Let’s
Think
About It
VOLUME 13 • ISSUE 1 • FALL 2011
Let’s Think About It is published three times a year by the Center for the Advancement of Teaching and Learning (CATAL) in Mercer University’s College of Pharmacy and Health Sciences. The purpose of CATAL is to support and promote effective and innovative teaching that enhances learning at the College. CATAL’s vision is to create a learningcentered community that promotes a culture of excellence in teaching and learning.
Let’s Think About It has been the newsletter for the Center for the Advancement of Teaching and Learning (CATAL) since February 1997 when Issue 1, Volume 1 was published. For the last several years, Dr. Grady Strom has edited the newsletter. Dr. Strom has personally contributed numerous articles to the newsletter and shared his perspectives and vision of innovations in teaching. We are grateful to him for his able guidance for many years to bring this newsletter to you. Starting with this issue of the newsletter, Dr. Leisa Marshall will serve as the new editor, and I will assist Dr. Marshall as the associate editor. Dr. Strom will still continue to provide guidance to the newsletter, as part of his overall championship of CATAL activities and events, and as chair of CATAL. The newsletter will continue to provide a forum for faculty to share their experiences in teaching, and we will bring information from the literature to enhance teaching at the College of Pharmacy and Health Sciences. We encourage our College of Pharmacy and Health Sciences faculty to write for the newsletter and send your submissions to Dr. Marshall. Your submissions can include, but are not limited to, short reflective essays about your first one or two years teaching in the academy, reports of your pedagogical research, innovative techniques and approaches that facilitate learning, what works in your class, or summaries of educational books or articles. Each submission will be reviewed by the editors and selected members of CATAL. Please consult the CATAL website at mercer.edu/catal for previous issues of Let’s Think About It and for information about programs offered by CATAL, such as the Journal Club and colloquy meetings. This issue of the newsletter features two projects highlighting teaching and learning in the classroom in the pharmacy program. The first article, authored by Drs. Lisa Lundquist, Angela Shogbon and Kathryn Momary, provides a comparison of students’ perceptions and faculty evaluation of students’ communication skills during an oral examination in a therapeutics module. The second article, authored by Drs. Diane Nykamp and Leisa Marshall, provides an example of using an existing electronic case study program on pain management as the basis of an active learning activity in a therapeutics module. Thank you and I hope you enjoy this issue of Let’s Think About It. Ajay K. Banga, Ph.D. Chair, Department of Pharmaceutical Sciences Mercer University COPHS Associate Editor
INSIDE THIS ISSUE Communication Skills Comparison, P.2 A Pain Management Assignment, P.5
Communication Skills:
a Comparison of Students’ Perception and Faculty Evaluation of Performance on Therapeutics Oral Examinations Lisa M. Lundquist, Pharm.D., BCPS | Angela O. Shogbon, Pharm.D., BCPS | Kathryn M. Momary, Pharm.D., BCPS
Background
Methods
The Center for the Advancement of Pharmaceutical Education (CAPE) and the Accreditation Council for Pharmacy Education (ACPE) both advocate for patient-centered pharmaceutical care.1-3 The CAPE Outcomes recommend that pharmacists must be able to communicate and collaborate with prescribers, patients, caregivers, and other involved health care providers to engender a team approach to patient care2 and that pharmacists must apply effective communication skills in interprofessional relationships to improve the clinical, economic, and humanistic outcomes of patients.3
Two patient case-based oral examinations were given to all second professional year students enrolled in the Cardiovascular/Renal III therapeutics course. Students were provided with patient cases prior to each oral examination to allow adequate preparation time and the cases incorporated disease states and pharmacotherapy previously tested in written format. One oral examination was given individually and one was a group oral examination with groups of 4 students. During the oral examinations, questions that were asked were consistent with clinical practice. The students served as the pharmacist developing and communicating therapeutic recommendations to the faculty members who served as another health care provider.
There are many opportunities to reinforce students’ communication skills with patients in our College of Pharmacy and Health Sciences through a communications course, introductory pharmacy practice experiences, mock patient counseling, and oral examinations. Opportunities to strengthen communication skills with health care providers include introductory pharmacy practice experiences and four classroom hours of instruction and application of a framework for presenting clinical recommendations regarding drug therapy and specific communication skills to utilize. The majority of opportunities to improve students’ communication skills with health care providers are not until advanced pharmacy practice experiences. In an effort to evaluate students’ communication skills with health care providers, we compared second professional year students’ perceptions and faculty evaluation of performance of communication skills during therapeutics oral examinations.
