The Layered Learning Practice Model

Lauren Antal, PharmD

PGY-1 Pharmacy Resident

Holy Cross Hospital

As a newly licensed pharmacist in a residency program, each day brings new opportunities and challenges to me. My pharmacy school education gave me a good solid background for tackling most of these challenges, including an understanding of how to manage medically complex ICU patients and making therapy recommendations to providers. I have an idea where to begin to start to solve the problem and the next steps I should take to reach a solution. One of the areas that I do not feel as prepared for is precepting students. I am interested in becoming a preceptor for pharmacy students in the future and possibly even teaching some lectures at a school of pharmacy. However, before I tackle those challenges, I would like to gain additional experience and skills. As a resident, I will be given the opportunity to precept a student who is on rotation at my hospital.

The Layered Learning Practice Model is a model that was developed and implemented at University of North Carolina.¹ This model is also known as the Attending Model.² It is a teaching model that teaches residents how to precept student pharmacists or other pharmacy residents under the supervision of an experienced clinical pharmacist. This model allows residency programs to develop precepting opportunities for their residents. The Layered Learning Practice Model sets up opportunities to effectively utilize multiple learners at various stages into a practice setting.³

The Layered Learning Practice Model utilizes at least 3 layers. These first of the 3 layers is the primary preceptor who is the preceptor on file for the school or pharmacy program or the residency program. The second layer is the resident. This layer may include PGY-1 and/or PGY-2 residents. PGY-2 residents may precept PGY-1 or student pharmacists and PGY-1 residents may precept student pharmacists. The third and final layer of the Layered Learning Practice Model is the student pharmacist.^1,2,3 The roles and responsibilities of each layer are clearly delineated.³

The primary preceptor has the responsibility of orienting both the resident(s) and student(s) to the Layered Learning Practice Model. They are also responsible for creating/obtaining syllabuses for the resident and student. The primary preceptor is expected to outline responsibilities and set expectations for the resident and student. The primary preceptor assists the resident in providing constructive feedback to the student. They must also evaluate the resident’s performance. The primary preceptor has the responsibility of overseeing all the patient care activities’ as well as the pharmacy education.³

The resident has many roles and responsibilities too. They are expected to meet with the primary preceptor prior to the first day in order to discuss the learning experience. The resident must help develop the student’s rotation calendar and activities.³ They are expected to serve as a mentor to the student pharmacist.¹ The resident takes on the role of orienting the student to the practice site, establishing goals, and incorporating the student into patient care activities. The resident is expected to supervise the student during the patient care activities. They must provide constructive feedback to the student regularly. The resident is responsible for leading topic discussions and other activities. They must evaluate the performance of the student.³

The student has the responsibility of participating in the patient care activities as well as the other rotation activities. The student should report to the resident preceptor. They should provide feedback about the resident as a preceptor. They should also provide feedback on the Layered Learning Practice Model.³

There is a four-step process that allows the Layered Learning Practice Model to be successfully implemented. The first step is Orientation. This step can include primary preceptors as well as residents who are unfamiliar with the Layered Learning Practice Model. It serves to familiarize new preceptors to the model. Orientation also familiarizes the resident to the model and sets expectations for the rotation. Orientation can provide resources for preceptor development and provide evaluation tools. The next step is the pre-experience planning where the primary preceptor and resident meet to review and finalize any material for the student’s rotation and set expectations. The resident takes on the responsibility of communicating with the students prior to the rotation beginning. The implementation step is the first day of the student’s rotation where the primary preceptor and the resident provide an orientation to the rotation and the Layered Learning Practice Model. This meeting sets the precedent that the resident will serve as the student’s primary preceptor and the resident will be giving the student feedback and their evaluation. The final step is the post experience evaluation where both the resident and student pharmacist are given written and verbal evaluations. Feedback about the Layered Learning Practice Model is solicited and ways to improve the learning experience are looked at.³

This model provides the framework to successfully set up a resident to precept a student pharmacist with supervision from a senior preceptor. It allows the resident to gain experience precepting under the supervision of an experienced preceptor. This allows the resident to gain additional knowledge from a preceptor while they are actively precepting a student pharmacist.  It will also allow residents who may be more hesitant to take on precepting a student to gain confidence under the oversight of their primary preceptor. This model allows for multiple pharmacists and student pharmacists to participate in patient care together.

While the Layered Learning Practice Model provides many benefits, there are also challenges along with the model. One of these challenges is coordinating multiple people’s schedules. The resident and the student’s schedules may start and end at different times. This model can also create more work for the senior preceptor. Every person’s role in the model must be clearly understood as well. Residents may also receive less attention because the senior preceptor has a resident as well as student to focus on. Residents must also have good time management skills in order to balance all of their responsibilities. While there are challenges associated with the model, these can be overcome.³

References:

1.       Pinelli NR, Eckel SF, Vu MB, Weinberger M, Roth MT. The layered learning practice model: Lessons learned from implementation. American Journal of Health-System Pharmacy. 2016;73(24):2077-2082. doi:10.2146/ajhp160163. https://academic.oup.com/ajhp/article-abstract/73/24/2077/5102177?redirectedFrom=fulltext

2.       Sarigianis J. The Layered Learning Practice Model. Regional Preceptor Development Network. Sept 28, 2018. https://ce.pharmacy.uconn.edu/wp-content/uploads/sites/2102/2019/01/HO-6-per-page-Layered-Learning-final.pdf

3.       Loy BM, Yang S, Moss JM, Kemp DW, Brown JN. Application of the Layered Learning Practice Model in an Academic Medical Center. Hospital Pharmacy. 2017;52(4):266-272. doi:10.1310/hpx5204-266. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424830/

Motivational Learning

Victoria Joseph, PharmD

PGY1 Pharmacy Resident

Suburban Hospital – Johns Hopkins Medicine

Scott Geller’s Ted Talk shared three questions to discern empowerment and self-motivation: can you do it? Will it work? Moreover, is it worth it? These three questions check training, education, and motivation.  Answering yes to all three questions demonstrates empowerment that leads to self-motivation. In order to empower someone, Geller recommended utilizing the 4 C’s to fuel self-motivation: consequences, competence, choice, and community. Consequences is the idea that people do things because they expect something in return, and they may need to be convinced of its worth. Providing feedback and recognition shows people they are competent which inspires them. Training people to be success seekers and not failure avoiders encourages sense of autonomy, which is motivational. A sense of relatedness and community leads to happiness and motivation [2]. 

