The Value of Team-Based Learning

Sara Gholamrezaeiboushehrinejad
PGY-1 Pharmacy Resident
Holy Cross Hospital

Team-based learning (TBL) is a structured form of small-group learning that emphasizes student preparation out of class and application of knowledge in class. Students are organized strategically into diverse teams of 5-7 students that work together throughout the class.  Before each unit or module of the course, students prepare by reading prior to class.1 TBL was originally designed by Professor Larry Michaelsen during the 1980s, in the United States of America, for use in business schools. 2 Following individual answers, students join teams and work through problems, appealing when they are incorrect. 3 TBL provided the opportunity to continue teaching in a manner that was engaging, catered for large numbers of students, provided immediate feedback, involved students in decision making, and promoted active small group and class discussions. 2 In the first class of the module, students participate in a “Readiness Assurance Process,” or RAP. Specifically, students complete a test individually (the “Individual Readiness Assurance Test,” or iRAT); and then complete the test with their group members (the “group Readiness Assurance Test,” or gRAT). Both the individual scores and the group scores contribute to the students’ grades. 1 

This process motivates students by holding them accountable to themselves and one another, while introducing them to a variety of thought processes devoted to a single problem. To increase motivation and introduce a fun gaming environment, instructors often group their students into teams and have them compete on various classroom learning tasks. 3 Various teachers have found that team-based learning can be especially helpful in dealing with a number of situations that can be and often are particularly challenging for teachers. Four situations in which this is true are when teachers are faced with: larger classes, classes with a high level of student diversity, courses with extended meeting times, and courses that emphasize thinking skills. 4 Recent systematic reviews provide evidence of positive outcomes in terms of student experience and academic achievement, particularly when compared to traditional lectures. The interactive nature of TBL encourages healthcare students to develop their communication and collaboration skills, providing a valuable learning experience. 2

TBL is designed to get students actively engaged in the learning process by ensuring that most face-to-face course time is spent on Application Exercises, where teams of students work together on significant, challenging problems toward a common goal. Unlike many other teaching techniques, TBL is a highly structured, whole-course learning framework that incorporates a sequence of carefully designed readiness assurance and application activity cycles carried out by intentionally selected permanent teams, coupled with summative peer evaluation. The power of TBL comes from the integrated nature of the strategy – it is more than a collection of techniques or activities. 4

When teachers are faced with the responsibility of teaching large classes of 100 or more students and seek advice on how best to do this, they frequently get technical suggestions: get more organized, try to make your lectures lively, use more audiovisual materials, and so on. But technical changes like those do not have the ability to make a significant impact on the two biggest problems with large classes from a learning perspective: student anonymity and passivity. Teachers frequently have classes in which students are diverse in terms of key factors such as prior preparation, age, related background experiences, ethnicity, attitudes toward the subject, and so forth. Team-based learning creates conditions in which people who are very different from one another learn that they need to work together and that they can work together. They find ways to make their differences an asset rather than a liability. 3

Reference: 

1. Brame, C. J. (2013). Team-based learning. Vanderbilt University Center for Teaching. Retrieved [12/10/2021] from https://cft.vanderbilt.edu/guides-sub-pages/team-based-learning

2. Burgess, A., van Diggele, C., Roberts, C. et al. Team-based learning: design, facilitation and participation. BMC Med Educ 20, 461 (2020). https://doi.org/10.1186/s12909-020-02287-y

3. Team-Based Learning. Yale Poorvu Center for Teaching and Learning. Retrieved [12/10/2021] from https://poorvucenter.yale.edu/Team-Based-Learning 

4. Michaelsen LK, Knight AB, and Fink LD. The Value of Team-Based Learning in Particularly Challenging Teaching Situations. Stanford University. Retrieved [12/10/2021] from https://tomprof.stanford.edu/posting/474 

