started using an audience response system, a polling technology that collects and displays aggregate responses.  The technology is often used to assess the audiences’ understanding of the material or to generate discussion.  The instructors also used the technology to record attendance and the data was used to determine the participation component of each student’s course grade.  This worked fairly well (in terms of improving attendance) but it required all students to purchase a clicker device and register it with the course.  A downside to this method was the occasional technological malfunction that can occur.  In addition, there is the potential problem of a student’s clicker being lost or stolen. This would require the student to purchase another clicker and re-register it with the course. Another option would be to take attendance manually (the old fashioned way) but this may not work for large classes as it would take away from valuable class time. A third option is to stop the video recording before class ends and then discuss material that would be appear on an exam.

A study was conducted by Bollmeier and colleagues at the St. Louis College of Pharmacy evaluated the performance of pharmacy students (P2) after they had been given access to recorded lectures in a therapeutics course.²  The recorded lectures were available online for a period of 72 hours after the lecture.  Attendance at each of the lectures, student scores on the final exam, overall course grades, the number of times students accessed the recorded videos, and the length of time that the videos were viewed were recorded. Although students performed better on the final exam when compared to historical norms, there was no correlation between a student's final course grade and the number of lectures he/she accessed online. In addition, there was no correlation between class attendance and the number of minutes that videos were viewed online. The authors also noted that the use of the online lectures was far less than expected. Overall, the study showed that video recording did not have a negative impact on lecture attendance. 

In the end, it is about students learning and not about showing up to class. We can all agree that students learn differently and for some, watching a recorded lecture may be the best method. The best way to determine if class attendance  impacts learning is to measure grade performance (short term) and by examining the NAPLEX/MPJE pass rates.  Unfortunately, assessing the impact on NAPLEX/MPJE pass rates would take several years and can be confounded if there are significant changes in the curriculum.

The decision of whether or not to record lectures should be addressed at each academic institution.  The course instructors should determine if there are particular class sessions where attendance would be of particular benefit to students. Examples might include guest speakers or the use of active learning techniques that require in-class participation. The course instructors and the pharmacy administration should also evaluate the cost, available IT support, and predicted use of the recordings.

References:

1.  Romanelli F, Cain J, and Smith KM. To record or not to record? Am J Pharm Educ  2011; 75(8): Article 149.

2.  Bollmeier SG, Wenger PJ, and Forinash AB. Impact of online lecture-captureon student outcomes in a therapeutic course. Am J Pharm Educ. 2010; 74(7): Article 127.

Mentoring: Give Back and You’ll Get More

By Jasmine Shah, Pharm.D., PGY1 Pharmacy Resident, Suburban Hospital

In middle school I joined a community tennis program which met every weekend year-round. For the first few years, my only focus was to improve my tennis skills and endurance … until one day my coach asked me to become a mentor for the new students that had just joined the program. I agreed, not really knowing what my responsibilities would be.  I thought it would be fun! Little did I know I would be tutoring, counseling, assigning “homework,” and (of course) teaching tennis! I was starting to feel like I was becoming a role model for these students, especially when they would come to me seeking advice from anything related to tennis, school, friends, family, and more.

Mentoring can be simple or complex, depending on the situation and commitment from both the mentor and the mentee. Research from the University of Glasgow describes mentoring as “a supportive relationship; a helping process; a teaching-learning process; a reflective process; and a career development process.”¹ Clearly, this definition exhibits complexity, but that’s the beauty of mentoring. Mentoring can be basic counseling to career development and spans across many fields from the educational setting to work.

There are different types of mentoring including: classic mentoring (one-to-one), individual-team mentoring, friend-to-friend mentoring, peer-group mentoring, and long-term relationship mentoring.¹  After reading about these definitions, our tennis mentoring program exhibited the qualities of all these types of mentoring. Mentoring is all about making a difference in someone else’s life, and the research from University of Glasgow states that “the more experienced shall care for and train the less experienced, in a non-judgmental manner.”¹   I can honestly say that after I became a mentor, I learned more about myself and how to be a better role model.