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Faculty assessed students’ communication skills using a scoring rubric in the areas of rapport (confidence, non-verbal, tone of voice, eye contact) and presentation of therapeutic recommendations (concise, pronunciation, well-prepared, patient-focused). Immediately following each oral examination, students were asked to rate their own communication skills using the same rubric.
All data collected were approved by Mercer University Institutional Review Board. Students voluntarily signed informed consent prior to participation. Students’ perceptions were compared to faculty evaluation of their communication skills using descriptive statistics and Wilcoxon Signed Ranks test.
Results A total of 136 (97.8%) students completed communication self-assessments. Faculty’s evaluation of students in both the individual and group oral examinations, were statistically significantly
Figure 1. Individual Oral Examination: Student Perception and Faculty Evaluation +
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Me an Co mmun ication Scor es
To date, there is little published literature on communication skills assessment in pharmacy education.4-5 In a description of the current practices of communication skills assessment in colleges of pharmacy, the focus was on communication with patients, not with other health care providers.4
Communication skills were rated on a 4-point Likert scale with 1=needs significant development, 2=needs improvement, 3=developing excellence, and 4=accomplished. Student’s perception of performance on communication skills during each oral examination was compared with their respective faculty’s communication evaluation. In addition, student’s perceptions of performance on communication on their respective individual and group oral examinations were compared. Faculty evaluation of each student’s communication performance on the individual and group oral examinations were also compared.
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p <0.01 p <0.05
Figure 2. Group Oral Examination: Student Perception and Faculty Evaluation *
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M ean Com m unic at ion Sc ores
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higher than the students’ self-assessment of their communication skills in the following areas: confidence, respectful tone, absence of obvious nervousness, and concise and articulate. In addition, in the individual oral examination, faculty rated students’ performance on ‘correct professional phraseology’ higher than the students’ selfassessment (p<0.05). Students’ self-assessment of communication increased from the individual to the group oral examination in the following areas: confidence, respectful tone, absence of obvious nervousness, individualized approach, wellprepared, and concise and articulate. Figures 1 – 4 illustrate the comparisons of student perceptions and faculty evaluation of communication skills in both the individual and group oral examinations.
Discussion Students’ perception of communication skills were consistently lower than the evaluation scores provided by faculty in both the individual and the group oral examinations. A potential cause of students’ lower perception of communication skills may be a lack of practice in the verbal communication of clinical recommendations, which is supported by the increase in student perception with the second oral examination. Another possible explanation is that students tend to be their own worst critics. In areas where students tended to be particularly judgmental with themselves, examination of faculty evaluations could provide balance.
p <0.01 p <0.05
Students’ perceptions of communication skills were higher in the group oral examination setting when compared to the individual oral examination setting. Since the group oral examination occurred after the individual oral examination, confidence in skills and performance of communicating therapeutic recommendations may have increased, and the students likely felt more selfconfident with the support of their peers. Evaluation of students’ communication skills with health care providers may contribute to a better comprehension of the practice of pharmacy and the integration of professional competence, clinical aptitude and patient care. Greater use of this evaluation method of communication skills may further
Figure 3. Students’ Individual and Group Oral Examination Perceptions
Mean Communi cation Scor es
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p <0.01 p <0.05
3
Figure 4. Faculty’s Individual and Group Oral Examination Evaluations +
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M ean Com m unic at ion Sc ores
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contribute to improving student’s confidence and competence in the verbal communication of clinical recommendations to health care providers and better prepare them for practice as future pharmacists. In addition, appropriate self-evaluation of performance is a key component to professional development. If you have the opportunity in your course, we encourage you to consider incorporating communication skills evaluation.
Conclusion Students’ perceptions of communication skills were consistently lower than faculty’s evaluation. Greater utilization of formal case-based oral examinations may help to improve student’s confidence and perception of their communication skills.
References 1. Accreditation Council for Pharmacy Education (ACPE). Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Available at: http://www.acpe-accredit.org/pdf/ACPE_Revised_ PharmD_Standards_Adopted_Jan152006.pdf. Accessed June 17, 2010.