Layered Learning Model

Olyad Begna
PGY1 Pharmacy Resident
Holy Cross Hospital

The layered learning practice model (LLPM) involves training pharmacy residents to precept pharmacy students under the supervision of a clinical pharmacist.¹ The model is used by many residency programs to provide teaching experience for new residents. The layered learning model is being routinely utilized as the need for pharmacy practice experiential sites increases with the increase in the number of pharmacy schools. The number of pharmacy schools increased by 65% between 2000 and 2015 from 80 to 132.² According to the American Association of Colleges of Pharmacy (AACP), as of January 2021, there are 140 pharmacy schools across the nation and the demand for experiential sites continues to increase. Moreover, the increase in the number of pharmacy students graduating has led to an increase in the number of applicants seeking post-graduate residency training who need preceptorship experience. Due to the primary departmental responsivities of clinical pharmacists, accommodating an increasing number of pharmacy students is becoming challenging for institutions. LLPM is one approach that can be implemented to meet the increase in the demand for preceptorship. Some studies at community teaching hospitals have demonstrated that LLPM can increase medication reconciliation rates, discharge counseling, and the overall number of pharmacy interventions. ^(3,4) In addition, learners have reported an overall positive experience with LLPM.⁵

The LLPM model involves a minimum of three layers consisting of a senior preceptor, a pharmacy resident, and a pharmacy student.¹ The senior preceptor oversees the entire rotation experience with responsibility for the submission of evaluations and patient care. The second level of precepting consists of the pharmacy resident, who serves as the primary preceptor for the pharmacy student. Pharmacy students are incorporated into the third level of the learning model with active involvement in patient care activities. Loy et al reported on the implementation of the LLPM at a tertiary medical center with a 4-step process which includes orientation, pre-experience planning, implementation, and postexperience evaluations.¹ There are various benefits to implementing LLPM in teaching medical institutions which include maximizing the number of learners, improving efficiency, and enhancing quality improvement opportunities.¹ For the resident, the LLPM provides teaching experiences at different learning levels, enhances leadership skills, and increases clinical and teaching decision-making. For health care institutions, even though there is not enough data to support improved patient outcomes, implementation of LLPM may increase pharmacy presence in clinical practice and can lead to an increase in pharmacist interventions and improve medication safety and patient satisfaction.³

Integration of LLPM into a residency program helps to encourage team-based learning between residents and pharmacy students and helps residents expand their roles as practitioner learners.¹ The LLPM also allows residents to engage in precepting other residents by participating in a teaching certificate program to fulfill the American Society of Health-System Pharmacists (ASHP) requirements. ASHP developed the Pharmacy Practice Model to expand pharmacist care for patients by capitalizing on the pharmacists' role in patient care teams, encouraging pharmacist training and board certification, expanding the use of technology, as well as promoting leadership roles in medication management and outcomes.⁶ With pharmacy residents sharing precepting duties with clinical pharmacists via LLPM, senior pharmacy clinicians may not have to compromise on their patient care responsibilities and have more time to actively participate in patient care tasks as well as continuing education programs. In addition, the American College of Clinical Pharmacy (ACCP) also encourages residency programs to incorporate a teaching experience component for pharmacy residents to develop as competent clinicians.⁷ Moreover, LLPM can help residents grow their leadership skills as they precept pharmacy students and directly get involved in patient care teams. Feedback from senior clinical pharmacists, residents and pharmacy students should regularly be assessed to continuously improve the learning experience. Feedback and evaluation can also be used to implement changes in applying the LLPM, such as improving orientation structure and updating objectives and expectations.  

There are some limitations to the LLPM, which include not being adopted at all practice sites and lack of enough data supporting the quality of learning for the pharmacy resident and student.¹ In addition, there need to be more studies conducted to compare LLPM to traditional precepting models head-to-head in evaluating learning and other outcomes. To be successful, the LLPM relies on the participation of all three levels, and a deficit in any of the layers of teaching can negatively affect the outcome for learners.

References

1. Loy BM, Yang S, Moss JM, Kemp DW, Brown JN. Application of the Layered Learning Practice Model in an Academic Medical Center. Hosp Pharm. 2017;52(4):266-272. doi:10.1310/hpj5204-266.

