Bridging the Gap within Incoming Pharmacy Students

Bobbie Nguyen, PharmD

PGY-1 Pharmacy Resident

Baltimore Washington Medical Center

Prerequisites for admission to a Doctor of pharmacy program (PharmD) varies among United States schools. In general, students are required to complete at least two years of undergraduate studies in general chemistry, organic chemistry, general biology, calculus, microbiology, and other general education courses.1 Data examining the impact of these pre-professional courses on an individual student pharmacist or practitioner’s abilities remain unclear. Additionally, the level and quality of education provided among different colleges and universities may vary substantially. This results in variability of academic preparedness within incoming PharmD students.

In an effort to address these differences, some pharmacy schools have adopted a growing practice commonly utilized within medical education – bridging courses. The purpose of bridging courses is to provide an intensive, short review of foundational concepts from which to build upon in subsequent coursework. It can also serve as an introduction to students on the instructional methods that will be used throughout their didactic classwork. The exact composition and duration of these courses may vary, but they are generally provided to incoming pharmacy year 1 (PY1) students prior to the start of the usual curriculum.

One such bridging course was piloted in 2015 at the UNC Eshelman School of Pharmacy.2 Instructors held a three-week, 3.5-credit hour course comprised of five modules: applied math, biochemistry, biostatistics, organic chemistry, and physiology to their incoming first-year PharmD students. Each module was designed by their respective directors to best fit the content area, and students were required to earn 55 points (out of 100) within each module in order to pass. Students were also required to take a pre-test prior to the start of the bridging course as well as a post-test at the conclusion of the course in order to assess acquired knowledge. Those who did not pass were given remediation tasks.

Researchers found that a majority of students failed (90.2%) one or more of the module pre-tests. This number significantly improved across all five modules in the post-test assessment. Most notably, student performance on the bridging course modules correlated with the student’s PY1 GPA (rp=0.8, p<.001), PCAT (rp=0.5, p<.001), and undergraduate GPA (rp=0.4, p<.001). This finding opens another potential benefit to implementing a bridging course: It allows instructors to identify students who may struggle with pharmacy coursework early in the program and offer additional assistance.

Another study examining the utility of bridging courses was conducted at Midwestern University, Chicago College of Pharmacy in the form of an online, self-directed, 10-module assignment offered to incoming first-year students.3 The modules focused on physiology, biochemistry, math, and medical terminology. However, one key difference in this study was that students were only required to take the bridging course if they scored less than 70% on the pre-test. Those who scored 70% or higher were exempt from completing the modules. At the conclusion of the bridging course, those who originally failed the pre-test were given the same test again as a post-course assessment. Students who failed the assessment for the second time were offered additional help with an education specialist.

The main findings of the study revealed a majority of the incoming class failed the pre-test (76%), but were subsequently able to increase their scores significantly at the end of the bridging course (52% vs. 76%, p<0.001). Most notably, 26% of the students who failed both the pre- and post- assessment went on to fail a first-quarter course in addition to four students who originally passed the post-course assessment. Examining this finding through another lens, the bridging course was able to identify a majority of the students who struggled with pharmacy coursework early in the program.

Both of these studies shed light on the unique advantages with utilizing bridging courses. The best method with which to conduct these courses remains unclear and student performance in subsequent coursework may vary. However, it is evident these courses not only identify students who will require additional assistance, but also re-introduces foundational concepts to pharmaceutical education. It is important to recognize pharmacy students enter their respective programs with different educational backgrounds and there must be efforts in place to bridge these gaps.

References

1. Boyce EG, Lawson LA. Preprofessional Curriculum in Preparation for Doctor of Pharmacy Educational Programs. Am J Pharm Educ. 2009 Dec 17; 73(8): 155.

2. McLaughlin JE, Khanova J, Persky A, et al. Design, Implementation, and Outcomes of a Three-week Pharmacy Bridging Course. American Journal of Pharmaceutical Education 2017; 81 (7) Article 6313.

3. Verdone M, Joshi MD, Bodenstine TM, et al. An Online, Self-directed Pharmacy Bridging Course for Incoming First-Year Students. American Journal of Pharmaceutical Education 2020; 84 (7) Article 7684.

Teaching Students with Learning Disabilities

Danielle Koubek, PharmD

PGY1 Pharmacy Resident 

Children’s National Hospital

According to the Oxford Dictionary, a learning disability is defined as “a condition giving rise to difficulties in acquiring knowledge and skills to the level expected of those of the same age.” Learning and attention issues are brain-based difficulties in reading, math, organization, focus, listening comprehension, social skills, motor skills, or a combination of these. It is important to note that learning and attention issues are not the result of low intelligence or lack of access to quality instruction.

Learning and attention issues are more common than many people think. The National Center for Learning Disabilities reports that one in five children in the United States have learning and attention issues. Unfortunately, only a small subset of students currently receive specialized instruction or accommodations. In fact, only one in sixteen public schools have Individualized Education Programs (IEPs) for specific learning disabilities such as dyslexia and for other health impairments such as ADHD and dyspraxia. Students with learning and attention issues often don’t receive early or effective interventions. These students are often held back a year, which increases the risk of dropping out. Students with disabilities are also more than twice as likely to be suspended as those without disabilities. The loss of instructional time increases the risk of course failure and school aversion. Unaddressed learning and attention issues also lead to conditions that push students into the school-to-prison pipeline. A large study found that half of young adults with learning disabilities had been involved at some point in the justice system. Additionally, only 46% of working-age adults with learning disabilities are actually employed (National Center for Learning Disabilities). These shocking statistics prove that there should be more attention given to teaching students with learning disabilities.

