Peer-Based Assessment in the Classroom

Derek Edwards, PharmD
PGY-1 Pharmacy Resident
University of Maryland Baltimore Washington Medical Center

        Acknowledging the shift in educational outcomes for graduates of higher education, that being the transition from knowledge acquisition as a discrete endpoint towards generation of a workforce capable of higher level cognitive process (including the skills of problem solving, metacognition, and social competencies needed for productive collaboration with co-workers), there is an associated need for shift in mechanisms for assessment of outcomes. ¹ Though traditional test-based assessments may carry more immediate utility via a simple, discrete outcomes-based means of determining student “success,” ¹ these may be limited in their ability to both foster and screen for generation of these higher level cognitive processes as part of a didactic course. Instead, through the integration of more global means of assessment involving learners, such as peer assessment, course managers may not only stimulate improved determination of the degree of success with which students practice learning, ¹ but also, stimulate higher level cognitive processes and encourage students to engage course mobilization. 

        As suggested by its name, peer assessment is at its core a simple procedure, that being, “the process through which groups of individuals rate their peers.” ¹ Although by definition alone, this may appear to be a simplistic process, in fact, peer assessment is fairly broad reaching and modular in nature, encompassing both qualitative or quantitative evaluation in addition to either procedural or outcomes-based assessment of given criteria. ¹ That being said, although peer assessment may carry utility as the sole means for appraisal for success in evaluating student effectiveness in the process of learning, it should only be used adjunctively when aiming to determine concrete learning outcomes. ¹ From a hypothetical stance, the benefits of peer assessment for learners are theorized to include improved engagement with educational content on a critical basis in addition to the ability to compare and contrast both individual knowledge and performance with peers. ² Meta-analysis of several controlled investigations of peer assessment has demonstrated an overall positive impact of peer assessment on learner academic performance relative to both no assessment and teacher assessment of learners. ² Notably, this effect did not differ across education level (i.e. primary, secondary, or tertiary – defined as post-high school education) nor course subject, ² suggesting possible broad-reaching effects of peer assessment. There were however a limited number of graduate-level students included in this meta-analysis, ² making direct application to didactic pharmacy education perhaps more questionable. Furthermore, in regards to the question of where grades factor into peer assessment, although there was no difference in education outcomes whether or not peer assessment included a graded component for primary and secondary students, at the tertiary level, graded peer assessments was associated with positive results. ² Survey of graduate level students also revealed overall preference for a small portion of the assignment’s grade to be determined by peer assessment. ³ Nonetheless, in addition to positive impacts on academic performance, peer assessment was also associated with favorable response by students, ¹ though the setting of peer assessment may play an important role, with online peer assessment associated with less favorable response. ³ 

In terms of mobilization, qualitative investigations have suggested several factors to be potentially impactful on the results of peer assessment, including the importance of structured rubrics to guide assessment, the role for anonymity for mitigating bias, and the possible positive impact of repeated peer assessments on outcomes, ¹ though this was not supported through meta-analysis. ² These results, though perhaps less helpful in guiding best practices for implementation of peer assessment, do support the value for individualized assessment of each classroom for determination of which structural components may best yield student buy-in and positive educational outcomes. Thus, for the pharmacy educator, peer assessment may perhaps be integrated within activities that may better foster open debate amongst students (such as in clinical cases where the “grey areas” of practice may support multiple options for therapeutics) with a small portion of the grade arising from peer assessment. Course managers should not anticipate the implementation of peer assessment to result in less overall time required from them to grade assignments, but rather, may serve to foster greater learner buy-in and promote more positive educational outcomes.

References:

1.   Dochy F, Segers M, Sluijsmans D. The Use of Self-, Peer and Co-assessment in Higher Education: a review. Studies in Higher Education. 1999;24(3):331. doi:10.1080/03075079912331379935

2.   Double KS, McGrane JA, Hopfenbeck TN. The Impact of Peer Assessment on Academic Performance: A Meta-analysis of Control Group Studies. Educational Psychology Review. 2020;32(2):481-509. doi:10.1007/s10648-019-09510-3

3.   Wen ML, Tsai C-C. University Students’ Perceptions of and Attitudes toward (Online) Peer Assessment. Higher Education. 2006;51(1):27-44. doi:10.1007/s10734-004-6375-8

Self-Regulated Learning

Danielle Yu

With the COVID-19 surge, many students found themselves at home and away from the hustle and bustle environment of school. For those motivated by the stress of peers and tests, the comfort of open-book tests and lectures in pajamas were both welcoming and terrifying. The sudden urge to forego lectures for recordings and depend on open-book tests was tempting. Instead of extrinsic motivation from faculty and friends, students had to rise to the challenge of self-regulated learning.