2. American Association of Colleges of Pharmacy. Academic pharmacy's vital statistics. http://www.aacp.org/about/pages/vitalstats.aspx. Accessed November 12, 2021. [Ref list]

3. Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations. Delgado O, Kernan WP, Knoer SJAm J Health Syst Pharm. 2014 Nov 1; 71(21):1871-6. [PubMed] [Ref list]

4. Expanding care through a layered learning practice model. Bates JS, Buie LW, Amerine LB, Savage SW, Eckel SF, Patel R, Valgus JM, Rao K, Daniels R Am J Health Syst Pharm. 2016 Nov 15; 73(22):1869-1875. [PubMed] [Ref list]

5. A Study of Layered Learning in Oncology. Bates JS, Buie LW, Lyons K, Rao K, Pinelli NR, McLaughlin JE, Roth MT Am J Pharm Educ. 2016 May 25; 80(4):68. [PubMed] [Ref list]

6. American Society of Health-System Pharmacists. Pharmacy Practice Model Summit: Executive summary. Am J Health Syst Pharm. 2011; 68: 1079– 1085. [Google Scholar]

7. Havrda DE, Engle JP, Anderson KC, et al. Guidelines for resident teaching experiences. Pharmacotherapy. 2013; 33: e147– 161. [PubMed] [Google Scholar]

 

Impact of a Peer Teaching Model in Pharmacy Schools

Ryan Nguyen, PharmD
PGY-1 Pharmacy Resident
Sinai Hospital

Developing new, effective methods to engage students in their learning is often a significant challenge in higher education settings. Pharmacy schools, in particular, have been gradually implementing andragogic approaches to optimize student preparedness for the transition to advanced pharmacy practice experiences (APPEs) and subsequent post-graduate work. In order to succeed as a pharmacist, students must have a robust foundational knowledge of drug information, strong communication skills, and effective problem-solving capabilities. As part of the curricula of many pharmacy schools, students are expected to be heavily involved in their learning. Various learning activities such as breakout counseling sessions, simulated case scenarios, and objective structured clinical examinations (OSCEs) have been employed to further students’ learning beyond the classroom. Nevertheless, teaching methods are constantly evolving as pharmacy schools aim to produce the most well-equipped pharmacists to tackle the dynamic healthcare landscape. 

One teaching method that has been increasingly discussed throughout the literature is the peer teaching model. As the name suggests, pharmacy students would be involved in actively teaching concepts to their respective classmates or student learners from other healthcare specialties. This collective effort toward active learning allows students to work closely with their colleagues to bridge any gaps in knowledge. In order for students to be able to effectively teach certain concepts, they must first gain enough baseline knowledge through their own studies. Not only does this hopefully motivate students to become self-directed learners, but also students will be more confident as they transition into their APPEs.

Tsai et al. describe the implementation of a “Pre-APPE Readiness (PAR) Block” for third professional (P3) year students prior to the start of their APPEs. Based on a pre-assessment that evaluated students’ knowledge of general medication information, the authors noted that a significant number of students had difficulty retaining drug information learned during the earlier years of pharmacy school. Thus, the authors developed a six-week course in which each student was assigned a unique drug from a list of the top two hundred most commonly prescribed drugs. Four students were selected to present each week based on the specific drugs they were assigned. For instance, during a given week, one student would present on nitroglycerin and another student would present on sildenafil due to the established drug-drug interaction. The goal of these pairings was to aid students in understanding the relationships between certain drugs, whether they were synergistic, antagonistic, or analogous. Course facilitators summarized the key points at the end of each presentation and assisted the presenter in answering any questions from the student audience. Finally, each session concluded with a brief quiz with immediate feedback to assess for any knowledge gaps. Ultimately, the authors found that after the implementation of the PAR Block, there were significantly less students who performed poorly on the pre-assessment that was administered before the start of APPEs.1

By the same token, Delnero and Vyas describe the impact of a peer-taught interprofessional education (IPE) activity involving pharmacy and physician assistant (PA) students. Prior to the activity, students formed teams consisting of one PA student and four to five pharmacy students. The main premise of the activity was that teams would be teaching each other in breakout sessions about key skills related to physical assessment, inhaler counseling, or diabetes education. For example, the PA student would provide instruction about performing lung auscultation and the pharmacy student would provide education about appropriate administration of various inhalers. Overall, the authors concluded that the IPE activity led to improved confidence and enhanced interprofessional attitudes.2 

Based on the two educational models implemented in the previously discussed studies, peer teaching appears to be an effective learning method for pharmacy students. Peer teaching adheres to the concepts of andragogy in which students are self-directed and draw from their own baseline knowledge to provide education to their colleagues. Additionally, peer teaching is supported by the notions of cognitive and social congruence in which students share the same knowledge framework. Based on these theories, students are better able to relate to one another and address gaps in knowledge.3 Thus, peer teaching models should continue to be incorporated into the curricula of pharmacy schools and be used in conjunction with other active learning methods to enhance student engagement.

