Situational Judgment Tests (SJTs) to Measure Beyond Recall

by Karmen McMinn, PGY1 Pharmacy Community Practice Resident, Mississippi State Department of Health

In order to become a pharmacist, a student must receive a Doctor of Pharmacy degree. This means that they receive several years of education, but does all of that knowledge mean they will be successful? In addition to having a wide range of factual knowledge, pharmacists must also be able to display empathy towards patients and caregivers, work well in teams, and many other qualities that do not rely on the recall of facts.^1,2 These qualities (empathy, team player, etc) are sometimes be referred to as “soft” skills while being able to recall factual knowledge is often referred to as academic or cognitive skills.³ Some have argued that strong academic skills are inversely related to soft skills.^1,2 Thus, someone who earned straight A’s in those early science classes may struggle during advanced practice experiences.

One common requirement for pharmacy school admission is the Pharmacy College Admission Test (PCAT). The PCAT was designed to measure general academic ability and scientific knowledge. This background knowledge is something all students must have in order to be successful in pharmacy school. The problem with a test like this is that it only looks at a student's general academic knowledge while neglecting to assess other important skills a successful pharmacist must possess. For example, the PCAT does not assess a person’s ethical decision-making ability. This is where situational judgment tests (SJTs) might be useful. They can be an effective tool for assessing soft skills.^2,4

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SJTs are a type of psychometric test in which learners are presented with a realistic scenario or situation. Examinees are then presented with 4 or more actions they could take and instructed to pick the option they believe is the most appropriate – an action they would take in real life. The test taker is often asked to pick not only the most appropriate response but also the least appropriate response. In some SJTs, they are asked to rank the relative appropriateness of the responses from most appropriate to least appropriate.⁵ SJTs can measure traits not related to a person’s ability to recall factual knowledge.⁶ This can be done by making sure questions ask what the person “would do” instead of what someone “should do.”⁷ Skills that can be measured on an SJT include personality traits like conflict management, interpersonal skills, teamwork, and cultural awareness.^3,5 All of these skills can help identify people who would make amazing pharmacists that have the ability to interact with a wide range of people and work effectively as a part of a healthcare team.¹

In one study, investigators at Monash University in Australia developed an SJT. They used experts to evaluate the tool’s validity, reliability, fairness, and to determine the appropriateness of using an SJT as a formative assessment. This study appears to be the first to report on the development, implementation, and evaluation of SJT as a formative assessment for pharmacy students. They developed the test to help identify students that might need more training to develop the soft skills integral to becoming a successful pharmacist.³

Here is an example SJT scenario and directions³

Scenario
Nikhil, a pharmacy student, is working in a community pharmacy. A customer explains to Nikhil that she came to the pharmacy yesterday to collect some blood pressure tablets. However, when she arrived home, she realized that she had been given double the strength of the tablet that she required and has not taken any of the new medications. Nikhil arranges for the pharmacist to correct the medication and apologizes to the customer for the error. However, the customer looks angry and says, “sorry is not good enough.”

Response Instructions
How appropriate are each of the following responses by Nikhil in this situation?

Options: 
1 = a very appropriate thing to do; 2 = appropriate, but not ideal; 3 = inappropriate, but not awful; 4 = a very inappropriate thing to do

Responses

Inform the customer that he has already apologized to her and that there is nothing more that he can do

1. Tell the customer that he was not working yesterday
2. Tell the customer that she needs to calm down
3. Ask the customer whether she would like compensation
4. Ask the pharmacist to come and speak to the customer
5. Provide the customer with information on the pharmacy’s formal complaints procedure

The potential advantages of using SJTs in health professional curricula include building a student’s understanding of the concept “best” and “better” ways of performance and increases self-assessment skills. Self-assessment skills are an important part of continuing professional development. Providing students with feedback and the opportunity for reflection can help motivate further development of these soft skills. It can also be helpful to students by administering multiple SJTs so that they can see their improvement over time.^3,6

There are a few issues that educators should consider before implementing SJTs. First, it is important to make sure the scenario or situation is well described. There must be enough information for a student to be able to fully visualize the scenario. If a student cannot envision the scenario, it will be difficult for them to pick the “best” answer. Secondly, it is best to develop a scenario that does not force a student to choose an action that would go violate their personal beliefs and values.^3,7

Educators can use SJTs to help develop skills and traits, such as interprofessional skills and cultural sensitivity, that help students become better pharmacists. These tests can be used as a tool to assist with admission decisions but also deployed repeatedly throughout the curriculum in order to document change over time. By using SJTs for formative purposes, an institution can personalize the development of soft skills, focusing the student’s attention on weaknesses as well as uncovering strengths. In the end, every school wants to graduate well-rounded and well-educated pharmacists.^1,3


References:

