Implementation and Refinement of a Problem-based Learning Model: A Ten-Year Experience

American Journal of Pharmaceutical Education, 2007 by Ross, Leigh Ann, Crabtree, Brian L, Theilman, Gary D, Ross, Brendan S, Et al

Objectives. To evaluate the effectiveness of a problem-based learning (PBL) model implemented in 1995 at the University of Mississippi School of Pharmacy.

Design. The third-professional (P3) year curriculum was reoriented from a faculty-centered model of teaching to a student-centered model of learning. Didactic lectures and structured classroom time were diminished. Small student groups were organized and a faculty facilitator monitored each group's discussions and provided individual student assessments. At the end of each 8-week block, students were assessed on group participation, disease and drug content knowledge, and problem-solving abilities. Faculty and student input was solicited at the end of each year to aid programmatic improvement. In 2000, a formal 5-year review of the PBL program was conducted.

Assessment. Recommendations for improvement included clarifying course objectives, adopting a peer-review process for examination materials, refining the group assessment instruments, and providing an opportunity for student remediation after a course was failed. A weekly case conference presided over by a faculty content expert was also recommended. Ongoing critical evaluation during the following 5-year period was provided by graduates of the program, faculty participants, and accreditation reviews.

Conclusion. Over our 10-year experience with a PBL model of P3 education, we found that although the initial challenges of increased demands on personnel and teaching space were easily overcome, student acceptance of the program depended on their acknowledgment of the practical benefits of active learning and on the value afforded their input on curricular development.

Keywords: active learning, problem-based learning, student-centered learning

INTRODUCTION

The profession of pharmacy evolves to meet the changing demands of the society it serves. With each metamorphosis new opportunities arise for expanding the scope of pharmacy practice. The responsibilities of pharmacists have grown from appropriately dispensing medications to providing services that optimize the benefits of pharmaceutical therapies. The knowledge base and skill sets of pharmacists must expand to address the patient and institutional needs for suchmedication therapy management. The Accreditation Council for Pharmacy Education (ACPE) recognizes that pharmacy education must change to accommodate this heightened expectation of its practitioners. The ACPE's enhanced requirements for accreditation encouraged all schools and colleges of pharmacy to implement a lengthier and more rigorous curriculum that prepares pharmacists to fulfill these new responsibilities and that insures its graduates can adapt to future professional imperatives.

The Standards for Curriculum published by ACPE state that ''The educational process should promote lifelong learning through the emphasis on active, selfdirected learning.'' The standards further state that curricula should include ''teaching strategies to ensure the adeptness of critical thinking and problem-solving.''1 To assess whether the pharmacy curriculum at the University of Mississippi conformed to ACPE requirements, a review of our course content and teaching methods was undertaken. Many of our courses were found to be structured along the lines of traditional medical school education: they were organ-based and they relied upon a didactic lecture format for teaching. This organization was especially evident in the third-professional (P3) year, when drug information was presented to students in a modularized fashion (ie, cardiovascular medications were considered in isolation from gastrointestinal therapies). This teaching model did not profit from the recent insights of adult learning theorists, in that it provided few opportunities for active, self-directed learning. From an assessment standpoint, our curriculum was also deemed deficient in that educators could not evaluate a student's ability to integrate information from different modules and to apply such integrated content knowledge by solving clinical problems.2 Over-reliance on clinical practice experiences in the fourth and final curriculum year to develop a student's critical thinking skills was also noted. Given that the quality of these extramural experiences could not be uniformly ensured, no certainty that graduates had developed these crucial professional capabilities could be anticipated. After identifying manifold deficiencies with the currently employed faculty-centered model of teaching, the School of Pharmacy reoriented the curriculum by adopting a student-centered model of learning.

A movement away from a didactic teaching model to an educational design that fostered active, self-directed learning did not necessarily mean that a problem-based learning (PBL) model would be adopted. Active-learning techniques such as small-group discussions or writing exercises can exist within the confines of a lecture format, which may also be enhanced by classroom debate, roleplaying, or peer teaching.3 A taskforce of Department of Pharmacy Practice faculty members carefully considered different options for increasing the student role in facilitating self-education. Their review and recommendations led to a decision to implement a PBL model at the University of Mississippi. Our PBL program provides students the opportunity to develop critical thinking and problem-solving skills in a controlled environment. We employ these innovative teaching methods in the P3 year of the curriculum, which is now termed the Pharmaceutical Care course series. The following is a descriptive report of our program and an overview of our experiences with a PBL model of pharmacy education.