References:

1. Tsai T, Vo K, Ostrogorsky TL, et al. A peer-teaching model to reinforce pharmacy students' clinical knowledge of commonly prescribed medications. Am J Pharm Educ. 2021;85(5):8451. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174616/

2. DelNero T, Vyas D. Peer teaching in an interprofessional education activity focused on professional skills development. Pharmacy (Basel). 2021;9(2):112. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293411/

3. Loda T, Erschens R, Loenneker H, et al. Cognitive and social congruence in peer-assisted learning - A scoping review. PLoS One. 2019;14(9):e0222224. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733464/

Residency Preparation Programs for the Fourth-Year Pharmacy Student

Ami Patel, PharmD
PGY1 Pharmacy Resident
University of Maryland Medical Center

Post-graduate training for pharmacy students is competitive, and the match rate decreases every year. There are so many more residency candidates than there are residency spots in programs all over the country.1 Students are doing more and more every year to stand out to “match” to a position in a residency program. Because of this competition, some pharmacy schools across the country have developed a residency preparation curriculum to help guide interested and qualified students through their own “mini-residency” to increase their students’ success (and school match rates). 

Developed in 2012, the first program of its kind is called the “Pharmacotherapy Scholars” at the University of Pittsburgh School of Pharmacy.2 This program really set the precedence for residency preparation programs. Its curriculum includes first-choice clinical rotations at the UPMC health-system, intermittent clinical knowledge examinations, personal mentor advising, team-based mentoring, peer-to-peer learning, longitudinal research, and professional development sessions about various topics. Their overall residency match rate was 93% in the 64 students that enrolled and completed the program from fall 2013 to spring 2019. This program is an exceptional example of the Dick and Carey model. The instructional goal of this program was simply to achieve high match rates for fourth-year pharmacy students interested in residency. The performance objectives were updated with each clinical rotation and research meeting to ensure learners were reaching expectations and completing the required work. The intermittent clinical exams were the assessment instruments. Evaluations and feedback done after every rotation and every curriculum experience helped improve the program and refine it for the rest of the year and for future years. The program was developed in a linked approach, which is why its instructional methods of following the Dick and Carey model has led to this program’s success and for other pharmacy schools to adopt a similar approach.  Since there were many steps of this program, feedback, and changes to the program as it was implemented, the Pittsburgh program aligns with the Dick and Carey model. 

Another program that followed closely to the University of Pittsburgh was the University of Buffalo.3 When creating their program, they more closely followed the linear ADDIE model. Since this program was able to develop their model from other programs (such as the University of Pittsburgh), they offer many of the same components of the program, but the evaluation process occurs only at the end of the program at the University of Buffalo. This is indicative of the ADDIE model vs the Dick and Carey model.  The ADDIE model has five phases, including analysis, design, develop, implement, and evaluate. The Buffalo program aligns with this closer than the Dick and Carey model due to the more linear approach to the program. This program also was very successful in their match rates at 91% vs the national average in the 60% range. Although the instructional methods differed between both programs, they had a similar end result.

In conclusion, instructional methods were very crucial to the development of these residency preparation programs at the two schools of pharmacy; however, although different methods were used, results were similar and the programs were successful. Both programs focused on the input, output, and design of the curriculum. However, the ADDIE model is more structured and evaluations are only done at the end, which can be disadvantage in newer programs. Meanwhile, the Dick and Carey model has evaluations at every phase. However, in pharmacy schools that are beginning residency preparation programs, I believe that the Dick and Carey model is a better initial choice. The evaluations at each part of the program and the many detailed steps will allow more acute changes to be made often, leading to a better overall experience for the program if obstacles were to arise. The ADDIE model would be a great choice after the program is established and overcomes any initial obstacles.  This is an important conclusion; the instructional design and methods used to create a curriculum is not black and white.4 As future educators, we should keep this in mind when developing our own educational methods. There is no clear answer, but there can be many right ones. Choosing the right instructional design and methods is an individualized approach based on instructor preference and what aligns with the focus and the objectives of the course best. 