A student’s disclosure of a disability is always voluntary. However, students with disabilities may feel nervous to disclose sensitive medical information. Often, students must combat negative stereotypes about their disabilities held by others and even themselves. For instance, a recent study by May & Stone (2010) on disability stereotypes found that undergraduates with and without learning disabilities rated individuals with learning disabilities as being less able to learn or of lower ability than students without those disabilities. In fact, students with learning disabilities are no less able than any other student to learn. These students simply receive, process, store, and/or respond to information differently (National Center for Learning Disabilities).

There are a number of strategies that educators can implement in order to establish teaching models that are inclusive for students with learning disabilities including:

• Writing a statement in the syllabus inviting students with disabilities to meet with the educator privately is a good way to start a conversation with students who need accommodations and feel comfortable approaching the educator about their needs

• Making sure that all students can access the educator’s office or arrange to meet in a location that is more accessible

• Arranging time on the first day of class to distribute a brief “Get to Know You” questionnaire that includes a question that asks if there is anything the educator should know about the student

• Not assuming what students can or cannot do with regards to participating in classroom activities – think of ways students can participate without feeling excluded

• Providing an easily understood and detailed course syllabus and making sure the syllabus, texts, and other materials are readily available

One of the common concerns that educators may have about making accommodations is whether they will change the nature of the course. Accommodations, however, are designed to give all students equal access to learning. When planning your course, consider the following questions (Scott, 1998):

• What is the purpose of the course?

• What methods of instruction are absolutely necessary? Why?

• What outcomes are absolutely required of all students? Why?

• What methods of assessing student outcomes are absolutely necessary? Why?

• What are acceptable levels of performance?

Answering these questions can help educators define essential requirements for students. When teaching a student with any disability, it is important to remember that many of the principles for inclusive design are considered beneficial to any student. One specific design methods is called universal design. This is a method of designing course materials, content, and instruction to benefit all learners. Instead of adapting or retrofitting a course to a specific audience, universal design emphasizes environments that are accessible to everyone regardless of ability. By focusing on these design principles when creating a syllabus, educators may find that most of their course easily accommodates all students (Hodge & Preston-Sabin, 1997).

Many universal design methods emphasize a deliberate type of teaching that clearly lays out the course’s goals. Providing an outline of the day’s topics at the beginning of the class period and summarizing key points at the end can help students understand the logic of the educator’s course organization and give them more time to process the information. Similarly, some instructional material may be difficult for students with certain disabilities. For example, when showing a video in class educators need to consider the audience. Students with visual disabilities may have difficulty seeing non-verbalized actions while those with disorders like photosensitive epilepsy may experience seizures with flashing lights or images and those students with hearing loss may not be able to hear the accompanying audio. Using closed-captioning, providing electronic transcripts, describing on-screen action, allowing students to check the video out on their own, and outlining the role the video plays in the day’s lesson helps reduce the access barrier for students with disabilities and allows them the ability to be an active member of the class as well as allows other students the opportunity to engage with the material in multiple ways (Burgstahler & Cory, 2010).

In summary, it is important to remember that disabilities are not always obvious or apparent to the naked eye. Being open and accommodating will ensure that all students learn equally and feel included. Often times, the curriculum provided to healthcare professionals neglects to consider that some students may in fact have disabilities. While the percentage of students with disabilities in the healthcare profession is typically smaller than general education, educators must still be vigilant and understand how to teach students with disabilities.

References:

1. Oxford Languages Dictionary
2. The National Center for Learning Disabilities. http://www.ncld.org
3. Picard D. (n.d.). Teaching students with disabilities. Vanderbilt University Center for Teaching. Retrieved September 3, 2020 from https://cft.vanderbilt.edu/guides-sub-pages/disabilities/
4. May, A. L., & Stone, C. A. (2010). Stereotypes of individuals with learning disabilities: views of college students with and without learning disabilities. Journal of Learning Disabilities, 43(6), 483-99.
5. Scott, S. S. (1998). Accommodating College Students with Learning Disabilities: How Much Is Enough? Innovative Higher Education, 22(2), 85-99.
6. Hodge, B. M., & Preston-Sabin, J. (1997). Accommodations–or just good teaching?: Strategies for teaching college students with disabilities. Westport, Conn: Praeger.
7. Burgstahler, S., & Cory, R. (2010). Universal design in higher education: From principles to practice. Cambridge, Mass: Harvard Education Press.

The Flipped Classroom

Cassie Roberts, PharmD

PGY1 Pharmacy Resident 

Sinai Hospital

The flipped classroom model is an approach to teaching that is both innovative and impactful. Traditionally, the typical classroom approach involves direct instruction from the teacher that is completed in the classroom, while students are sent home with assignments intended to apply what they have learned. In the flipped classroom, however, direct instruction from the teacher is completed in an independent manner, usually via pre-recorded lectures, and then the application assignments or activities are completed in the classroom. This method of teaching is essentially a timeline rearrangement of Bloom’s Taxonomy where the lower cognitive functions, which include remembering and understanding, are completed prior to class rather than in class.¹ The higher cognitive functions, including application and analyzing, are done in the classroom with guidance from the teacher. This can include group discussions, practice cases, or even role-playing.