In the classroom, there tends to be two different types of people, students who are genuinely interested and want to succeed at the subject and students who do the course out of obligation to fulfill a requirement or obtain a reward. The first type is considered intrinsic motivation, where the learner is fascinated with the subject and its application whereas the latter is extrinsic motivation where the learner does something to meet expectations or be rewarded. Geller’s idea of consequences relates to intrinsic and extrinsic motivation because regardless of the outcome, people expect something in return. For intrinsic motivation that would be knowledge or self-fulfillment and for extrinsic motivation that would be a reward or fulfilling a requirement [1].

The advantage with intrinsic motivation is that it can be long lasting and self-sustaining since the motivation is inherent. The disadvantage is that fostering intrinsic motivation can be a lengthy process and different students may require different approaches to motivate them. The advantage of extrinsic motivation is that it is more likely to produce behavioral changes and does not require the effort and preparation of intrinsic motivation. In addition, it does not require different approaches or background knowledge of students.  The disadvantage is that extrinsic motivation can distract students from the subject and they may not be truly interested since it is an obligation rather than a choice. In addition, if rewards are involved, the rewards may need to be escalated to maintain interest. Once rewards are removed, students tend to lose their interest. James Middleton, Joan Littlefield, and Rich Lehrer proposed an intrinsic motivation model: the student has to determine if the activity is interesting and then evaluate the stimulation the activity provides and the personal control it allows. Ultimately, there has to be a balance between stimulation and personal control or the student will lose interest [1].

Unmotivated students will not learn, even if the lesson is perfect. Some professors do not see motivating students as their job, but teaching is meant to benefit the students. Effectively teaching entails capturing the audience’s attention and interest. So one can argue that effective teaching requires motivated students [3]. The following are different strategies to motivate students to learn:

Presenting with energy and enthusiasm and displaying motivation shows the professor’s interest and allows the professor to serve as a role model to the students. In addition, taking the time to develop a meaningful relationship with the students makes it easier to tailor the course to their needs and interests. If a professor takes interests in their students, then students are more likely to notice the attempt and reciprocate by taking more interest in the course. Utilizing real world and practical examples and assignments shows students the applicability and utility of the subject. It allows the students to find personal meaning and value in the material. Incorporating a variety of active teaching activities engages students in the material. They can learn by self-discovery and group projects, which encourage active learning. Group work provides a sense of relatedness and correlates with the community component of Geller’s talk. Giving students’ autonomy to choose their own essay or project topics allows them to explore their areas of interest.

Emphasizing a growth mindset over a fixed mindset, which is the idea that abilities and talents can be cultivated and are not innate, can inspire self-motivation [3]. Providing realistic goals and assignments, appropriate emphasis on tests and grades, and thoughtful feedback are good ways to keep the subject relevant and not distract students [1]. Realistic goals and assignments relates to the choice component of Geller’s talk because students should be set up for success, which trains them to become success seekers and not failure avoiders. Feedback relates to the competence component because thoughtful feedback and recognition shows people they are competent which inspires them.

A majority of these teaching practices are familiar concepts. The biggest difference is conscious awareness to inspire self-motivation, which provides the student with the tools to succeed outside the classroom, not only for the course but also for life.

References

1)  Motivating students. Vanderbilt Center for Teaching. Vanderbilt University. https://cft.vanderbilt.edu/guides-sub-pages/motivating-students.

2)  TEDx Talks (2013). The psychology of self-motivation | Scott Geller | TEDxVirginiaTech [video]. YouTube. https://www.youtube.com/watch?v=7sxpKhIbr0. Published December 5, 2013.

3)   Wilcox L. Top 5 strategies for motivating students. National Board for Professional Teaching Standards. https://www.nbpts.org/top-5-strategies-for-motivating-students. Published June 4, 2018.

Free open access medical education (FOAM)

Adam C. Greenfield, PharmD

PGY-1 Pharmacy Practice Resident

University of Maryland Medical Center

“If you want to know how we practiced medicine 5 years ago, read a textbook. If you want to know how we practiced medicine 2 years ago, read a journal. If you want to know how we practice medicine now, go to a (good) conference. If you want to know how we will practice medicine in the future, listen in the hallways and use FOAM.”1

Free open access medical education (FOAM) is a completely decentralized conglomeration of educational media including, but not limited to, social media, blog posts, podcasts, videos, tweets, and more originating and focused largely in the fields of emergency medicine and critical care.  In a world dominated by social media with information available at the click of a mouse, at its core, FOAM is an adjunct to traditional medical education that we are accustomed to seeing in textbooks, peer-reviewed journals and organizational guidelines and accompanying recommendations. FOAM, over the past decade and a half, has grown tremendously regarding the amount of blogs, websites, and twitter pages devoted to the dissemination of FOAM-related content and media. As of November 2013, over 140 blogs and over 40 podcasts were identified on over 175 different websites.2 However, these numbers are certainly conservative underestimates of the amount of FOAM content available today. (See embedded link below for examples of popular FOAM content)

Given the open-access nature of the educational material presented and published, opponents of FOAM argue that the lack of a peer-review process could potentially lead to the spread of misinformation or of information that is more opinion-based rather than fact-based. On the contrary, FOAM advocates, counter that FOAM is not scientific research, but rather a “useful way of disseminating, discussing, dissecting, and deliberating over the products of research.”3 Through navigating the post-publication analysis of studies, FOAM can aid in acting as a bridge between publication (research) and practice.3 It should be noted that various groups, including Academic Life in Emergency Medicine (ALiEM) in particular, have developed initiatives to increase the scholarship of asynchronous medical education. ALiEM established the Approved Instructional Resources (AIR) Series which uses a national expert panel to adjudicate asynchronous educational material available online through a peer-review process, creating assessment questions for high quality blog content.4

Although the idea of FOAM was born out of Emergency Medicine and Critical Care it is not a wild concept to think that medical education that is so readily available could branch out to a variety of disciplines. Because of the variety of media used and the open-access nature of the material, the use of FOAM could provide useful for teaching modalities such as the ‘Flipped Classroom’ approach. The availability of FOAM resources and educational platforms provides an avenue for learners to explore FOAM content prior to classroom experiences, allowing the majority of the time spent in the classroom being related to higher level analysis, problem-solving, and critical thinking. The concept of self-teaching and learning aligns most closely with the educational theory of andragogy which we have discussed at length previously throughout the year.