References

1. National Matching Services, Inc. ASHP Match Statistics. https://www.natmatch.com/ashprmp/stats.html. Accessed October 24, 2021.

2. Coons J, Benedict N, Seybert A, et al. A Pharmacotherapy Scholars Program to Provide Intensive Training to Enhance Pharmacy Students’ Postgraduate Readiness. Am J Pharm Educ. 2019 Nov;83(9):7327. 

3. Slazak E, Prescott G, Doloresco F, et al. Assessment of a Scholars Program Designed to Enhance Pharmacy Students’ Competitiveness for Postgraduate Residency Training. Am J Pharm Educ. 2020 Jul;84(7). 

4. Khalil M, Elkhider I. Applying learning theories and instructional design models for effective instruction. Adv Phys Educ. 2016 Jun;40(2):147-156. 

Service Learning in HealthCare Education

Victoria Fusco, PharmD
PGY1 Pharmacy Resident
MedStar Union Memorial Hospital

Hands-on experience in the education of health care professionals has been widely accepted as a core component of instructional design. Nursing programs typically have formal hands-on experience (i.e., clinicals) from the start of instruction whereas medical and pharmacy programs typically have two or three didactic years followed by clinical rotation years. In these programs, students begin working with patients and applying their skills before graduation and stepping into new practitioner roles. In a review article, this approach to learning has historically been one-sided and focuses on how the student can benefit.1 In recent years, perspectives in health education have shifted the focus equally on student learning and service to patients and communities.1 Service-learning can be defined as, “a structured learning experience that combines community service with explicit learning objectives, preparation, and reflection, in which students learn about the context in which the service is provided, the connection between the service and their academic coursework, and their roles as citizens.”1

The benefits of service-learning have been described as creating community-responsive, culturally competent healthcare practitioners, cultivating citizenship, and achieving social change, and transforming relationships between communities and educational institutions. 1 My experience with service-learning began my first year of pharmacy school. Notre Dame of Maryland University School of Pharmacy created an innovative Advocaring program that pairs students with community-based organizations for the course of their four years of study.2 While students are not ready to be clinical practitioners on day one, they can begin to learn to value the basics of human interaction, respect, cultural awareness, and respect.1 My first Advocaring assignment was at the Arc of Baltimore. As a group of 10 pharmacy students, we were responsible for providing health education through interactive activities about topics such as healthy eating, proper handwashing, and stress management for children and adults with developmental disabilities. We had a pharmacist mentor who would oversee our work and help guide us through the process and debrief afterword. These experiences provided us with a chance to work on our communication skills, build rapport with the community, better understand the needs of our underserved communities in Baltimore, MD. 

In addition to building on the soft skills early on necessary to be health care professionals, we were responsible for developing education events for service-learning. For example, our group identified that the children would benefit from a lesson around hand-hygiene given flu season was approaching. We designed an interactive lesson to explain what germs were, why they can be dangerous, and how we can help prevent spreading our germs by washing our hands. Next the group worked together to draft materials for the session and made necessary edits based on evaluation by our mentor. After implementing the group would meet with the pharmacist and evaluate the event and submit a reflection. This process, also known in instructional design as the ADDIE process, was repeated as we encountered new community groups and continued to identify needs. 

As healthcare continues to focus on a patient-centered approach, how can instructional design incorporate more service-learning? An article about incorporating service-learning into medical education recommends building university-community partnerships, establishing structure, funding, and recognition for faculty as a few ways to get started.3 The article suggests service-learning activities can be categorized into three categories: 1. educational/training (i.e. diabetes education) 2. Clinic/community-based (i.e. health fair for elderly), 3. Advocacy, policy, and outreach (autism awareness, fundraising).3 The service should be meaningful, have academic integrity and put the student in a position of responsibility and ownership.3 An important part of instructional design and service learning is reflection. Best practices for reflection in service-learning include setting goals, knowing the audience, making time, sharing expectations, identifying resources, reviewing skills, creating transparent evaluations, demonstrating the importance of different types of reflection, and embracing/capitalizing on teachable moments. 3 Typical pedagogical learning measured student outcomes through exams and quizzes for example. Student service-learning should still be assessed but may be better suited by written reflections, open-ended questions, or poster-presentations to share the experience with faculty and other students. 3 

In summary, service-learning has the potential to develop healthcare students and improve the lives of underserved communities through the identification of community needs and instructional design. 

