The use of electronic health records (EHR) technology in pharmacy curriculum

Megan Fuller, PharmD, MS

PGY-1 Pharmacy Resident

University of Maryland Prince George's Hospital Center

Learning to navigate through an electronic medical record (EHR) can be daunting for any student and while becoming proficient in healthcare technology is a must for those pursing certain careers in healthcare, it takes time and practice in order to fully become comfortable navigating through different systems and networks. 

Medication reconciliation is one of the National Patient Safety Goals set forth by The Joint Commission1. It is defined as a process of comparing the medications a patient is taking (or should be taking) with newly ordered medications1. Poor, or lack of, medication reconciliation constitutes a significant risk for medication discrepancies that can result in adverse drug events, and it has been shown that pharmacist involvement in admission and discharge medication reconciliation can significantly reduce medication errors. However, this requires students not only know how to appropriately gather information, but to also understand how to effectively navigate through electronic health technology as well. 

The goal of meaningful use technology is to improve clinical outcomes by reducing errors related to the patient’s medications through the use of electronic health records (EHR) technology2. In an era where 95% of critical access Medicare hospitals participate in meaningful use technology, and Medicare and Medicaid programs have now offer financial incentives to hospitals and providers that utilize meaningful technology, it is essential for pharmacy students to have exposure to electronic health records (EHR) technology prior to graduating given its high use in the real world2. While advanced pharmacy practice experiences (APPEs) provides students access to EHR technology throughout the year, students are extremely limited given they cannot legally perform final verification checks and the concern for patient safety and privacy, which is where simulation and order verifications activities can bridge the gap2.

Simulation exercises have the potential to provide a more in depth learning experience for students, which has the impact to improve learning outcomes and enhance performance for students not just on APPEs, but also in the classroom. Prior to EHR simulations, many students had reported feeling inadequate with regards to EHR technology. For example, a University reported that approximately 70% of their pharmacy students had stated having some experience in using HER technology, but still possessed low confidence when having to perform typical pharmacist duties3. 

Previous studies on EHR technology in pharmacy describes its use primarily for collecting subjective and objective data in order to develop assessments and plans for SOAP notes2. In 2019, the American Joint Task Force on Informatics (AACP) recognized that EHR technology played a vital role in the pharmacy curriculum and could be used as a tool to ensure new pharmacy graduates are prepared for their duties when “Fulfilling a mediation order4.” 

Recent studies have taken a closer look at EHR simulations to determine their effectiveness in the pharmacy curriculum. In 2018, a prospective study conducted in a cardiovascular therapeutics course set out to evaluate the impact virtual EHR technology had on students capabilities compared to patient based scenarios alone. Students were randomized to use a virtual EHR with patient simulation or to a patient simulation alone. The efficiency of learning was assessed by the time to optimal recommendation for each scenario. The use of the virtual EHR decreased the amount of time needed to provide the optimal treatment recommendations by 25% compared to the control2. The virtual EHR also significantly improved students’ perceptions of their clinical skills, communication, and satisfaction compared to the patient simulation alone2. The virtual EHR established value in learning productivity while also providing students the opportunity to engage with technology comparable to the technology in today’s health care practice2. 

There have been various studies at other institutions, such as McWhorter School of Pharmacy, Concordia University Wisconsin, and even the University of Maryland that have all demonstrated significant changes in performance and confidence in pharmacy students after exposure to simulated EHR technology5. As the field of pharmacy and healthcare continues to change and become more technologically advanced it is crucial that the pharmacy curriculum takes every opportunity to ensure its students can keep up with an ever changing field. 

References:

1. Barnsteiner JH. Medication Reconciliation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 38.

2. Ives AL, Tucker SR, Trovato JA. Using Electronic Health Record Technology to Teach Inpatient Medication Order Verification to Pharmacy Students. Am J Pharm Educ. 2020;84(8):ajpe7534. doi:10.5688/ajpe7534

3. Coons JC, Kobulinsky L, Farkas D, Lutz J, Seybert AL. Virtual Electronic Health Record Technology with Simulation-Based Learning in an Acute Care Pharmacotherapy Course. Pharmacy (Basel). 2018;6(4):123. Published 2018 Nov 28. doi:10.3390/pharmacy6040123

4. Haines ST, Pittenger AL, Stolte SK, et al. Core entrustable professional activities for new pharmacy graduates. Am J Pharm Educ. 2017;81(1):ArticleS2