According to the Flipped Learning Network, there are four pillars of flipped learning that help guide educators to successful implementation of the flipped learning model.² This is referred to as The Four Pillars of F-L-I-P^TM, which stands for “Flexible Environment”, “Learning Culture”, “Intentional Content”, and “Professional Educator”. The first pillar, “Flexible Environment”, refers to the flexibility that is often required of educators seeking to flip their classroom. They must be physically flexible, since classroom arrangement may be necessary depending on the activity, and must also have flexible expectations. Since much of the initial learning is done at home, timelines for learning may have to adjust as well.

The second pillar, “Learning Culture”, reflects the switch from a traditional model where the teacher is at the center of guiding learning, to a model in which the students are at the center of their own learning. The students are engaged and are actively learning rather than passively learning, taking the information they learned independently and exploring them in greater detail while in the classroom.

“Intentional Content” is the third pillar and this refers to the importance of determining what ideas and concepts the students can learn on their own, and what would be better to delve into as a group with teacher guidance. This pillar is about maximizing classroom time, and, by extension, the various methods used to promote individual learning at home. These can include pre-recorded lectures, educational videos on the internet, learning modules, or several other activities. The goal here is not only that the content should be relevant to what is being taught but also that it is accessible to all students. For example, some students may not have internet at home. This doesn’t necessarily ban the use of internet videos, but rather goes back to the flexibility and adaptability of the teacher to make sure that all students are included and are able to participate.

The last pillar of flipped learning is “Professional Educator”. This pillar reminds us that, although the teacher is no longer at the center of learning in this model, that does not mean they get the day off! Teaching in a flipped classroom setting is very much an active process, with ongoing observation and assessments, providing feedback to students, keeping them engaged, as well as reflecting on the activity when its completed. A large part of this pillar is about reflection and collaboration with other educators to improve their teaching methods and instructional design.

Research indicates that while the flipped classroom model may not necessarily improve student academic performance, compared to traditional methods, it doesn’t hurt student performance. The model has been well-received by students and promotes student engagement and empowerment to take charge of their own learning. One study completed at the University of North Carolina Eshelman School of Pharmacy compared student perceptions and academic performance in a pharmacotherapy course delivered in a traditional manner one year, to the same course delivered via a flipped classroom the following year.³ It found that, while there were no significant differences between final examination scores, there was a significant increase in students’ support for this model and the belief that learning the material prior to class better enabled them to apply their learning while in class. In addition, a survey conducted prior to the execution of the flipped classroom showed that only 34.6% of students indicated that they preferred this format, while the same survey conducted after the execution of the flipped classroom showed that 89.5% of students preferred this format.³

The flipped classroom is an alternative method of learning that enhances student engagement and allows them to take a more active role in their learning. While there will always be a place in the classroom for traditional approaches to teaching, flipping the classroom gives us the ability to utilize another teaching modality.

References

1. MSU: Office of medical education research and development [Internet]. East Lansing: Michigan State University. What, why, and how to implement a flipped classroom model; [cited 2020 Sept 18]; [about 6 screens]. Available from: https://omerad.msu.edu/teaching/teaching-strategies/27-teaching/162-what-why-and-how-to-implement-a-flipped-classroom-model

2. FLIP learning [Internet]. Flipped Learning Network. Definition of flipped learning; 2014 March 12 [cited 2020 Sept 15]; [about 3 screens]. Available from: https://flippedlearning.org/definition-of-flipped-learning/

3. McLaughlin JE, Griddin LM, Esserman DA, Davidson CA, Glatt DM, et al. Pharmacy student engagement, performance, and perception in a flipped satellite classroom. Am J Pharm Educ. 2013 Nov 12; 77(9):196. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831407/

Motivational Learning

Irene Ruiz, PharmD

PGY-1 Pharmacy Resident

University of Maryland Medical Center

Motivation is a strong predictor and a fundamental skill for academic success. Those who are motivated tend to perform better in school and within their careers.^1,2 Motivation is the reason one behaves or acts in a particular way and drives a person to accomplish something.¹ Motivational learning is necessary to engage all students in the classroom setting. The goal of motivational learning is to give students a reason to learn the material beyond the necessity of learning solely to pass a course. Educators should strive to elevate their students from extrinsic to intrinsic learners.

There are multiple pertinent theories surrounding this topic with the Intrinsic and Extrinsic Motivation Theory predominating. This theory relies on the foundations that intrinsic motivation leads students to accomplish tasks because of their own contentment, they do not need external factors to drive them. Usually, this attitude helps carry these students to perform well as they have internal desires to learn, improve themselves and avoid mistakes. Those who are motivated by extrinsic factors require positive/negative reinforcement such as a reward or punishment to accomplish tasks. A strong extrinsic factor for many students is their grades and failing a class.^2,3 They often want to avoid the repercussions rather than learn the material for personal growth. Extrinsic learners tend to lack the initiative to seek additional resources and tasks to preform above the standard. They also require the promise of material gain to pursue higher education and knowledge in their given field.⁴

A model presented based on the fundamentals of behavior and emotion is the ARCS (Attention, Relevance, Confidence, and Satisfaction) model. This model presents the idea that students can be motivated directly using attractive, satisfying and stimulating learning material. If you can create an environment that grabs the attention of the students, this may spark interest in any given subject that they themselves were not aware of. Students may even enter a course or begin studying the material with preexisting ideas and biases on what to expect. If the instructor can present the material in a more attractive way, these biases can be overturned and allow the student to acquire a higher level of interest on the material. This can then allow the students to develop more intrinsic motivation, pushing them towards a more self-driven approach.⁴

