Teaching clinical problem solving in a nonprescription medication course iwth treatment algorithms

American Journal of Pharmaceutical Education,  Fall 1999  by Nykamp, Dian

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Two methods of teaching, treatment algorithms versus traditional format (lecture with case study integration) were compared to determine if there was: (i) a change in student test scores, and (ii) change in student ratings of the course. The sample consisted of 125 third year entry-level pharmacy students enrolled in a Nonprescription Medicines class. Different aspects of first aid and common cold were taught using the two different methods. Treatment algorithms were employed for the first aid topics of abrasions, heat injuries, and broken bones. Algorithms were also used to teach the role of antihistamines in the management of the common cold. The traditional format was employed for the first aid topics of bleeding, nosebleeds, and insect stings. The traditional format was also used to teach the role of decongestants in the management of the common cold. Student learning was measured via pre- and posttest questions. The number of students whose score improved from pre- to posttest on a topic was recorded. Additionally, examination test scores as well as student ratings from two classes were compared. The results demonstrated there were no significant differences between teaching methods in the area of first aid and the common cold. However, improved examination scores as well as student evaluations of the course were associated with use of algorithms. Treatment algorithms are a different approach to classroom teaching and in some instances may enhance learning in some areas of nonprescription drug therapy.

INTRODUCTION

The Nonprescription Products course is required during the fall semester for approximately 125 third-year entry-level pharmacy students. The focus is placed on assessment of the patient and in making product recommendations. The course is designed to be practical so students are able to leave the classroom and immediately use what they have learned in a practice setting.

A barrier that has become more obvious each year is the increasing amount of new material that must be incorporated into the learning experience. This is compounded in that students generally feel a great amount of information is already covered at a rapid pace. Additionally, as more products make the shift from legend status to the over the counter (OTC) market, more focus will be placed on self care. With these concerns in mind, a new approach to teaching was investigated. To assist the student in problem solving and in making product recommendations treatment algorithms were introduced into the Nonprescription Products course. Patient management with the use of treatment algorithms has been used in the past(1-6).

GOALS

Treatment algorithms were introduced into a Nonprescription Products course and compared to a traditional lecture with case study presentation to determine if this was associated with: (i) a change in student test scores; (ii) a change in student ratings of the course. It was hypothesized when using treatment algorithms to help problem solve students would find the method to be a good instructional resource.

DESCRIPTION OF TEACHING METHODS

Traditional lecture format with case study integration has been the teaching framework used in the Nonprescription Products course for the past several years. The course is a three hour semester team taught course which is lead by Pharmacy Practice faculty who have practice interests in Ambulatory Care, Geriatrics, Community Pharmacy, and Pediatrics. Students are given a comprehensive syllabus containing objectives for all of the topics and a schedule on the first day of class. Case studies, outlines, additional methods, and in some instances copies of slides are usually distributed on the specific class day. The textbook used is the Handbook of Nonprescription Drugs distributed by the American Pharmaceutical Association(7). The traditional format includes a didactic lecture and case study accompanied by discussion. In the past, this type of instruction has been rated by the students on their evaluations of the course as good (student evaluations of the course overall in 1996 were ranked 4.1 on a five-point scale). However, there may be a better way in some areas to assist students in problem solving and enhance learning.

METHODS

A new approach using treatment algorithms was implemented during the fall of 1997 in selected topic areas. The selected topic areas were taught by one of the course instructors. The algorithm approach centered on discussion using decision pathways and was used for the following topics: (i) First Aid: abrasions, heat injuries, and broken bones; and (ii) Common cold: role of antihistamines. See Figure I for example of algorithm on Self-Care of the Common Cold. The final version of the algorithm is published elsewhere(8). The traditional format was used for the following topics: (i) First Aid: bleeding, nosebleeds, and insect stings; and (ii) Common cold: role of decongestants.

A comparison of the two teaching methods (traditional vs. algorithm) was conducted using chi square (significance was set at P