The Role of Peer Instruction in Health Professions Education

by Whitley Tassin, MBS, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Instructors are always looking for methods to improve student participation and engage learners in the classroom. Multiple methods have been proposed including pop quizzes, audience response systems, small group discussion, group work, case vignettes, and more. But what is the evidence to support these methods and what are the best methods to engage learners? In recent years, peer instruction has gained increasing support and has become widely used in undergraduate education in an effort to not only engage students but, most importantly, improve learning.¹ Multiple methods of peer instruction have been developed and there are subtle differences between each of these methods.  Table 1 below describes the different peer instruction methods.

Table 1: Types of Peer Instruction¹

Term	Definition
Peer Teaching	Learners with similar levels of expertise and from comparable social groups (but who are not professional teachers) assist each other to learn and learn by teaching
Peer Modeling	The teacher provides (or points out) a competent exemplar(s) by a learner(s) in the group with the purpose that others will emulate these examples
Peer Education	Learners share information and talk about attitudes or behaviors with the goal of educating people, clarifying general life problems, and identifying solutions
Peer Monitoring	Learners observing and checking to determine if their partners/peers are engaged in appropriate and effective processes for learning and studying
Peer Assessment	Learners provide feedback or score/grade (or both) their peers’ performance based on a set criteria

 

While these tactics have been employed across various disciplines, few have been studied in pharmacy education. However, the literature consistently points to the positive impact that peer instruction has had on improving learning outcomes.

One study at Cedarville University looked at the effect of peer instruction in a self-care course within a Doctor of Pharmacy program.² Peer instruction was employed for seven topics: constipation and anorectal disorders; nausea, vomiting, and diarrhea; allergies; cough and cold; fungal and wounds; ophthalmic, otic, and oral; and dermatitis and sun care. Students were asked to prepare for each topic before class in anticipation of a “quiz” given on each topic. They were paired with a peer to discuss each topic after the quiz. If the average was above 70%, this indicated that most students had a good understanding of the concept, and discussion was not needed. When a score fell below 30%, this indicated that most students did understand of the topic, and the instructor provided additional instruction about the concept. If the score was between 30% and 70%, students would then engage in a discussion about their answers.  Students were instructed to justify their answers to their peers. Following this brief period of peer instruction, the questions were again presented to the class and scored. Results showed that scores improved significantly for each topic when peer instruction was implemented. In addition, students were asked to voluntarily complete a survey about their opinions and experiences with peer instruction. More than 80% of students responded to the survey and the results suggested that students felt very positive about peer instruction. Students reported that defending their thoughts was beneficial and that peer instruction reduced the awkwardness and “embarrassment” of approaching a professor with a question. They also reported that they enjoyed discussing concepts with their classmates and that they would like to see this technique used more frequently and in other courses.

Another study at the University of California San Francisco looked at the effectiveness of peer instruction in a pharmacology course taught by pharmacy students to physical therapy students.³ Physical therapy students were instructed to review pre-recorded lectures prior to attending class and take quizzes on the material. Under the mentorship of a faculty member, all lectures, quizzes, cases, and final assessments were developed by pharmacy students. In-class sessions consisted of working in small groups and then presenting what was discussed to the larger group. Pharmacy students served as teaching assistants and were present to answer questions and facilitate discussion. When surveyed at the end of the course, physical therapy students reported that they felt that learning about other healthcare professions from someone outside of their discipline was beneficial and it increased their comfort interacting with other members of the healthcare team. This demonstrates that peer instruction improves student’s learning and can also be a potential tool to increase interprofessional interaction.

What are some best practices that faculty should follow if they wish to use peer instruction in their classes? A recently published scoping review sought to determine the best methods for peer instruction, identify barriers to implementation, and student perceptions of peer instruction in pharmacy education.¹ The results suggested there was a positive impact on learning and feedback from students was positive regardless of what type of peer instruction was used. Using both quantitative and qualitative survey methods, students in the included studies reported that participating in peer instruction would likely result in a higher grade and they are open to using this learning method more often. Students also reported that peer instruction challenged them to think critically, defend answer choices, and discuss aspects of the topic they might not have otherwise considered.^1,2