Research published in Advances in Health Sciences Education² explored mentoring in health care educational programs.  The researchers specifically focused on the professional development of medical students. The authors of this study wanted to explore one-to-one mentoring of medical students and examined its influence on theoretical knowledge and clinical competencies. This was a voluntary program with 122 medical students.  Mentors were able to meet with their mentees 1-3 times per semester. The authors concluded that students enrolled in the program had a positive experience and the mentors were able to facilitate their professional development. Students felt a sense of security because they had a mentor to talk to and gain support when needed. Personal issues were also addressed. Lastly, the authors commented that the students enrolled in the program exhibited increased professional competence by “handling relationships, interacting with colleagues, patients and others in a good way and gaining insight into social codes associated with the profession.”²

Mentoring programs in grammar and high school can change a student’s life. The Department of Education designed a mentoring program to expand and improve mentoring for children with special needs.  There are several examples of how these programs help students all over the nation. For example, students interested in medicine are able to shadow a plastic surgeon in San Diego. In another program, students are able to enroll in SAT mentoring programs to improve their scores. If one is fortunate to have a supportive mentor, education and professional development can positively be influenced. You never know when your advice and leadership can lead to someone else’s success.³

How does one become a mentor? I hate to break it to you, but you do not become a mentor overnight.  A good mentor must first believe in themselves and believe that they can make a difference. The best mentor is someone who has been in situations similar to those faced by the mentee and can relate to their situation. A mentor must have a plan regarding how they will help their mentee and how they will help them acquire new knowledge, skills, and attitudes. I would recommend reading teaching and mentoring books in order to gain insight on how to be a great mentor. Most importantly, a mentor must consistently be in contact with their mentee in order to establish a lasting relationship.  Phone calls or regular face-to-face discussions are a must.

Some experts say that mentoring is not well-defined and is poorly-researched. This may be true, but I strongly feel that mentoring has as much to offer.¹ After being part of the tennis program for nearly 7 years, I started a tennis program with two of my colleagues. We are still in touch with every one of our students that we mentored. The best part is that these students have now become mentors to a group of newer students. It’s a rewarding to see new mentors for a new generation!

References:

1.  Hall JC. Mentoring and Young People: ALiterature Review. Research Report 114 (2003). Web. Date Accessed: 5 Nov 2011.

2.  Kalén S, Ponzer S, Silén C. The core ofmentorship: medical students'experiences of one-to-one mentoring in a clinicalenvironment. Adv Health Sci Educ Theory Pract. 2011 Jul 27.

3.  About the U.S Department of EducationMentoring Program. U.S Department of Education. Web. Date Accessed: 6 Nov 2011.

Problem-Based Learning in Pharmacy Education: Effective or Problematic?

by Kelly Parsons, Pharm.D., PGY1 Pharmacy Resident, Union Memorial Hospital

Problem-based learning (PBL) is a teaching strategy used among many pharmacy and medical schools that strives to teach students using realistic scenarios. The purpose behind this educational approach is to increase retention of learning by having students think independently and problem solve. There are two key features of PBL. The first feature is student-centeredness. Learning takes place in small groups and is facilitated by instructors. The second feature is problem solving.  The goal is to have students solve specific problems and thereby enhancing the skills necessary to perform well throughout the curriculum (and in life). When PBL is successfully implemented, the presentation of clinical material serves “as the stimulus for learning” and this “enables students to understand the relevance of underlying scientific knowledge and principles in clinical practice.” ¹

Many research studies have analyzed PBL and compared this teaching strategy to more traditional approaches such as a series of didactic lecture. Leslie Nii and Alfred Chin compared PBL to lecture-based instruction by randomly assigning students to these two forms of instruction during their third year of pharmacy school and assessing the mean grade point averages (GPA) of each group.²  The goal of the course was to help students acquire the skills necessary to manage patients’ drug therapy.  Faculty members served as resources for students during PBL class sessions and facilitated meaningful discussions, with emphasis on skills necessary for pharmaceutical care. Students assigned to the traditional didactic lecture group were taught via presentation-style lectures. At baseline the GPA of two groups was not statistically different during the first two years of school when all students received traditional didactic lectures.  However, there was a significant difference in GPA during the third year of school when PBL was implemented.  Students who received PBL instruction had significantly higher GPAs during fourth year rotations than students received traditional didactic instruction. This suggests that PBL gives students a set of skills that enable them to more quickly become competent and self-sufficient, and may be more effective than traditional lectures. ²

Robert Cisneros and his colleagues completed a systematic review of PBL in pharmacy education based on research articles published between 1980 and 2000.³ In their review, several examples of PBL were described including the use of PBL in an introductory pharmaceutical care course, a therapeutics course, as well as throughout the second and third years of a pharmacy curriculum.  Most examples in the systematic review incorporated PBL after students had completed introductory science courses where they received didactic instruction.  In only one case, where PBL was used in an introductory pharmaceutical care course, that students were introduced to PBL early in the pharmacy curriculum prior to receiving other forms of instruction.  The results of these studies indicated that PBL was an effective method of instruction and could be successfully implemented during any year of pharmacy education.³  Given these positive findings, it is not surprising that PBL continues to be implemented in many pharmacy school curriculums today. Pharmacy education programs have placed more emphasis on patient care and PBL is well suitable to teaching students the skills needed in practice.