5. Skelley JW, Wulz JL, Thibodeaux AM. Implementation of an electronic medical record simulation activity aligned with the Pharmacist Patient Care Process in an ambulatory care elective course. Pharm Educ. 2018;18(1)91-98

Breaking the Cycle of Imposter Syndrome

Samantha Minnick, PharmD 

PGY2 Pharmacy Resident 

Children’s National Hospital

Have you ever felt as though you don't deserve to have your career or educational success? Potentially doubted your own knowledge or skillset; waiting for those around you to discover you're an "imposter" among the group? Like you are waiting for the shoe to drop and be "discovered" for who you really are? If you can relate to any of these concepts you may have experienced a phenomenon called imposter syndrome.

im·post·er syn·drome: (noun Psychology) 1. anxiety or self-doubt that results from persistently undervaluing one's competence and active role in achieving success, while falsely attributing one's accomplishments to luck or other external forces.¹

Pauline Rose Clance and Suzanne Imes from Georgia State University first described "imposter phenomenon" in 1978 through their work in psychotherapy with highly educated women who possessed PhD's, scholastic honors or were respected professionals in their field of work.² They discovered a trend where these women, albeit very successful, did not possess an internal sense of success. They frequently described feeling like an "imposter", being wrongfully admitted to a graduate program, strongly feeling as though they were not as intelligent as others praised them to be and that their success was from luck alone. These women were more likely to project their successes onto a temporary quality or an external factor such as "good timing" or "luck", where men were more likely own their success and experience this imposter phenomenon both less frequently and with less intensity. The authors deemed this imposter phenomenon was mostly plaguing middle class, white women who were high achieving and well accomplished when compared to men.² As the years went on Clance and other researchers acknowledged that these feelings of self-doubt and being underqualified were not unique to women and also affected men at similar rates.³  

Imposter syndrome also affects instructors, specifically higher education instructors, instructional designers and those within an academic system. Kristi Owens, an Idol Courses academy member and instructional designer, conducted an anonymous survey across LinkedIn and Facebook to determine how many other shared the feelings of Imposterism she so frequently felt despite 15 years of experience in education.⁴ The survey population included those from higher education, finance, healthcare, corporate and government job settings to name a few. Nearly 40% of the study population had functioned as an instructional designer for 5 to >10 years, another 40% had practiced for 1-5 years. The results showed that 2/3 of instructional designers who were surveyed reported feeling Imposterism at least once per month.  Those in healthcare instructional design reported feeling Imposterism once per week (30%) or every day (~40%). This group had the highest percentage of experiencing feelings of Imposterism every day.⁴ This is a pivotal statistic to consider as a group of learners actively pursuing a role in instructional design within a healthcare setting. If we ourselves are struggling with feelings of self-doubt or lack of belief in our success it could be extremely difficult to provide the confidence and support we need for our learners.

Maqsood and colleagues presented a cross sectional analysis in the International Journal of Research of Medical Sciences in 2018 to evaluate the frequency and severity of imposter syndrome experienced by medical students to assist in improving teaching and learning methodologies.⁵ The Clance Imposter Phenomenon Scale was used to assess the severity of imposter syndrome among participants. This scale helps to identify common behaviors or thoughts that are seen in imposter syndrome such as perfectionism, fear of failure, overworking and saying phrases such as "I just got lucky" to discredit their achievements. A total of 189 (94.5%) students completed the questionnaire, 38% had moderate severity and 54.5% had severe imposter syndrome. Male students accounted for a larger percentage in both the moderate and severe categories (70.8% and 68.9%) compared to women. Which is an interesting statistic when comparing the rates of imposter syndrome to the original research of Clance and Imes. Imposter syndrome in the setting of medical training can alter learning styles, student participation when compared to those unaffected and reduce the efficiency of a learners work or lead to burnout.⁵ Pharmacy students have only been explicitly described within one study from Henning et al, that surveyed a multidisciplinary school which included nursing, medical and pharmacy students. This study reported 30% of that surveyed reported experiencing imposter syndrome.⁶       

