Interprofessional Education: Where Have We Been and Where Are We Going?

Christopher Medlin, PharmD

It’s probably safe to say that most pharmacy students in modern times know what it’s like to attend an interprofessional training session as part of their school or college curriculum. You meet in a classroom with social work, nursing, and medical students (and sometimes others), discuss a patient case or clinical scenario, develop a plan together, and frankly, you learn how much you don’t know about the other healthcare professions. To up and coming pharmacists, interprofessional education may seem like a given part of any curriculum of a school or college of pharmacy, but it’s important to recognize the evolving role of multidisciplinary training in a rapidly evolving profession such as pharmacy.

Interprofessional education (IPE) is “when students from 2 or more professions learn about, from, and with each other to enable effective collaborations and improve health outcomes.”¹ The need for interprofessional and interdisciplinary learning in the health professions began decades ago and continues to shape the landscape of pharmacy education. There has been a historical lack of understanding between different health professions, which has led to misconceptions about professional responsibilities, misunderstandings about healthcare knowledge, and malfunctioning of the healthcare team.² There have been many studies, task forces, and committees dedicated to IPE over a couple of decades, but the general consensus is that a well-functioning, cooperative healthcare team leads to better patients outcomes³, which should be a universal desire of all health professions. Additionally, with new accreditation standards demanding that performance on an interprofessional healthcare team be taught⁴, many schools and colleges of pharmacy have re-evaluated and modified curricula to reflect current standards.  That being said, there will likely be a staunch increase in IPE education and training sessions in pharmacy schools across the country.

While there are multiple ways to conduct an IPE training, what seems to be agreed upon is that IPE competencies must be built upon over time and integrated throughout health professions curricula.⁵ IPE courses tend to consist of multiple learning modalities combined, including lectures, role-plays, case studies, and discussions.⁶ Assessment of learning outcomes and objectives is a major priority for advocates of IPE training and may be done in several ways, including the validated 19-item Readiness for Interprofessional Learning Scale (RIPLS) scale, and the British 12-item Interdisciplinary Education Perception Scale (IEPS).⁷

The presence of primary literature surrounding the effectiveness of IPE is not expansive, but there are many pilot IPE programs that have been shown to demonstrate changes in student and patient attitudes about the differing health professions and function of the healthcare team. These pilot programs range from pediatric prescribing⁸ to diabetes management⁹, each of which demonstrated improved student knowledge and understanding about the specific topic, as well as development of interprofessional teamwork and communication strategies.^8.9 An additional study utilized reflective prompts, discussion seminars, and presentations to increase student understanding on a vulnerable population’s healthcare needs. This study gathered quantitative and qualitative student participant input that was positive and indicated an increased understanding of interprofessional team functioning in order to address health disparities within their community.¹⁰

          Regardless of study findings and the differing techniques for effectively teaching in IPE, it is clear that a paradigm shift in pharmacy education has started and continues to make waves in schools and colleges of pharmacy across the United States. In fact, a 2011 survey of all schools and colleges of pharmacy indicated that 78% include written interprofessional curricular goals and 70% use subjective IPE outcomes in Introductory Pharmacy Practice Experience (IPPE) assessments.¹¹ Similar trends can be seen in nursing and medical schools, a vast majority of which conduct IPE activities and teach IPE competencies.¹² Staying up to date with current educational practices and following evidence-based techniques for educating students on interprofessional practice should be a focus of curricula across the country as we shift toward outcome-centered care and expansion of services provided by pharmacists. After all, we should be focused on providing better outcomes for our patients, and it seems as though IPE might be a promising step towards accomplishing that goal.

References:

1. World Health Organization. Learning together to work together for health. Report of a WHO study group on multiprofessional education of health personnel: the team approach. World Health Organ Tech Rep Ser. 1988;769:1–72.

2. Poirer S, Lipetz M. Pharmacy in interprofessional education: a course on images of the health professions in the media. Am J Pharm Educ. 1987 Summer;51(2):133-7.

3. Buring SM, Bhushan A, Broeseker A, et al. Interprofessional Education: Definitions, Student Competencies, and Guidelines for Implementation. Am J Pharm Educ. 2009;73(4):59.

4. Accreditation Council for Pharmacy Education. (2016). Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Retrieved from https://www.acpe-accredit.org/deans/StandardsRevision.asp

5. Poirier TI, Wilhelm M. Interprofessional Education: Fad or Imperative. American Journal of Pharmaceutical Education. 2013;77(4):68. doi:10.5688/ajpe77468.