When considering Grasha’s Five Teaching Styles, PBL is best matched with the facilitator teaching style.⁴ Instructors guide students through the learning process while encouraging independent thinking and responsibility.  Students are perhaps more engaged because “real life” scenarios are presented.  Students are expected to consider the “whole patient” as opposed to one specific issue.

As a recent pharmacy school graduate, I have experienced PBL first-hand during a therapeutics course.  My experience was similar to the one described by Calvin Meaney in the “Creating a Critical Learning Environment” blog.⁵  Students were divided into groups of ten and each group was given several patient case scenarios to research, identify pertinent medical problems, and develop a therapeutic strategy. This approach fostered critical thinking and was an effective teaching method when group members reviewed material prior to attending the group sessions and actively participated during scheduled class times. However, in my experience, attendance was poor at many sessions and many students worked independently on the case studies.  Thus, the opportunity to capitalize on the strengths of PBL were often lost. Many students elected to forego attending PBL sessions when exams were scheduled in close proximity. Students wanted to use the time to study. In order to overcome this problem, it’s important to schedule PBL sessions at least two or three days apart from exams to encourage student attendance. As an alternative, teachers could make attendance a requirement.  In general, I found that pharmacy students appreciated the PBL sessions and benefited from the learning experience when they were focused on the material.

PBL is an instructional method that can, should, and does play a significant role in pharmacy education.  It fosters strong critical thinking skills.  Although initial findings seem to have positive, there is need for more research to evaluate the effectiveness of PBL in pharmacy education. Challenges will arise as PBL is more frequently used, but these can be overcome as educators become more experienced in this teaching strategy.

References:

1.  Novak S, Shah S, Wilson J, Lawson K, Salzman R.  Pharmacy students’ learning styles before and after a problem-basedlearning experience.  Am J Pharm Educ  2006; 70: 1-8.

2.  Nii L, Chin A.  Comparative trial ofproblem-based learning versus didactic lectures on clerkship performance.  Am J Pharm Educ  1996: 60: 162-164.

3.  Cisneros R, Salisbury-Glennon J, Anderson-Harper H.  Status of problem-based learning research in pharmacy education:  a call for future research.  Am J Pharm Educ 2002; 66: 19-26.

4.  TeachingStyles and Instructional Uses of the World Wide Web [Internet].  Terre Haute (IN): Indiana State University; 2011.

5.   Meaney C.  Creating a critical learning environment [Internet].  Educational Theory and Practice Blog.  Baltimore (MD): University of Maryland; 2011.

Teaching Communication Skills to Pharmacy Students

by Eamonn J. Murphy, Pharm.D., PGY1 Pharmacy Practice Resident, Georgetown University Hospital 

A key concept that I learned during pharmacy school is the importance of communication.  Several classes in the pharmacy curriculum put a strong emphasis on communication.  There were therapeutics labs that incorporated one-on-one counseling of mock patients on medication adherence, side effects, and techniques for using inhalers and medical devices.  However, working with various students and teachers in lab is quite different than practicing as a pharmacist.  This practice was a great stepping stone, but it is vital that students get structured counseling and feedback while interacting with actual patients.

I recently read an article, Improving communication skills of pharmacy students through effective precepting, by McDonough and colleagues.¹ This article emphasizes the importance of students developing and practicing their communication skills during their advance pharmacy practice experiences (APPEs), especially their community-based rotation. This article brings up an interesting concept, “see one, do one, teach one”.  A pharmacy student is going to shadow a preceptor and follow their example.  Every interaction a pharmacist has on a daily basis goes back to the principles of communication, and the student will be influenced by these observations.  Whether talking to a patient, a physician, a nurse, or another pharmacist, these skills will used every day.¹ 

To help develop and teach professional communication during the APPE, it would be beneficial to students to have the preceptor introduce all staff members and their respective roles (or position) in the pharmacy.  This would be the first step in creating professional relationships in which the student would feel comfortable relaying information and asking questions to staff.¹ 