As educators and high achieving members of our fields we have the opportunity to assist our learners in identifying these feelings and providing resources for them to combat these feelings of self-doubt. Much of the recent research surrounding imposter syndrome does provide resources on how to identify and combat feelings of imposter syndrome as instructors, for ourselves and our learners. Some opportunities to overcome imposter syndrome as an educator is to change our own narrative; to tell ourselves instead of "I don't know anything" but rather "I may not know this, but I am capable of finding the answer".⁷ Another opportunity is to use the resources we all have readily available; be it literature, group forums, colleagues or past mentors. This will allow you to explore information you may already know or to find answers you knew you needed. For our learners, it will be crucial to recognize the student population we are engaging with and to recognize the possibility for feelings of imposter syndrome and to design classes or educational opportunities that directly work against behaviors we have discussed above that reinforce imposter syndrome. Examples could include; working in smaller groups to ease the fear of being incorrect, focusing on strengths of the learners to build confidence and a rapport rather than being solely critical of mistakes and to encourage discussion that will allow for a collaborative thought process between peers that can empower those with more self-doubt. By advancing the conversation surrounding imposter syndrome, it will bring with it an increased awareness and an increased acknowledgement of what changes need to occur to break the cycle of these intrusive and self-doubting thoughts.

References

1. Dictionary.com; https://www.dictionary.com/browse/impostor-syndrome

2. Clance PR, Imes S. The imposter phenomenon in high achieveing women: dynamics and therapeutic intervention. Psychotherapy Theory, Research and Practice. 15(3): 1978

3. Dalla-Camina M. The Reality of Imposter Syndrome. Psychologytoday.com. Sep 03, 2018.

4. Olivia K. Do you feel like an imposter? You're in good company. Idolcourses.com. Aug 2020 https://www.idolcourses.com/blog/Imposter

5. Maqsood H et al. The descriptive study of imposter syndrome in medical students. Int J Res Med Sci. 6(10): 3431-3434. 2018

6. Boyle JA, Bonenfant SE. The fear of being found out in pharmacy: how imposter syndrome may be holding us back. Pulses. Published: Jul 23, 2019.

7. Schock G. How imposter syndrome affects students - and instructors. Today's Learner/ Insight for Educators. https://todayslearner.cengage.com/how-imposter-syndrome-affects-students-and-instructors/

Standardized Testing and Predictions for Success in Pharmacy Education

Marisa Rinehart, PharmD

PGY-1/PGY-2 Pharmacotherapy Resident

University of Maryland School of Pharmacy

Standardized testing is an overwhelmingly large part of the American education system. The first form of standardized testing dates back to 1845 as a part of the educational reform that occurred during this time period. Utilization of standardized testing took off in the era of war, as a way to categorize the US military members in World War I. Around the same time, the approval of standardized testing by the National Education Association led to a rapid increase in the development of these assessments. Later in 1935, the invention of scoring machines drastically improved efficiency and decreased costs of tests, further increasing their popularity. Under the Reagan administration, the need for educational reform became a political topic, leading to the passing of many “reforms” that we have today, i.e. No Child Left Behind and Race to the Top. The one common factor that can be seen in all of these education reforms, is the focus on assessing math and reading through standardized testing. It is through these test scores that students are able to be compared.1

On the basis of comparing students, standardized testing is the simplest and easiest formula to use, however it’s not a perfect system. The limitations stem from the lack of evidence supporting standardized tests as an effective measure of learning, as well as the inequality when looking at differences in resources. On the reverse side, these scores allow schools to compare their student bodies and in theory help to motivate students to perform better.2 The standardized tests that come to mind when relating this concept to pharmacy school are the Pharmacy College Admission Test (PCAT), the Pharmacy Curricular Outcomes Assessment (PCOA) and the North American Pharmacist Licensure Examination (NAPLEX). The PCAT exists to determine an individual's likelihood of success in the science based curriculum of pharmacy school. There is no “passing score” for this exam, rather colleges have the flexibility to set their own minimum score for admission applications.3 The PCOA is used to assess students’ knowledge obtained in pharmacy curriculum, and is used in accreditation.4 The NAPLEX was created to determine if pharmacy school graduates are competent enough in the profession to gain a license and practice as a licensed pharmacist.3

The three of these exams have been included in many studies assessing outside factors that can help to predict scores, ultimately attempting to predict passing of the NAPLEX.3-6

Firstly, when looking at the PCOA and PCAT, an article published in the American Journal of Pharmaceutical Education showed that higher PCAT scores, higher undergraduate science GPA and higher cumulative pharmacy GPA correlated to higher PCOA scores. Interestingly, when looking at those who struggled academically, there was a negative correlation (lower PCOA scores) for those students who had academic issues that required them to appear before the college’s progression committee but were not required to repeat course content when compared to those with no academic issues. For the student who repeated course content, their scores did not significantly differ from students with no academic issues.4 

Next let’s take a look at NAPLEX pass predictors. Both higher GPAs and PCOA scores are associated with passing NAPLEX scores. Appearing before the academic review committee, as well as repeating didactic courses is associated with decreased likelihood of passing the NAPLEX. There are also demographic factors that play into NAPLEX pass rates. First-time pass rates are higher in universities within academic health centers, universities established before 2000, public universities, and universities utilizing traditional (4 year) structures.4-6 One of the most significant results from this literature I found was that the success of students who match for PGY1 residency is a strong predictor of first-time NAPLEX pass rates.5 As all of this literature is fairly recent (published in or after 2019), I am interested to see what further studies surface in this area, and if and how pharmacy curriculum changes as a result.