I believe that the concept of FOAM is very valuable and the ability to have resources that are extremely informative and timely is important for the continued growth of new practitioners and learners alike. However, all information that is presented should be vetted to some degree with critical thinking skills by the reader/listener/learner with particular attention paid to the sources of the information including experience and prior accolades. As social media continues to grow and evolve, it will be interesting to see how FOAM and traditional educational resources (e.g. textbooks, peer-reviewed journals) continue to evolve together.

Top FOAM Blogs and Websites

References
1. Lex JR.  International EM Education Efforts & E-Learning, recorded August 2012 in New York City.  Listen or download from http://freeemergencytalks.net/wp-content/uploads/2012/08/2012-08-21-08h00-International-EM-Education-Efforts-E-Learning.mp3
2. Cadogan, MD, Thoma, B, Chan, TM, et al. Free Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002-2013). Emerg Med J 2014;31(e1):e76-7; online first. Available at: http://emj.bmj.com/content/early/2014/02/19/emermed-2013-203502.abstract
3. Nickson CP, Cadogan MD. Free Open Access Medical education (FOAM) for the emergency physician. Emerg Med Australas 2014;26: 76-83. Available at: https://lifeinthefastlane.com/wp-content/uploads/2014/02/emm12191.pdf
4. Lin M, Joshi N, Grock A, Swaminathan A et al. Approved Instructional Resources Series: A National Initiative to Identify Quality Emergency Medicine Blog and Podcast Content for Resident Education. J Grad Med Educ. 2016 May;8(2):219-25. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857492/pdf/i1949-8357-8-2-219.pdf

Digital Lecture Recording: Enhancing or Detracting from the Classroom Experience?

Kerry Lambert, PharmD

PGY-1 Pharmacy Resident

University of Maryland Baltimore Washington Medical Center

In the digital age, the use of technology within the classroom has significantly increased and expanded. One technological enhancement on the rise is digitally recording lectures, also called lecture capture, and posting them online so that students of that institution may access them.1 There are many benefits of digital lecture recording for both students and faculty, however there are also many concerns among institutions and administration, leading to apprehension about implementation of this practice in many places.1
Lecture capture has many benefits to both students and instructors alike. Students regularly utilize the lecture recording technology, and find it helpful for various reasons.1 Digital lecture recording gives students greater flexibility in terms of their schedule, especially for non-traditional students who may have other job, family, or caregiver responsibilities that can interfere with their ability to go to class.2 Many students also find the recorded lectures useful for enhancing their learning by helping them to clarify their notes, review topics that were confusing or unclear, and prepare for exams.3 Some students also feel that the recorded lectures allow them to be more actively engaged during class time, and less focused on just note taking.1 Faculty members also agree that recorded lectures can help to improve students’ learning and comprehension of material, as well as with exam preparation.1 Having a library of recorded lectures can also be beneficial for instructors in terms of lesson planning for each year as they can look back previous courses and identify areas that they would like to keep or adjust. Additionally, if a student has a question about something specific from the lecture, the instructor has the ability to go back to that point in the class and review exactly what was said if necessary.
Although the introduction of this technology in the classroom can be positive for several reasons, there are also some possible pitfalls. The biggest concern that both teachers and schools have with the implementation of lecture recording technology is the effect on student attendance in class.1 Several studies have researched the effect of lecture recording on attendance, and results are somewhat varied. A larger study at the University of Leeds found a slight, though statistically significant reduction in attendance from 85.7% to 81% after videos became available.3 Other smaller studies have reported varying degrees of decline in attendance, from no effect to a large decline, with the availability of recorded lectures.1,2,4 In general, faculty members perceive a decline in student attendance with the implementation of lecture capture, though students generally disagree.1 Another concern often expressed by faculty is the impact on student performance. Instructors fear that the decrease in class attendance and increased reliance on video lectures will lead to poorer studying habits and thus worsening performance on exams.1 Again, the current literature on these outcomes are conflicting. Some studies reported that access to recorded lectures led to significantly poorer academic performance, some reported no effect, and another reported that students actually performed better on exams.1,2,4,5 Finally, there are other concerns that have arisen among faculty that should also be considered, such as effect on teaching style and questions about intellectual property rights.2
The implementation of technology can be a wonderful way to enhance the learning experience within the classroom. Digital video capture of lectures provides many opportunities for students to improve their learning and understanding of course material, which is acknowledged by both students and faculty alike.3 However, as with the implementation of any new practice, schools, teachers, as well as students, should be aware of the pitfalls and consequences that may arise and have a plan in place to prevent and address these concerns as they arise. Overall, when utilized appropriately and effectively, lecture capture can be a positive way to introduce technology in the classroom to enhance both teaching and learning.


References:
1. Marchand J, Pearson M, Albon S. Student and Faculty Member Perspectives on Lecture Capture in Pharmacy Education. Am J Pharm Educ. 2014;78(4):74. doi:10.5688/ajpe78474
2. Johnston A, Massa H, Burne T. Digital lecture recording: A cautionary tale. Nurse Educ Pract. 2013;13(1):40-47. doi:10.1016/j.nepr.2012.07.004
3. McKie A. Study: Lecture capture reduces attendance, but students value it | Inside Higher Ed. Insidehighered.com. https://www.insidehighered.com/digital-learning/article/2019/07/05/study-lecture-capture-reduces-attendance-students-value-it. Published 2019. Accessed October 21, 2019.
4. Bollmeier S, Wenger P, Forinash A. Impact of Online Lecture-capture on Student Outcomes in a Therapeutics Course. Am J Pharm Educ. 2010;74(7):127. doi:10.5688/aj7407127
5. Schnee D, Ward T, Philips E, et al. Effect of Live Attendance and Video Capture Viewing on Student Examination Performance. Am J Pharm Educ. 2019;83(6):6897. doi:10.5688/ajpe6897.

