PGY2 Psychiatry Pharmacy Resident
University of Maryland School of Pharmacy
Behaviorism, one of the most common learning theories, requires repetition and reinforcement for sustained learning.1 Pharmacy education has traditionally been executed through “silo-like” courses where a single or select few faculty members are responsible for the content.2 A recent survey of faculty members from 94 pharmacy schools regarding curricular integration demonstrated a variety of methods being used such as themed content alignment, skills laboratories, multi-disciplinary case studies and examinations, introductory and advanced pharmacy practice experiences (IPPE/APPEs), capstone course, team-based learning, and performance-based assessments. Out of the schools surveyed, only seven indicated no formal curricular integration between science and practice. In a perception analysis of curricular integration on knowledge-acquisition, high-order thinking, and application to clinical practice (in the case of APPEs), over half of the 145 respondents strongly agreed or agreed that curricular integration improve learner performance in the aforementioned domains.3
Learners also acknowledge the benefits of content integration as demonstrated in a study of pharmacotherapy and evidence-based medicine (EBM) courses aligned over the course of one semester. Instructors coordinated and incorporated landmark trials with cardiology and infectious disease pharmacotherapy courses and evaluated benefit through the ACE (Assessing Competency in Evidence-Based Medicine) tool utilizing data from a non-aligned semester as the comparator and found a statistically significant difference in learner performance in the intervention group. Learners completed both post-assessment and -semester evaluations, the latter evaluating skills gained proportional to time invested and alignment aiding EBM and pharmacotherapy understanding. The majority of learners responding strongly agree or agree (79.6%, 94.2%, and 69.9%, respectively) and 90.3% of learners were in favor of continuing to incorporate landmark trials within pharmacotherapy courses. 4
Data from both faculty and learners supports formal content alignment and curricular integration within pharmacy education, so what is holding us back? Curricular integration exists in multiple forms, such as horizontal, vertical, and spiral integration, the latter combining both preceding methods. Implementation of integration allows for the reinforcement of content over time and progression of learner skills from novice to mastery, further reinforcing the learning theory of behaviorism.1,2 There are many challenges facing curricular integration from both logistical and professional standpoints. As new therapeutics are developed and guidelines updated, the amount of content to be taught in the same amount of time presents a challenge for course designers. Faculty who delivers the content are also faced with the challenge of removing content that is no longer clinically relevant but potentially still important to them. With the degree of content growth, it is imperative for designers to ensure content is not repeatedly rehashed, but rather streamlined through collaboration.2 One method to content integration and streamlining is through team-based learning (TBL).
A defined application of content integration through team-based learning is demonstrated by The Regis Model. This model was designed to integrate “biological, pharmaceutical, social/behavioral/administrative pharmacy and clinical sciences using a teaching methodology that is [learner]-centered emphasizing high-order learning” to meet increasing demands for pharmacy education to shift away from knowledge transmission towards enhanced critical thinking and problem-solving. Learners are organized into small groups in which application-based activities are completed after independent study. Seven courses with sequences are administered over the first three professional years to implement horizontal and vertical integration (which, when combined, exhibits spiral integration). For example, one of the courses, integrated pharmacotherapy (IP), is facilitated by a multidisciplinary team around an individual disease state. After developing learning objectives as a team, faculty utilizes a template for learner resources to cover the following elements: introduction, anatomy, physiology, biochemistry, etiology, presentation, diagnostics, classification, goals of treatment, non-pharmacotherapy, pharmacotherapy (formulation, ADME, interactions, etc.), therapeutic application of EBM, research opportunities, and public health factors (screening, prevention). While the IP course is being administered, learners are concurrently enrolled in integrated laboratory (IL) which provides hands-on activities that align with the disease state being covered in IP – emphasizing horizontal integration. Vertical integration is demonstrated through the introduction of topics earlier in the didactic curriculum then revisited later. The ratio of basic science versus clinical application is also modified based upon the learners’ academic year, focusing more on basic science earlier in the curriculum and clinical application towards the end of didactic training – exhibiting spiral integration.5
In this case of integrated curriculum through team-based learning, we see results complementary to studies previously published. Both learners and faculty agreed there is a positive impact of TBL in the administration of integrated curriculum. Learners demonstrated improved confidence in independent learning, teamwork, critical thinking, an expression of professional opinions while faculty noted enhanced preparedness for class, engagement, and self-responsibility for learning.5
Team-based learning via The Regis Model is just one approach to integrating pharmacy curriculum, however other methods exist. The key takeaway from this discussion is that content alignment and integration of coursework produces more confident, prepared learners who can solve real-world problems in a growingly interprofessional environment, demonstrated through objective improvements in performance during their didactic training.
References
1. Badyal DK, Singh T. Learning Theories: The Basics to Learn in Medical Education. Int J Appl Basic Med Res. 2017;7(Suppl 1):S1-S3. doi: 10.4103/ijabmr.IJABMR_385_17
2. Sun D, Kinney J, Hintz A, Beck M, Chen AMH. Advancing Pharmacy Education by Moving From Sequenced "Integration" to True Curricular Integration. Am J Pharm Educ. 2023;87(6):100056. doi:10.1016/j.ajpe.2023.100056
3. Poirier TI, Fan J, Nieto MJ. Survey of Pharmacy Schools' Approaches and Attitudes toward Curricular Integration. Am J Pharm Educ. 2016;80(6):96. doi:10.5688/ajpe80696
4. Bowers BL, Sperry M, Englin EF, Wombwell E. Evidence-Based Medicine and Pharmacotherapy Content Alignment [published online ahead of print, 2023 Jun 28]. Am J Pharm Educ. 2023;100554. doi:10.1016/j.ajpe.2023.100554
5. Nelson M, Allison SD, McCollum M, et al. The Regis Model for pharmacy education: A highly integrated curriculum delivered by Team-Based Learning™ (TBL). Curr Pharm Teach Learn. 2013; 5(6): 555-563. doi:10.1016/j.cptl.2013.07.002
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