Now that I am in the fifth month of my pharmacy residency, I have had precepting experiences and I will be responsible for co-precepting P4 pharmacy students in the future.  I have been thinking about some lessons that a preceptor should teach to a student.  Even though this article by McDonough focuses on community pharmacy, several of the lessons are equally applicable in hospital pharmacy and precepting in that setting.  A pharmacist in an institutional setting should perform medication reconciliations every day and go into patient rooms to discuss new medications that have been prescribed. One style of teaching is through direct observation of a preceptor conducting medication reconciliations and discharge counseling.  While conducting medication reconciliations and discharge counseling on new medications, it would be appropriate to use the Indian Health Service questions. A pharmacy preceptor should make sure to teach these questions to their APPE student.  Before the student first observes the preceptor patient counseling, time should be spent discussing and rehearsing the Indian Health Service questions with the student. These questions focus on the patients understanding of what medications they are taking, why they are taking them, and what they can expect.

Indian Health Service questions:¹

Prime Questions to ask patients who are receiving a new prescription:

• What did your doctor tell you the medication is for?
• How did the doctor tell you to take it?
• What did the doctor tell you to expect?

Final verification or asking the patient for feedback

• Just to make sure that I didn't leave anything out, please tell me how you are going to take your medication.

Strategy when a patient is receiving a refill

• What do you take the medication for?
• How do you take it?
• What kind of problem are you having?

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As a preceptor, you could demonstrate the use of these questions in front of a student, and then have them counsel patients once they are ready. Through discussion, memorization, practice, and then observation, an APPE student can become comfortable using these Indian Health Service Questions. Other important aspects of communication that could be focused on and discussed with P4 students while precepting is using open ended questions, good eye contact, and active listening.  The responses to these open ended questions will help show what the patient truly understands about their medication and help direct a student or pharmacist toward what should be addressed.² This is especially important because, as Kripalani and colleagues state, only 12% of adults in the United States are proficient health literacy.³

Additionally, in an institutional or hospital setting it is important at the beginning of the APPE to discuss appropriate interactions with physicians. As a pharmacist, there may be several medication-related interventions that need to be communicated directly to the prescribing physician.  A preceptor should spend adequate time discussing how the APPE student should interact with a physician. One method to teaching this type of communication is for the students to write up a series of hypothetical scripts they would use during telephone calls or face-to-face interactions.  Hasan⁴ describes this method of teaching where the pharmacy students writes three scripts for telephone interaction with physicians.  The script types including: passive, aggressive, and assertive.  The purpose of this is for the student to think critically and to explore the various types of communication skills and determine which would be most effective.  Once the student writes these, a preceptor can discuss the pros and cons of each of these styles. Having a student listen to several phone calls and interactions with physicians would also be appropriate.  McDonough includes a brief list of things that should be discussed with a student.

How to Communicate Information to Physicians:¹

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• Keep patient focused
• Provide the physician with meaningful background information
• Clearly and concisely outline the problem the patient is experiencing with the drug therapy
• Propose a solution
• If face-to-face, request physician feedback regarding the solution

In order to be a pharmacist today, effective communication with patients and all members of the interprofessional team is vital.  Preceptors play an important role by helping APPE students acquire the knowledge and skills needed to be effective communicators.

References: 

1. McDonough RP, Bennet MS, et al. Community pharmacy improving communication skills of pharmacy students through effective precepting. Am J of Pharm Educ. 2006; 70 (3) Article 58. 1-12.

2. American Society of Health-System Pharmacists. ASHP guidelines on pharmacist-conducted patient education and counseling. Am J Health-Syst Pharm. 1997; 54:431–4.

3. Kripalani S, Jacobson KL, et al. Strategies to improve communication between pharmacy staff and patients: a training program for pharmacy staff. AHRQ Publication No. 07(08)-0051-1-EF. 2007

4.  Hasan S, et al. A tool to teaching communication skills to pharmacy students. Am J Pharm Educ. 2008; 15; 72(3): 67.

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Students Teaching Themselves: The Unschooling Movement

By David Ngo, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

In our traditional schooling culture, there is a belief that children must be taught how to read, and most learn how to do so at a certain pace. In addition, the children who do not stay at the school curriculum’s pace are often looked down upon, while those who read at a higher grade level are applauded.¹ However, Peter Gray, a psychology research professor at Boston College, discusses the “unschooling” movement and the Sudbury “non-school” movement.²  He claims that children can teach themselves how to read and will enjoy the process, rather than resent it like those who struggle with the conventional schooling system. The Sudbury “non-school” movement focuses on allowing the students to learn at their own pace, with no set syllabus or curriculum, among peers of various ages. Moreover, Gray summarizes the following principles:²

1)    For non-schooled children there is no critical period/best age for learning to read

2)    Motivated children can go from apparent non-reading to fluent reading very quickly.