Serving as an Effective Preceptor

Nadine Nwana, Pharm.D. 

PGY-1 Pharmacy Resident

Pharmacy Department

Holy Cross Hospital

There are many different fields within the profession of pharmacy that students can join after completing pharmacy school. Many students go into pharmacy school thinking they know where they would like to practice after graduation but most end-up changing their minds and picking a different practice setting. Pharmacy schools are responsible for assuring that students are exposed to as many avenues of pharmacy as possible and they are paired with preceptors who are passionate about the field and enjoy teaching pharmacy students. Many pharmacists would like to give back to their profession by serving as preceptors but some struggling with serving as an effective preceptor. Being a good preceptor can be very challenging but yet rewarding. Whether you’re a new preceptor or simply looking to brush up on your skills, follow these tips to be successful.1

The first step in being an effective preceptor is understanding your role.1 These roles are typical set by the school of pharmacy. Each school has a syllabus that outlines learning objectives and terminal performance objectives that they want their students to complete by the end of the rotation. Some schools allow total autonomy to the preceptors and the preceptors decide what they think is important for the student to learn. The next step is to know your student.1 Pharmacy schools typically require students to reach out to their preceptor at least two weeks in advance. The purpose of this initial email is for the student to introduce himself or herself to the preceptor and express their interest.  As a preceptor this is the prefect opportunity to learn more about your student. You can do this by creating a questionnaire, which has questions like, what are you interests in pharmacy, what are your strengths and weaknesses, what would you like to get out of this rotation, and what is your goal after pharmacy school? Use the answer to these questions to help design a rotation that is tailored to the student’s preferences. This will help keep you and the student organized and also helps to assure that all of the students goals are being met.

Within the first few days of the student’s rotation, you want to make sure that you inform the student on his or her goals and responsibilities for the rotation. You want to provide the student with clear expectations of his or her responsibilities. An example would be informing a student on a clinical based rotation how many patients they would be responsible for working up, what working up a patient comprises of, how to properly document and how to appropriately follow up on patients. Depending on the students background, you might need to have the student shadow you as you complete these tasks or walk them through it a couple of times until they are comfortable completing the tasks by themselves.
As a preceptor, you should also provide practical learning experiences.1 During rotations, students are looking for an opportunity to learn and grow as clinicians. Sarcona and colleagues stated that students prefer an experienced and knowledgeable preceptor.2 Having the student complete assignments such as topic discussion, drug information questions, journal clubs and patient case presentations can help integrate the information that the student is learning in school with what is actual being done in practice. This will help the student improve their clinical thinking skills.

Last but definitely not least is making sure you provide consistent and constructive feedback. Feedback should be ongoing feedback throughout the experience.1 The students are on rotation for such a short period so we want to make sure that they are progressing in the right direction. Show the students what they did correctly and the impact their intervention had on patient care.1 When the student makes a mistake, do not only tell them what they did wrong, make sure to explain how the mistake can negatively affect patient care and then show them how to correct their mistake.  You should also have the student evaluate you so you are aware of what changes you need to make to assure that the experience is valuable.

References:
1. Admin. “Become a Successful Preceptor.” American Nurse Today, 2 Oct. 2019, https://www.americannursetoday.com/become-successful-preceptor/.
2. Sarcona, et al. “Characteristics of an Effective Preceptor: Dietetics Education as a Paradigm.” Journal of Allied Health, vol. 44, no. 4, 1 Dec. 2015, pp. 229–235.

The Role of Interprofessional Education within Healthcare Training

Alex Ponce, PharmD

Pharmacy Resident

University of Maryland Medical Center

What is interprofessional education?

According to the Centre for the Advancement of Interprofessional Education, interprofessional education is defined as education involving learners from two or more professions who create a joint learning environment1. It helps learners develop the knowledge and skills needed to interact and understand different professions. During these opportunities, it is important that each profession involved has an opportunity to contribute to the care plan, and that each member reflects upon the experience1. The ultimate goal of interprofessional education is to promote interdisciplinary teamwork so that students may continue these practices into the workforce in order to improve patient care1. At this point in time, several accrediting bodies for healthcare education now require the incorporation of interprofessional education in the curriculum, including the American Association of Colleges of Pharmacy1.

What are advantages of interprofessional education?

Interprofessional education may provide many advantages to students in the healthcare field. The first potential benefit is that students may better understand the roles of different healthcare professionals2. In a study conducted by Cohen et al, a group of medicine students, nursing students, occupational therapy students, physical therapy students and other disciplines completed an evaluation before and after participating in an interprofessional event related to Parkinson’s disease3. There was significant improvement in self-perceived knowledge, understanding of the role of other healthcare professionals, and attitudes toward other disciplines in the post-group compared to the pre-group3.   Another advantage of interprofessional education is promoting the importance of communication2. In a study conducted by Brock et al, 149 pharmacy and physician assistant students completed evaluations before and after partaking in an interprofessional event surrounding an area of interest, such as adult care, pediatrics, or obstetrics4. This study found that in the post-education group, students perceived that their attitudes and knowledge toward team communication and motivation significantly improved2. A third advantage of interprofessional communication is it allows students of different professions to interact before entering the workforce2. By having a chance to interact and better understand the role of the various team members in a safe learning environment, it is suggested that students will be more likely to utilize an interdisciplinary approach later on in their careers1. This in turn provides many benefits for the healthcare system, including improved quality and patient safety.

What are barriers to interprofessional education?

Although there are many benefits to interprofessional education, there are many barriers educators face when trying to plan an event. One of the first barriers is logistics5,6. One of the core concepts of these events is to work with other disciplines. However, it may be difficult to coordinate with several departments to find an opportunity when all of the students would be available. Some schools may be geographically disadvantaged, meaning that they do not have students in other professions within a short distance5. Other institutions may have insufficient facilities to host the amount of people who wish to participate in the event5. Another challenge to coordinating an event is topic selection. The curriculum is different in each profession, so determining a topic that all students could contribute to the team may be difficult6. A third barrier would be lack of participation by one party. In a meta-analysis examining the barriers to an interprofessional event, one of the more frequent issues was that one of the committed parties decided to withdraw from the event6. This would be detrimental to the activity as each profession brings a unique aspect to the team. Additionally, many of the events are designed to utilize the skills of each discipline, so the concept or activity that was planned may no longer be able to be completed.