4
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2. Center for the Advancement of Pharmaceutical Education (CAPE) Pharmacy Practice Supplemental Educational Outcomes. Available at: http://www. aacp.org/resources/education/Documents/PharmacyPracticeDEC06.pdf. Accessed June 17, 2010. 3. Center for the Advancement of Pharmaceutical Education (CAPE), Social and Administrative Sciences Supplemental Educational Outcomes. Available at: http://www.aacp.org/resources/education/Documents/SocialandAdminDEC06.pdf. Accessed June 17, 2010. 4. Kimberlin CL. Communicating with patients: skills assessment in US colleges of pharmacy. Am J Pharm Educ. 2006 Jun 15;70(3): article 67. 5. Beardsley RS. Communication skills development in colleges of pharmacy. Am J Pharm Educ. 2001;65:307-14.
p <0.01 p <0.05
A Pain Management Assignment Incorporating an Electronic Learning Program Diane Nykamp, Pharm.D. Leisa L. Marshall, Pharm.D.
Background Incorporation of varied active learning techniques has been shown to increase learning in students enrolled in Doctor of Pharmacy programs.1-3 Characteristics of active learning include: students who are involved in more than listening, student involvement in higher-order thinking such as analysis, synthesis, and evaluation, and students who are engaged in activities, e.g. reading, discussing, writing.4 All of these characteristics are needed to meet the Commission to Implement Change in Pharmaceutical Education (CAPE) outcomes and the Accreditation Council on Pharmaceutical Education (ACPE) standards.5,6 With active learning, emphasis is placed on exploration by the students of their own attitudes, values, and skill development with less emphasis on transmitting information.4 Didactic lectures used alone may limit students’ retention rates.7 A goal of active learning is to hold students responsible for their own learning by providing them with opportunities to practice or utilize concepts and skills learned in the classroom. Active learning assignments may be incorporated into the large classroom setting, allowing students to demonstrate problem solving or critical thinking skills after instruction inside or outside the classroom.3,4 Three components suggested as necessary for successful active learning are: explanation of the context of the activity, student engagement in the activity, and activity closure via some form of reflection.3 Barriers or limitations to active learning assignments include large class size, lack of technology or faculty resources, and the time needed to develop and implement activities.3,4 Faculty use of previously developed case study programs, including continuing education programs, can minimize the faculty resource and time
barrier. Formats for continuing education activities available on the Internet include live webcast, video with slides, short interactive. case studies, conference coverage, posters and abstracts, journal articles and practice guidelines. A variety of these programs can be used to supplement course content in the didactic setting.8-11 Most are available without a fee and are readily accessible to faculty and students. This article describes a Pain Management Activity (PMA) using a professionally developed Continuing Medical Education (CME) electronic learning case study program available on the Internet. The CME case study program was coupled with a faculty developed assignment and break-out discussion session designed to incorporate and assess student problem solving skills in pain management in a required pharmacotherapy module, Disorders of the Musculoskeletal System and Pain Management. Learning objectives of the PMA included developing proficiency in: • recommending appropriate medication therapy and monitoring parameters, considering patient specific parameters presented; • identifying adverse drug reactions to therapy; • identifying follow-up plans that demon strate appropriate and effective practices for patient care; • identifying treatment plans that demonstrate effective strategies to overcome or manage treatment-related side effects.
Methods The program used in this project was a CME program from BiMark Center for Medical EducationTM entitled CME IDOL (Improvement Demonstration Outcomes Leaders).11 Permission was obtained to use the program in an educational class setting. The case study program consisted of clinical reviews of three patients with chronic pain syndromes. Student learning and achievement of the PMA learning objectives were assessed via performance on the PMA. An 18-item active learning assignment was developed by faculty using questions from the medical education program, with the addition of questions focusing on proper medication use and monitoring, adverse reaction identification, and proper follow-up and treatment plan identification. A graded rubric and detailed
answer key for the 18-item assignment were also developed. Student impression of the active learning activity was assessed using a faculty developed 10-item survey and open- ended responses to three guided questions. The project was approved by the Institutional Review Board of Mercer University. The PMA occurred during the third week of the four-week module, following didactic lecture presentations on medicinal chemistry, pharmacology, and therapeutic management of acute and chronic pain. The exercise included an in-class preview of the electronic learning site and three cases, student work outside of class to review the cases and complete the 18-question assignment, mid-sized group (23-24 students) break-out case discussion meetings with faculty facilitators the next day, and voluntary survey completion. The electronic learning program cases were: 1) a 70-year-old female with neuropathic pain, 2) a 48- year-old male with renal cell carcinoma and hip pain, and 3) a 35-year-old male with a 6-month history of chronic back pain.11 Faculty facilitators used the provided answer key and grading rubric for case facilitation and to begin assignment grading. Course coordinators finished grading the assignment. During the break-out session, mimicking the American Idol television show™, students chose, by vote, the care plan that demonstrated the most effective patient care practices and the care plan that provided the most effective strategies to manage treatment related side effects and provide proper follow-up care. After the final results were tallied, the winning results were announced in class. The voluntary survey assessing the students’ perceptions of the activity was administered after the final voting. Student learning was assessed using student performance on the 18-item assignment.