What is self-regulated learning? In a short and crass explanation, self-regulated learning is the art of knowing and controlling how to care. In a more convoluted explanation, self-regulated learning can be described as “a cyclical process, wherein the student plans for a task, monitors their performance, and then reflects on the outcome.”¹ Once learners can utilize self-regulated learning, it often indicates that andragogy, or adult teaching, can be applied to the population. In higher education, instructional design and methods typically assume that students have achieved self-regulated learning. Despite this assumption, students are rarely taught how to self-regulate their learning. Therefore, if tasked with teaching self-regulation, educators must be self-regulated learners themselves as well as advocators for this learning method.

Self-regulated learning depends on three important aspects: cognition, metacognition, and motivation.² Cognition includes skills that are essential for memorizing and recalling information as well as problem-solving strategies and critical thinking. In adults, cognition can be taught by having learners create questions about the assigned topic or engaging in a classroom debate. Metacognition depends on declarative knowledge, procedural knowledge, and conditional knowledge. Declarative knowledge is knowing about oneself as a learner while procedural knowledge is about how to accomplish a task. Lastly, conditional knowledge emphasizes when to use acquired knowledge in a setting and understanding why you are using that knowledge. Motivation, although it sounds self-explanatory, is a complex element of realizing the degree of confidence in finishing a task while also understanding the nature of the knowledge being learned.

There are many instructional models to teach self-regulated learning including the Zimmerman, Boekaerts, Winne and Hadwin, Pintrich, Efklides as well as Hadwin, Jarvel, and Miller.³ To many, this is a list of useless words and names. Although there is some truth to that statement, the outcome of these instructional models is the development of self-regulating learning. Each instructional method is unique in their approach, but the general layout of each model includes a forethought phase, a performance phase, followed by self-reflection. Educators can take advantage of these models and utilize them to the benefit of the students.

Self-regulating learning does not mean learning or struggling alone. In fact, one of the most important aspects of self-regulating learning is feedback, both from the learner and the educator. Feedback provides insight for a student about their current performance and how it compares to their desired achievements. At first, feedback may initially start with the educator, but as leaners become self-regulating, they will learn the ability to assess their performance, generate internal feedback, and monitor their progress. To give effective feedback for self-regulating students, educators can exemplify how to solve a problem, encourage motivational beliefs and behaviors as well as provide opportunities to help the student reach their desired performance level.

Anyone can be a learner, but it takes conditioning and setting your mind to become a good student. Working hard is, as you would expect, hard at times. Becoming a self-regulated learner allows students to motivate themselves, adapt to teaching strategies, and set their own goals and expectations. In the end, this will contribute to an individual’s identity as a life-long learner, which every pharmacist has fated themselves to be by entering the profession. Overall, self-regulated learning should be taught and utilized by educators to inspire intrinsic motivation and prepare future pharmacists for the profession.

References

1.    What is self-regulated learning? Develop Self-Regulated Learners. https://serc.carleton.edu/sage2yc/self_regulated/what.html . Published June 8, 2017.

2.    Self-regulated learning. LINCS Adult Education and Literacy. https://lincs.ed.gov/sites/default/files/3_TEAL_Self%20Reg%20Learning.pdf.

3.    Panadero E. A Review of Self-regulated Learning: Six Models and Four Directions for Research. Front Psychol. 2017 Apr 28;8:422. doi: 10.3389/fpsyg.2017.00422. PMID: 28503157; PMCID: PMC5408091.