While peer instruction has several potential benefits, faculty should be aware of the potential barriers when implementing this teaching strategy. It is important to train peers instructors and reviewers. If the peer instructor doesn’t have a good understanding of the topic, this can lead to misinformation and would obviously negatively impact student learning. In addition, when peer assessment is used, the students giving feedback must have very clear guidelines or rubrics that should be used when delivering feedback. Peer reviewers should receive training not only on the appropriate use of the rubric but also on how to effectively deliver constructive feedback. Thus, students who are actively teaching or leading any portion of peer instruction must receive proper training in order for the program to succeed.¹  This requires the teacher to spend an adequate amount of time and energy developing train-the-trainer materials.

Overall, the results of numerous studies demonstrate that peer instruction can have many beneficial effects. Implementing peer instruction throughout the curriculum can increase student engagement, improve learning outcomes, and build important critical thinking skills.

References

1. Aburahma M, Mohamed H. Peer Teaching as an Educational Tool in Pharmacy Schools; Fruitful or Futile. Currents in Pharmacy Teaching and Learning [Internet]. 2017; 9(6): 1170-1179.
2. Straw A, Wicker E, Harper N. Effect of Peer Instruction Pedagogy on Concept Mastery in a First Professional Year Pharmacy Self-Care Course. Currents in Pharmacy Teaching and Learning [Internet]. 2021; 13(3): 273-278.
3. Hsia S, Tran D, Beechinor R, et al. Interprofessional Peer Teaching: The Value of a Pharmacy Student-led Pharmacology Course for Physical Therapy Students. Currents in Pharmacy Teaching and Learning [Internet]. 2020; 12(10): 1252-1257.

Accelerated Curriculums: Potential Benefits … and Harms

by Brett Lambert, PharmD, PGY1 Pharmacy Practice Resident, North Mississippi Medical Center

For those looking to pursue a career in pharmacy or other health professions, the decision as to which school to attend is often based on a few key factors. Important factors applicants typically assess include the duration of the program, the passage rates on licensure exams, the quality of the education, the benefit to their career, and the memories that can be made with peers or the quality of the social life. Some colleges/schools offering an accelerated program and prospective students are left to consider the benefits of completing their desired curriculum faster than normal. It is therefore important to consider the potential benefits (and harms) of completing an accelerated curriculum.

Accelerated programs provide an opportunity for students to complete their preferred professional program in a shorter period of time than a normal curriculum length. For pharmacy schools, this means students complete their doctoral degree in three years rather than the usual four years. To accomplish the same curriculum in 3 years, accelerate program conduct classes year-round without end of semester breaks like summer or winter break. According to the American Association of Colleges of Pharmacy, as of July 2020, there are a total of 142 colleges or schools of pharmacy.¹ Of these schools, there are at least fifteen programs that offer an accelerated Pharm.D. curriculum.

One way to determine if accelerated programs are as good or, perhaps, superior to traditional programs is to compare pass rates on the licensure exam.  In pharmacy, the NAPLEX (North American Pharmacist Licensure Examination) is required to become a pharmacist.  The NAPLEX first attempt passage rates from the past three years (2017,2018, and 2019) for the fifteen accelerate programs were substantially lower than the national average passage rate. Using data reported by the National Association of Board of Pharmacy,² accelerated programs averaged a passage rate that was 3-5% lower than the average national passage rate.

While this data is not a full analysis of the data available, it does provide some insight as to how these programs compare to the traditional four-year programs. However, the length of the curriculum is but one factor and there are other factors that could affect NAPLEX pass rates. One of which is the age (or maturity) of the program. In a recent survey that examined pharmacy school characteristics and their first-time NAPLEX pass rates, pharmacy schools established before 2000 had significantly higher first attempt pass rates on the NAPLEX than those established after.³ Thus historic (or more mature) programs seem to produce students better prepared to pass the NAPLEX on the first attempt. The authors also reported that between 2015 and 2016 when the NAPLEX testing structure was changed, a smaller percentage of four-year programs experienced a 10% or greater decrease in first-time pass rates than three-year accelerated programs (c²=5.54, p=.02).³ The pass rate dropped from 92.5 to 86.6 among traditional four-year programs and from 90.2 to 80.4 in three-year accelerated programs.  This difference was significant.³

Another study compared the length of advanced pharmacy practice experiences (APPE) to determine the correlation with first-time pass rates. The lengths of the APPEs included four, five, or six-week blocks.⁴ However, the results provide no evidence that APPE rotation length correlated with a higher first attempt pass rate for the NAPLEX. This would argue that the length of clinical rotations does not affect a student’s ability to pass the NAPLEX.