Another theory that focuses on improving the performance of extrinsic learners is the Expectancy theory. The theory states that there is a direct relationship between the amount of effort put into a task and the performance that can be achieved from the learners. The theory depicts that strong effort will lead to a better performance, which leads to positive reward. The idea is that the learners are expected to perform their tasks with a genuine and maximum amount of effort in order to achieve an acceptable performance. When the instructor acknowledges the genuine effort, the performance will then be rewarded. This theory was first used in a working environment and later expanded and revised for education. This seems to fit better in a working environment as it rewards an outcome and performance-based system. Perhaps with a mixture of other motivational theories this can help kickstart and develop academic discipline in students who are heavily driven by extrinsic motivation.⁴

Understanding whether a classroom has intrinsically, or extrinsically motivated students will help an instructor better engage all students to complete tasks and learn. Stated in each theory is the recognition of intrinsic and extrinsic learning. It is tasked then, by successful implementation of the theories from the instructors, to help guide the development of their learners from reward-based learning to a genuine interest in the material.

References

1.    Pelaccia T, Viau R. Motivation in medical education. Med Teach. 2017;39(2):136-140. https://pubmed.ncbi.nlm.nih.gov/27866457/.

2.    Sedden ML, Clark KR. Motivating students in the 21^st century. Radiol technol. 2016;87(6):609-616. https://pubmed.ncbi.nlm.nih.gov/27390228/

3.    Psychology: Motivation and Learning [Internet]. 3030 [cited 2020Sep20]. Available from https://gsi.berkeley.edu/gsi-guide-contents/learning-theory-research/motivation/.

4.    Gopalan V, Abu Bakar JA, Zulkifli AN, et al. A review of the motivation theories in learning. AIP Conference Proceedings. 2017;1891(1):020043. https://aip.scitation.org/doi/abs/10.1063/1.5005376

 

 

The Flipped Classroom Model

Precious Ohagwu PharmD

PGY1 Pharmacy Resident

Suburban Hospital- Johns Hopkins Medicine

Flipped classrooms have gained popularity in the last decade. It has brought with it a different approach to teaching and learning. The flipped classroom is an educational model in which students become familiarized with a concept outside of the classroom through assigned readings, problem-solving as well as writing. Then, they come into class and apply the knowledge gathered previously to synthesize new knowledge, analyze new situations and perform higher-level problem-solving¹. With reference to Bloom’s taxonomy, students perform the remembering and understanding portion before class, and then apply and analyze during class². With this approach, the focus is shifted from teacher-centered to learner-centered instruction.

The flipped classroom model has been adopted by some educators because it allows students to learn at their own pace, increases student engagement with the material and frees up class time³. Various studies have found out that students taught in a flipped classroom model actually prefer it because they felt more engaged with the material than students in traditional courses.

If flipped classrooms are so great, why are they not more popular, you may ask. A couple of criticisms of the flipped classroom model is that there is a significant amount of trust required of students to actually do the pre-class work. Students who have low motivation to complete work on their own may start lagging behind on coursework. This leads to issues with inability to move forward with the curriculum as the class may become fragmented into well-prepared and ill-prepared students. Furthermore, due to the fact that there is a lot of work required to be done prior to class time, both by the student and instructor, preparation may become overwhelming to both parties.  Preparing beforehand for a class, as seen in the flipped classroom model requires student access to the internet in order to access required materials for pre-class time work. For students who do not have access to these resources, the flipped classroom may do more harm than good when compared to a traditional classroom.

So how does the flipped classroom translate into pharmacy education?

For flipped classrooms to be successful, there has to be achievable objectives. Objectives should be defined using the SMART acronym. They have to be Specific, Measurable, Actionable, Relevant and Timely⁴. These objectives also have to relate to soft skills like problem-solving, teamwork, and communication skills.

In order to acquire the foundational knowledge require for the flipped classroom approach, pre-class assignments should be assigned. These can range from pre-assigned readings, to pre-recorded lectures or videos. It is important to note that the assigned material must be written at a comprehension level that is well-suited to students’ expected knowledge level. If material is too advanced, students may lose the motivation that is so important in a flipped classroom.

Another strategy used in the flipped classroom model is the use of in-class activities. These activities should have active learning strategies embedded in them to keep students motivated. However, efforts should be made to avoid ‘double lecturing’ and repetition of the pre-class work as this can lead to student apathy to the material.

After-class work is the next stage in this process. In order to consolidate what has been learned before and during the class session, after-class work should provide feedback to students and help students apply their skills to a variety of situations.

Finally, the last piece of the puzzle is assessment. In traditional learning, assessments are usually done after lectures, are lesser in number therefore often weighing more. However, in the flipped classroom model, more frequent, lower stakes assessments may be required as a motivation for students to do the pre-class work, and also for the instructor to gauge how well the class is doing in order to identify areas of weakness early on. Common assessment tools utilized in the flipped classroom include quizzes, guided questions, recorded audience response as well as cases.

Overall, flipped learning is an innovative model which has led to a shift in how students are educated. It has been shown to increase student knowledge as well as motivation to learn. While there are still challenges that are posed by this model, it may prove to become a very significant part of graduate education, especially pharmacy education.