What are important factors when designing an interprofessional event?

The first step to developing a successful interprofessional event is to ensure that one’s own profession or department prioritizes interprofessional education and is interested in participating1. The identification of faculty members who are willing to serve as facilitators for the event early on will help provide foundational support. Next, it is beneficial to identify and establish relationships with different disciplines within one’s geographical area1. Once a relationship has been developed, one can determine their interest regarding participating in an event. Once the contributors are identified, create an interprofessional event development team utilizing members from each organization1. This committee will be responsible for the majority of the planning and execution of the event. When planning an activity, it is important to understand the audience. The committee should do its best to choose a topic that all participants should have had previous exposure1. When designing learning objectives, the objectives should be applicable to all professions involved and should not focus on concepts specific to clinical knowledge of one profession1. The activity should highlight to participants what each profession can bring to the team, and it should include a reflective portion so that each participant can self-assess their learning1. Next, the committee should identify the facilitators for the event and develop the logistics of the event such as where and when it will occur. Sometimes, it is best to start with smaller groups and then gradually increase participation1.  After the event has been completed, it is important for the committee to reflect about the execution of the event, such as what went well, what did not go well, and how it can be improved in the future. As more events are planned, the creators can adapt the activities from their previous experiences in order to become more effective and efficient at designing interprofessional activities.

References

1. Buring SM, Bhushan A, Broeseker A, et al. Interprofessional Education: Definitions, Student Competencies, and Guidelines for Implementation. Am J Pharm Educ. 2009 Jul 10;73(4):59.
2. Benefit of Interprofessional Education: Short- and Long-term [internet]. Johnson + Johnson. 2018 Jan 26. Available from: https://nursing.jnj.com/benefits-of-interprofessional-education-short-and-long-term
3. Guraya SY, Barr H. The effectiveness of interprofessional education in healthcare: A systematic review and meta-analysis. KJMS. 2018 Mar;34(3):160-5.
4. Brock D, Abu-Rish E, Chiu CR, et al. Interprofessional education in team communication: working together to improve patient safety. Postgrad Med J. 2013 Nov;89(1057):642-51.
5. Schapmire TJ, Head BA, Nash WA, et al. Overcoming barriers to interprofessional education in gerontology: the Interprofessional Curriculum for the Care of Older Adults. Adv Med Educ Pract. 2018;9:109-118.
6. Sunguya BF, Hinthong W, Jimba M, et al. Interprofessional Education for Whom? – Challenges and Lessons Learned from Its Implementation in Developed Countries and Their Application to Developing Countries: A Systematic Review. PLOS ONE. 2014 May 8; 9(5): e96724.

Simulation Based Learning (SBL)

Kafilat Adeleke

PGY1 Pharmacy Resident

Holy Cross Health Hospital

Imagine teaching a class of pharmacy students practical topics such as Advanced Cardiovascular Life Support (ACLS) skills or patient medication counselling. What is an effective learning theory model that would be applicable to encourage students and enhance learning and motivation?  Are didactic lectures sufficient for learning these practical courses?  Simulation based education is defined as a learning model that replaces and amplifies learners’ real experiences with guided experiences.1 Over the years, pharmacists’ roles have continued to be evolved and developed with the main focus shifting from medication oriented to more patient oriented roles. Application of SBL provides innovations to enhance independent and collaborative skills required to become a successful candidate in the evolving roles in pharmacy.

Sole use of pedagogy teaching theory have been shown to limit development skills required for clinical practice. In a brain activity assessment study of students while asleep, in class, labs or while doing homework, students were found to have the lowest brain activity in class compared to other daily functions mentioned above. This ascertains that there is a need for active teaching and engagement of students in order to maximize their learning experience.2 Addition of the SBL model augments learners experience and allows for self-reflection and identification of knowledge gaps. This model provides learning opportunities for students where they can make and correct their mistakes without necessarily posing risks to patients. As a result, it provides an educational platform which maintains equilibrium between mitigating ethical tensions whilst resolving practical dilemmas.1, 3 It is imperative for learning to be practical in order to be relevant and applicable to real world experience. SBL applies an andragogy teaching style that accepts that students are adult learners who are intrinsically motivated and require practical learning in order to furnish their understanding and comprehension. Application of SBL allows students to attain these learning outcomes and as a result become better pharmacists.

In addition, SBL aids in developing collaborative teamwork skills. The majority of SBL are often assigned in groups such as role playing among students in class, or in conjunction with other multidisciplinary teams. For example nursing, medical, pharmacy students collaborating together to perform their respective roles in a response to emergency situations. Substantial part of the evolving pharmacy role is integrating with other healthcare team which has collectively improved patient outcomes. SBL activities help to build teamwork and communication skills and as a result become clinical pharmacist. SBL can be divided into different subgroups contingent upon the learning objectives and commitment as illustrated below:

Independent skill procurement:  This allows learners to operate independently without necessarily posing a risk to true patients. An example is blood pressure monitoring. A partial task trainer (defined as practice on some set of components of the whole task as a prelude to the performance of the whole task)4 can be utilized such as an artificial arm for blood pressure.3

Independent and communication skills procurement: This allows the learners to practice independently and improve their communication skills as well. This can be applied to patient counselling, medicine information scenario, and dealing with error performance assessment. A part task trainer with a standardized patient may be utilized in this setting.3

Collaborative team resource management: This allows for students to effectively work as a team member. This can be applied in the management of clinical conditions, responding to emergency crises, and developing communication skills amongst team members. Advanced technology such as the Simman mannequin patient simulator in emergency response training may be utilized in this setting.3

One of the most common conceptions of the simulation based learning model is that it requires utilization of advanced technology. SBL is a technique and not technology. Although technology may be used to execute SBL, but it is not a required tool for SBL design. Well-planned role playing is as effective as use of technology in enriching learners' experiences for some learning objectives. Also, as instructors, designing simulation based learning can be time consuming, as it takes a certain level of commitment to assign and develop an effective simulation based learning. Although, the amount of pre-class preparation time needed to implement SBL strategies may be greater than that needed to recycle old lectures; but it will not necessarily take any more time than that needed to create thorough and thoughtful new lectures. When planned properly, SBL model allows students to experiment, explore, and motivated by the class5, 6. SBL is an innovative training modality that could support the development of the clinical skills and competencies required of learners to become successful clinical pharmacist, and thus, should be utilized when teaching for effective learning outcomes.