One metric that some programs use to boast about the quality of graduates they produce is the number of students that match with PGY-1 and PGY-2 residency programs. According to the National Matching Service, the official matching program for PGY-1 and PGY-2’s, in 2020 there was a total of 7535 students who registered for the match and 3904 who matched; which is a 51.8% match rate for all programs. The 15 three-year programs had a match rate of 39.7% compared to a 53.1% match rate for four-year pharmacy programs.⁶

Another difference between programs of different lengths that is more difficult to quantify is the impact an accelerated curriculum might have on a student’s social life. A curriculum that completely consumes a student’s life and does not allow enough time to get involved in professional or social organizations, maintain hobbies, or spend time with family reduces opportunities for a healthy social life. These barriers to social and professional development could affect the student’s interactions with patients, peers, or co-workers.

Given the potentially negative consequences of accelerated curriculum, why would any student consider applying to or attending such a program? The most obvious benefit is that by graduating a year early the student enters practice a year sooner – which translates in an extra year of work, an extra year of practical experience as a pharmacist, and can lead to an improved financial situation in both the short and long-term. However, there is no promise of a better job, career, or future opportunities.

The debate about accelerated professional programs is not unique to pharmacy — the medical professional is now deliberating the merits of accelerated medical school programs. Recently, there have been medical school programs that are reviving a three-year program structure. These three-year accelerated programs originated during WWII when there was a shortage of physicians.⁵ Once the war was over, the students who graduated from the accelerated programs felt the need for more courses.⁵ Which suggests that graduates from these accelerated programs didn’t feel fully prepared despite the fact that they received on-the-job experience. Surprisingly, these three-year programs were not discontinued due to lower pass rates of the USMLE (the United States Medical Licensing Examination) compared to those of four-year programs. Indeed, there are no differences between the pass rates based on program length.⁵

It seems to me that when designing a program and teaching students, there needs to be time for the information to sink in. The literature suggests that out-of-class learning, including extra-curricular activities, can be very beneficial to one's career. This includes building leadership skills through service in professional organizations and developing social skills.  Students also need time to think deeply about the material covered in class. There are many factors that influence licensure pass rates, but I don’t think we know yet the key ingredients to creating a shorter curriculum that is equally effective.

References

1. Academic Pharmacy's Vital Statistics. American Association of Colleges of Pharmacy. Published July 2020. Accessed February 20, 2021.
2. North American Pharmacist Licensure Examination Passing Rates for 2017—2019 Graduates Per Pharmacy School. National Association of Board of Pharmacy. Published February 25, 2020. Accessed February 20, 2021.
3. Williams JS, Spivey CA, Hagemann TM, Phelps SJ, Chisholm-Burns M. Impact of Pharmacy School Characteristics on NAPLEX First-time Pass Rates. Am J Pharm Educ. 2019;83(6):Article 6875.
4. Ried LD. Length of advanced pharmacy practice experience and first-time NAPLEX pass rate of US pharmacy programs. Curr Pharm Teach Learn. 2020;12(1):14-19.
5. Schwartz CC, Ajjarapu AS, Stamy CD, Schwinn DA. Comprehensive history of 3-year and accelerated US medical school programs: a century in review. Med Educ Online. 2018;23(1):1530557
6. NUMBER OF APPLICANTS APPLYING FOR PGY1 PROGRAMS BY SCHOOL 2020 MATCH – COMBINED PHASE I AND PHASE II. National Matching Services. Published 2020. Accessed April 1, 2021.

Beware! Teacher’s Bias and Favoritism

by Mariah Cole, PharmD, PGY1 Community Pharmacy Practice Resident, Mississippi Department of Public Health

“Ugh, ____ is such a teacher’s pet.”