Results One hundred percent of the students enrolled in the course completed the assignment and attended their assigned break-out case session. This activity was worth a possible 1% of the grade in the course. Student performance on the activity (18 items graded) was good with a mean of 90.6 (SD 9.26), n=146. Of the 146 third-year students enrolled in the course that year, 86 (58.9%) completed the voluntary questionnaire regarding their perceptions of the PMA. Several students failed to answer all 10 items on the survey.
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Table 1. 5 Strongly Agree, %
4 Agree, %
3 Neutral, %
2 Disagree, %
1 Strongly Disagree, %
Average
The PMA helped me to learn pain-related subject matter in this course.
1.3
33.8
24.7
26.0
14.3
2.82
The PMA served as a useful supplement to the information provided during the course.
2.5
40.7
18.5
25.9
12.3
2.95
The PMA enhanced my problem-solving skills.
1.2
26.8
35.4
23.2
13.4
2.79
The PMA challenged me to think critically about my approach to pain management.
3.6
45.2
21.4
20.2
9.5
3.13
The PMA involved me in the learning process.
3.5
58.1
17.4
11.6
9.3
3.35
The PMA will help me to prepare for Advanced Practice Experiences.
2.6
23.4
42.9
18.2
13.0
2.84
The PMA will help me to become a competent pharmacist.
2.5
19.8
40.7
24.7
12.3
2.75
The quality of the electronic learning medical education was excellent.
1.2
28.4
38.3
21.0
11.1
2.88
The PMA was a useful learning tool.
1.2
32.5
36.1
20.5
9.6
2.95
The PMA should be made available to future students.
2.4
34.9
27.7
26.5
8.4
2.96
Survey Items
Mean responses (Table 1) ranged from 2.75 (SD =0.99) to 3.35(SD=1.05), based on a 5-point Likert scale (1= strongly disagree, 2= disagree, 3=neutral, 4= agree, and 5= strongly agree). Forty-one (48.8%) students agreed or strongly agreed that the activity actively challenged them to think critically about their approach to pain management. Fifty-three (61.6%) agreed or strongly agreed that the activity involved them in the learning process. However, only 28 (33. 7%) agreed or strongly agreed that the activity was a useful learning tool, and only 18 (22.3%) agreed or strongly agreed that the active learning activity would help them to become a competent pharmacist. The three open-ended survey questions were: what was the most valuable aspect of the activity, the least valuable aspect of the activity, and how would you improve the activity? Students indicated the use of real live patients and the opportunity to practice problem solving skills via patient cases to be the two most valuable components, whereas the use of unfamiliar medical terminology in the cases and taking time away from studying to complete the activity were the two least valuable components. The two suggestions for improvement most often given were to provide the cases in text, as well as on the Internet, and to give students more time to complete the assignment.
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Discussion In our experience, electronic learning case based programs can easily be integrated into a pharmacotherapy module as one type of active learning activity. This professionally developed program designed for health care professionals, physicians, and pharmacists was chosen as it included content and pain management guidelines relevant to course content and learning objectives. Furthermore, the current generation of students generally like multi media entertainment, so an electronic program mimicking the American Idol™ format had appeal.12,13 The use of other types of game formats, such as Trivial Pursuit™, Jeopardy™, and Hollywood Squares™ to analyze and present patient cases, have been successfully incorporated into required pharmacotherapy modules with 16-20 student group sections.14 Our students reported that on demand access to the electronic program allowed them the opportunity to review information at their own pace after didactic lectures, prior to completing the assignment and attending the discussion session the next day. Students reported that they appreciated the opportunity to practice problem solving skills using patient scenarios based upon real patients, whether working alone or with other students.