6.  Meyer SM. The Imperative for Interprofessional Education. Am J Pharm Educ. 2009;73(4):58.

7.  Lie DA, Fung CC, Trial J, Loheny K. A comparison of two scales for assessing health professional students' attitude toward interprofessional learning. Med Educ Online. 2013 Jan;18(1):21885. doi: 10.3402/meo.v18i0.21885.

8.  Taylor D, Yuen S, Hunt L, Emond A. An Interprofessional Pediatric Prescribing Workshop. Am J Pharm Educ. 2012;76(6):111. doi:10.5688/ajpe766111.

9.  Pittenger AL, Westberg S, Rowan M, Schweiss S. An Interprofessional Diabetes Experience to Improve Pharmacy and Nursing Students’ Competency in Collaborative Practice. Am J Pharm Educ. 2013;77(9):197. doi:10.5688/ajpe779197.

10. Hasnain M, Koronkowski MJ, Kondratowicz DM, Goliak KL. Training Future Health Providers to Care for the Underserved: A Pilot Interprofessional Experience. Educ Health. 2012;25:204-7.

11. Jones KM, Blumenthal DK, Burke JM, et al. Interprofessional Education in Introductory Pharmacy Practice Experiences at US Colleges and Schools of Pharmacy. Am J Pharm Educ. 2012;76(5):80. doi:10.5688/ajpe76580.

12.  West C, Graham L, Palmer RT, et al. Implementation of interprofessional education (IPE) in 16 U.S. medical schools: Common practices, barriers and facilitators. Journal of Interprofessional Education & Practice. 2016;4:41-49. doi:10.1016/j.xjep.2016.05.002.

Theory of Learning for a Mobile Age

By Ian Booth, PGY-1 Pharmacy Practice Resident, University of Maryland Medical Center

        The idea of learning and cognitive development across different generations is a difficult concept to assess, given the multitude of digital technologies that are accessible. In the current educational system, there is a need for separation of what could be considered as two different groups: new millennium learners (NMLs) and old millennium learners (OMLs).¹ Through my experience in higher education, with a wide range of learners, finding differences between their development, in what could be identified as the “mobile age”, can be very important. Learning is now heavily dependent on mobile devices, such as phones, tablets, audio players, etc., and the OMLs may be at a significant disadvantage.¹ In my experience through the educational system, I have seen this transition into technology dependence. In this blog, I will be discussing ways in which mobile learning has progressed over time.

Accessibility

        I believe the first issue that needs to be addressed before focusing on the idea of incorporating mobile learning into an educational theory is the accessibility of electronics. In a survey in 2003 in the UK, they found that over 75% of the population, and 90% of young adults owned mobile devices.² This may overestimate the general population, especially in different areas of the world with less socioeconomic capabilities.¹ Not all learners have the means to use these types of devices through their education, which can make their learning more difficult. With the cost of electronics increasing year after year, during a time where the learners are not able to support themselves, can cause significant impacts to their growth. Although many people may incorporate this idea of learning into their everyday routine, the lack of accessibility can impact someone else’s ability to reach those same expectations.

Is technology mobile, or the learner?

Although we know that technology has advanced progressively over time, and most likely will continue to do so, consideration into the learners schedule is an important concept. People are continuously on the move throughout the day, thus learning takes place all the time. The idea of classroom only learning is no longer applicable, and is something that OMLs may not be used too.¹ With the variety of access to mobile devices, NMLs are able to take learning and organization to a completely different level, and thus are at an advantage.

I think a key example of this is the use of Google and the internet. Researching the answer to a question is now at the tip of our fingers, with a quick search online, where this was not always possible. Learning the answer to a question required a book, which usually required a library. Now the library is right in our technology, whenever we need it.³ As for organization, now we have the capability to have an up to date calendar, integrated within your own schedule, but also other peoples as well, in order to know exactly what is planned at all times. Calendars can be linked to phones, computers, tablets and desktops, making accessibility easier than ever before. This allows learning to be incorporated into all activities of daily life, which also compliments the idea of formal education.¹ Having access to “mobile learning” is a concept that OMLs have had to become used to, where NMLs were raised in a world of this being second nature.¹ This can be a difficult concept to grasp for many OMLs.