Does this ring a bell for you? The teacher’s pet was a title given to any student who had a “preferential” relationship with the teacher. What does the teacher’s pet relationship look like? The teacher's pet could be the child who was consistently picked to pass out papers or lead the lunch line. It wasn’t just the most helpful students but the “smart” students as well. The “smart” students seemed to know the answers to all the questions asked during class or were consistently recognized by the teacher for scoring the highest on quizzes or tests. Not every student called a “teacher’s pet” was actually given any form of favoritism. None-the-less, such preferential treatment can have a positive effect on students. But just as importantly, favoritism impacts the rest of the students in class.  Thus, teachers need to be mindful of how their relationships with students are perceived.

Teachers and students are human and subject to bias, whether intentional and/or unintentional.  This trickles into their interactions with and among each other.¹ Bias arises from both positive and negative attitudes towards people based on their socio-cultural and economic background, gender, and many other factors. For example, students or teachers from differing geographical regions may experience bias due to beliefs about regional dialects or accents. And bias can lead to barriers to effectively working together.¹ In addition, teachers and students may have interfering dynamics that arise during interactions such as approval seeking, competition, excessive dependency, and psychological withdrawal or reactance.¹ Thus bias and interfering dynamics culminate in favoritism, neglect, or prejudicial actions towards others.

Teacher favoritism may be defined as “the act of giving preferential treatment to someone or something; the tendency to favor a person or group for factors “such as a characteristic they possess, or their personal contacts, or merely out of personal preferences”.¹ Thus, the “teacher pet” relationship is a type of teacher favoritism. It may be noted that there are various definitions within the literature for the “teacher pet” relationship. One author defines it as, “a phenomenon of a special emotional relationship (often a love relationship) between the teacher and a particular student (or two) in the classroom.”¹ Meanwhile, another author defines the concept as “student favored by teachers because they have actual and/or alleged characteristics that are highly valued by teachers but not necessarily by classmates.”¹ Favoritism may also manifest from teachers’ affectionate ties to a student, which derive from the pleasure that the student brings to the teachers’ work.² One study characterized teacher’s pets are more likely to be girls who come from higher socioeconomic backgrounds but may not be considered the best academic students.²

While overt favoritism toward particular students may not be seen in the same way in college and professional degree programs, the mentoring relationship has the potential to be interpreted as a teacher’s pet or favoritism relationship. A few students, by virtue of their background or preferential characteristics, are given more access to the instructor or professor and are given opportunities not afforded to other students.  The development of a friendship may complicate or compromise the mentoring relationship. One author notes that a professional mentor is a position of power. Thus, a hierarchy should predominate and the mentor should not be considered equal to the mentee. For this reason, a friendship-type relationship should never be established during the mentorship period.³  This is not to say that mentors should not act in a friendly, helpful manner to mentees and that these relationships should not have a personal dimension.⁴ Befriending mentees increases the psychosocial support provided to students. However, befriending is not equivalent to friendship. Befriending is about building a positive relationship that is collegial.  Thus, the mentoring relationship can still be cordial, personal, and enjoyable.

As the mentoring relationship progresses, the relationship should evolve. Setting clear expectations of the relationship at the beginning may increase the effectiveness of the mentoring relationship. Heidrun Stoegar explains “effective mentoring relies on mentors and mentees having clear ideas about what mentoring entails, how it is distinct from other support measures, and what expectations for a given mentoring experience are realistic”.⁵ One method of setting expectations includes creating a mentoring contract which would include “defining relationship’s boundaries, reduce confusion about roles and expectations, clarifies commitments including time, and defines relationship’s objectives. However, making formal contracts may stifle informal support”.^6,7 Thus, a conversation about expectations, rather than a written contract, is probably more appropriate.

Favoritism is cultivated by our conscious and unconscious biases. Bias may lead to positive and negative attitudes toward various groups of students and differences in the way they are treated. Favoritism may manifest within undergraduate, professional, and graduate education in the form of mentoring. If the boundaries of the mentoring relationship cross into friendship, students may interpret this relationship as favoritism. Setting boundaries and expectations can help prevent perceptions of favoritism and maintain a professional relationship with all learners.