References: 

1. Kayser C. Cultivating community-responsive future healthcare professionals: Using service-learning in Pre-Health Humanities Education. Journal of Medical Humanities. 2017;38(4):385–95. 

2. The advocaring program [Internet]. Notre Dame of Maryland University. [cited 2021 Oct 18]. Available from: https://www.ndm.edu/colleges-schools/school-pharmacy/resources/advocaring-program. 

3. Stewart T, Wubbena A. An overview of infusing service-learning in medical education. International Journal of Medical Education. 2014;5:147-156. 

Simulation-Based Learning (SBL) and its Application to Pharmacy Education

Sara Foreman, PharmD
PGY-1 Pharmacy Resident
Suburban Hospital Johns Hopkins Medicine

Pharmacists across the country are increasingly transitioning from a traditional role of dispensing medications from behind the counter to a more patient-focused clinical role. Clinical pharmacists are progressively serving as part of a team that provides bed side and emergency care to patients in hospitals and other clinical facilities. The nature of this clinical work is dynamic and stressful, and typically involves techniques and pharmacotherapy not widely covered by students in PharmD and Bachelor of Pharmacy curriculums.1 Simulation-based Learning (SBL) is a proven, innovative learning technique that mimics real-world scenarios allowing students to not only practice and improve their clinical knowledge and skills with no risk to a patient, but to also improve critical thinking and decision-making in high stakes environments. Simulation has been defined as: “an event or situation made to resemble clinical practice as closely as possible”.2 This method of teaching will enable pharmacy students across the country to improve both rudimentary and advanced skillsets and their own confidence in wide variety of clinical situations.  

Currently, multiple forms of SBL are being utilized around the country in pharmacy education.3 These forms vary in technological complexity and differ mainly on the focus of which skill(s) are being emphasized by the specific training. One of the most advanced forms of SBL currently is the high-fidelity patient simulator mannequin.4 This form is most associated with simulation-based training in healthcare. These simulator mannequins are software-driven and load data to mimic human actions and physiology and respond accordingly to physiological and pharmacological interventions of students. Some mannequins are advanced enough to be disease specific (such as a cardiopulmonary simulator), while some are designed to simulate a variety of disease states.4 More, less-technically complex forms of SBL include the use of standardized patients. Standardized patients are live people who are portraying patients and all the associated medical history, emotions, and personality associated with medical patients in a clinical setting. Standardized patients are a very widely utilized form of simulation-based learning and are commonly used to develop students’ communication and intervention skills.2 The most complex and immersive form of SBL is the full environment simulation.4 It is the incorporation of high-fidelity mannequins, standardized patients, healthcare professionals, and other ancillary equipment to re-create a real-life clinical environment. This type of SBL is expensive and requires extensive planning to execute correctly. Therefore, full environment simulation is less common and is typically shared between multiple different healthcare education programs (i.e., nursing/PharmD/MD students) when implemented.5  

Multiple pharmacy schools across the country have successfully implemented SBL into their core curriculum.2 At both the University of Pittsburgh and Rhode Island College of Pharmacy, simulation has been integrated into the pharmacology, therapeutic, and medicinal chemistry coursework. In both programs, PharmD students participate in the SBL laboratories alongside both nursing and medical students.5 Furthermore, University of Minnesota holds a yearly professional workshop for medical, nursing, public health, and pharmacy students called “Disaster-10” that reproduces a mass-casualty event at an office building using standardized patients and high-fidelity mannequins. The program’s objective is to assess the effectiveness of live simulations for teaching emergency response skills to students and professionals.6 This form of instructional design forces students to “think outside the box” and induces further knowledge recall by the learners based upon their experiences within the simulation. As technology progresses, these forms of instructional design become more feasible to implement into pharmacy school and medical professional programs.   