1. Gilchrist A. Top 5 Pharmacist Personality Traits. Pharmacy Times. 2015 July 23.
2. Jones J, Krass I, Holder GM, Robinson RA. Selecting pharmacy students with appropriate communication skills. [Internet]. Am J Pharm Educ 2000; 64(1): 68-73.
3. Patterson F, Galbraith K, Flaxman C, Kirkpatrick CMJ. Evaluation of A Situational Judgement Test to Develop Non-Academic Skills in Pharmacy Students. Am J Pharm Educ 2019 [Ahead of Print]
4. About the PCAT. [Internet]. Pearson. 2019. Cited 2019 Nov 12.
5. Situational Judgement Test [Internet]. Psychometric Tests. 2019 Jan 9. [cited 2019 Nov 11].
6. Austin Z, Gregory PAM. Evaluating the accuracy of pharmacy students’ self-assessment skills. Am J Pharm Educ. 2007;71(5): Article 89.
7. Assessment & Selection. Other Assessment Methods. Situational Judgment Tests. United States Office of Personnel Management. 2019. Cited 2019 Nov 21.

Creating Meaningful International Pharmacy Experiences

by Katherine Baker, Pharm.D., PGY1 Pharmacy Practice Resident, North Mississippi Medical Center

International pharmacy experiences are increasingly popular. Today, students are eager to see the world and compare their learning environments to those of other students around the globe. In 2010, a survey of 114 pharmacy schools in the United States revealed that 40 had an active global/international program.¹ Having completed a global pharmacy experience during pharmacy school, I can speak to their value. I was fortunate to spend 5 weeks in Phitsanulok, Thailand at Naresuan University teaching hospital. What seemed like a distant dream soon became a reality when I found myself in rural Thailand with one of my best pharmacy school friends relying on the Google translator application to help us communicate. While international experiences have important benefits simply from “being there,” it is equally important to know how to design these experiences to maximize learning.

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First, it important to ensure that international experiences foster the development of the competencies required for graduation. Second, that there should be policies in place to ensure that the international site and faculty are qualified.² To address these requirements and the increasing demand for global health experiences, several initiatives have sought to improve the quality of international pharmacy rotations. Indeed, the American Association of Colleges of Pharmacy developed a special interest group that includes a dedicated team of individuals who discuss topics and ideas related to global healthcare.¹  

Prior to establishing an international experience and sending student pharmacists across the globe, great attention should be paid to ensuring that both the student and the host site are prepared for the visit. The planning period for my international rotation was stressful due to unknowns that come with living and learning in a foreign country. These stresses were alleviated when the host site sent me documents with helpful information about our living arrangements and coordinated everything before arrival. A number of articles have explored important considerations that must be taken into account before developing a Global/International Advanced Pharmacy Practice Experience (G/I APPE). These considerations include host country, home institution, host institution, faculty/preceptors, and student issues.² 

The host country is an important factor to consider before establishing an international rotation. While having a well-thought-out curriculum is necessary, ensuring a safe and functional learning environment in a foreign country is even more important. Pharmacy schools need to ensure that students are well informed about the country they will be traveling to.  Students should try to learn about the local culture(s) and basic parts of the native language. This will help them while navigating abroad as well as improving patient interactions during the experience. While in Thailand, I worked in an anticoagulation clinic and was asked to interview and counsel patients. I struggled to communicate and had to rely on my preceptor. This particular experience would have been much more meaningful had I learned the language ahead of time. Logistics of the rotation such as visas, living arrangements, transportation, and financial considerations should also be addressed well in advance. 

Equally important are the host institution and the curriculum. To justify an international experience, the host institution should be vetted and deemed an appropriate pharmacy experience. It is recommended that the host and home institutions have a designate representative. These designated faculty members will be responsible for communicating student educational needs, learning outcomes, and detecting any red flags.¹  In addition, a thorough and thoughtful syllabus must be drafted and approved. Just like any other course or experience in pharmacy school, the syllabus should lay out expectations, goals, objectives, and grading criteria.¹    

Student interaction while on rotation is another important consideration to create a meaningful experience abroad. For students to take full advantage of their international pharmacy experience, they should be meaningfully engaged and aware of what they are learning. One descriptive study discusses the importance of reflective writing while on rotation. Based on student reflections, the authors noted a pattern to student learning while on a G/I APPE. Students use “communication, problem-solving, and adaptability”³ skills while on rotation and then reflect on the major differences between their home and host country. There a couple of ways to get students to reflect about their experiences.  One method is to ask students to keep a personal journal and regularly writing entries.  Another way to encourage reflection is to require students to give a presentation to peers after completing the experience. My pharmacy school required each student to create a weekly travel blog reflecting on their experiences (check out our blog: Thailand Adventures - Two Pharmacy Students Finding Their Way Through Thailand). This exercise helped us to reflect and translate what we learned abroad and apply it to our lives in the United States. Our blog essays were also useful to future participants. Indeed, many of our weekend excursions were based on blog posts from previous students!