References

1.   Brame C. Flipping the Classroom [Internet]. 2020 [cited 2020Sep18]. Available from: https://cft.vanderbilt.edu/guides-sub-pages/flipping-the-classroom/

 2.   Office of Medical Education Research And Development [Internet]. What, Why, and How to Implement a Flipped Classroom Model. [cited 2020Sep18]. Available from: https://omerad.msu.edu/teaching/teaching-strategies/27-teaching/162-what-why-and-how-to-implement-a-flipped-classroom-model

 3.   Nouri J. The flipped classroom: for active, effective and increased learning-especially for low achievers... [Internet]. International Journal of Educational Technology in Higher Education. [cited 2020Sep18].

 4.   Persky AM, McLaughlin JE. The Flipped Classroom - From Theory to Practice in Health Professional Education. Am J Pharm Educ. 2017 Aug;81(6):118. doi: 10.5688/ajpe816118. PMID: 28970619; PMCID: PMC5607728.

Future of Online Education

 

Jonathan Tran, PharmD 

PGY1 Community-Based Pharmacy Resident 

Safeway/University of Maryland

The advent of online education programs first came in the 1990’s but has been more prevalent over the past 10 years. Upon its arrival, enthusiasm was widespread as many thought the virtual classroom would revolutionize the educational experience by increasing access, flexibility, efficiency, and innovation for educators and students.¹

Trouble on the Horizon

Since its adoption, different models of online education, such as live online seminars, massive open online courses (MOOCs), and hybrid classrooms, have been formed. However, despite all the benefits they provide, several recurring limitations continue to plague the delivery of online education for pharmacy students.

What has been the biggest issue with online education and how do we solve it? The difficulties with it are numerous and affect each student uniquely.

·       Difficulty Transitioning: Transitioning from an in-person classroom to an online platform presents many additional challenges for students due to the lack of a controlled environment. Reports show that while some students benefit from online education, less proficient students that were previously struggling in the classroom setting are less likely to succeed virtually.² For these students, they were more likely to be affected by the increased distractions and limited instructor oversight in uncontrolled learning environments.

·       Technology Requirements: The necessity of having a computer and stable internet connection for online learning may serve as greater hindrance for lower-income students than others. At times, it may be more difficult for them to gain access to technology than to attend a live class.

·       Absence of Hard Skills Training: Because students are not in a physical learning environment, there are limitations on the types of skills that can be taught online. While online methods can be used in some instances, there are certain hard skills that require more hands-on instruction for mastery. These are primarily complex physical activities that involve a higher level of technical ability, such as checking blood pressure, administering immunizations, or performing sterile compounding.

·        Access to Instructor: For MOOCs, learning modules, and prerecorded lectures, students do not usually have immediate access to instructors. The lack of direct access during the learning process can impede the progress of students when they have questions that would normally be quickly addressed. Once this initial learning breakdown occurs, it can also affect learning material taught later in the lecture that builds upon the initial concept.

·       Need for Accountability: The lack of direct oversight from instructors places more responsibility on students to take ownership of their own education. Aside from students needing to have high self-motivation and discipline to finish the course, it’s also very difficult to prevent cheating for online assessments without the use of testing security software such as ExamSoft or online proctoring. This heightened responsibility can hinder the overall learning ability for pharmacy school students.

Developing the Future of Education

Despite being around for more than a decade, there are still several areas for growth in virtual learning. In order to improve online learning experiences, many educators are attempting to revolutionize the field with new ideas and teaching methods.

·        Personal Engagement: Many educators believe that increasing a students’ personal engagement during the learning experience will help students learn new material more efficiently. According to Dr. George Greenbury, one method to do this is to adjust online education so that it closer emulates a one-on-one teaching environment.³ This helps increase the engagement as learning experiences would be more hands-on for graduate students. Alternatively, Dr. Aaron Barth has proposed the idea of using story-based learning more within online teaching models. With stories, students are be able to develop empathy which in turn creates personal meaning and engagement for the student.⁴

·       Empowerment: According to Dr. Sugata Mitra, learners must first be empowered to learn. His model of empowerment is similar to the idea of a flipped classroom but focuses more on technology. To diversify and tailor learning experiences for each student, he suggests that educators embrace all forms of technology as tools for learning rather than treating them as distractions.⁵

·       Innovation: There is a need to modernize the current standard of teaching so that it’s better adapted for education on a virtual platform. Through continued innovations, new types of online platforms will be developed to improve the integration of education and virtual learning. One example, called Massive Adaptive Interactive Texts (MAITs), was developed by Dr. Niema Moshiri and has helped revolutionized MOOCs and flipped classroom models for teaching.⁶ Rather than having simple MOOCs, MAITs adds automation to the traditional lecture model of MOOCs. The automation helps identify any learning breakdowns while the lesson is taught to the students and adapts its lesson plan according to the learner’s needs. In addition to addressing knowledge gaps of students efficiently, the platform helps convert generic learning modules into adaptive lesson plans that can simulate one-on-one learning experiences with a teacher. With the innovations such as these, it would be possible to one day have all online teaching be done through automated adaptive texts powered by artificial intelligence.

We are still in the early phases of online education. However, now that COVID-19 has driven several pharmacy schools to make their courses virtual, professors must adapt to the new frontier. Regardless of anyone’s feelings towards it, virtual learning is here and will only keep growing over the years.

References:

1.       Lips, D. How Online Learning Is Revolutionizing K-12 Education and Benefiting Students. The Heritage Foundation. https://www.heritage.org/technology/report/how-online-learning-revolutionizing-k-12-education-and-benefiting-students. Published January 12, 2010. Accessed August 30, 2020.

