Innovative enabling strategies in self-directed, problem-based therapeutics: Enhancing student preparedness for pharmaceutical care practice

American Journal of Pharmaceutical Education, Spring 2001 by Raman-Wilms, Lalitha

Innovations in Teaching

Innovative Enabling Strategies in Self-Directed, Problem-Based Therapeutics: Enhancing Student Preparedness for Pharmaceutical Care Practices1

The objectives of this innovation were to enhance student learning in therapeutics taught in a large-group, problem-based format in third and fourth professional years of the program and to increase student preparedness in providing pharmaceutical care. Feedback from students and instructors helped identify some limitations to learning and included limitation of breadth of knowledge learned, increasing students' awareness of the patient's perspective of illness, and students' ability to verbally justify recommendations. Alignment of the courses in relation to students' expected competency were also considered. Strategies to address limitations included development of criterion-based assessments, oral examinations, use of real patients, and development of a web infrastructure. The innovation resulted in an enhancement of student learning in a self-directed problem-based environment and a better understanding of the patient's perspective of illness. It can be concluded that preparedness for pharmaceutical care practice by the student increased motivation to pursue self-directed, life-long learning.

INTRODUCTION

In 1994, the Faculty of Pharmacy at the University of Toronto changed its existing four-year curriculum to a new 1 4-year undergraduate pharmacy program, leading to a baccaulaurate in pharmacy. The emphasis in the new curriculum was on the students' ability to provide pharmaceutical care upon graduation(l). Therapeutics, taught in a problem-based format and offered in the fourth year of the old program(2) was expanded significantly to two courses, to be taught in the third and fourth year of the new program(1). In addition to the lecture compovent in the courses, five small group seminars on key disease states were incorporated into the two therapeutics courses, Pharmaceutical Care II and III((1). The new Therapeutics courses were initiated in 1996-97 (Pharmaceutical Care II -- offered in third year) and 1997-98 (Pharmaceutical Care III -- offered in fourth year). During the last semester of fourth year, students undergo 16 weeks of structured practical experience in community and institutional practice sites. Hence, therapeutics plays a significant role in building students' knowledge and skills in preparation for practice.

Underlying Principles of Teaching and Learning in Therapeutics

Therapeutics is taught in a large-group format of 120 students, using self-directed, problem-based learning. Underlying the courses are also the principles of Pharmaceutical Care(3). Students in the class are divided into groups of eight to facilitate group work. Paper patient cases, along with required readings from course textbook and/or journal articles, are provided in advance. Students, working within their groups, are expected to carry out an assessment of the patient utilizing the pharmaceutical care process(2) and identify and resolve any drug-- related problems, in preparation for class discussion. An expert instructor facilitates the discussion during class time. Each case discussion takes 1.5 hours. The classes are all taught by practicing pharmacists.

Development of Knowledge and Skills within the Curriculum

Students are evaluated using criterion-based assessment in most of the pharmacy practice courses. In ensuring that students meet the required level of knowledge and skills upon graduation, a well-defined admissions process is used to ensure that students entering the program can perform at the interface of the Uni- and Multistructural level(4) (see Appendix A) of competence in communication skills as a condition of entry. During the first year of the program, a communications course emphasizes listening, verbal and written communication skills at the Unistructural-Multistructural level. Students are also guided through self-assessment skills starting in the first year. The curriculum is aligned with respect to communication skills and students' development of knowledge and skills are built on each other over the four years.

The overall goal of the therapeutics courses is to enable students to optimize their knowledge and skills required to provide pharmaceutical care. During the two-year therapeutics courses, students are gradually exposed to therapeutic problems that range from being well-defined and routine (see Appendix B), to ill-defined and non-routine problems, thus ensuring that their knowledge and skills are developed to a multistructural (Appendix A) level in the third year and bridging between a Multistructural and Relational level in the fourth year, in preparation for their practical experience. Upon graduation, students should be at a Relational level of learning. The alignment of skills throughout the curriculum ensures that students entering Pharmaceutical Care II in third year can be expected to function at a beginning Multistructural level of knowledge acquisition and skill.