Global pharmacy experiences are not only an adventurous, once-in-a-lifetime experience, they also enhance a pharmacy student’s professional advancement. In a world that is becoming smaller and more connected through technology, a G/I APPE will give students an opportunity to grow their perspective and sensitivity towards people from other cultures.¹ Students who have participated in a global pharmacy rotation are more likely to be culturally aware and “demonstrate increased interest in volunteerism, humanitarianism, and public health.”² Moreover, international experiences often help students improve their communication skills, problem-solving skills, and adaptability.³  

Having participated in an international rotation myself, I can attest to many of these benefits. If I could give any piece of advice, I would encourage students heading into an international experience to learn some of the host country’s language and keep a travel journal or blog. It’s also important to give both the host and home sites feedback. The home institution often go to great lengths to ensure that the rotation will be maximally beneficial but the best information is feedback based on personal experience. The host institution that I completed my rotation at required students to complete an in-depth exit survey. The institution wanted an honest review of the experience and it was important to openly discuss any concerns to better serve students for the future.

International pharmacy experiences are a once-in-a-lifetime opportunity that I would recommend to all pharmacy students. If the experience is well planned and executed by both the host and home institutions and if the student approaches the experience with enthusiasm and an open mind, it will be a personal and professional growth experience the student will never forget.

References:

1. Steeb DR, Overman RA, Sleath BL, Joyner PU. Global Experiential and Didactic Education Opportunities at US Colleges and Schools of Pharmacy. Am J Pharm Educ. 2016;80(1): Article 7. doi:10.5688/ajpe8017
2. Alsharif NZ, Dakkuri A, Abrons JP, et al. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations. Am J Pharm Educ. 2016;80(3): Article 38. doi:10.5688/ajpe80338.
3. Steeb DR, Miller ML, Schellhase EM, et al. Assessment of Global Health Learning Outcomes on International Experiences. Am J Pharm Educ. 2019. doi: 10.5688/apje7586

Is There a Perfect Late Work Policy?

by Kaitlyn Dupuis, PharmD, PGY-1 Pharmacy Resident, North Mississippi Medical Center, Tupelo, MS

When it comes to teaching, there are several logistical issues that people often overlook — like dealing with students who do not turn-in assignments on time.  When assignments are submitted late, it often creates additional work for the teacher and inequities with other students who did not have the benefit of extra time.  It’s difficult to develop a completely fair and consistent “late work policy.”  Some teachers choose to accept late work within a few days of the assignment’s due date for full credit.  While others will accept late work with points deducted. And still others do not accept late work at all.  Some teachers believe that if the work is assigned, it is important to the student’s education. Therefore, they accept late work to encourage students to complete all assignments.

The majority of teachers understand that there are certain circumstances when students simply can’t finish their assignment by the due date.  Sometimes things pop-up in life that nobody has control over.  While some excuses are valid, there are times when students lie or use excuses that really did not prevent them from submitting their assignment on time.  It’s very difficult to determine which excuses are valid and which excuses just don’t “add-up.”   While teachers want to be compassionate and understanding, it is also in their job description to prepare students for the future in a world where deadlines matter and there are consequences.

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In a recent article posted on the Faculty Focus website entitled A Headache-Free Late Work Policy by Dr. Laura Schisler, the author proposes a “make-up day.”¹ The “make-up day” allows for students to turn-in they missed assignments throughout the semester on the make-up day to receive partial or full credit.  This removes the need to determine the validity of each student’s excuse.  This provides everyone the same opportunity to submit missed assignments, no matter the reason.  This policy makes it harder to miss multiple assignments, because students must turned-in all assignments on the predetermined make-up day at the end of the semester. The student either has to complete the assignment near the initial due date and hold-on to it until the end of the semester or complete the assignment at the end of the semester when there is typically an overwhelming number of tests and assignments.

In her essay entitled It’s Time to Ditch Our Deadlines, Dr. Ellen Boucher writes about her experience with a rigid late work policy.²  She states that early in her career students would lose one-third of their grade for an assignment for every day that passed without turning in the work.  In her experience, because the consequences were so severe, students were turning in work just to say that they were turning it in.  Other students would not submit anything and simply disappear because there was no way to pass the class.  Dr. Boucher began to realize that anxiety and burnout were a problem, so she then adopted a policy where students could submit their assignments two-days late for full credit.  Even after the two-day grace period, she would allow the student to meet with her to discuss a plan to turn-in the assignment.  Dr. Boucher saw that her students were working diligently to turn-in quality assignments rather than turning-in assignments simply for completion.  Dr. Boucher saw the level of anxiety and burnout decrease and felt this compassionate approach benefited her students. While it is true that anxiety and burnout are on the rise among students in both college and high school, allowing students to freely turn assignments in, beyond the deadline, can teach students bad habits.^3,4

While researching late work policies, I came across a few articles regarding “No zero policies.”  There are several schools that are transitioning to policies that don’t allow grades lower than 50%.  If the student refuses to turn-in his or her assignment, they still receive a 50%.  The philosophy behind this approach is that a zero is simply impossible to “bounce back” from.  One zero in a semester can cause a student to fail the entire class.  People in favor of the “no zero policy” argue that punishing the student with a zero is not actually assessing their knowledge.  While some people are very much in favor of a no zero policy, some people think it’s ridiculous.  The article cites a Facebook Post called “Is Our Grading System Fair” that asked 300 members Edutopian Innovative Teachers of English to comment.  Many people disagreed with the policy, simply because it requires students to do very minimal work in order to pass a class.³ 