2.       Dynarski, S. Online Schooling: Who Is Harmed and Who Is Helped?. Brookings Institution. https://www.brookings.edu/research/who-should-take-online-courses/. Published October 26, 2017. Accessed September 1, 2020.

3.       Greenbury, G. Schools Without Classrooms: The Potential of Online Education. TEDx Talks. https://www.ted.com/talks/george_greenbury_schools_without_classrooms_the_potential_of_online_education_and_how_to_fulfil_it/up-next. Published June 2019. Accessed Sept 7, 2020.

4.       Barth, A. Why E-Learning is Killing Education – TEDx Talks. Youtube. https://www.youtube.com/watch?v=iwSOeRcX9NI. Published March 19, 2020. Accessed September 8, 2020.

5.       Mitra, S. The Future of learning – TEDx Talks. Youtube. https://www.youtube.com/watch?v=VGF3kjgCaMQ. Published Nov 12, 2018. Accessed September 10, 2020.

6.       Moshiri, N. The Era of Online Education – TEDx Talks. Youtube. https://www.youtube.com/watch?v=5JKgUoY9pTg. Published June 14, 2017. Accessed September 8, 2020.

 

The Rise of Telemedicine in Healthcare Training

 

June Trinos, PharmD 

PGY1 Pharmacy Resident 

Suburban Hospital – Johns Hopkins Medicine

               The ongoing COVID-19 global pandemic has permeated itself into our lives and has changed how we act in every aspect of our personal and public lives. Classrooms across the United States have certainly felt the impact of the pandemic and this includes healthcare education. In addition to lectures, most healthcare students also rely on hands-on training as a part of the traditional curriculum. Many healthcare programs require lab practicums, internships, and even job shadowing or rotations to practice real-life situations.¹ Now, this particular aspect of hands-on training is limited at most pharmacy schools as rotations off site and abilities labs become more limited, requiring a shift in the curriculum. As students and instructors shift into the world of the online classroom and virtual meetings, there is also a parallel shift in how healthcare is practiced with the increased use of technology. While telemedicine has been around for decades, it appears that many doctor’s offices and patients have been slow to accept healthcare technology and remote medicine based on observation.¹ According to data from a software analytics company, Pendo, usage of telemedicine rose about 63% in the third week of March in 2020.¹

             Telemedicine did not gain traction until the development of technology during the early 1970s when NASA partnered with the Papago Nation of southern Arizona. They worked to develop a project that eventually led to the advent of technology that allowed for remote health care to become more accessible.² Now, in the era of social distancing and limited office visits, both patients and healthcare providers are opting to utilize more technology to continue the daily rhythms of patient care.² As virtual visits continue to rise and become more prevalent in our society, students in healthcare must learn to adapt to this trend.  This will require both learning and adapting to new technology and embracing “soft skills” that will prepare students for utilizing telemedicine. In pharmacy school, students are often pressed to memorize new information with every lecture and new skills such as compounding and vaccinating. These are “hard skills” that will allow them to practice pharmacy, however, there must also be an emphasis on the “soft skills” needed to provide excellent care through the virtual route.  This unique set of skills includes clear, effective, and confident communication, maintaining eye contact and positive body language, and learning how to work within a team. Adding exercises such as an telemedicine-based OSCE into an abilities lab course, is a way to integrate telemedicine training, where these skills can be assessed.

             Alongside students, pharmacists can take this opportunity to expand their roles with telepharmacy, or by providing pharmacist care through the “use of telecommunications or other technologies to patients or their agents at distances that are located within U.S jurisdictions.^”4 Opportunities that students may now look into include medication therapy management, chronic disease management, transitions of care, pharmacogenomics, remote dispensing, and ambulatory care.⁴ Through a new phase of virtual learning, students must learn to adapt to the ever-changing landscape of healthcare. With these new “soft skills” and further exposure to new technologies, they will be better equipped to handle the ongoing demands of caring for patients from 6 feet away or more.

 Students and instructors must be equipped with not only a computer and camera for virtual learning, but they must also be able to embrace new technologies. Newly developed apps draw in more capabilities to screen share, allow more users to simultaneously tune in, and find creative ways to allow for a more accessible interface for users (thumbs up and applause emojis for less disruptive responses). However, a major barrier in the current virtual classroom includes inconsistency in users turning their cameras on, which may make it difficult for instructors to gauge how engaged their students are in their lecture or presentation.  Beyond navigating the logistics of technology, students must also learn to develop skills to communicate compassion and empathy, which is not always easy through the screen. As these encounters provide a physical barrier in between students and instructors, it becomes even more important for future healthcare professionals to become self-aware of how they present themselves through non-verbal cues, which can present themselves as interested or not. Despite the ongoing challenges of virtual learning, students are in the unique position to practice other important traits of patient care such as effective communication, learning to adapt and improvise, becoming proficient users of telemedicine. The COVID-19 pandemic has taught healthcare that there must be measures in place to allow healthcare to move forward with telemedicine especially in times of crisis.⁵ And in order to address this need, it all begins with ensuring that health professionals are given the proper training and education to arm themselves with telemedicine competency.⁵

References: 

1. Dennon, Anne. (2020 May 21) The Impact of Coronavirus on Healthcare Education. Best College. Available from: https://www.bestcolleges.com/blog/coronavirus-impact-on-healthcare-education/