References

1. Cheng E. Teacher Bias and Its Impact on Teacher-Student Relationships: The Example of Favoritism [Internet]. [cited 2021Mar8].
2. Tal Z, Babad E. The teacher’s pet phenomenon: Rate of occurrence, correlates, and psychological costs. Journal of Educational Psychology. 1990;82(4):637–45.
3. Detsky AS, Baerlocher MO. Academic mentoring--how to give it and how to get it. JAMA. 2007;297(19):2134–6.
4. Mullen CA, Klimaitis CC. Defining mentoring: a literature review of issues, types, and applications. Annals of the New York Academy of Sciences. 2021;1483(1):19–35.
5. Stoeger H, Balestrini DP, Ziegler A. Key issues in professionalizing mentoring practices. Annals of the New York Academy of Sciences. 2021 Jan 1;1483(1):5–18.
6. MacLeod S. The challenge of providing mentorship in primary care. Postgrad Med J. 2007 May;83(979):317-9.
7. Burgess A, van Diggele C, Mellis C. Mentorship in the health professions: a review. Clin Teach. 2018 Jun;15(3):197-202.

Should Standardized Patients Score Student Performance?

by Ashley Miller, PharmD, PGY1 Community Pharmacy Resident, University of Mississippi School of Pharmacy

It's the end of the semester, and the last thing standing between you and your summer break is the objective structured clinical examination (OSCE). You know that you’ll be entering multiple interactive stations that will assess your ability to perform patient care-related activities. Who do you hope will be grading your performance – a teacher you’ve had, or a stranger — a standardized patient (SP)? I know what I preferred when I was the one undergoing these evaluations, but I was curious to learn more about what other professional students, faculty, and researchers had to say about who is the best person to evaluate and score a student’s performance.

OSCEs date back to the 1960s and were first used as assessments in medical schools.  Each OSCE station is intended to represent a realistic clinical scenario during the student interacts with a “patient.”^1,2  At many schools, the patient role is played by an experienced actor known as a standardized patient (SP).  An OSCE allows students to "practice" in an environment safe for both them and patients.¹ OSCEs are reliable and valid assessment tools and predict students' future success.^1,2  Their use was expanded to other health professional programs including dentistry, pharmacy, and nursing.^1,2 They were designed to comprehensively evaluate clinical, interpersonal, and problem-solving skills and consistently portray the clinical scenario so that every student has the same experience (and opportunities).^1,3 While preparing and delivering an OSCE is very time-consuming, both educators and students alike agree that OSCEs are a valuable learning and assessment tool.³

One thing not always agreed upon when considering OSCEs is whether a faculty member or SP should grade performance. In some instances, an SP may interact with the student while a faculty member grades the interaction while observing the encounter either remotely or in the same room. Some argue that having faculty graders introduces additional bias and negatively influences students' performance when compared to a more neutral grader.³ Others claim SPs do not have the skillset or training needed to properly assess students.³ Previous studies involving faculty versus SP graders have not provided a clear answer as to who makes the “best” grader.

Different evaluator factors contribute to variability when scoring OSCE encounters, including lack of defined criteria, lack of training, and the number of items to be assessed.⁴  One study looked at factors that affected student scores during an OSCE when evaluated by faculty versus SPs.⁴ Before grading began, all examiners were first put through a series of training on the OSCE process and the criteria they were to use for scoring students.⁴ The researchers found that the scores given by SPs were higher than those given by faculty members, suggesting that the type of grader does influence scores.⁴ Another interesting finding was that the faculty evaluators assessed technical skills more strictly, yet were not as strict when grading communication skills when compared to SP evaluators.⁴ The technical skills assessed included history-taking, physical examination, and patient education.⁴ Communication skills that were graded include the attitude of the student, active listening, ability to build rapport, and effective questioning.⁴ Notably, faculty members who were scoring items related to their specialty tended to assign lower grades.⁴ The authors hypothesized that these differences are seen because faculty graders are more familiar with assessing the technical skills (particularly if it was relevant in their specialty) and have higher expectations for performance, while SPs are not as comfortable giving lower scores on technical matters.⁴