I think that late work policies should vary, depending on the student age and nature of the course.  When teaching elementary school kids, late work policies should be more lenient.  Children in lower grade levels do not have control of their home life and aren’t always responsible enough to get their school work done without parental guidance.  I believe that it is appropriate for teachers to allow students to turn-in late work with minimal consequences when they are in lower grade levels.  As students age, they should become more responsible and should know that school is a priority. While life can still get in the way of older students, I believe that there should be consequences for late work the majority of the time.  Of course, there should be exceptions for unforeseeable life events, like an serious illness or death in the family, but students must learn that there are consequences in life when things aren’t done by their deadline. College professors should have a more stringent late work policy.  I know that burnout and anxiety are very real, but deadlines are deadlines and the consequences should be bad enough to create strong incentives to turn assignments in on time.  Indeed, a study done at Illinois Wesleyan University actually showed that students think that late work penalties are fair.⁵

There probably is no perfect “late work policy.”  I believe that there are times that deadlines should be extended — so I disagree with “zero tolerance policies.”  I also believe that students should meet deadlines.  While I agree that teachers should be compassionate and understanding, I also believe that they are doing students an injustice by allowing them a two-day grace period on every assignment or by giving them 50% even if they fail to submit anything.  I really like having a “make-up day” at the end of the semester.  This allows for students to still receive credit for missed assignments but doesn’t require the teacher to create a policy about "acceptable excuses" for late work.  The “make-up day” is usually during a very busy and stressful point in the semester which should encourage students to turn in their work by the due date.  The major drawback to a “make-up day” is that it signals to students that it’s “ok” to not meet deadlines.  Important life skills are learned in school and one is time-management.  If you fail to meet deadlines in life, you will find yourself without a job … and maybe without electricity.

References:

1. Schisler L. A Headache-Free Late Work Policy. Faculty Focus. Faculty Focus - Higher Ed Teaching & Learning. August 22, 2019.
2. Boucher E. It's Time to Ditch Our Deadlines. ChronicleVitae for higher ed jobs, career tools and advice. September 2, 2016.
3. Minero E. Do No-Zero Policies Help or Hurt Students? Edutopia. https://www.edutopia.org/article/do-no-zero-policies-help-or-hurt-students. July 3, 2018.
4.  Center for Collegiate Mental Health. 2018 Annual Report (Publication No. STA 19-180).
5. Lui M and Nillas L. Late Work Policies: Their Impact on Student Achievement. John Wesley Powell Student Research Conference, 2015. Abstract 8.

Team-based Learning (TBL) in the Health Professions

by Mallory Pullman, PGY1 Pharmacy Practice Resident, The University of Mississippi Medical Center 

Today, to meet the current healthcare needs of society, health professions students must be able to learn vast amounts of information and have a deep understanding of difficult concepts. In addition to having a comprehensive knowledge base, health professions students must be able to apply this knowledge to varying clinical scenarios.  Further, they must be able to work both independently and in collaboration with others. It is therefore necessary that teaching approaches in health professions education be tailored to these needs, preparing students for their careers. 

One method of learning that is starting to gain traction within health professions education is team-based learning (TBL). TBL is an instructional method that emphasizes self-preparation outside of class followed by the application of the knowledge learned in class. In TBL, courses are typically separated into modules or units and students are assigned to small groups. Before class, students are given materials to review, which they must learn independently. Assigning materials to review prior to class ensures students are responsible for their own understanding and gives students the opportunity to learn the material in a way that is most effective for them.

Then, at the start of each class, students are given an assessment to analyze how well they have learned the material. The assessment is termed an individual Readiness Assurance Test (IRAT).  Students first complete the test as an individual and, then, as a team – an assessment called the group Readiness Assurance Test (GRAT). Both the individual and group scores contribute to students’ grades. After the students complete the team test, they have the opportunity to discuss the material with the instructor and appeal answers they got incorrect. The discussion and appeal process enhances students’ understanding by requiring students to defend their answers. Students also learn by listening to the rationales provided by other teams, providing students with diverse perspectives. To conclude the assessment portion of each class, the instructor may present a brief lecture and lead a discussion on concepts students appear to be struggling with most. To further reinforce students’ learning, the remainder of each class is focused on completing application exercises.¹ 

Before deciding to implement TBL, it is crucial to examine how effective the learning method is, especially in health professions education. Constructivist learning theory, whereby the student “constructs” his/her own knowledge, provides the theoretical basis for TBL. TBL places the responsibility of learning on students by requiring them to be prepared for assessments at the start of each class and be ready to use their new knowledge to solve relevant problems.²  Several studies have shown TBL improves learning. One study assessed the impact of TBL on academic performance during comprehensive course examinations for second-year medical students.³ In a 2-year analysis of 178 second-year medical students, analyzing scores on 28 comprehensive course examinations, the investigators found that grades increased by a mean of 5.9% after TBL implementation, with lower-achieving students reaping a greater benefit.³ The authors concluded that the application exercises, allowing teams to use their aggregated knowledge to solve challenges, and the interaction with peers and faculty, likely contributed to the positive impact on students’ learning.