A pilot study in nursing students assessed the outcomes of simulation on the clinical skills of the students and suggested that simulation-based teaching coupled with clinical experience led to an overall improvement in their clinical knowledge and recollection.7 Another study of found that the use of SBL in PharmD curriculum showed significant improvement of students’ clinical skills performance and increased their knowledge of the pharmacotherapy of hypertension. The students involved in the study also expressed high levels of satisfaction with this SBL type of learning experience.5 

Unfortunately, some colleges and universities are experiencing pushback when inquiring about the possibility of substituting simulation for some aspects of Introductory Pharmacy Practice Experiences (IPPEs). This standard has precluded use of any simulation experience, regardless of the quality and nature of the simulation, as acceptable for IPPE credit. Some administrators of colleges and schools of pharmacy have argued that simulation should be considered an alternative for some portion of the required IPPEs, and most educators would agree that a student’s ability to learn and retain how to treat a patient with is best served by being involved with actual patients or via high-fidelity simulation versus shadowing a clinical preceptor.2

There are many clear advantages to SBL in pharmacy education: patient safety/quality, the ability to directly address gaps in clinical conditions and settings, a completely safe learning environment that poses no risk to patients or the learner, the ability to practice difficult skills and build confidence about complex procedures or pharmacotherapy. However, there are some disadvantages that critics of SBL have voiced as well. The most obvious being, simulation is not real life. Real human factors are not portrayed well in simulations as they are in the real world. Because of this, students’ take away from the simulation is dependent on how engaged they are and how willing they are to take the simulation seriously.7 From an instructional design perspective, it may be difficult to predict the students’ level of engagement. If a student is fully committed, they are likely to benefit from the simulation, but if the student thinks the simulation is unrealistic and are unengaged, their learning will be hampered, and the learning will be sub-optimal. Another key disadvantage to simulation-based learning is the large focus on specific skills or competencies. An SBL exercise using a blood pressure task trainer vastly improved PharmD students’ abilities to measure blood pressure but did little to none to develop their communication and assessment skills.5 

Another key drawback to SBL is the cost of the equipment. High-fidelity simulators typically cost around $30,000 a piece, and require maintenance, training for educators, and technical support for the software inside them.4 The ability to provide real-time immediate feedback to the students based on their medical interventions is a great advantage of teaching using SBL, but to do so requires faculty resources to conduct simulations and assess the students.1 Much of the published literature in support of teaching via SBL is subjective. However, some studies have demonstrated that students who receive simulation training in combination with clinical experiential education exhibit better assessment and management skills than students who receive only one form of training. 

Furthermore, the implementation of instructional design using simulation-based learning allows pharmacy school students to learn/retain the skills necessary to excel as pharmacists in clinical settings and has evidence to support this evolutionary form of teaching.

References: 

 

1. Lavelle BA, McLaughlin JJ. Simulation-based education improves patient safety in Ambulatory Care. Agency for Healthcare Research and Quality.  (Dr. LaVelle, formerly); HealthPartners Medical Groups and Clinics (Ms. McLaughlin). https://www.ahrq.gov/downloads/pub/advances2/vol3/Advances-Lavelle_33.pdf. Accessed October 15, 2021.

2. Vyas D, Bray BS, Wilson MN. Use of simulation-based teaching methodologies in US colleges and Schools of Pharmacy. American Journal of Pharmaceutical Education. https://www.ajpe.org/content/77/3/53. Published April 12, 2013. Accessed October 14, 2021. 

3. Cheema E. The need to introduce simulation-based teaching in pharmacy education in Saudi Arabia. Pharmacy (Basel, Switzerland). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163641/#:~:text=The%20use%20of%20simulation%20in,in%20sound%20clinical%20decision%2Dmaking. Published July 3, 2018. Accessed October 16, 2021. 

4. Sarfati L, Ranchon F, Vantard N, et al. Human‐simulation‐based learning to prevent medication error: A systematic review. Wiley OnlineLibrary.https://onlinelibrary.wiley.com/doi/abs/10.1111/jep.12883. Published January 31, 2018. Accessed October 13, 2021. 

5. Seybert AL, Barton CM. Simulation-based learning to teach blood pressure assessment to Doctor of Pharmacy Students. American journal of pharmaceutical education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913304/. Published June 15, 2007. Accessed October 15, 2021. 