While some faculty members believe that their presence does not impact student performance, students often report that knowing teachers are grading OSCEs increases testing anxiety.³ The increased stress then impacts performance which, in turn, affects students’ grades.^3,4 In a study conducted using student questionnaires to survey the use of SP versus faculty graders, McLaughlin et al. found that the majority of students felt SPs helped create a less stressful testing environment, were as good at giving feedback as faculty graders, and felt they were adequately equipped to assess their skills.² The findings of this study demonstrate that students generally prefer to be graded by an SP and believe that an SP can competently assess their performance.²

So, who should grade a student’s performance during an OSCE? It likely depends on who you are asking. Overall, it seems that most students feel SPs are equipped for the task, are fair graders, and help them to feel more at ease. Much like how I felt when I was a student, it seems students would prefer an SP in these encounters since it is a more realistic experience — similar to interacting with patients in the “real world.”³  However, some may contend that, while students may not be as comfortable, having professors performing the assessment is in the student's best interest long-term because they can more accurately assess the student’s technical skill. One point made for this argument is that some studies have shown that grades given by faculty are predictive of future performance.² Another point made by researchers and those in academia for having faculty graders is that they are content experts and may be able to identify students who have only surface-level knowledge but appear confident and skillful to a non-expert.² It is also possible to have SPs interact with the students while faculty members observe and grade the encounter synchronously or asynchronously.  In this way, the student performance is scored by both the SP and faculty members.  However, this would cost more time and money as both SPs and faculty would need to be trained. Research shows SPs focus more on communication while faculty focus more on technical skills in an encounter, thus, it may come down to the most important skill being assessed in a particular OSCE station when choosing who should score it.

^References 

1. Alsaid A, Al-Sheikh M. Student and Faculty Perception of Objective Structured Clinical Examination: A Teaching Hospital Experience. Saudi J Med Med Sci [Internet]. 2017;5 (1):49-55.

2. McLaughlin K, Gregor L, Jones A, et al. Can SPs Replace Physicians as OSCE Examiners? BMC Med Educ [Internet]. 2006;6: Article 12. 

3. Salinitri FD, O’Connell MB, Garwood CL, et al. An Objective Structured Clinical Examination to Assess Problem-Based Learning. Am J Pharm Educ [Internet]. 2012;76(3): Article 44. 

4. Park YS, Chun KH, Lee KS, et al. A Study on Evaluator Factors Affecting Physician-Patient Interaction Scores in Clinical Performance Examinations: A Single Medical School Experience. Yeungnam Univ J Med 2021;38(2):118-126.

Facilitating Student Success in Remediation Programs

by Madison Gray, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Some colleges of pharmacy and other professional schools have programs in place to identify students early who are underperforming so that they can provide additional help and coaching before they fail a course.¹ Many of these strategies focus on tutoring and supplemental academic assistance to address underperformance and, ultimately, prevent failure.^1,2  Course failure is not only associated with a significant financial burden but also psychological and social consequences.¹ So, what is the most appropriate approach to remediation? Should remediation programs focus on course/content review or strategies for success? Several remediation approaches have been described in the literature for various professional schools and range from course repetition to developing individual remediation plans.² Individualized remediation that focuses on helping students become self-regulated learners is, in my opinion, a more effective approach to ensuring a student’s long-term success.^1-3

Years of research have identified self-regulated learning to be a differentiating factor separating high and low-performing students.³ Three key factors underly the success of self-regulated learning including preparation, performance, and self-reflection.³ Self-regulated learning requires the identification of barriers, appropriate time management skills, motivation, and strategic study habits.³

Many factors affect student performance and individual barriers often exist that impact each student’s ability to develop a self-regulated learning behavior.^1,3 Sansgiry and colleagues evaluated the effect of these factors on both high and low-performing students.  They found that test competence (which includes test anxiety) was one differentiating factor between the two groups.¹ They defined test competence as a “student’s ability to manage and cope with the amount of study material for examinations and/or tests.”¹ Many students (69.3%) reported feeling some type of anxiety during testing and some students even report experiencing physical symptoms.¹ Some other barriers affecting student performance include access to learning materials and technological barriers.¹ Identifying barriers for students is the first step in addressing issues that may hinder their success. Strategies to identify and address these barriers should be a routine part of the remediation process and could include interviews, surveys, and student self-reflection.