3)    Attempts to push reading can backfire.

4)    Children learn to read when reading becomes a means to some valued end or ends.

5)    Reading, like many other skills, is learned socially through shared participation.

6)    Some children become interested in writing before reading, and they learn to read as they learn to write.

7)    There is no predictable course through which children learn to read.

Gray brings up several salient points.² For example, his seventh principle discusses how each student is different; therefore, the method and time required to learn how to read will be different. This not only applies to children, but to learners of all ages.  Everyone has a unique approach to learning. This is related to learning styles including Visual, Auditory, Reading, and Kinesthetic. Learners may dominantly learn best in a certain way or a combination of these styles. VARK and the “unschooling” movement are related because it shows that not only does everyone learn at their own pace, but also that they will learn best in their own specific way. A child may learn best visually, by associating the word with the visual image of the object; or a child may learn by hearing the word aloud and associating that with the word; or a combination of both. Through the “unschooling” method, the child will approach the parents/teachers and will learn how to read in the manner that suits them best. Therefore, the “unschooling” or Sudbury movements have implications for learning because it allow students to learn in their own way rather than following a set curriculum that forces each student to learn in one specific way.

Moreover, pushing the conventional reading method upon a child may breed resentment and disdain throughout a lifetime, doing more harm than good. Children will learn more easily and find it more enjoyable once they find their own motivation to read.  Young learners may develop the desire to read because they want to know what a video game says, to write a story, or to emulate family and friends. This is related to the educational theory known as cognitivism. Cognitivism is interested in understanding how the brain functions, how learners think, and the influences of mood, feelings, motivations, and past experiences on learning.  In Sudbury schools, children learn with other students of various ages. Gray talks about how the younger children wanted to learn to read to be like their older peers. Once a child is motivated to read, he or she can learn the skill quickly and fluently. Although unconventional, the “unschooling” movement provides some interesting insights about how best to educate young students, and these are strategies that traditional schools and teachers should incorporate.

If children are able to teach themselves to read, adult learners can successfully teach themselves as well. Self-directed learning is becoming more important particularly as online schools and degree programs are becoming more established.  And more adults are going back to school. As a Shady Grove student at the University of Maryland School of Pharmacy, I was skeptical about how I could earn a Pharm.D. primarily through distance education and web-based strategies.  I’ve seen through personal experience that “unschooling” can apply to pharmacy students.  Personal motivation plays a major role in how well students learn in a self-directed, online learning format.  Shady Grove students are able to watch lectures whenever they want — not restricted by set class times. I have seen that this works well for some and poorly for others.  It works well for students that are motivated and set their own learning schedule. I found this freedom to be great, as I learn better in the afternoon and night.  So I schedule myself to watch my lectures during the afternoon. Other adult learners with families also find this method to be great because they can take care of their family and set aside time to learn. However, some students have difficult with this level of freedom and do not do any work until an exam looms.  Under extreme pressure, they have marathon lecture sessions, binging on as much materials as possible.  This may be effective for short-term learning but this method does not work very well for long-term retention.

“Unschooling” applies to medical residents as well. A qualitative analysis regarding self-directed learning among medical residents found that they believe self-directed learning skills serve as the basis for a physician’s lifelong learning.⁴  Moreover, they found that most residents viewed self-directed learning as important to themselves and their patients.  However, most medical residents felt that they lacked the skills to engage in self-directed learning and valued teacher-centered teaching approaches. Therefore, although self-directed learning has a lot of potential, motivation is important for it to be effective.

References

1.  Anderson R. Junior Knows Best. Utne Reader. 29 Jun 2006 [cited 2011 Oct 17]

2.  Gray R. Children Teach Themselves to Read. Psychology Today [Internet]. Freedom to Learn. 24 Feb 2010 [cited 2011 Oct 17]

3.  Gray R. Nature’s Powerful Tutors; The Educative Functions of Free Play. Eye on Psi Chi. Psi Chi, The National Honor Society in Psychology. 12(1):18.

4.  Nothangle M, Anandarajah G, Goldman RE, Reis S. Struggling to Be Self-Directed: Residents' Paradoxical Beliefs About Learning. Academic Medicine. 2011 Oct 25;Published Ahead of Print.