Pick Me! I Was a Pharmacy Technician

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

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

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

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

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

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

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

References

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

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

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

Social Networking and Professional Education

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

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

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

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

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

Reference

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

A Different Small Group Learning Method - POGIL

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

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

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

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

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

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

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

Recorder- writes up group answers to turn in

Spokesperson/presenter- presents report to class

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

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

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

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

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

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

References

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

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

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

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

Interprofessional Education: Building a Bridge to Interprofessional Cooperation

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

Taking Learning Outside the Classroom

by Olabode Ogundare, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

Do you remember those schools days when the weather was so nice outside and you wish your class was also outside so you could really enjoy the fresh outdoors as well as learn? How about those last days of spring semester when your school still had the heat on and it was unbearable for you to learn anything … but if you were outside it probably would have improved your attention span? Well, if you agree with these statements, then taking learning outside of the classroom might be just what you need to help improve your learning experience!

Outdoor education is relevant to educational theory and practice because it is an instructional method. Outdoor education is a type of instructional style that dates back to the early 1940s. It involves the use of outdoor learning settings to cover subject matter through hands on learning experiences. Outdoor education is still practiced in today’s educational system and can involve educational activities outside of the classroom such as field trips, field work, camping, or simple observation of the environment. What differentiates outdoor education from the more ‘traditional’ instructional methods is that it incorporates several of the different learning styles into its teaching method, thus allowing students to have an individualized learning experience that correlates with how they learn.  Outdoor education plays a significant role in shaping the education of children and may help enhance their learning.¹

In an article from Education.com titled, Environmental Education Programs Help Kids Connect to the Earth, Peter Bergstrom discussed how many adults feel that there is a steady decline of appreciation for nature in recent years. He emphasized that it is important especially for children to get in touch with nature because in his words, “fundamental to discovering who you really are, that you are not a person apart from nature, but a part of nature." If take a look at our education system, the amount of outdoor time children are allotted gradually declines overtime as they progress through their education. I think being able to connect with nature helps to develop critical skills that are not taught in the classroom setting. Outdoor educational programs similar to Bergstrom’s, help “kids recognize that they are smart in a different way from classroom smart,” which highlights that outdoor learning helps students engage beyond the norms of the classroom and enhance their learning experience.²

A study by the California Department of Education showed that six graders’ science knowledge test improved by 27% after participating in an outdoor educational program. Feedback received from the students showed that a majority of them felt that their participation in the outdoor education program actually changed them. When one student was asked whether he benefited from the program, the student responded, “Yes, because I learned more; I like science a lot because it helped me to protect the environment even more.” This demonstrates that outdoor educational programs really can enhance one’s learning experience and help students perform better academically.^3,4

The study entitled Effects of Outdoor Educational Programs on Children clearly demonstrates the potential role outdoor education may have on shaping the education system in years to come.⁴ Educators need to realize the students they encounter have different learning styles and it may not excel when traditional classroom-based methods are used.  Outdoor education is an alternative for students who seek to be engaged and have an active role in their learning experience. Most importantly, outdoor education programs have shown to improve academic performance in students.  Educators should be inclined to incorporate this instructional method as part of their teaching style to enhance their students’ learning.

References:

1.  Outdoor and Environmental Education. [Internet]. [Online: Education.com, Inc]; [Periodically updated; cited 2010 Nov 10] 

2.  Boutis, Nick.; Krisko, Beth. A Life Shaping Week: The Outdoor Education Experience [Internet]. [Online: Education.com, Inc]; [Periodically updated; cited 2010 Nov 8]

3.  What Does Environmental Education do for Children [Internet]. [Online: Education.com, Inc]; [Periodically updated; cited 2010 Nov 10]

4. Effects of Outdoor Education Programs for Children in California. American Institutes for Research. January 31^st 2005: 33-41