Instructional Design for Effective eLearning

Jansie Villanueva, PharmD                                                                                PGY-1 Pharmacy Resident                                                                                MedStar Montgomery Medical Center

In the last several years, virtual education has been an evolving and prominent part of our lives.  Although online learning is a natural part of education today, the concept of distance learning was born with correspondence colleges in the mid nineteenth century.  Utilizing the newly developed U.S. postal service, students were encouraged to partake in instruction delivered to the student and returned to professors.  In 1873, the “Society to Encourage Home Studies” was established as the first correspondence education program in Boston, Massachusetts. “The Channel That Changes You” was offered in 1953 as the first program to offer televised classes on public television. Notably, the channel offered many televised courses in the evening to allow for working individuals to participate in distance learning. In 1989, the University of Phoenix launched their online institution for higher learning.¹ As technology continues to evolve and expand, virtual learning continues to grow in popularity and complexity. 

Virtual learning’s intended purpose was for intermittent instruction but has become an answer to educating students throughout the COVID-19 pandemic and beyond. Intermittent instruction through online modalities and long-term online education share many similarities, including the need for a systematic approach for instructional design to deliver effective and engaging content.  Although online learning provides an opportunity to further one’s education while tending to other responsibilities, the quality of online programs is varied.  Instructors spend a large amount of time planning and developing content for in-person lectures, but the development of online courses requires a different kind of instructional design, combined with tried-and-true methods.  Farmer and colleagues have developed three sequential learning modules to facilitate better design and development of virtual learning experiences with a focus on ‘design judgement’. ² Both deliberate and unconscious thinking processes contribute to design judgement and can be applied to the three steps in the development of virtual learning experiences.

Design judgements are described as “deliberate and unconscious thinking processes experienced by designers in the design and development of learning experiences”.²  Design judgements occur throughout the design process and into the implementation of virtual learning experiences.   Although some schools had adopted virtual learning procedures prior to the COVID-19 pandemic, professional development and special training was not mandated prior to implementing a virtual learning program. The learning modules that Farmer and their group have described are focused on design judgements throughout the processes of preparation, design, and facilitation of material. This process of instructional design for virtual learning programs facilitates the development of a more effective design vetted for challenges that can be anticipated, as well as those that cannot.

Module 1: Preparation

Module 1 is focused on the development of policies and expectations that can then be communicated to students and/or families. Instructors should explore the challenges that may affect their learning plan and develop solutions or methods to circumvent these challenges.  This module closely aligns with the first step in the ADDIE training system, in which an instructor should analyze the audience and what prerequisites the students must have for success and allow for review as necessary.³   The instructor should also analyze what technology is available to each learner and the feasibility of the chosen technology.  Further analysis should be made in methods to communicate procedure and policy to learners. Instructors may use ‘appreciative judgement’ to prioritize the concerns and principles that are of most importance. Instructors should also use ‘instrumental judgement’ to determine what technological tools will be used and in what ratio to other methods of learning.  Care must be taken to ensure that the tools chosen are easy for students to obtain and utilize. Finally, ‘default judgements’ are made instinctually and without conscious deliberation.²   Many instructors choose the type of technological tools that they are familiar with and do not consider other tools of the same variety.  Challenges in delivery may be uncovered that can often be solved by choosing to use different tools.  Once analysis is made to uncover needs and goals of learners as well as appropriate instructional tools, instructors may move into Module 2.

Module 2: Designing

Instructors use their established procedures and expectations to develop instructional objectives and connect both content and learner activities to drive goals. This module closely aligns with the design and development steps of the ADDIE training system.  Instructors may choose to incorporate analysis as they uncover strengths and weaknesses of their chosen delivery method. Instructors will also use ‘connective judgements’ to ensure that activities, tools, and teaching methods are designed to connect the goals and objectives of the course to the needs of the students. ² Teachers in this module are encouraged to use Merrill’s 5 Principles of Instruction: demonstration, application, activation, integration, and engagement. ⁴   Instructors completing module 2 are encouraged to solicit feedback from a colleague regarding their designed lesson and adjust accordingly.

Module 3: Facilitating eLearning

The instructor is now preparing to deliver their lesson plans and explore challenges that they may experience with a variety of student populations and prior experience with technology. These issues may not have been considered earlier and will need to have solutions in order to move forward. More instrumental judgement may be necessary to ensure appropriate tools for the variety of learners and compositional judgements can now be considered to consider the cohesiveness of the elements of the design. This may be an opportunity for instructors to become comfortable with new tools. Teachers who have more experience with technology feel more confident about virtual learning, in general. ²   Finally, instructors will need to use more analysis and navigational judgement as they consider unpredictable scenarios and adapt their lesson plan to account for challenges. Many times, navigational judgements must be made in response to a challenge during instruction, so having a plan is beneficial.