Self-regulated learning is a behavior that requires well-developed time management skills.³ Students who try to learn course material in a short amount of time tend not to perform as well as those who develop study plans whereby the learning effort is distributed over an extended period of time.^3,4 Appropriate time management skills that allow for more time for studying may also help decrease test anxiety and increase the student’s confidence in their preparation.^3,4 A study by Hartwig and colleagues assessed the study habits of college students in correlation with their grade point averages (GPAs).⁵ Students who reported scheduling study times over an extended period rather than cramming the day (or two) before an exam trended toward higher GPAs although the results were not statistically significant⁵. Remediation programs that encourage students to set goals, create tasks, and use schedules will help teach time-management skills that can be used in and out of the classroom.⁴ Effective time-management skills are necessary for both academic and career success.⁴ Once a student has good time management skills, learning how to use other study strategies may be helpful.^4,5

Students who use a variety of strategies to study, such as re-reading material, summarizing, note-taking, flashcards, and self-testing, are more likely to be successful.⁵ These different strategies have been studied and some of these strategies are used by high performing students more often when compared to low performing students.^3,5 In the study by Hartwig and colleagues, a survey administered to college students included questions about study strategies, self-testing, and study schedules.⁵ Self-testing correlated with higher GPAs versus other study strategies.⁵ The majority of students who reported using self-testing as a study strategy also reported that they did so to test themselves on how well they learned the material.⁵ Notably, re-reading was also associated with higher GPAs among the surveyed students; however, other studies have not found this association.⁵ These are just a few positive study strategies that can be utilized by college students to promote self-regulated learning.^3,5 Having students reflect back on their study habits to determine what works and what doesn’t work is one strategy that can be utilized during remediation programs.^3,5 Some students are not accustomed to having to study and this creates a challenge when they get to college.¹ They may go from previously not having to study (at all!) to learning how to study.^1,2 An individualized remediation program is an opportunity to address some of these challenges.^1,2

Course repetition is used by many schools and colleges of pharmacy.² This approach to remediation focuses on academic competence by requiring students to simply repeat the course they have failed.^1,2 Course repetition aims to re-expose students to the same course material in the hopes they achieve higher performance.^1,2 Some programs allow students to continue in the program and repeat the course once it is offered again while other programs require that the course be successfully passed prior to moving forward within the program.^1,2 The later strategy often involves students sitting out for a year and this obviously has significant financial implications.^1,2 Course repetition is not individualized and often does not address the underlying issues that contributed to the failure. This approach to remediation fails to address the non-cognitive barriers to students’ success.

Programs that focus on individualized remediation allow students to actively participate in the remediation process and help set them up for success both in the classroom and their careers. In an individualized remediation program, students must identify their barriers (with guidance) and engage in self-reflection. Such programs help students develop plans to address their identified barriers. Additionally, individualized programs should aim to promote self-regulated learning behaviors by giving students experience creating goals, formulating learning tasks, and developing time-management skills. Individualized programs should also focus on helping students develop new study strategies such as self-testing and summarizing. By identifying and addressing the non-cognitive barriers that often cause students to fail, remediation programs can foster the development of self-directed behaviors that enable students to be successful in subsequent coursework … and life.

 

References:

1. David M, Fuller S, Hritcko P, et al. A Review of Remediation Programs in Pharmacy and Other Health Professions. Am J Pharm Educ [Internet]. 2010;74(2): Article 25.
2. Sansgiry S, Bhosle M, Sail K. Factors That Affect Academic Performance Among Pharmacy Students. Am J Pharm Educ [Internet]. 2006;70(5): Article 105.
3. McKeirnan K, Colorafi K, Kim A, et al. Study Behaviors Associated with Student Pharmacists’ Academic Success in an Active Classroom Pharmacy Curriculum. Am J Pharm Educ [Internet]. 2020;84(7):Article 7695
4. Britton B, Tesser A. Effects of Time-Management Practices on College Grades. J Educ Psychol [Internet]. 1991 [cited 2021 Jan 10];83(3):401-10.
5. Hartwig M, Dunlosky. Study strategies of college students: Are self-testing and scheduling related to achievement? Psychon Bull Rev [Internet]. 2012;19:126-34.