Learning to "think like a pharmacist": Problem-solving activities for first-year pharmacy students

American Journal of Pharmaceutical Education, Winter 1998 by Brandt, Barbara F, Clements, Markie, Piascik, Peggy

Learning to "Think Like a Pharmacist": Problem-Solving Activities for First-Year Pharmacy Students1

Barbara F. Brandt, Markie Clements, and PeaY Piascik2

PROLOGUE

The purpose of this article is to describe an approach to incorporate a modified problem-based learning (PBL) format into a first professional year curriculum. For each case, groups of eight students meet with a faculty member and a community practitioner in two sessions to work through well-defined pharmacy problems using a method adapted from classical PBL. Cases are written from the perspective of a pharmacist practicing pharmaceutical care in a community pharmacy setting. A case writer designs scenarios to integrate content from across the curriculum and builds in dilemmas to encourage students to consider new roles in pharmacy. Early feedback from practitioners working with students who have participated in the first year is positive. In this article, the authors describe the instructional method, effective case writing for first year students and their experience in assessing and improving the activities.

INTRODUCTION

In 1992-93 when designing a new entry-level Doctor of Pharmacy program, the University of Kentucky College of Pharmacy curriculum task force considered a number of educational innovations in higher and health professions education, most notably problem-based learning (PBL). Additionally, the faculty conducted a series of interviews, focus groups and assessments with students, practitioners, and faculty members to understand their perspectives on the prior, traditional curriculum and their vision for the future of pharmacy practice. The purpose of this extensive data gathering was to make recommendations for building upon the strengths of the former program while addressing perceived needs.

A common recurring issue that surfaced during this time was that students viewed the first year of pharmacy school as a continuation of their pre-pharmacy curriculum. That is, students believed the first year of the program focused extensively on basic science and suggested that more practice and drug-based content be included in that year. As a result, fundamental changes in the new program include: (i) introducing pharmacy practice, the pharmaceutical care philosophy, and pharmaceuticals from the very beginning of the program; (ii) developing group-based problem-solving activities in a modified-PBL format; and (iii) integrating basic science information with practice skills and clinical knowledge. Practice-based problem-solving group activities are a component of a comprehensive, highly adaptable six-semester course sequence entitled "Contemporary Aspects of Pharmacy Practice" (CAPP) that is taught across professional years one, two and three (PY1, 2, 3) of the entry-level Doctor of Pharmacy curriculum. The curricular design intentionally provides maximum support, or a "scaffold" of facilitated group activities, at the beginning of the program that is lifted over time by PY3 to move students from dependent to independent learners. These activities in PY1 modify the classical PBL approach.

CLASSICAL PROBLEM-BASED LEARNING

In classical PBL as originally implemented in medical schools, students are presented with ill-structured, multistaged, professional situations and problems to solve(1). The format can include paper cases, computer patient-management problems, live patients, or standardized patients. In a PBL curriculum, these situations are designed to address carefully selected learning outcomes to guide students through their development in a program. Students use the cases to "discover" what they need to know and research to find information to address the situation and/or solve the problem. Classical PBL is typically conducted in small groups of six to eight learners and one faculty member. The group meets formally to address the case using a problem-solving structure, and the learners determine the schedule for working on the problem. Because formulating questions and researching information is an important component of the process, students spend considerable time outside of the formal class working on the problem. Therefore, the design of the curriculum must be structured to allow blocks of time for students to research and assimilate information. Faculty members serve in the roles of tutor, resource, mentor and advisor to facilitate the learning process by keeping discussion on track, providing information, reinforcing group decisions, and stimulating new thinking. To be effective educators, faculty members need to modify their approach to teaching and to move from the role of expert providing information to facilitator guiding learning.

At the beginning of a PBL session, students are given case learning objectives to provide structure for their group discussion and research. Faculty members then guide students in analyzing the problem, developing hypotheses, generating learning issues, constructing research strategies, and applying information as solutions to the case. After the group completes one portion of the case, the tutor provides another stage of the problem and guides the group in applying the problem-solving process again. At the end of the entire case, students engage in self, peer and case assessment.