This project was not without limitations, notably the results of the voluntary student survey (Table 1). According to the Likert Scale, success would be defined as 4 or 5. The highest ranked question from this survey was 3.35. The remaining 9 questions received scores of 2.75 to 3.13. This activity, however, was the last of 5 graded active learning activities in the course that year. Four of the five activities occurred in weeks 3 and 4 of a 4-week block. The block scheduling of this course, where class meets 18 hours a week for 4 weeks, presents time-constraint challenges. Students in the course may have perceived the activity as extra work outside of class without value added benefits. Furthermore, two hours of didactic instruction on pain management was deleted in order to allow time to have the break-out patient case discussion sessions. Students were responsible for reading materials that were not covered in lecture. As a final limitation, the project design did not include an assessment of mastery of learning objectives in the area of pain management comparing traditional lecture to the PMA with a shortened lecture and additional required outside reading.
Conclusion An existing electronic case study program can easily be used as the basis for an active learning
activity to involve students in the learning process. Further work is needed comparing student competency in selected topics when graded active learning activities are employed versus traditional lecture format.
George Washington University, School of Education and Human Development; 1991.
References
6. Accreditation Council for Pharmacy Education (ACPE). Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Available at: http://www.acpe-accredit.org. Accessed 2010 June 18.
1. Brandt BF. Effective teaching and learning strategies. Pharmacotherapy. 2000; 20 (10): 307S-316S. 2. Kerr, RA. Curricular integration to enhance education outcomes. Pharmacotherapy. 2000;20 (10): 292S-296S. 3.Van Amburgh JA, Devlin JW, Kirwin JL, Qualters DM. A tool for measuring active learning in the classroom. Am J Pharm Educ. 2007; 71 (5): Article 85. 4. Bonwell C. Eison J. Active Learning: Creating Excitement in the Classroom. ASHE-ERIC Higher Education Report No 1. Washington D.C.: The
5. American Association of Colleges of Pharmacy, Center for the Advancement of Pharmaceutical Education. Available at: http://www.aacp.org/ resources/education/Documents/CAPE 2004.pdf . Accessed June 18, 2010.
7. Machemer PL, Crawford P. Student perceptions of active learning in a large cross-disciplinary classroom. Active Learn Higher Education 2007; 8:930. 8. Medscape. Available at: http://www.medscape. com/pharmacists. Accessed Sept 1, 2009.
10. Princeton Media Associates. Available at: http://www.princetoncme.com. Accessed Sept 1, 2009. 11. Optimizing Pain Management, Bimark Center for Medical Education. Available at: www.bcmeonline.com/cmeidol. Accessed Sept 1, 2009. 12. Gardner SF. Preparing for the nexters. Am J Pharm Educ 2006; 70(4): Article 87. 13. Grover TP, Groscurth CR. Principles for teaching the millennial generation: innovative practices of U-M faculty. University of Michigan Center for Research on Learning and Teaching Occasional Papers 2009; Paper No. 26. Available at: http://www.crlt.umich.edu/publinks/CRLT_no26. pdf. Accessed Jan 28, 2010. 14. Patel J. Using game format in small group classes for pharmacotherapeutics case studies. Am J Pharm Educ. 2008; 72(1): Article 21.
9. Free CME. Available at: http://www.freecme. com/gindex.php. Accessed Sept 1, 2009.
Publisher Hewitt â&#x20AC;&#x153;Tedâ&#x20AC;? Matthews, Ph.D. Dean and Senior Vice President for the Health Sciences
Editor Leisa L. Marshall, Pharm.D.
Associate Editor Ajay Banga, Ph.D.
Editorial and Production Manager David Hefner
Graphic Designers Terry Menard Jenifer Cooper, CooperWorks Inc.
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College of Pharmacy and Health Sciences
Letâ&#x20AC;&#x2122;s
Think
About It
Promoting Effective and Innovative Teaching
A Newsletter by Mercer Universityâ&#x20AC;&#x2122;s College of Pharmacy and Health Sciences
INSIDE THIS ISSUE Communication Skills Comparison, P.2 A Pain Management Assignment, P.5