Similarly, a study conducted by Zgheib and colleagues examined the effect of TBL on learning in a second-year medical pharmacology course.⁴ The researchers evaluated individual and group answers to all IRAT and GRATs, concluding that TBL approaches were more effective than traditional learning methods. While TBL appeared to improve student understanding of difficult concepts, the authors felt the method was not more effective for learning simpler concepts.

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Another advantage of implementing TBL, especially in health professions education, is the opportunity to acclimate students to working in teams. In the health professions, it is common for physicians, pharmacists, nurses, and other medical professions to work closely together to solve complex medical problems. Using TBL methods in the classroom, where students practice listening to one another and sharing knowledge to solve challenges can prepare students for collaborating with health profession colleagues throughout their careers. Overall, TBL not only improves academic performance and students’ understanding of difficult concepts, it gives students an opportunity to practice the team-work skills they will need throughout their careers.

The potential advantages of the TBL method provide enough justification for health profession educators and programs to implement this learning technique. Health professions educators can implement TBL techniques by simply requiring students to self-prepare outside of class and reserving class time for group interaction.  To hold student accountable for pre-class work, it is important to use reinforcement examinations. This pre-class work is critical for the discussions and application exercises to be successful.

However, there are a few logistical issues that educators should consider before implementing TBL in their courses. First, educators must consider how they will form student teams. In order to develop group cohesion, TBL groups should remain the same throughout the duration of the course. Ideally, teams should be strategically formed based on three principles: 1) teams should be assigned by the instructor - not student-selected; 2) teams should be as diverse as possible; and 3) the selection process should be transparent.⁵ Implementing these principles allows the development of diverse groups that bring different strengths and experiences to the discussion and application exercises. In addition to discussing how team assignments were made, educators must orient students to the TBL method by explaining pre-class preparation, application exercises, and the readiness tests. Ensuring that students have a complete understanding of TBL and its benefits is essential for students and co-instructors.  Getting everyone’s commitment is critical when implementing a novel teaching approach. Using the principles of instructional design, considering the design, development, and implementation of each instructional unit, are fundamental to the success of TBL. 

References:

1. What is TBL?. Team Based Learning Collaborative. Published 2019. Accessed October 23, 2019.
2. Brame C. Team-based learning. Vanderbilt University. Published 2019. Accessed October 23, 2019.
3. Koles, P. et al. The Impact of Team-Based Learning on Medical Students’ Academic Performance. Academic Medicine 2010;85(11): 1739-45.
4. Zgheib N. et al. Using team-based learning to teach pharmacology to second-year medical students improves student performance. Medical Teacher 2010;32(2):130-5. 
5. Getting Started with TBL. Team Based Learning Collaborative. Published 2019. Accessed October 24, 2019.

Generational Differences and Its Impact on Teaching and Learning

by Hannah Daniel, PharmD, PGY-1 Pharmacy Practice Resident, University of Mississippi Medical Center

People from different generations routinely interact in higher education today and generational differences impact the learning environment. Members of Generations Y, also known as Millennials, and Z make-up the majority of the health professional students with most faculty members being members of earlier generations, primarily Generation X and Baby Boomers. The learning environment is significantly different for each generation. Millennials are accustomed to instant gratification, technologically advanced learning, and interactive activities aimed at providing lots of stimulation to stay engaged. Generation Z is accustomed to even higher levels of digital technology and connectedness, which will potentially lead to greater expectations for customized instruction for each student.¹ With so much focus on technology and the need for constant stimulus, faculty members are challenged to teach in ways that are quite different from the ways they were taught. Marc Prensky in his essay about the differences between digital natives and digital immigrants makes an intriguing point: “Today’s students are no longer the people our education system was designed to teach.²” Current literature suggests we should be adapting to the learner; however, it is unclear if learning outcomes are improved.  This raises an important question:

“Should teachers make adjustments in their teaching methods to accommodate students from a different generation?”

To understand some of the generational differences between students and faculty, one can compare leadership style preferences between generations. In 2018, the American Journal of Pharmaceutical Education (APJE) published an article about leadership styles reflecting generational differences in the academy. The four leadership styles they described included:

• Classic entrepreneur: Competitive and opportunistic
• Modern missionary: Looks for significance and meaning to promote impact
• Problem solver: Focuses on concrete results; values top-down experiences and a “take-charge” approach
• Solution finder: Modest and humble

Baby Boomers, those primarily exposed to male and military leaders, tend to lean towards a problem solver style. On the other hand, Millennials have a tendency to lean towards a modern missionary or solution finder style.³ The difference in styles also reflects learning styles. Baby Boomers thrive on concrete information and structure while Millennials strive for more hands-on and less structured approaches.

