Innovative, problem-based, pharmaceutical care courses for self-medication

American Journal of Pharmaceutical Education, Summer 1998 by Sibbald, Debra

Two nonprescription medication courses were developed for large classes of 120 to 130 students at the Faculty of Pharmacy, University of Toronto, which prepare students with the knowledge and skills to practice pharmaceutical care using problem-based, student-directed learning. This manuscript describes the first three years of implementation and evolution, including course design, teaching methodology, reinforcing and enabling strategies, case preparation, assessment tools, evaluations and examinations. Experiences in managing issues, using peer teaching, while fostering an interactive, motivating environment, are presented.

INTRODUCTION

Over the last eight years, the self-medication courses at the Faculty of Pharmacy, University of Toronto have undergone a series of three revisions designed to implement the theories of active life-long learning and patient-centred care.(Figure 1) Prior to 1989, two elective courses in the third and fourth year were offered using a traditional didactic approach. Twenty drug product classes per course were presented by a guest pharmacist with expertise in the area. In 1989, the format changed to problem-based learning. Groups of seven to eight students role-played the patientpharmacist encounter in a series of ten minute, impromptu scenarios. In 1991, the third year course become compulsory and the format introduced a systematic approach to cases. Students were required to prepare a 10 minute class presentation which included role-playing. The following year, the courses incorporated the pharmaceutical care model, and the nine-step process developed by Hepler and Strand.(3,4,5) (Table I) This process had been adapted in the fourth year therapeutics course in a more detailed form, the previous year, with positive feedback from the students(6).

In September 1994, the Faculty accepted its first year of students in a new, second year entry level curriculum. Sixteen months later, these students began a series of two, fourmonth compulsory self-medication courses. entitled Pharmaceutical Care 1A and 1B(1). These courses were modelled on principles developed in former self-medication courses. but the format was altered in order to support changes inherent in the new curriculum, and evolved into an approach which combines motivational interaction with self-directed learning using student teams.

1995-96: THE NEW CURRICULUMPHARMACEUTICAL CARE 1A AND 1B

As part of the mission statement for pharmaceutical education in the new curriculum, courses are structured with activities involving clinical judgement. decision making, and problem solving to enable students to learn knowledge. skills and values necessary to meet drug-related needs of patients in society(l ). Students enrolled in the new program at the Faculty of Pharmacy entered after at least one year of university education with prerequisites including general arts and science courses. Self-Medication courses were moved into second and third year and became part of a continuum of four Therapeutics courses. renamed Pharmaceutical Care. These courses would focus on the application of the pharmaceutical care process, beginning with mild or self-limiting conditions in the two self-medication courses, followed by progressively more complex diseases, in the latter two courses. Both self-medication courses became compulsory: the first, PCI A, taught in the second semester of the second year. and the second. PC 1B, taught in the fall semester of third year. They would use a problem-based, student-centred approach to meet educational outcomes: the problem would involve a paper patient, and the assessment would evaluate students on knowledge, process and integration skills. The same process for solving cases would be used in all PC courses. and be introduced in the initial course. The Therapeutics Integration Flowsheet, developed formerly bv a group of faculty members, would be incorporated into the nine-step process used in the self-medication courses. This flowsheet is a secondary problem-solving process, used to help students standardize an approach to identifying all drug-related problems(7) (Figure 2). A series of patient, drug and disease questions are addressed in sequence allowing for collection and synthesis. The coordinator designed the course and modified it over the next three years in response to student needs, to incorporate innovative reinforcing and enabling strategies for learning.

YEAR ONE OF THE NEW CURRICULUM (1995-96): TEACHING METHODOLOGY

The educational outcomes in the new curriculum are presented in Table II. The topics presented in each course are summarized in Table Ill.

Syllabus

A course syllabus was prepared and distributed to students at registration which included course outline, schedules, group assignments, forms and cases with recommended supplemental readings and product list

Groups

The initial class of 132 students was divided into 15 groups, according to academic standing the previous year. For example, the first group consisted of students with the highest standing, the lowest standing, the sixteenth highest standing, the sixteenth lowest standing, etc. Each group had a cross section of academic abilities to facilitate mentoring between stronger and weaker students. This standardized membership: no group would have any perceived academic, or cultural advantages or disadvantages over others. The results from term assignments supported this contention: each group received similar overall averages, with very little variances in performance. Students were not advised as to the process for group assignment.