The implementation of instructional design is seldom a straight path, but if a systematic approach is taken, there may be fewer excursions and challenges during delivery of instruction.  Farmer’s modules are an approach to instructional design to analyze audience, content, and needs and align these initial considerations with tools and delivery to work toward a common goal.  Both intrinsic and intentional judgements are considered in developing content to anticipate challenges and provide solutions before instruction is interrupted.  Overall, instructional design is a complex and unpredictable process and must be met with cycles of analysis and judgement.

 

References:

1.   Visual Academy, (2022). The History of Online Schooling. [online] OnlineSchools.org. Available at: <https://www.onlineschools.org/visual-academy/the-history-of-online-schooling/> [Accessed 19 September 2022].

2.   Farmer, T. and Koehler, A., (2022). Design Judgments in the Creation of eLearning Modules. Journal of Formative Design in Learning, 6(1), pp.1-12.

3.   Allen, W., (2006). Overview and Evolution of the ADDIE Training System. Advances in Developing Human Resources, 8(4), pp.430-441.

4.   Pappas, C., (2022). Merrill's Principles Of Instruction: The Definitive Guide. [online] eLearning Industry. Available at: <https://elearningindustry.com/merrills-principles-instruction-definitive-guide> [Accessed 23 September 2022].

Service-Learning Theory

Andrea Richardson, PharmD

PGY-1 Pharmacy Resident

Holy Cross Hospital

Service-learning incorporates meaningful community service and guided reflection to provide a structure that benefits both the student learning experience and the community. Service-learning falls on the middle of the spectrum in which either end puts more emphasis on the service provided (volunteerism or community service) or on the student’s hands-on experience (field education or internships). Maintaining this balance between service and learning is very important when evaluating the design of a course. This is a particularly important concept for students in pharmacy school that are actively learning to dedicate themselves to a profession of service.

The criteria for service-learning includes academic connection, community voice and quality service, reciprocity and collaboration, reflection, and assessment. Academic connection incorporates the service into the curriculum and identifies and articulates the goals of the service-learning within the goals of the course. Community voice and quality service ensure that the students are adequately prepared to provide necessary services to the community and that the service fulfills community needs. Reciprocity and collaboration suggest that everyone involved in the program functions as both a teacher and a student to achieve their shared vision. Reflection allows the student the opportunity to connect their service experiences with the knowledge from their didactic courses and to thoughtfully process their personal experiences. Assessment requires a method for measuring the effectiveness of the program for achieving the pre-defined learning and service goals¹. Assuring that a pharmacy program utilizes this type of learning appropriately requires proper planning with clear pre-defined learning outcomes, service to communities in need, consistent opportunities for sincere student reflection, and timely feedback from faculty².

Service-learning can be further categorized into different types, including pure, discipline-based, problem-based, capstone, service internships, and undergraduate community-based action research. Pure service-learning courses typically focus on sending students into communities to serve without narrowing down to a specific discipline. Discipline-based service-learning has the expectation that students are present in the community and reflect regularly with the content in the course. Problem-based service learning has students work to understand a problem in the community and develop a solution. Capstone courses are usually available during a student’s final year of school, and they provide the opportunity for students to combine their acquired knowledge with relevant community service prior to entering post-graduation practice. Service internships tend to require more hours and for students to develop a beneficial body of work for the site. Undergraduate community-based action research involves students working closely with faculty to become skilled with research concepts to be an advocate for the community. Each of these types could definitely play an important role when it comes to educating pharmacy school students and providing service to communities in need of our expertise.

        The benefits of implementing a service-learning program within the pharmacy school curriculum can have a lasting impact on student pharmacists as they prepare to go into practice after graduation. Students that have completed such programs reported improved confidence with communication and applying knowledge to specific patient scenarios. These are key skills to have as a pharmacist, along with an increased awareness of health disparity issues. Incorporating service-learning into their education provides more opportunities to participate in direct and indirect patient interaction and interprofessional collaboration. Some examples of these programs include health fairs, health screenings and education, student-run pharmacies, mission trips, IPPE or APPE rotations, and elective and required courses³.