The majority of current faculty were taught in a traditional and passive manner.  They were encouraged to read the material and to take notes in class. Although these methods of learning are effective, today’s students struggle to learn in this environment due to a strong desire for hands-on and more interactive methods. Some programs have transitioned away from teacher-centered approaches to more learner-centered methods, such as problem-based learning, to adapt to a new generation of learners. A major reason to adapt teaching methods is premised on the idea that “successful students are those that are engaged during the learning process,” which means using strategies that motivate your students. One study conducted at Creighton University in Nebraska compared pre-test scores vs. post-test scores and average time spent on a case between an interactive computer-based case and a standard paper-based approach. While students assigned to the computer-based case group scored slightly higher on their pre-test and post-test and spent less time on the case, none of these results were significant.¹

However, not all students in the same generation share the same learning preferences. Some students learn best in traditional ways while others learn best when interactive methods are employed. Thus, it can be argued that adapting teaching styles to match students’ preferences is not infeasibility or wise. Moreover, exposing students to different learning methods will challenge them, leading to better educational outcomes, and teaching them to be more adaptable. In a study conducted at Texas Tech University Health Sciences Center School of Pharmacy, students on rotation and preceptors completed the validated Pharmacist’s Inventory of Learning Styles (PILS) questionnaire to identify their dominant learning styles. The investigators found that, although this information helped guide the preceptors to challenge students, it did not impact student or preceptor performance — even when the preceptor adapted his/her teaching methods to better align with the student’s preferred learning style.⁴ Even though this study did not specifically address classroom-based instruction, it provides some insights regarding the use of individualized instruction using the student’s preferred learning style as well as their non-preferred styles.

It seems clear there must be a compromise between students and educators. Educators should not be expected to change their entire way of teaching.  Similarly, students should not be expected to change their entire way of learning. Educators can incorporate active learning strategies into their traditional lectures to increase motivation and engagement. By adding versatility to their teaching repertoire, educators will be able to reach a wider range of students.¹ Examples of active learning that can be incorporated into a lecture include the following:

• Problem-solving exercises
• Think-pair-share
• Short demonstrations followed by a class discussion

It is also useful, after lecturing for 20-30 minutes, to pause for five to ten minutes, allowing students to work together in pairs or groups to recall, clarify, and elaborate on the material before moving forward. Another way to engage students is to ask five to ten questions related to the most pertinent material from the previous class session to stimulate recall before the start of class.⁵

There are generational differences between students and educators, leading to different learning preferences. Although impractical for educators to tailor their teaching methods to each student’s learning style, it is important for all, students and educators alike, to acknowledge the changing dynamics between generations and be open to all styles of learning. Again, “successful students are those that are engaged during the learning process,” but responsibility for engagement does not fall solely on the educator. Educators should not make major adjustments to what they do but rather find common ground. Students should be open to different ways of learning to challenge themselves and increase their adaptability.

References:

1. Pick A, Begley K, Augustine S. Changes in teaching strategies to accommodate a new generation of learner: A case study. Pharm Educ. 2017;17(1):95–99.

2. Prensky M. Digital natives, digital immigrants. MCB University Press, 2001. Accessed 31 October 2019.
3. Boyle CJ, Gonyeau M, Flowers SK, et al. Adapting Leadership Styles to Reflect Generational Differences in the Academy. Am J of Pharm Educ. 2018;82(6): Article 6886. doi.org/10/5688/ajpe6886.
4. Robles J, Cox C, Seifert C. The impact of preceptor and student learning styles on experiential performance measures. Am J Pharm Educ. 2012;76(7): Article 128. doi:10/5688/ajpe767128.
5. Promoting active learning. Standford: Teaching Commons. Accessed 4 November 2019.

Smartphones and Applications: Teaching Student Pharmacists to Appropriately Use Them

by Dylan B. Ware, PharmD, PGY1 Pharmacy Resident, Baptist Memorial Hospital-North Mississippi

I once heard a classmate say: “I don’t have to know this off the top of my head.” “Just Google it” and “Hey Siri” are other common phrases that I hear quite often from pharmacy students. Honestly, I have been guilty of expressing statements similar to these when I was a student. However, as a pharmacist now, I approach this form of thinking quite differently.