Relationship of Mobile Learning to Cognitive Development

        One of the statements from the authors that I felt explained the use of this concept the best was, “mobile learning can be an opportunity to bridge the gulf between formal and experiential learning, opening new possibilities for personal fulfilment and lifelong learning.”¹ Creating this bridge between education that is moving toward a “mobile age” and incorporating it into lifelong learning is something that sticks out the most with this concept. In a profession like pharmacy, where continuous learning is the most important thing we can do, incorporating both mobile and lifelong learning into our daily lives is extremely important, yet also very challenging to do. The practice of pharmacy is an evolving field, just like the theories of education, and I think that combining these aspects of mobile and lifelong learning into our daily lives, as well as understanding the deficits that certain learners may experience with them, will make us better practitioners, educators, and also learners throughout our whole careers.

References

1.   Taylor J. Digital Technologies and Cognitive Development. Paper Presented at MLEARN 2005. Accessed August 26, 2018.

2.   Crabtree J, Nathan M & Roberts S. MobileUK: Mobile phones and everyday life, 2003. London: The Work Foundation; 1-53.

3.   Sharples M. Learning As Conversation: Transforming Education in the Mobile Age. In Proceedings of Conference on Seeing, Understanding, Learning in the Mobile Age, 2005; 147-152.

Procrastination

Procrastination

Lisa Chen, PharmD
PGY1 Pharmacy Practice Resident
Adventist HealthCare Shady Grove Medical Center

Procrastination is something everyone has done at some point or another. It can have direct consequences on productivity at work, at school, or at home.1-3 Some people may be affected by it more or less than others. It can happen with anything from delaying everyday life tasks such as cleaning the house or washing the dishes to putting off writing a paper or studying for an exam. Sometimes procrastinating studying for the exam leads one to actually clean the house or vice versa. But what is procrastination? Merriam-Webster defines “procrastinate” as “to put off intentionally and habitually” something that “should be done.”4 Everyone procrastinates at some point, but not everyone is a chronic procrastinator.

There are many theories and scientific explanations for why procrastination occurs and why people have varying degrees of procrastination. A 2016 TED talk by blogger Tim Urban breaks it down into an extremely simple and (sadly) comedic model.5 In his talk, Urban compares a non-procrastinator’s brain to that of a procrastinator. A non-procrastinator’s brain has a “rational decision-maker” (RDM) at the helm of the ship making sensible decisions from day to day to get work done. A procrastinator’s brain, on the other hand, has an “instant gratification monkey” (IGM) who only cares about maximizing pleasure and fun in the present moment. In a procrastinator’s brain, the instant gratification monkey and rational decision-maker are constantly struggling for control of what you should be doing, resulting in a sort of purgatory that Urban denotes as the “Dark Playground”. The IGM is telling you to have fun and look at this video here or check out that social media post there, while the RDM is trying to pull you back to the task at hand to be completed. In the meantime, feelings of pleasure, guilt, self-hatred, and more are all mixed together into a complex smorgasbord of emotions because you’re “wasting time” enjoying leisurely activities that you haven’t “earned”. Finally, when there is imminent danger of a due date, for example, a final character that Urban calls the “Panic Monster” awakens. The only thing the IGM is afraid of is the Panic Monster, so, when it awakens, the RDM is able to regain control and allow the task at hand to be completed. However, when this series of events occurs, the completed product is often subpar or below the quality that the procrastinator had the potential to produce had they not allowed the IGM to take over.

There are a number of questions to be asked. Why are there some people who have this instant gratification monkey in their head? How can procrastinators allow the rational decision-maker to be in control more often than not? In what ways might procrastination be a positive asset? Does making a habit of procrastinating at school or work lead to procrastination in daily life or vice versa? What skills can educators use in the classroom to help students avoid procrastination? We could come up with a very, very long list of questions related to this topic; however, I would like to address just a few that would be more important for instructors and the classroom, as these are more relevant to the contents of this course.

First, why do some students fall into the vicious cycle of procrastination? The American Psychological Association provides a list of 15 procrastination rationalizations, at the top of which are ignorance, skill deficiency, apathy/interest, and fixed habits.6 Procrastination has also been classified into different types as well, such as dysfunctional/passive form and positive/strategic/”active” form.1,7,8 The dysfunctional/passive form is your “traditional” sense of procrastination that we are all familiar with: tasks are not completed due to indecision and unintentional delay. Reasons for these types of delay include feeling of inadequacy, lack of self-control for instant gratification and impulsivity, and even fear that success will raise others’ expectations of the procrastinator.9,10 On the other hand, “active procrastination” has been used to describe those who choose to delay tasks intentionally.8 These individuals seem to prefer to work under pressure because they believe that they achieve better results under a certain level of stress. One study showed that these active procrastinators delayed tasks to the same degree as passive procrastinators, but were more similar to non-procrastinators than passive procrastinators in terms of use and control of time, coping mechanisms, perspective of self-efficacy, and outcomes such as academic performance.8 Procrastinators may fall anywhere in between these two types of procrastination, but it is the true passive, habitual procrastinators who need the most help and motivation from themselves, instructors, or other people in their lives.