        Service-learning supports a mutually beneficial relationship between pharmacy students and underserved communities, and its many types can be applied to help students achieve their learning goals. The structure of this type of program is very important for being successful and meaningful for all parties, so the role of the teacher is crucial for developing and maintaining it. As service-learning continues to be utilized in pharmacy programs, it will be interesting to see the impact that will have on future generations of pharmacists.

References:

1.   Kasinath, H. (2013). Service Learning: Concept, Theory, and Practice. International Journal of Education and Psychological Research, 2(2), 1–7.

2.   Dicks M, Mitchell T. Service or Disservice? Ensuring Pharmacy Students Provide Authentic Service-Learning. Am J Pharm Educ. 2019 Sep;83(7):7465. doi: 10.5688/ajpe7465.

3.   Alessa D. Gonzales, Kiersi S. Harmon, Norman E. Fenn, Perceptions of service learning in pharmacy education: A systematic review, Currents in Pharmacy Teaching and Learning, Volume 12, Issue 9, 2020, 1150-1161, https://doi.org/10.1016/j.cptl.2020.04.005.

Situational Leadership: Adapting Your Instructional Style to Your Learner’s Current Place in Their Educational Journey

 Alec Martschenko, PharmD

    As anyone who has embarked on an educational journey can attest, not everyone reaches the same level of educational achievement at the same time. Even within the same class or the same cohort, an educator may find that his or her students are at vastly different stages of their educational journey. At this point in the 21^st Century, it is well known that trying to apply a one-size-fits-all method to education will invariably lead to the exclusion of a subset of learners. Those who struggle and are left behind or those who excel and feel unchallenged—or both—will not have their needs met by such a strategy.

       Situational leadership is a framework that aims to identify a followers readiness level and provide leadership strategies most applicable to that particular stage in development. While originally developed for and most commonly used in corporate settings, situational leadership has generalizable applicability outside of executive board rooms and managerial development retreats. In particular, situational leadership can be applied to the experiential education of healthcare professional students.

While the basics of situational leadership theory are explained below, the interested reader is encouraged to consult the references for further information.^1,2 In brief, situational leadership ranks a follower (or student) on two broad categories: task readiness and psychological readiness. Task readiness refers to a student’s ability to perform a task, for example, a pharmacy student’s ability to recall important drug information or a nursing student’s ability to start an IV in a patient. Psychological readiness, on the other hand, refers to a student’s willingness to perform a task, including the desire, motivation, energy, and confidence to do so. For example, a medical student may know that a patient with asymptomatic bacteriuria does not always require antibiotics but may lack the confidence to contradict his or her attending physician in saying so. On the flip side, a learner can be psychologically ready, but not task ready—think of a pharmacy technician happy to work in the IV lab, but unaware that he or she does not know the difference in technique required between vertical and horizontal laminar flow hoods.

In the attached visualization, an altogether unready learner falls under D1, a psychologically ready but task unready learner falls under D2, a task ready but psychologically unready learner falls under D3, and a psychologically and task ready learner falls under D4. Variations in the model exist, and each individual learner is unique. Some may skip steps or regress at times, so it is important to continually assess where a learner is on the continuum to tailor their educational experience. More important, however, is knowing how to adapt your educational methods.

The method most appropriate for learners in the first domain (psychologically and task unready) is often described as directing. It often involves step-by-step directions, close supervision, and a certain level of coercion. For example, a pharmacy student may be tasked with making an intervention with a provider and receive direction on how best to phrase the recommendation.

For learners in the second domain (psychologically ready, but task unready), coaching is the preferred leadership style. This involves a high level of directive behavior and psychologically supportive behavior. A highly motivated student may best learn by doing but would require close supervision as he or she as of yet lacks the skills necessary to do so independently.

The third domain (task ready, but psychologically unready) requires a supporting teaching strategy. While a student may possess the skills to perform a task, they may require supportive confirmation that their knowledge is correct before building up the confidence to follow through on that assignment.