When I was enrolled in pharmacy school, I had the opportunity to hear many professors speak about their educational experiences when they were a student. These conversations helped me understand the differences in the learning methods and examination processes between my professors’ experiences compared to mine. Each of these conversations always seemed to have one commonality; they did not have access to online resources and smartphones like pharmacy students have today. The Internet and smartphones have become a huge part of American culture over the past ten years. The Pew Research Center reports that about 96% of people in the United States own some kind of cellphone and the vast majority of those people own a smartphone.¹

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Healthcare professionals and students use smartphones that are capable of downloading applications to assist with daily functions. Healthcare professionals can use applications for information management, time management, reference and information gathering, and clinical decision making.² Information management incorporates an easy way to write notes, take photographs, and organize information on smartphones.² Smartphones allow healthcare professionals to manage their time by scheduling appointments and meetings.² Most medical textbooks, medical literature sources, and drug reference guides have smartphone applications for health care professionals to download and use.² Clinical decision-making tools such as treatment guidelines, diagnosis aids, medical calculators, and laboratory test interpretations can all be found through applications available on smartphones.²

Pharmacy students should be taught to utilize tertiary resources such as Micromedex^®, Clinical Pharmacology, and Lexicomp^®. Each of these sources has a personalized mobile application that can be readily accessible in the palm of a hand.  But how should we teach student pharmacists to appropriately use these applications? I have found it effective to first explain some purposes of these applications which include: finding dosing recommendations, looking up drug interactions, adjusting medications for renal and hepatic dysfunction, and understanding how to explain adverse effects and counseling points to patients. Once the purpose of these applications is understood, teaching students how to use and apply the information is a vital skill.

The University of Mississippi School of Pharmacy has partnered with my residency site, Baptist Memorial Hospital-North Mississippi, to host second-year student pharmacists as they complete their Introductory Pharmacy Practice Experiences (IPPEs). Some of the educational activities that the student pharmacists complete include: gathering a medication history and performing a medication reconciliation, reviewing medical records for laboratory monitoring data, and participating in discharge counseling. As a preceptor for these student pharmacists, I have taught them how to use Micromedex^®, Clinical Pharmacology, and Lexicomp^® to complete these activities.

1.   Medication history with reconciliation

a.  Using these applications to look up medications that are unfamiliar to the student pharmacists and understanding their indications for use

2.   Chart review with laboratory monitoring

a.  Reviewing a patient’s lab values and using these applications to look up important monitoring parameters of each medication to ensure the medication is safe and effective for each patient

3.   Discharge counseling

a.  Looking up every medication the patient is expected to take after hospital discharge and using the counseling section of these applications to ensure all information is discussed before discharge

However, there will be certain situations in clinical practice where instant drug recall is needed. Examples include: treating cardiac arrest, stabilizing critical care patients, and creating repertoire with other health care professionals when pharmacy specific questions are needed immediately. In these situations, we should teach student pharmacists that using these smartphone applications is not feasible and being able to respond immediately is critical.

When else should students be taught they cannot use smartphone applications? That would be for examinations that prepare students for licensure: the NAPLEX^® and MPJE^®. The NAPLEX^® first-time pass rate was 94.9% in 2014 and dropped to 89.5% in 2017.^3,4 In a recent commentary published in AJPE, the authors discuss possible explanations for the decreasing pass rates, including diminished exam preparation, declining academic ability, and the increasing difficulty of the NAPLEX^®.³ Additionally, the authors speculate that smartphones may be affecting students' ability to apply and recall information.³  In a recent study, the investigators found that  "when people expect to have future access to information, they have lower rates of recall of the information itself and enhanced recall instead for where to access it."⁵ It's true that smartphones are capable of replacing some cognitive functions.⁶ But student pharmacists should be taught early in their pharmacy school curriculum that smartphones are not allowed on the NAPLEX^® and MPJE^®. Therefore, immediate recall of information learned during pharmacy is required to successfully pass the board examinations.

Learning or memorizing all the information about every single drug available is impossible. Smartphone applications obviously have a role. Therefore, student pharmacists should be taught about how to effectively use tertiary resources such as Micromedex^®, Clinical Pharmacology, and Lexicomp^®. However, they should understand the difference between when it is appropriate and not appropriate to use smartphone applications. All student pharmacists should have a strong fund of knowledge that is not dependent on checking a smartphone and should be lifelong learners.

References:

1. Pew Research Center Internet and Technology. Mobile Fact Sheet. 2019 June 12.
2. Ventola CL. Mobile Devices and Apps for Health Care Professionals: Uses and Benefits. PT. 2014 May;39(5):356-364.
3. Fjortoft N, Getting J, Verdone M. Smartphones, Memory, and Pharmacy Education. American Journal of Pharmaceutical Education. 2018;82(3) Article 7054.
4. National Association of Boards of Pharmacy. NAPLEX Pass Rates August 2019.
5. Sparrow B, Liu J, Wegner DM. Google effects on memory: cognitive consequence of having information at ourfingertips. Science. 2011;33396043):776-778
6. Wilmer HH, Sherman LE, Chein JM. Smartphones and Cognition: A Review of ResearchExploring the Links between Mobile Technology Habits and Cognitive Functioning. Front Psychol. 2017;8:605.