Second, what effects does procrastination have on academic performance, lifestyle, and personal satisfaction and achievement? The meta-analysis by Steel suggested procrastination may lead to negative academic performance such as lower grade point average, exam scores, and assignment grades.1,2 It can also negatively affect physical, mental, and social health, with procrastinators reporting higher levels of stress, anxiety, depression, illness, delayed treatment, loneliness, and more.2,3 Professionally, procrastination has also been found to negatively affect employment status, duration of employment, and income level.2 Clearly, the disadvantages outweigh potential short-term, pleasurable benefits of procrastination.

As such, what can we do, then, as educators to help students minimize procrastination and maximize time and task efficacy? As mentioned above, one major rationale for procrastination is feeling of inadequacy. As educators, we can use different styles of teaching to better understand each student and learn where they stand on the learning curve. Rather than pure lecture style, perhaps using more of a facilitator or delegator teaching style will allow educators to move around to different groups and different students more readily, providing a better environment for assessing each student. Granted, this may be more difficult for large university classrooms with hundreds of students, but for pharmacy classes of 80-150 students, this is usually manageable. Next, as Urban points out in his TED talk and as a study by Ariely and Wertenbroch showed, externally imposed deadlines allow procrastinators to complete tasks more readily than if students are free to establish self-imposed deadlines.5,11 While adding deadlines may seem more overwhelming for students and teachers alike (more assignments, more grading, etc.), actually setting and reinforcing hard deadlines for long-term projects can help students stay on track in the long run and complete projects throughout the course—much like with our Self-Directed Learning Project. Another method to engage students and keep their interest in various topics and assignments is to design non-traditional classrooms and activities, such as team-based learning or use gaming as a learning tool. One method that could be especially beneficial is using simulation software to lead them through various clinical scenarios as they might occur in real life inpatient, outpatient, retail, or other non-traditional environments. This was used in my therapeutics classes during pharmacy school.

Procrastination is a very real problem that affects everyone at some point in life. For the chronic procrastinators, the detrimental effects can take a toll on academic performance, employment, and personal well-being. As educators, we have the opportunity to engage students in a lively classroom and motivate them to complete tasks and assignments. The design of a course and each class session are crucial to maintaining interest, boosting confidence in abilities, and keeping students on track for success. Why wait?


References

1. Steel P. The nature of procrastination: a meta-analytic and theoretical review of quintessential self-regulatory failure. Psychol Bull. 2007;133(1):65-94.
2. Beutel ME, Klein EM, Aufenanger S, et al. Procrastination, Distress and Life Satisfaction across the Age Range - A German Representative Community Study. PLoS One. 2016 Feb 12;11(2):e0148054.
3. Tice DM, Baumeister RF. Longitudinal Study of Procrastination, Performance, Stress, and Health: The Costs and Benefits of Dawdling. Psychol Sci. 1997;8(6):454-458.
4. procrastinate. 2017. In Merriam-Webster.com. Retrieved October 25, 2017, from https://www.merriam-webster.com/dictionary/procrastinate
5. Urban, T. (2016, February). Tim Urban: Inside the mind of a master procrastinator [Video file]. Retrieved from https://www.ted.com/talks/tim_urban_inside_the_mind_of_a_master_procrastinator
6. The top 15 procrastination rationalizations. gradPSYCH. 2010;8(1):17.
7. De Palo V, Monacis L, Miceli S, et al. Decisional Procrastination in Academic Settings: The Role of Metacognitions and Learning Strategies. Front Psychol. 2017;8:973.
8. Chu AH, Choi JN. Rethinking procrastination: positive effects of "active" procrastination behavior on attitudes and performance. J Soc Psychol. 2005 Jun;145(3):245-64.
9. Kim J, Hong H, Lee J, Hyun MH. Effects of time perspective and self-control on procrastination and Internet addiction. J Behav Addict. 2017;6(2):229-236.
10. Novotney A. Procrastination or 'intentional delay'? gradPSYCH. 2010;8(1):14.
11. Ariely D, Wertenbroch K. Procrastination, Deadlines, and Performance: Self-Control by Precommitment. Psychol Sci. 2002;13(3):219-224.