Finally, learners in the fourth domain (task ready and psychologically ready) can best be managed by a delegating approach. Students can be trusted to perform tasks accurately and have the motivation and confidence to do so independently. A senior resident, for example, would be able to trust the assessment of an intern in this domain before examining the patient independently.

The terms used above may vary, but the principles remain the same. By performing continual assessments of a learner’s willingness and capabilities, their education can be individualized and adapted to best meet their needs. However, caution must be made to acknowledge the limitations and pitfalls of the situational leadership model. There are certainly more than four types of learners, and an educator must realize that students can fall under different domains in different circumstances. A more granular approach, taking into account a student’s area of strength or weakness, could more appropriately address these variances.

It should also be noted that, while situational leadership has been used in various aspects of healthcare delivery, real outcomes data on its efficacy are sparse and unconvincing.^3,4 It would be a mistake to take situational leadership, or any teaching philosophy, as an immutable gospel that cannot be deviated from. Rather, a wise educator and leader should study this theory and incorporate it into their vast armament of didactic strategies, wielding it only when it suits the situation at hand. In combination with other teaching strategies, situational leadership can be a powerful tool to make healthcare learning more adaptable, specific, and successful.

References:

1. de Bruin L. Hersey and Blanchard Situational Leadership Model explained: B2U. Business-to-you. https://www.business-to-you.com/hersey-blanchard-situational-leadership-model/. Published March 28, 2020. Accessed August 28, 2022.

2. Hersey P, Angelini AL, Carakushansky S. The Impact of Situational Leadership and Classroom Structure on Learning Effectiveness. Group & Organization Studies. 1982;7(2):216-224. doi:10.1177/105960118200700209

3. Johansen, B.-C. P. (1990). Situational leadership: A review of the research. Human Resource Development Quarterly, 1(1), 73–85.doi:10.1002/hrdq.3920010109

4. Walls, Elaine (2019) The Value of Situational Leadership. Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association, 92 (2). pp. 31- 33. ISSN 1462-2815

The Flipped Classroom

Tiffany Khieu, PharmD

PGY-2 Psychiatric Pharmacy Resident

University of Maryland School of Pharmacy

“We follow a flipped model of instruction,” answered my interviewer at Oregon State University in 2016 after I had asked what made their pharmacy program unique. At the time, I wasn’t too familiar with this approach, but was impressed by what I’ve learned about the model in addition to their graduation rates compared to previous years. According to a review article by Persky et al, “flipping the classroom” is an evidence-based, hybrid, pedagogical approach that enhances student learning, engagement, and critical thinking.1 Moreover, it is described as a combination of technology, pre-class learning and in-class activities compared to traditional lecture-based learning (attending class with no or little knowledge, receive the knowledge via didactic lecture, and complete assignments related to the lecture). As healthcare education moves towards the flipped classroom model, it is important to understand the core elements that make the approach successful and how to apply it into practice.

While lecture-based learning is one of the most common methods utilized in healthcare education, it elicits students to recite or describe facts rather than evaluate or synthesize information.2 Further, it promotes superficial and passive learning, leaving students with insufficient exposure to build their skills and apply their knowledge to real-world settings.3 Flipped-based learning, in contrast, is based on constructivist learning theory that begins with a set of clear learning objectives and supported by activities before, during, and after a lecture. As students progress towards the end the course, they should be able to transfer their knowledge and skills into practice and develop self-regulated behaviors to promote their own learning.

The first and foundational step in a flipped classroom model is establishing clear course objectives that communicates expectations to the students. Without these objectives, students will not connect the relevance of what they are learning to their practice or have guidance throughout the course. Persky et al. further describes objectives should go beyond content knowledge to address practical skills required to be successful beyond a classroom setting. For example, objectives should be relevant to teamwork, communication, and problem-solving skills, as these elements are highly valued in the healthcare field.