2. Board on Health Care Services; Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington (DC): National Academies Press (US); 2012 Nov 20. 3, The Evolution of Telehealth: Where Have We Been and Where Are We Going?Available from: https://www.ncbi.nlm.nih.gov/books/NBK207141/

3. Wheel Health Team. (2019 June 26) The 7 Qualities Top Telehealth Providers Share. Available from: https://www.wheel.com/blog/the-7-qualities-top-telehealth-providers-share/

4. Telehealth. American Pharmacists Association website. pharmacist.com/telehealth.

5. Smith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. 2020;26(5):309-313. doi:10.1177/1357633X20916567

Layered Learning

J. Emily Von Bulow

PGY1 Resident

University of Maryland Medical Center

    Preceptor teaches resident, resident teaches student, student teaches their peers. Can this way of learning really be beneficial? But residents were just students themselves mere months ago. Isn’t this complicated? Why wouldn’t learners just learn from their preceptor? All of these questions come to mind when one thinks about layered learning. From an outside view one might think how does this make any sense. Let’s start at the beginning and work our way through. It may be a surprise to some but this way of learning has outstanding benefits! It not only works for students but for all levels of learning from a PGY3 medical resident to fellows.

    What even is layered learning? According to Loy et al, layered learning is a teaching strategy that involves training residents to precept students with a senior clinical pharmacist overseeing the process.1 It is a common learning model used in residency programs and is supported by ASHP.3 Two surveys of PGY1 programs within the Veterans Health Administration found that 85% to 90% offered precepting opportunities in general. More specifically, the PGY2 residency programs offered opportunity to precept PGY1 residents at 59.3% of programs and the opportunity to precept students at 74.1% of programs.1 Each person has a specific role that is clearly defined so that the process runs smoothly. This model seems to be most beneficial to the resident. Not only are they learning clinical information, they are also having the added benefit of learning how to precept and teach at the same time. As residents ourselves, our environment is surrounded with teaching opportunities no matter if assigned or incidental. These teaching and precepting roles are a huge part of pharmacy practice. Being able to refine them early on will lead to more benefit for the pharmacy resident as well as any students or future residents that they may encounter and teach as well. There are many strategies for a successful layered learning model. 

    When people think of their favorite teachers, there are many attributes or teaching strategies that people will bring up. Many would probably say their favorite teacher was encouraging, relatable, or accessible for help. These teachers must be basing their skills off of some type of experience or strategy that they learned in school or through practice. The layered learning model is no different for the healthcare field. There are specific strategies that have been shown to create a beneficial environment for all parties involved. The steps include orientation to layered learning, pre-experience planning, implementation, and post-experience evaluation.4 Orientation, according to ASHP, is crucial to the success of the experience for both the preceptor and learner.4 It sets expectation and gives all parties an idea of the daily workflow and patient care responsibilities. Without these expectations, the resident and student may not be living up to the ideas that the preceptor has. 

    Pre-experience planning should be done in terms of a rotation syllabus and projects for the student and resident.4 It allows for effective time management for all parties. Most importantly in this step is the baseline assessment. It gives the preceptor an idea of where their resident’s knowledge is and it allows the resident to see where the student’s knowledge is so that all deficits can be worked on and the most is made of the rotation. Post-experience evaluation is needed to sum up the whole process.4 It allows for feedback so that all those involved can better themselves for either their next rotation or their next precepting experience.

    This is all well and good but what have been the real, proven benefits of layered learning? Some may still be skeptical especially because these residents were students not long ago. Residents are there to learn so how can they be learning clinical information as well as precepting skills at the same time. The Durham Veterans Affairs Medical Center implemented the layered learning model into their practice. The study found that from the perspective of the clinical pharmacist overseeing the model, they can increase the amount of students they take which is ever growing in the current times.1 For the resident, it allows for increased leadership skills and more practice in teaching which is greatly involved with the role of a pharmacist.1 Lastly, for the student, it allows them more exposure to different levels of practice.1 They may feel intimidated by a clinical pharmacist but with a resident they might be able to learn more and be more willing to answer a question even if they don’t know for sure. It also increases networking responsibilities by meeting more people in the field of pharmacy and increasing their opportunities to better themselves such as through research. 

    There is no direct data related to peers teaching peers but according to an article by Mercer and Wegerif, the idea of exploratory talk can stimulate the learning environment. This idea to me seems like it could be easily incorporated into a layered learning environment. In this communicative process, it allows the students to talk through a learning point leading to ideas of how to better understand a topic.2 Prescott DC et al., conducted a survey that echoes these benefits. The survey found that the benefits of layered learning included an increase in patient access to pharmacy team (42.3%), increase in the number of precepting opportunities for learnings (34.9%), and improved patient education (33.2%).3 There is no direct data on if this model enhances patient outcomes but anecdotally, one could think with multiple people looking at the same patient and increased time, it could possibly lead to better patient outcomes. In conclusion, layered learning involves multiple people in different roles all coming together for one common goal: to learn the most they can. 

    Although this blog focuses mainly on residents, layered learning could be beneficial in many different environments such as doctor helping another doctor in an area they are unsure in. The majority of data is in residents and teaching hospitals, however, research in other fields would be interesting. Incorporating layered learning into everyday life can help out each of us as we continue on through our residency year so why couldn’t it help in another environment? Whether that learning is clinical or how to teach or precept, every party involved is benefitting and refining their skills. No matter if you are a pharmacy resident or medical attending, layered learning is involved in all aspect of the healthcare field.