Global Competence: An Emerging Trend in U.S. Education

Global Competence: An Emerging Trend in U.S. Education

Lola Omopariola

The U.S. public school system is rapidly approaching a new demographic era. In 2014, minority student enrollment in public schools rose to approximately 50.3%, which is a dramatic increase from 38% in the previous decade.1 This demographic shift translates to today’s classrooms consisting of multiple ethnic groups, religions, and spoken languages. 

Today, more than ever, it is essential for students to have the ability to collaborate with others from various cultures and understand the world from different perspectives. Students must be knowledgeable about current world affairs and socioeconomic issues that are impacting the globe beyond the borders of the United States. The concept of global competence is an emerging trend in 21st century education, ranging from elementary to graduate school.2 Global competence is an effort to equip students with the knowledge and tools necessary to develop a deeper understanding of the world’s economic, social, and political issues. This knowledge and skillset prepares students for life and employment in culturally diverse societies. 

Global competence is defined by the National Education Association (NEA) as the acquisition of in-depth knowledge regarding international issues, the ability to appreciate and learn from others from diverse cultural backgrounds, proficiency in a foreign language, and the ability to compete on a global level.2 In their policy brief on global competence education, The NEA notes several valid reasons why the concept is imperative in today’s society. Not only is American society becoming more culturally diverse, but the economy of the U.S. is also becoming more globally connected. An estimated one in five US jobs is connected to international trade, and that number will only continue to rise in the future.3 Furthermore, global challenges continue to emerge, including global health, natural disasters, global warming, and poverty. The ability to respond to these challenges requires an understanding of other cultures and languages to communicate effectively. 

The Organization for Economic Co-Operation and Development (OECD) proposed a framework for global competence which is divided into four dimensions – knowledge and understanding, skills, attitudes, and values.4 The first dimension requires the knowledge and understanding of intercultural and global issues. The next dimension includes several essential skills, such as the ability to communicate in more than one language, being able to effectively communicate with people from diverse cultures and other countries, and the ability to comprehend other people’s thoughts and beliefs in order to see the world from a different perspective. The third OECD dimension includes the attitudes of openness towards people from other cultures, respect for others, and a responsibility for one’s own actions. Finally, the last dimension requires valuing human dignity and cultural diversity.  

Although set standards for global competence are not yet officially adopted in most schools’ curricula, today’s educators are already incorporating the concept in their instructional methods. For example, this may be achieved by lesson plans about various cultural festivals, climate change, and expanding the teaching of foreign languages. AFS-USA (formerly the American Field Service) is a non-profit leader in intercultural learning. The organization has developed a “Teacher’s Toolbox” consisting of lesson plans for educators to adopt which relate to global competence.5 The toolbox includes comprehensive lesson plans on various world topics such as human rights, cultural studies, global awareness, and intercultural learning. The AFS-USA website also includes several key global competency resources for additional information. These tools are great sources for educators looking to incorporate the concept of global competence in the classroom today.    

Global competence is an exciting new field in education that will only continue to grow in the coming years. When implemented systematically, it will have the ability to surmount cultural barriers and enhance student achievement both inside the classroom and out. 

References:

1. Badger E. The rapid demographic shift of American public schools. The Washington Post. 2014. Accessed Oct 21 2017. Available from: https://www.washingtonpost.com/news/wonk/wp/2014/08/18/the-rapid-demographic-shift-of-american-public-schools/?utm_term=.36680199931d

2. National Education Association Policy and Practice Department. 2010. Global competence is a 21st century Imperative. Accessed Oct 21 2017. Available from: http://www.nea.org/assets/docs/HE/PB28A_Global_Competence11.pdf 

3. U.S. Census Bureau. Exports from manufacturing establishments.

2005. U.S. Department of Commerce, Washington, DC. Accessed Oct 21 2017. Available from: www.census.gov/mcd/exports/arp05.pdf 

4. The Organization for Economic Co-Operation and Development. 2016. Global competency for an inclusive world. Accessed Oct 21 2017. Available from: https://www.oecd.org/education/Global-competency-for-an-inclusive-world.pdf

5. AFS-USA. 2017. Teacher’s Toolbox. Accessed Oct 21 2017. Available from: http://www.afsusa.org/educators/teachers-toolbox/