After establishing course objectives, pre-class learning assignments is essential in the flipped classroom approach. Compared to traditional learning, this is one of the biggest differences in the flipped model to help students be engaged and develop interpersonal skills. Learners are expected to come into the classroom prepared with baseline knowledge obtained from pre-class readings, either from assigned textbook chapters, narrated PowerPoints, or other video media. Without student preparedness, the flipped model would “fail”, but this failure can also serve as preemptive motivation to self-regulate learning behaviors. For example, a student who comes to class unprepared and is unable to participate in discussion can modulate the amount of time and effort spent in pre-classroom learning for subsequent sessions. This is an advantage for students in the flipped classroom model because it allows autonomy to learn material at their own pace, an intrinsic element in self-determination theory.1 In fact, when pre-class learning is optimized through students’ self-motivation, they can learn up to one-third faster than in an instructor-controlled environment.1 However, it is important to keep in mind the materials assigned and amount of time spent in pre-class assignments for the flipped model to be sustainable and realistic. For example, reading a treatment guideline with new vocabulary may take longer to read and lose students’ motivation to continue learning because of the difficulty level. With this in mind, the importance of obtaining foundational knowledge prior to class additionally teaches learners accountability for preparation and an incentive for in-class learning.

Class time in the flipped learning approach is dedicated to discussions or team-based activities rather than didactic lectures. Its effectiveness is rooted in active-learning, which has demonstrated to cultivate student self-awareness, critical thinking, and collaboration skills.1 In a study of ninety-five fourth year medical students in an ophthalmology clerkship comparing flipped versus traditional teaching, more students in the flipped group agreed that the teaching method improved their clinical thinking and communication skills by completing pre-class assignments but also from increased student-to-student interactions in group discussions.4 Since their dialogue were based on real world examples in the ophthalmology practice, the relevance to their own practice enhanced their motivation to learn, contributing to developing higher order thinking skills. It also reflects a real-life example of communicating with other professionals when a complex case presents itself in their practice. It is important to understand that for these discussions to take place, instructors must be properly trained in facilitation skills through workshops or meeting with experts.1 This should be a consideration for educators who are interested in taking the flipped model approach.

Flipping a classroom is a contemporary pedagogical approach that shifts away from traditional lecture-based learning to a hybrid, comprehensive teaching model that increases student engagement and learning. For it to be successful, course objectives, pre-class assignments, and in-class activities need to be carefully crafted to motivate students to learn and develop their own interpersonal and professional skills. Educators who are interested in the flipped model approach can incorporate some elements of the flipped approach to their current instructional methods before committing to a complete flip. For example, lecture-based learning can still be utilized but enhanced with pre-class readings and in-class discussions. Overall, there are advantages to the flipped classroom approach that may result in long-term benefits, such as long-term retention of knowledge and transfer of skills. It should be considered by passionate instructors who are invested in their students’ knowledge and success.

References:

1. 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.

2. Faisal R; Khalil-ur-Rehman, Bahadur S, Shinwari L. Problem-based learning in comparison with lecture-based learning among medical students. J Pak Med Assoc. 2016 Jun;66(6):650-3. PMID: 27339562.

3. Alaagib NA, Musa OA, Saeed AM. Comparison of the effectiveness of lectures based on problems and traditional lectures in physiology teaching in Sudan. BMC Med Educ. 2019 Sep 23;19(1):365. doi: 10.1186/s12909-019-1799-0. PMID: 31547817; PMCID: PMC6757398.

4. Tang F, Chen C, Zhu Y, Zuo C, Zhong Y, Wang N, Zhou L, Zou Y, Liang D. Comparison between flipped classroom and lecture-based classroom in ophthalmology clerkship. Med Educ Online. 2017;22(1):1395679. doi: 10.1080/10872981.2017.1395679. Erratum in: Med Educ Online. 2017;22(1):1406198. PMID: 29096591; PMCID: PMC5678346.

Teaching Student Pharmacists to Apply Drug Literature

Ji-Yeon ‘Lis’ Kim

PGY-1 Pharmacy Resident

Sinai Hospital of Baltimore (Lifebridge Health)

In 2014, the Joint Commission of Pharmacy Practitioners published the Pharmacists’