References

1. Lateef F. Simulation-based learning: Just like the real thing. J Emerg Trauma Shock. 2010; 3(4):348–352.
2. Poh MZ, Swenson NC, Picard RW. A wearable sensor for unobtrusive, long-term assessment of electrodermal activity. IEEE Trans Biomed Eng. 2010 May;57(5):1243-52
3. Lloyd M, Watmough S, Bennett N, et al. Simulation-based training: applications in clinical pharmacy.  The Pharmaceutical Journal; 2018
4. Wightman D, Lintern G. Part-Task Training for Tracking and Manual Control. Sage Journals. June 1, 1985; Vol 27, Issue 3.
5. Bonwell, C. Active Learning: Creating Excitement in the Classroom. Green Mountain Falls, CO 8081, 1991
6. Filene P. The Joy of Teaching. A Practical Guide for New College Instructors. Chapel Hill, NC: University of North Carolina Press, 2005

Team-Based Learning

Alyssa Selinger, PharmD

PGY-1 Pharmacy Resident

Suburban Hospital- Johns Hopkins Medicine

Team-based learning was developed by Dr. Larry Michaelsen in the 1970s. This learning strategy is successful because it supports collaboration and provides opportunities to apply ones skills through structured group activities.1 It is a collaborative teaching strategy designed around units of instruction.2 It is a process which includes the following steps: strategically forming permanent teams, readiness assurance, application activities, and peer evaluation. This strategy puts more emphasis on the implementation and utilization of information, rather than memorizing basic concepts.

In order for this concept to be successful, students will be assigned pre-readings before class and are encouraged to come prepared. Once class begins, the student will be asked to complete an individual readiness assurance test (IRAT), commonly in the form of a short quiz. This will help the student to gauge their understanding of the material. After the IRAT is completed, the student will join their group to take the same test again but with their permanent group. This team readiness assurance test (TRAT) encourages collaboration to reach a consensus of the correct answer. Once completed, the class will go over the test and each individual group will be allowed to write an appeal for any answers they fell were incorrectly deemed to be wrong. At this point, it is important for the professor to intervene and clarify any weaknesses or misunderstandings regarding the material presented.

Now that the student and groups “readiness” has been evaluated, it is time for the team to proceed with an application activity. It is important that these activities adhere to the following guidelines: there is a significant problem, it requires a specific choice, each group has the same problem, and there is a simultaneous report to the class of the groups final assessment and plan. This allows the entire class to understand the differing viewpoints of the class, not only their group.

The last step of the team-based learning process is peer feedback. This allows for fellow students to provide feedback for each participant of the group. This feedback is meant to identify the student’s role in the group and what improvements the group would like each participant to make. I think this can be a great way for students to obtain feedback. It is sometimes easier to take feedback from peers rather than an authoritative figure, such as a professor.

If utilizing team-based learning in a didactic classroom, each activity can be assigned a point value and each step of the process can be evaluated. A student’s final grade or assessment can be split between the IRAT, TRAT, and peer feedback to arrive at a final score.

There are important aspects to consider if a team-based learning strategy is going to be utilized. It is important for the groups to be split based upon knowledge (year in school), academic performance (GPA), and experience. This will allow teams to be as diverse as possible, while also trying to match the teams’ abilities with the other teams of the class. It is important to keep the teams consistent. This allows the students to get comfortable with each other in order to form a cohesive atmosphere for collaboration.

I think one of the most beneficial aspects of team-based learning is that it makes a student accountable for their learning. The team expects each member to come to class prepared and ready to provide input to help the team problem-solve. I think traditional teaching strategies do not encourage non-motivated students to learn and become motivated. Team-based learning strategies require each team member to contribute, and if they do not they will be evaluated poorly during the peer feedback session. Students can gain a feeling of accountability for their knowledge which is very much like the accountability they will be accepting in their careers. I also think team-based learning not only helps students to develop problem solving skills, but it also encouraged students to work together effectively which is essential today in health care.

Please see the following resources for additional information about team-based learning and feel free to watch the video.

1. Fathelrahman, Ahmed. Pharmacy Education In the Twenty First Century and Beyond : Global Achievements and Challenges. First edition. London, England: Academic Press, an imprint of Elsevier, 2018.
2. Tblc-Admin. “Overview.” Team-Based Learning Collaborative, 2019, http://www.teambasedlearning.org/definition/.
3. Video: https://vimeo.com/51713733

Generational Influences on Teaching and Learning

Abigail M. Klutts, PharmD

PGY2 Ambulatory Care Resident

University of Maryland School of Pharmacy

A recent study published in Currents in Pharmacy Teaching and Learning attempts to determine whether different perceptions exist with regard to generational categories among APPE (advanced pharmacy practice experiences) students and their preceptors. Wingate University School of Pharmacy students and their preceptors were assigned generational categories according to birth year, as follows: Veteran (1929-1945), Baby Boomer (1946-1964), Generation X (1965-1980), and Millennial (1981-1996). They completed a six question generational survey to evaluate themselves and their counterparts regarding views on teaching and learning style, career purpose, communication style, technology, outlook on life, and the student preceptor relationship. Each question had four options that anonymously corresponded with one of the generational categories. Table 1 below provides a list of questions, responses, and corresponding generational categories.¹

       

The results show that students were categorized as Generation X (n=7, 8%) or Millennial (n=80, 92%) while preceptors were categorized as Baby Boomer (n=12, 18%), Generation X (26, 38%), or Millennial (n=30, 44%). No one was categorized as Veteran, although this descriptor was the second most commonly selected survey choice among both students and preceptors. Across all questions, students and preceptors frequently made choices that did not correspond with their personal generational category. Of note, for all six questions, preceptors selected identical categories about their students for which the student self-identified. Where student and preceptor responses aligned were upon self-reflection about preferred learning style (process-oriented; Veteran), career purpose (“I work to make a difference”; Millennial), and outlook on life (“I am grateful”; Veteran), which may be more indicative of their pharmacy career choice instead of true generational differences.¹ This study has several limitations including minimal external validity, small sample size, and recall and selection bias. However, it brings to light an interesting conversation about generational influences on teaching and learning; a field of study that is generally lacking in the literature.