This information can be used in many ways by pharmacy school educators. Overall, our goal is always the success of our students. With these shown correlations, modifications to curriculum can be made to better prepare students for success. Secondly, knowing that those who struggle academically have poorer chances of success can prompt intervention at an earlier time for these students. By having these trends, it allows us as educators to identify those students who may be struggling, intervene, and possibly change the outcomes. By knowing what factors have a negative impact on pass rates, universities as a whole can then modify curriculum to address these factors.

References:
1. Maranto, J. H. (2015). The effect of standardized testing on historical literacy and educational reform in the U.S. academic leadership. Journal in Student Research, (3).
https://files.eric.ed.gov/fulltext/EJ1062724.pdf

2. Kamenetz, A. (2015). The test: Why our schools are obsessed with standardized testing— but you don't have to be. New York, NY, US: Public Affairs Books.

3. Laurenzo, A. (2009). PCAT and NAPLEX: An Overview. US Pharm, (34), 9-11. https://www.uspharmacist.com/article/pcat-and-naplex-an-overview.

4. McDonough, S., Spivey, C., & Chrisholm-Burns, M. (2019, March). Examination of Factors Relating to Student Performance on the Pharmacy Curriculum Outcomes Assessment. American Journal of Pharmaceutical Education, 83(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448514/

5. Williams, J., Spivey, C., & Hagemann, T. (2019, August). Impact of Pharmacy School Characteristics on NAPLEX First-time Pass Rates. American Journal of Pharmaceutical Education, 83(6). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718508/

6. Spivey, C., Chrisholm-Burns, M., & Johnson, J. (2020, February). Factors Associated with Student Pharmacists’ Academic Progression and Performance on the National Licensure Examination. American Journal of Pharmaceutical Education, 84(2). https://www.ajpe.org/content/84/2/7561

Mentorship: A Source of Motivation in Andragogy

Elodie Tendoh, PharmD, MSc.

PGY-1 Pharmacy Resident

University of Maryland Baltimore Washington Medical Center

“A mentor is someone who allows you to see the hope inside yourself” Oprah Winfrey During my time in pharmacy school, I was met with many opportunities that required me to make critical decisions and there were many people who trusted me and gave me the confidence l needed to pursue the opportunities that came my way. In my second year, one of the student leaders motivated me to pursue a leadership position which I thought of as a being above my capabilities. This fellow student saw in me what I couldn’t see in myself and encouraged me to pursue the opportunity. Because I trusted this senior student’s observation, I accepted the challenge. This exposed me to numerous opportunities and taught me skills that aided in my professional and personal development.

Andragogy which is defined as the art and science of adult learning sets expectations for learners to excel in their learning experience through intrinsic and extrinsic motivational factors1. Stephen Pew in his article on pedagogy and andragogy as foundational theory for student’s motivation discussed the importance of intrinsic motivators in andragogy and their role in fostering the learner’s ability to employ strategies that demand more effort and enable them to process information more deeply1. Mentorship plays a vital role in nurturing these intrinsic learning behaviors.

Fruiht and Chan, in their study on naturally occurring mentorship in a national sample of first-generation college goers, found that this was a promising portal for academic and developmental Success2. The study had 4181 participants and their primary objective was to find a significant interaction between having a parent who attended college with having a mentor. They expected that mentoring would moderate the relationship between parental educational attainment and one’s own educational attainment. They also compared the primary functions of mentoring relationship in first generation college students to the mentoring functions received by continuing generation students and young people who did not attend college. Seventy-six percent of the participants reported having natural mentors whose role included but not limited to support for goal striving, explicit identity development, and teaching social skills. The participants used words like coach, parent-like, friend, etc., to describe their mentor’s role in their lives.

