Closing the Classroom Theory to Practice Gap

 

Chelsey Axelrod, PharmD

PGY2 Psychiatric Pharmacy Resident

University of Maryland School of Pharmacy

Education of several healthcare professionals requires both didactic training achieved in the classroom, as well as clinical experience through rotations or “clinicals.” Arguably the most vital step in professional education is the ability to transfer the information learned in the classroom into clinical practice. Having experienced four years of pharmacy school, and now being in my second year of residency, I can certainly speak to whether I felt I was adequately prepared through didactic training to enter APPE rotations and clinical practice. Everyone’s educational experience is different, depending on the pharmacy school attended, types/difficulty level of clinical rotations, and mentorship; however, I personally believe that the gap between classroom theory to APPE rotations is quite large, and perhaps even larger between student rotations and residency. During my first clinical APPE rotation, I remember feeling so lost and not knowing where and what to look for when collecting patient information in preparation for rounds. Developing treatment plans and making recommendations to physicians seemed close to impossible, when I really had no idea how to apply the knowledge used in school to actual patients. 

For this blog post, I looked for articles that addressed this classroom theory to practice gap and attempted to reduce it through an instructional activity. As I am the PGY2 in psychiatric pharmacy this year, I decided to choose an article that addressed the gap by simulating a psychiatric pharmacy practice experience during a P3 elective class. The writers of this article, similar to myself, believe that real-life scenarios/patients present challenges that pharmacy students are not necessarily prepared for when entering APPE rotations. They discuss the essential role reflective learning plays in the development of essential clinical skills necessary to bridge the classroom to practice gap.¹ Reflective practice includes analyzing past experiences to improve future performance and form deeper learning. According to Tsingos and colleagues, reflective practice “helps develop critical-thinking, problem-solving, and self-directed and lifelong learning skills through gaining new understandings, new perspectives, and new alternatives for future experiences.”² In an effort to guide reflective learning and bridge the gap between didactic learning and APPEs, Pittenger and colleagues, developed an educational design project and evaluation.¹

The educational design project implemented was a 15-week advanced psychiatric pharmacotherapy elective that was peer-led and team-based. The writers had a great understanding of what an instructional design project should entail. An instructional design project should create learning experiences that result in the acquisition and application of knowledge and skills. They should include assessing the needs of the audience, designing a process, developing the materials necessary for implementation, and evaluating the effectiveness of the design.³ In this article, the 4C/ID instructional design model was used to create the course, which includes the four components of learning tasks, supportive information, just-in-time (JIT) information, and part-task practice.

The learning tasks component of the 4C/ID model includes whole-task experiences which are organized from simple to complex with more support given to the learners at the beginning, and less as the course progresses. The learning tasks form the backbone of the course.³ The authors of this article incorporated learning tasks by including complex psychiatric cases that were given to the students each week that had intentional, but real-world clinical guideline conflicts and insufficient evidence that made decision-making difficult. The first case was completed together as a class with facilitation from the course instructors to make expectations clear. Future cases were worked up and presented by either of the two teams that students were divided into.¹

The other 3 components of the educational design support the learning task or case. Supportive information bridges the learner’s prior knowledge with the current learning task.³ The supportive information in the course included content previously learned from the students’ psychiatric pharmacotherapy course, and suggested readings, guidance from fellow teammates, and a patient case work-up template provided by the instructors that was to be complete prior to the class where they were presenting the case.¹

The just-in-time information component of the instructional design typically includes demonstration and corrective feedback.³ This aspect was implemented by including visiting psychiatric pharmacists who attended each case discussion, either in person or virtually through video chat. They provided feedback on the patient case work-up following students’ patient case presentation. Additionally, students completed reflective assignments where they would write pre and post-class personal learning objectives.¹ Part-task practice gives learners the opportunity to have additional practice on completing tasks in order to achieve the learning objectives.³  The instructional design project in the article included part-task practice by having the non-presenting students write comments and questions on a projected shared google doc in real time during the case presentation. All students would have guidance from the visiting experts each class session for the case. Evaluation of the course was provided through post-course conversations with visiting experts and an open-ended course evaluation for students to complete.¹

This article is a great representation of how an educational design project can be created and implemented to help close the gap between classroom theory and clinical practice. In fact, feedback from student’s post-course revealed they felt their previous classroom experiences were much simpler and falsely represented what it meant to practice pharmacy. After the course they felt more excited to begin APPEs and expressed interest in having a similar course design with complex patient cases in future courses. This article did not follow students and evaluate their performance in APPEs after having completed the course, but feedback from visiting experts did show belief that students had improved in their clinical skills and ability to make clinical decisions.¹ Although there may be other possible solutions to bridging theory with practice, I believe this instructional design project represents a feasible example that can be utilized by other educators, especially healthcare educators, to foster deeper learning and prepare students for clinical practice.

 References:

1.   Pittenger A, Dimitropoulos E, Foag J et al. Closing the Classroom Theory to Practice Gap by Simulating a Psychiatric Pharmacy Practice Experience. American Journal of Pharmaceutical Education. 2019;83(10):2102-2110.

2.   Tsingos C, Bosnic-Anticevich S, and Smith L. Reflective Practice and Its Implications for Pharmacy Education. American Journal of Pharmaceutical Education. 2014;78(1):1-10.

3.   Khalil M and Elhider I. Applying Learning Theories and Instructional Design Models for Effective Instruction. Adv Physiol Edu. 2016;40(2): 147-156.