If generational differences influence relationships among teachers and learners, it is important to identify how and find ways to overcome any present barriers. It would be ideal for a teacher from Generation X, for example, to provide the same educational experience to all students despite their personal generational identities. An article by Don Levonius², a consultant for talent development, highlights some of the ways that generational needs differ and how to accommodate their particular learning preferences. He claims that the Veterans, or “Silent Generation,” as he calls them, value hard work and slow, steady progress as a result of seeing their parents struggle through the Great Depression. They respect authority and stick to the task at hand rather than speaking up. As a result, they prefer instructor led lectures, predictability, and time to practice skills independently. Baby Boomers are described as “internally focused yet extrinsically motivated” which explains their strong self-efficacy and pride in working long hours. These learners require collaborative discussion and inclusive decision-making. Generation X marks a shift in attention away from children, as families evolved into two parent working households or single parent households. The resulting learners are self-directed and value work-life balance instead of working long hours like their parents did. Thus, effective learning activities are fun, prove their relevance, and allow individual discretion to complete tasks in various ways. Finally, Millennials, otherwise called “Generation Y” or “Echo-Boomers,” were born to financially stable Baby Boomers who carved out time to work from home and save for their education. They are described as achievement oriented and technologically savvy, preferring activity-based group work, individualized feedback, and technology incorporated into the classroom.²

While the above examples are, in part, opinion based and rooted in stereotypes that may not apply to everyone, they help explain how and why teaching strategies have changed over time. As workplaces evolve to accommodate changing market needs, learners must also be equipped to work in these new settings. Thus, it is important for teachers to avoid getting attached to one way of teaching that serves one point in time. Luckily, current teaching methods incorporate numerous types of learning activities to accommodate the various needs of learners, whether they be generational needs or otherwise. As seen by the results of the survey above, students and preceptors frequently identified with answers that did not correspond with their personal generational categories. Here is yet another example of the complexity of a learner. We use stereotypes to better understand a group while acknowledging that individuals exist who veer from the suspected course.

I challenge teachers, including myself, to consider generational differences when conducting an audience analysis prior to teaching a new class. While learning activities may be catered to a particular generational category, we know that variances exist and may require altering as the course progresses. Of course there is more to consider than generational category alone. In the research example above, students and preceptors showed preference toward a process-oriented learning preference which may be a result of career choice, as pharmacists overall tend to be process-oriented. Therefore, learning activities should be better suited for pharmacy students than otherwise. As three primary takeaways, we should be aware of generational differences as one aspect of a learner, include a variety of learning experiences that target different types of learners, and finally make sure that the learning experiences provided are well suited to raising exceptional pharmacists who are prepared for an evolving healthcare landscape.

References:

1.   Smith SM, Coleman M, Dolder CR. Evaluation of generational influences among 4th year pharmacy students and experiential preceptors. Curr Pharm Teach Learn [Internet]. 2019 Sept [cited 2019 Oct 4];11(9):888-94. Available from: https://reader.elsevier.com/reader/sd/pii/S1877129718303708?token=29F922C07CC7CADB480F12D37E105D043AFE8AEFEC8A557AEE4FC8E3C2593065A9EA3C104C20DCE516601B69EAE951F2

2.   Levonius D. Generational differences in the classroom [Internet]. 2018 Jun [cited 2019 Oct 4]. Available from: https://www.td.org/newsletters/atd-links/generational-differences-in-the-classroom

Grit and the Power of Perseverance

Shannon Riggins, PharmD

PGY2 Geriatric Pharmacy Resident

University of Maryland School of Pharmacy

Throughout the educational theory and practice course, we have talked about different types of learners and the differences in andragogy vs. pedagogy. This course has discussed the variant philosophies of internal motivation vs. that of external motivation. We have asked ourselves, is success dependent on the learner’s own accountability and ownership, or is it shared between the learner and the teacher?

In a ted talk led by psychologist Angela Lee Duckworth1, she shares her philosophy about perseverance and the power of grit in determining someone’s likelihood to be successful. Starting out as a seventh grade school teacher in a New York City public school system, she had begun noticing that IQ was not the only difference between some of her students. She noticed that some of her strongest performers did not have a high IQ, and some of her smartest students were struggling. This is where she began to question what factors were indicative of one’s ability to be successful and how do we predict that?

She began researching among a variety of populations with the question, who was successful and why? She studied cadets at West Point Academy to see who would stay through training vs those that would drop out. She evaluated competitors at a national spelling bee to see which children would advance the furthest. She even evaluated teachers who taught in a rough neighborhood to see who would still be teaching there at the end of the year, and of those teachers, which would be the most effective in improving learning outcomes for their students? What she began to find was that “grit” was the most common factor that determined the likelihood of these individual’s success.

Duckworth defines this grit as passion and perseverance towards a long-term goal. She was finding repeatedly, that those who had grit were far more likely to succeed in their long term goals. She then began testing this theory in the Chicago public school system utilizing a grit questionnaire.2 It was a self-reported questionnaire and over time she measured the correlation between their measure of grit, and their likelihood to graduate. When the students were compared against numerous other characteristics that could affect the outcome, grit was still the biggest predictor in the student’s likelihood to graduate. Her studies also found that the characteristic of grit, was usually unrelated and most often times inversely related to talent.

While this information is eye opening, the question that remains, is how do we encourage and cultivate this characteristic of grit in our students and ourselves? Duckworth suggests that the philosophy of a “growth mindset” which was founded by Dr. Caroll Dweck at Stanford University may be the answer. This philosophy supports the idea that when students believe that they can get smarter and that effort makes them stronger, they are more likely to succeed and persevere through failures as they realize that it is no longer a permanent state.3

So what does this mean for us as pharmacy educators? What does this mean for our students? How do we use this information to empower both our learners and ourselves? As I have listened to this ted talk, and researched into the growth mindset theory, I’ve concluded that like all variant theories and philosophies, it’s something to consider when determining our teaching philosophies and the needs of our students. Encouraging activities like self-reflection, and rewarding hard work and determination or even incorporating words like “yet” (i.e. “you have not mastered patient counseling yet”) are just a few ways to facilitate the process of growth mindset.