Having a college degree is important to secure future financial stability and positive developmental outcomes in adulthood3.Parents play a vital role as motivators to their adult children however parents who did not attend college are not able to play this role. That is why mentoring relationships are very important and they have been demonstrated to promote positive academic and developmental outcomes for young people of many backgrounds4. The findings of this study suggest that mentors can serve as compensatory resources to first generation college students. The authors concluded that naturally occurring mentorship relationships equalize the social and cultural capital which young people garner from their communities and it predicts long term academic success.

Pharmacy education recognizes the need for mentorship for both students and junior staff members. Sharif in an article on mentoring in pharmacy education and practice expand on the benefits of mentoring to the mentor and the mentee5. He believes that in a good mentoring relationship, the mentor learns and grows from their mentee as they help them to problem solve and develop professional and personal goals. He also points out the role of peer mentors to pharmacy students, pairing experienced senior students with junior students to ease their integration and aid in familiarizing them with the curriculum and general expectations.

Several pharmacy schools including the University of Maryland Baltimore, the University of North Caroline Eshelman School of Pharmacy, etc. have embraced the role of peer mentors by creating mentorship programs between their students and undergraduates who are interested in pursuing a career in Pharmacy. Creating these personalized relationships foster connections and increase the prospective students access to knowledge ensuring that they make informed decisions.

Mentorship is very important in the development of adult learners whose training and learning is highly dependent on factors such as their level of motivation. Having a mentor who is well accomplished inspires learners and builds the confidence they need to achieve their educational and professional goals.

References:

1. Pew S. Andragogy and Pedagogy as Foundational Theory for Student Motivation in Higher Education. Eric.ed.gov. 2020. https://eric.ed.gov/?id=EJ864274. Accessed October 3, 2020.

2. Fruiht V, Chan T. Naturally Occurring Mentorship in a National Sample of First-Generation College Goers: A Promising Portal for Academic and Developmental Success. Am J Community Psychol. 2018;61 (3-4):386-397. doi:10.1002/ajcp.12233

3. Trostel PA, Chase M. It’s not just the money: The benefits of college education to individuals and to society. Lumina Issue Papers. 2015 Retrieved from https://www.luminafoundation.org/files/resources/its-not-just-the-money.pdf.

4. Miranda-Chan T, Fruiht V, Dubon V, Wray-Lake L. The Functions and Longitudinal Outcomes of Adolescents' Naturally Occurring Mentorships. Am J Community Psychol. 2016;57(1-2):47-59. doi:10.1002/ajcp.12031

5. Sharif SI. Mentoring in Pharmacy Education and Practice. J Pharma Care Health Sys. 2014; 1: e115. doi:10.4172/2376-0419.1000e115

The Arts in a Science Curriculum

Dora Linkoff, PharmD

PGY1 Pharmacy Resident

Children’s National Hospital

The arts have often been viewed as a category outside of science, or even as an opposing force, rather than as a complementary discipline. In an effort to downplay the merits of arts courses within a general education curriculum, critics have argued that the arts are a less lucrative or productive career option. These sentiments are often coupled with, or borne out of, calls for increasing students’ exposure to STEM (science, technology, engineering, and math) education; ultimately, this focus has led to sharp decreases in funding for arts classes in the past decade1. 

This outcome is unfortunate because an education in the arts can help to produce better students. This claim is backed by popular sentiment, as 93% of respondents to a Harris Poll on the attitudes of Americans towards arts education agreed that an education in the arts produces more well-rounded individuals2. This idea that students gain from exposure to arts has also been supported by empirical research in early education, with improvements in students’ reading and language, mathematics, cognitive skills, social skills, and motivation to learn as well as in the creation of a positive school environment2. Arts classes not only serve to enhance soft skills (as is often cited), but provide additional crossover benefits to other subjects such as literacy and math. 

Paralleling findings in younger students, skills cultivated by arts courses are often transferrable into other areas of learning and achievement at a higher level of schooling. One study illustrates this in its finding that high school students who take arts classes have “higher math and verbal SAT scores” compared to students who do not take arts classes1. Specifically, music instruction has been shown to correlate with higher scores on standardized math tests and better performance in grade 12 math classes. This finding has been replicated in students from low-income families as well3,4, which has been proposed to be due to the fact that musical training “emphasizes proportion, patterns, and ratio expressed as mathematical relations.3” There is a scarcity of data on the contributions of the arts to PCAT exam performance, however, aside from an ostensible benefit of English composition on the reading and verbal sections of the PCAT exam.