Why Self-Assessment and Life-Long Learning Go Hand-in-Hand

By Brie Holmes, PharmD, PGY1 Pharmacy Practice Resident, Magnolia Regional Health Center

 

Healthcare is advancing and expanding at an astounding rate. Now, more than ever, healthcare professionals must take the initiative to learn about new technology, diagnoses, and treatment options to provide the best care to patients.¹ Healthcare practice is rooted in trusting patient/provider relationships, and healthcare professions are expected to continually expand their knowledge. It is simply not adequate to rely on one’s initial education and training or the required continuing education hours to stay well informed about the latest developments.² Instead, healthcare professionals must take responsibility and be self-directed learners to remain competent throughout their career.

Self-assessment methods and the utility of those methods has been well studied. Research has shown that those who regularly engage in a self-assessment process have increased academic achievement and workplace performance.¹ Andrade defines self-assessment as “…a process of formative assessment during which students reflect on and evaluate the quality of their work and learning, judge the degree to which they reflect explicitly stated goals or criteria, identify strengths or weaknesses in their work and revise accordingly.”³ There are other definitions of self-assessment, but all sources agree that it is a process with the goal of continuous improvement involving an intrinsic evaluation of one’s knowledge and performance, recognizing one’s own deficits, and implementing a plan to correct identified deficits. Because there is a clear expectation for healthcare professionals to stay up-to-date on new research, there is also an expectation that healthcare professionals skillfully use self-assessment techniques to accomplish this. Despite what’s known about effective self-assessment methods and their benefits, there are numerous studies showing the general inability of students and healthcare providers alike to accurately assess their knowledge and skills and, therefore, effectively address deficits. In fact, only 45% of the studies included in a systematic review of the physician literature showed a positive relationship between self- and external assessments.³ Not only is this a disservice to oneself as a professional, but it is also a disservice to our patients who have trusted us to provide the best care possible.

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Multiple studies have suggested students and some providers are not able to correctly assess their learning needs.  One possible explanation is that students have grown accustomed to dependent learning. Historically, evaluation of knowledge has largely been done using exams. This external form of evaluation often creates dependent learners who have very little intrinsic consideration or responsibility. Dependent learning can quickly dissolve motivation to gain knowledge outside of what will be on an exam and instead encourages memorization, resulting in a reliance on external motivation and validation.³ This process does not adequately equip students with the necessary skills required for work after graduation as they are not prepared to take the initiative to identify their learning needs or to address perceived deficits. After graduation, there will no longer be someone who will identify the student’s learning needs or direct them to appropriate learning activities.¹ Thus, educators can and should incorporate self-assessments early in the curriculum to teach students this important skill so that they can apply it in the real world.⁵

Developing good self-assessment skills can also improve the learner’s willingness to accept feedback as well as develop their self-confidence.³ It is well-accepted that self-assessment is a learned skill.  It not something that most people “just naturally” know how to do. Because of this, the Accreditation Council on Pharmacy Education has stated that self-assessment should be integrated into the pharmacy curriculum early and continued throughout the curriculum.³ Additionally, the American Medical Association considers self-assessments to be a vital professional skill and has suggested guided self-assessments be incorporated at the earliest possible stage in medical training.⁴ The key to guiding self-assessments is ensuring the student receives quality external feedback. Some examples of activities educators could incorporate that would provide an opportunity for self-assessment coupled with external feedback is an Objective Structured Clinical Examination (OSCE), particularly if they are videotaped and reviewed by the student.  Problem-based learning cases and independent learning projects can also be used, whereby students compare their self-assessment of their performance to external evaluations using rubrics.^1,3

If educators want their students to be competent and successful healthcare professionals who embrace the notion of continuous professional development, they must instill the importance and benefits of self-assessments and stimulate increased motivation to engage in the process.³ As research continues to show the clear benefits of self-assessment, accrediting bodies require health professional programs to include self-assessments.  Self-assessment techniques should be introduced early in curriculums alongside external assessments.  This will help students learn the vital skill of identifying deficits and critically evaluating their work.  In this way, students will be better prepared for post-graduation work and lifelong learning. Furthermore, self-assessments should prompt students to consider their personal and professional goals while equipping them with the tools necessary to achieve those goals. Without effective self-assessment strategies, healthcare professionals will not be adequately prepared for lifelong learning in a field that is constantly expanding and changing.

References

1.    Guglielmino LM. The case of promoting self-directed learning in formal educational institutions. South African Education Journal. 2013;10(2):1-18.

2.    Asadoorian J, Batty, H. An evidence-based model of effective self-assessment for directing professional learning. Journal of Dental Education. 2005;69(12):1315-1322.

3.    Motycka CA, Rose RL, Ried LD, Brazeau G. Self-assessment in pharmacy and health science education and professional practice. Am J Pharm Educ 2010;74(5) Article 85.

4.    Duffy FD, Holmboe ES. Self-assessment in lifelong learning and improving performance in practice. JAMA 2006;296(9):1137-1139. doi: 10.1001/jama.296.9.1137

5.    Adachi C, Tai JH-M, Dawson P. Academics’ perceptions of the benefits and challenges of self and peer assessment in higher education. Assessment & Evaluation in Higher Education. 2017;43(2):294-306. doi:10.1080/02602938.2017.1339775.