Overall, I think this video is a good reminder that whether our classrooms require an andragogy vs pedagogy approach, we can still encourage this philosophy of growth mindset in our teachings, and foster their perseverance towards both their success, and our own.

Bibliography
1. Duckworth, A. L. (n.d.). Grit: The power of passion and perseverance. Retrieved September 20, 2019, from https://www.ted.com/talks/angela_lee_duckworth_grit_the_power_of_passion_and_perseverance.
2. Duckworth, A. (n.d.). Grit: Perseverance and passion for long-term goals. Retrieved September 21, 2019, from https://psycnet.apa.org/record/2007-07951-009.
3. Dweck, C. (n.d.). Decades of Scientific Research that Started a Growth Mindset Revolution. Retrieved September 21, 2019, from https://www.mindsetworks.com/science/.

Role of MOOCs in Healthcare Education

Seferina Kim, PharmD, BCPS

Clinical Pharmacy Specialist

University of Maryland School of Pharmacy | University of Maryland Medical Center

Massive Open Online Courses (MOOCs) are free online courses with potentially large enrollment on a wide variety of subjects including healthcare.  They typically incorporate various media such as video, bulletin boards, and live chats, sometimes in conjunction with the traditional requirements of classes such as assigned readings and quizzes.  This platform inherently celebrates the pedagogical learner. 

There are two main types of MOOCs: xMOOCs and cMOOCs.  cMOOCs emphasize a learning style developed by George Siemens and Stephen Downes called, “Connectivism.”  Connectivism explains that internet technology creates opportunities for people to learn and share information in learning communities [1,2].  Imagine cMOOCs akin to forums established around common interests where participants can be both learner and teacher.  xMOOCs however incorporate more of a traditional approach to learning but through the online medium.  There are several websites and schools associated with xMOOCs.  Two of the largest companies act as repositories of these classes: Coursera (https://www.coursera.org/) and EdX (https://www.edx.org/)[3,4].  These companies offer a large catalog of courses affiliated with established, recognizable academic institutions such as UCSF, Stanford, Harvard, UC Berkley, UC San Diego, MIT.  Additionally, MIT (https://ocw.mit.edu/index.htm) and Johns Hopkins Bloomberg School of Public Health (https://ocw.jhsph.edu/) offer OpenCourseWare (OCW) which essentially provides all the teaching materials for free[5,6].  Aquifer (https://www.aquifer.org/) appears to be the only non-profit website devoted exclusively to virtual patient cases and promoting medical education in congruence with national standards for testing, including AMA and CME credits[7]. 

The initial excitement around MOOCs peaked in 2012-2013 with many large institutions offering classes which are now since defunct.  The enrollment and completion of these courses never fulfilled industry expectation.

Where does this leave healthcare education?  As stated earlier, MOOCs require a pedagogical learner.  Undergraduate studies and the didactic years of any healthcare program requires structure with formal assessment to ensure a uniform, baseline minimum knowledge as a foundation and therefore makes self-directed learning difficult.  While the theory of connectivism may not be conducive to andragogical styles, there are certain elements that might be translated for effective learning.  The presence of learning communities provides opportunities for collaboration and as such, UCSF currently offers an xMOOC through Coursera entitled, “Collaboration and Communication in Healthcare: Interprofessional Practice” which helps to facilitate communication between all the healthcare disciplines at their campus[3]. 

There are two current problems for once students transition to adult-learning styles.  First, in the context of pharmacy practice, xMOOC selection appears to be sparse.  As stated above, Aquifer provides an array of virtual patient cases in a variety of medical specialties however the coursework is geared towards physicians, NPs, and PAs.  Coursera appears to offer the greatest pharmacy-specific selection with 71 xMOOCs whereas EdX however only revealed three [3,4].  Coursera course content favors topics that are offered at the, “Beginner” level that are not directly pharmacy-related topics such as, “Global Health: An Interdisciplinary Overview” or, “The Science of Health Care Delivery.[3]”  While not to be discredited, they may not address the needs of the pharmacist, resident, or APPE pharmacy student.  The second problem is that there is little research describing outcomes such as completion rates or its impact upon scoring upon accrediting tests.  A study by Pickering and Swinnerton in the United Kingdom attempted to characterize the demographics and self-perceived benefits of providers after taking an xMOOC in anatomy however they only note a completion rate of the survey and not the course at 3% [8].

It is probable that xMOOCs are similar to required CEs in maintain knowledge, regardless of discipline, however this based on supposition and extrapolation to online CEs.  There is little validated data proving this, especially in the context of pharmacy.  There is even less little information on the role of cMOOCs upon healthcare education.  With the globalization and standardization of education, online education will also likely to continue to grow and hopefully, education research provides insight in the most effective manner in utilizing this medium.  Regardless, some of the courses currently being offered may simply just be interesting – I plan on starting a course on Chinese herbal medicine next year.

1. Goldie JG. Connectivism: A knowledge learning theory for the digital age? Med Teach. 2016 Oct;38(10):1064-1069. Epub 2016 Apr 29.
2. Kop, R. and A. Hill, Connectivism: Learning theory of the future or vestige of the past? The International Review of Research in Open and Distance Learning, 2008. 9(3).
3. Coursera [Internet]. Coursera, Inc. [cited 2019 Oct 6]. Available from https://www.coursera.org/.
4. edX [Internet]. edX Inc. [cited 2019 Oct 6]. Available from https://www.edx.org/about-us.
5. MIT OpenCourseWare. MIT. [cited 2019 Oct 6]. Available from https://ocw.mit.edu/index.htm
6. JHSPH Open courseware. The Johns Hopkins University. [cited 2019 Oct 6]. Available from: https://ocw.jhsph.edu/
7. Aquifer [Internet]. [cited 2019 Oct 6]. Available from https://www.aquifer.org/.
8. Pickering, J.D. & Swinnerton, B.J. An Anatomy Massive Open Online Course as a Continuing Professional Development Tool for Healthcare Professionals. Med.Sci.Educ. (2017) 27: 243. https://doi.org/10.1007/s40670-017-0383-7