In addition to increasing performance on standardized testing at a high school level, the arts can serve as a supportive learning environment. In secondary education, a stage where development is critical, the arts can facilitate an environment with “constructive acceptance of criticism and one where it is safe to take risks.2” Studies have shown that high school students who participated in dance perform better than non-dancers in assessments of creative thinking and abstract thought2. Arts also foster a desire to learn via encouraging active participation and engagement, discipline, and persistence.3

These benefits can also be conferred to professional training. In medicine, a background (or at least supplemental courses) in the arts help to foster a “tolerance for ambiguity and individual difference” as well as an insight into and appreciation for an individual’s unique perspective4. For example, as literature “enriches the language and thus the thought processes of practitioners,” it thereby provides a vocabulary with which to articulate a patient’s care4. 

Medicine has been characterized as both an art and a science. Panda (2016) describes the interplay as such: “Medicine…is an applied science, and its practice an art.5” The applied science of medicine refers to medicine’s fundamental purpose in diagnosing and treating disease in an individual, while the art of medicine encompasses the nuanced, empathetic and personalized care of patients, or in other words, the human side of medicine1. This definition encapsulates how clinicians can help understand an individual’s unique circumstances, and identify with a patient’s subjective life experience4. Literature in the pharmacy sphere echoes these sentiments, emphasizing the perceived benefits of coursework in the humanities as cultivating the attributes of “communication, ethics, moral reasoning, and critical thinking abilities” in pharmacy students.6 These attributes directly align with the American Council for Pharmacy Education (ACPE)’s standards for patient care, which include problem solving, patient advocacy, cultural sensitivity and communication.7

Therefore, arts courses have been shown to be beneficial to a range of professional students, refining cognitive and soft skills, and developing an appreciation for nuance and an individual’s humanity. Aside from admitting students who have backgrounds in humanities and the arts to health professions programs, how else can educators and employers ensure that the clinicians of tomorrow are well-rounded providers? 

A possible solution is to implement the use of arts strategies in a professional curriculum. Strategies to enhance providers’ “whole person approach” interweave artistic media into the standard material, drawing upon pedagogy associated with the arts1. This is because artistic activities may offer stimulation outside of what is typically employed in a traditional medical or scientific course. 

For example, the use of literary works and film in healthcare ethics classes can serve as a “consciousness raising activity” and can be more engaging than the standard curricular reading material4. Another teaching strategy is to assign readings for discussion from the Journal of the American Medical Association (JAMA) website dedicated to “The Arts and Medicine,” a series that explores the intersection of “arts, culture and medicine” and may provide educators with ways to link course topics with interdisciplinary areas of interest. Another method of engagement could be to encourage professional students to review winning entries into the “Dance Your PhD” contest. This contest, sponsored by Science magazine and the American Association for the Advancement of Science (AAAS), encourages researchers to explain their projects through interpretive dance9. Students can choreograph an expressive, visual representation of their research or coursework. Or students may participate in performing arts service organizations which provide them with “a creative outlet, leadership opportunities, and patient contact experiences that can increase their compassion and empathy and better prepare them to be practicing clinicians.10” 

To quote Albert Einstein, “The greatest scientists are artists as well.3” Educators and students should take this to heart in designing or completing professional education.

References: 

1. Braund, M., Reiss, M.J. The ‘Great Divide’: How the Arts Contribute to Science and Science Education. Can. J. Sci. Math. Techn. Educ. 19, 219–236 (2019). 

2. S.S. Ruppert. Critical evidence: How the arts benefit student achievement. 2006. Available from http://nasaa-arts.org/critical-evidence/.

3. Izadi, D. (2017). Arts in science education. Canadian Journal of Physics, 95(7), xliii–xlvi.

4. Scott PA. The relationship between the arts and medicine. Med Humanit. 2000;26(1):3-8. doi:10.1136/mh.26.1.3 

5. Panda SC. Medicine: science or art?. Mens Sana Monogr. 2006;4(1):127-138. doi:10.4103/0973-1229.27610 

6. Boyce EG, Lawson LA. Preprofessional curriculum in preparation for doctor of pharmacy educational programs. Am J Pharm Educ. 2009;73(8):155. doi:10.5688/aj7308155

7. https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf 

8. https://jamanetwork.com/collections/44037/the-arts-and-medicine 

9. https://www.sciencemag.org/projects/dance-your-phd 

10. NewsRx. Study Results from Appalachian College of Pharmacy Update. Understanding of Pharmaceutical Education (A Community Service Organization Focused On the Arts To Develop Empathy In Pharmacy Students). Education Letter. June 10, 2020; p 533. 

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.