Patient Care Process (PPCP).1 It is meant to provide pharmacists with a patient-

centered framework on providing clinical care through five steps: collecting patient

information, assessing patient information, developing an evidence-based care plan,

implementing the care plan, and following up to evaluate the effectiveness of the

plan. When it comes to the third step, developing an evidence-based care plan, it is a

key element for pharmacists to be able to interpret and evaluate medical literature

before applying its findings to a patient.1

Journal clubs are a common learning tool for student pharmacists and have been

utilized in healthcare professional education for over 150 years.2 The main goal is to

discuss medical literature in a group setting with other healthcare professionals,

improve evidence-based practice skills, and bring to attention new drug information

in studies. The focus of journal clubs is usually on the primary article at hand, and

potentially on related pharmacology, general drug information, clinical practice

guidelines, and key prior studies. However, there is a lack of evidence on whether

describing published articles in journal clubs truly help students to integrate the drug

literature evaluation to the care of an actual patient.1

The Manchester University PharmD program set out to assess the impact of drug

literature evaluation activities on pharmacy students’ ability to apply the primary

literature to patient cases. Foundational principles of evidence-based medicine were

taught in two courses in the first professional (P1) year that focused on first

gathering and interpreting information from tertiary drug information sources before

moving on to interpreting primary drug literature. The students further practiced in

their pharmacy practice laboratory (PPL) into their third professional (P3) year to

build on concepts already taught in the didactic curriculum.1

Manchester University transitioned from an ability-based outcomes (ABO) model to

an entrustable professional activities (EPA) model which ensures that learners

become proficient in essential competencies before undertaking them independently.

The didactic courses incorporated active-learning, such as project-based learning,

flipped classroom, and discussion guided by a constructivist approach to pedagogy.1

2-hour case-based article discussions were introduced in their P2 year, and during

class, students engaged in small-group discussion-based activities where they

applied these studies to a patient case. The primary class objectives were for

students to determine whether the study would apply to the patient according to the

inclusion/exclusion criteria and baseline characteristics, and whether results were

statistically and clinically significant to warrant use for the patient. During their P3

year, students engaged in a journal club series to prepare them for APPEs by

continuing to practice evaluating primary literature, use tertiary drug information

sources, and eventually apply to patient cases.1

A longitudinal assessment based on performance and perceptions was conducted by

Manchester University on a cohort of enrolled P3 students. Instructors were

responsible for evaluating the students’ journal clubs based on a standard rubric, and

an electronic assessment was created with multiple-choice/multiple-select questions

on determining whether a study would apply to a patient based on

inclusion/exclusion criteria and baseline characteristics (71.8% selected the correct

answer), whether results were statistically significant (100% selected the correct

answer), and whether results were clinically significant. The last objective used a

multiple-select question, with 62% selecting the three correct answers. Ultimately,

the study found a substantial improvement in pass rate from the initial evaluation to

their final evaluation at the end of P3 semester. Subjectively, an improvement in

self-confidence among P3 students to lead and participate in journal club discussions

was found in a post-intervention assessment.1

The integration of evaluating primary drug literature through journal club activities

into the students’ longitudinal pharmacy curriculum may be helpful in training

student pharmacists to apply future literature to patient cases in healthcare settings.

While journal clubs are traditionally used to discuss emerging literature, there is a

lesser used method of using clinical debates in health education, with both sides

presenting an argument with a rebuttal following and finally a summarization of the

argument at the end. A recent study in 2021 by Steuber et al. conducted a two-year

prospective study in which 50 students participated in a journal club as well as a

clinical debate during their APPE experience.2 The students completed a 10-item

knowledge assessment after each activity.2 After assessment scores were analyzed,

there were no differences between journal club and clinical debate assessment

scores.2

Regardless of the methods used, journal clubs or clinical debates, the ability to

critically evaluate up-to-date information on the treatment for patients is a vital role

for pharmacists on a healthcare team. It is also a skill that is necessary to complete

the Pharmacists’ Patient Care Process, which is a key element of the 2016 ACPE

standards in creating the Doctor of Pharmacy program curricula in using the PPCP in

practice. Therefore, it is crucial for pharmacy curricula to ensure that student

pharmacists are trained and able to demonstrate competence in evaluating literature

and applying the results to patient cases.

References

1. Beckett RD, Henriksen JA, Hanson K, Robison HD. Teaching student pharmacists to apply drug literature to patient cases. American Journal of Pharmaceutical Education. 2017;81(2):34. doi:10.5688/ajpe81234

2. Steuber T, Isaacs AN, Howard ML, Nisly SA. Effectiveness of journal club activities versus clinical debate activities in pharmacy experiential education. American Journal of Pharmaceutical Education. 2021;86(1):8562. doi:10.5688/ajpe8562