6. A simulation center for all of Minnesota and beyond! M Simulation. https://msimulation.umn.edu/. Published 2021. Accessed October 13, 2021. 

7. Seybert AL, Kobulinsky LR, Mckaveney TP. Human patient simulation in a pharmacotherapy course. American journal of pharmaceutical education. https://pubmed.ncbi.nlm.nih.gov/18483603/. Published April 2008. Accessed October 13, 2021. 

Self-Directed Learning

Clynton Musngi, PharmD
PGY-1 Pharmacy Resident
MedStar Union Memorial Hospital

“Teacher, teacher! What is 12x12?” “Professor! Can you tell me why cefazolin is effective against MSSA and not vancomycin?” Growing up, educators starting from kindergarten through 12th grade, and even through graduate school, have been vital to our learning experiences and attainment of knowledge. As students, we were highly dependent on the educator to provide us and teach us information of what we needed to know to pass an exam and succeed in our careers. Lecture-based classrooms has traditionally been and continues to be the style of learning environment for schools. But is this the most effective way of learning? It depends.

Don’t get me wrong. Classroom lectures is an effective method in higher education, given that a high amount of information may be relayed to a big crowd of students. But what if you need application-based learning to grasp a bigger understanding of a concept. Or once you’re out of school, how will you function independently? Once we get to a certain stage in our education and career, we must become adult learners.

Malcom Knowles keyed the term andragogy, which is the art and science of adult learning.1,2 Self-directed learning is a branch of adult learning, in which learners take the initiative, with or without the help of an educator, in recognizing their learning needs, formulating learning goals, identifying essential resources for learning, choosing, and implementing learning strategies, and evaluating their outcomes.2,3,4 As professionals, we are constantly seeking new and updated information relating to our profession, which is a life-long learning skill.4,5 Students sought learning styles that are most beneficial to them. With innovation of technology growing exponentially and students’ way of thinking are changing, educators are urged to develop teaching and learning methods that enable students to transition from dependent to self-directed learners. 

From personal experience, pharmacy school had a mix of mostly lecture-based classrooms with self-directed learning mostly occurring in the last year during experiential learning. Introduction of self-directed learning should be introduced and implemented in the didactic curriculum, as this allows for skill development over time.5 This is not to be confused with self-paced learning and self-regulation. To differentiate, the former is having students complete learning activities with deadlines, while the latter involves individuals guiding goal-directed activities over time in their own best self-interest.5 To differentiate even further, self-regulated learning stems from cognitive psychology and is imposed by the instructor, while self-directed learning stems from adult education and the student themselves design the environment.5 

As mentioned earlier, learners must take initiative to recognize their learning needs and goals, identify resources, establish a timeline, and have a faculty member complete an evaluation.2,3,4 In order to develop the skill of self-directed learning, a school’s curriculum should introduce self-paced directed activities early on to help students develop a self-directedness.5 Over time, the learning environment can transition to instructor led to student led. Ways to move forward with this development to self-directed learning can be through flipped classrooms.5 Flipped classroom allows students to first obtain foundational information from faculty-provided material.5 That information can then be utilized during class to answer questions or create a direction for discussion. This allows for knowledge application and expansion to deepen the learning experience, which may model and assist in the development of skills needed for self-direction.5 

But how do we assess self-directed learning itself? Unfortunately, there is no literature that objectively assesses this skill set.5 Only the knowledge of the students can be assessed through examination and experiential learning. 

Although self-directed learning is an effective method of education, challenges of willingness to change, lack of expertise by the learner, and time are limiting factors to implementation.5 The actual content learners must learn may be tough enough for learners to unsuccessfully utilize self-directed learning and rely on instructors for help.

References:

1. Culatta R, Kearsley, G. Andragogy (malcom knowles). Instructional Design. 2021

2. Pappas, C. The adult learning theory – andragogy – of malcom knowles. eLearning Industry. 2013 May

3. Guiter GE. Self-directed learning (SDL): a brief comprehensive analysis. Weill Cornell Medicine-Qatar. 2014

4. Manning G. Self-directed learning: a key component of adult learning theory. BPA Studies. 2007; 2(2)

5. Robinson JD, Persky AM. Developing self-directed learners. AJPE. 2020 Mar; 84 (3) 847512