References:

1) Loy BM, Yang S, Moss JM, Kemp DW, and Brown JN. Application of the layered Learning Practice Model in an Academic Medical Center. Hospital Pharmacy 2017;52:266-272

2) Mercer, N., & Wegerif, R. Is “exploratory talk” productive talk? In K. Littleton & P. Light (Eds.), Learning with Computers: Analyzing productive interaction. 1999:79-101

3) Prescott DC, Coffey CP, and Barnes KD. Innovative learning in pharmacy practice: The Perceived benefits of and barriers to a layered learning practice model. Journal of the American Pharmacists Association 2020: 1-5.

4) New Practitioners Forum Resident Advancement Advisory Group. Residency Guide: Recommendations for Practice and Engagement in a Layered Learning Model as a Resident. ASHP New Practitioners Forum. 2019 

Active Learning

Shelby Warring 

PGY2 Pediatric Pharmacy Resident 

University of Maryland School of Pharmacy

 

    In simple terms, active learning can be thought of as a student-centered teaching style that allows the student to interact with the learning process rather than passively absorbing material. As we continue to navigate through the challenges of a global pandemic, including virtual learning, it is now more important than ever for educators to consider utilizing active learning methods. Teaching via a virtual platform leaves room for many disruptions. Learners may have chaos occurring around them at home, or they may turn off their camera and focus on something other than the lesson. Regardless of the cause, a way to better engage your audience is by incorporating active learning into your teaching.

    A popular learning model that has helped facilitate the idea of active learning is Bloom’s taxonomy model. Bloom’s taxonomy utilizes three educational domains: cognitive (thinking), affective (emotional/feeling), and psychomotor (physical/kinesthetic).¹ Specifically, within the domain of cognition, skills of application, analysis, synthesis, evaluation are applied to enhance the learner’s understanding of the material.² Activities such as visual learning, cooperative learning, debates, drama, discussion, role-playing, and peer teaching can all be used to execute these strategies.²

    There are many ways for educators to include active learning into their lessons. Online platforms such as Poll Everywhere and Kahoot provide simple ways to incorporate active learning. Questions can be asked prior to starting a lesson to assess the baseline knowledge of the learners. Alternatively, questions can be asked to reinforce concepts that are taught in class. A great method to accomplish this is by polling the audience with a multiple choice question after each learning objective reviewed. Another strategy for active learning is the use of discussion boards. Having students take their learning, whether independent reading or something taught in the classroom, to a further discussion amongst their peers is a great way to promote engagement. This is an excellent strategy for virtual learning, as it allows the student time to complete an activity around their own schedule.

    Finally, the flipped classroom is becoming an increasingly popular method of active learning. The flipped classroom requires learners to complete an activity, typically assigned reading or a question-based assignment, prior to coming into the classroom. Once in the classroom, the learner should feel prepared to apply what they have learned to either a discussion, a case assignment, or a lecture that enhances the knowledge presented in the pre-classroom work. Learners may also be asked to educate their peers on the subject. This model is beneficial for educators, as having learners prepare in advance allows educators to dig deeper into the material in person and answer any questions the learners may have regarding the material. It is also great for students, as they are not simply memorizing notes they have taken from a lecture, but actually applying the information they have learned to confirm their understanding.

    Studies have shown that learning tactics tapping into multiple sensory, cognitive, and emotional processes cause more extensive physical changes in the brain and improve retention of memory and recall abilities.³ Neuroscience tells us that as we activate more areas of the brain, we create more opportunities for the hippocampus to connect neurons, promoting a deeper connection to the material.³

    As well, learners tend to have positive attitudes towards active learning. One study of undergraduate students from five courses that utilized an in-class and after-class activity approach revealed that the learners favored participating in active learning, and felt an impact on their education and experience.⁴ Another study of both undergraduate and graduate students found that active learning classroom environments increased student satisfaction compared to a traditional classroom format.⁵

    In conclusion, the concept of active learning has both evolved over the years alongside technology and has proven benefits for the learner. In a time when society must heavily rely on technology to facilitate education, methods of active learning can be pivotal in achieving optimal outcomes from a lesson.

    References:

1. Bloom BS, Krath
2. wohl DR. Taxonomy of educational objectives: the classification of educational goals. Vol 1. London: Longmans and Green; 1956. 207 p.
3. Khan A, Egbue O, Palkie B, Madden J. Active learning: engaging students to maximize learning in an online course. Electronic J e-Learning [Internet]. 2017 [cited 2020 Sept 5];15(2):107-15. Available from: https://eric.ed.gov/?id=EJ1141876
4. Hoogendorn C. The neuroscience of active learning [Internet]. New York (NY): City University of New York; 2015 Oct 15. [cited 2020 Sept 5]. Available from: https://openlab.citytech.cuny.edu/writingacrossthecurriculum/2015/10/15/the-neuroscience-of-active-learning/
5. Lumpkin A, Achen RM, Dodd RK. Student perceptions of active learning. College Student Journal [Internet]. 2015 [cited 2020 Sept 5];49(1):121-33. Available from: https://www.ingentaconnect.com/content/prin/csj/2015/00000049/00000001/art00012
6. Hyun J, Ediger, Lee D. Students’ satisfaction on their learning process in active learning and traditional classrooms. International Journal of Teaching and Learning in Higher Education [Internet]. 2017 [cited 2020 Sept 5];29(1):108-18. Available from: https://eric.ed.gov/?id=EJ1135821