Providing Validation Evidence for a Clinical-Science Module: Improving Testing Reliability with Quizzes.

DESCRIPTION OF THE PROBLEM: High-stakes decision-making should have sound validation evidence; reliability is vital towards this. A short exam may not be very reliable on its own within didactic courses, and so supplementing it with quizzes might help. But how much? This study's objective was to understand how much reliability (for the overall module-grades) could be gained by adding quiz data to traditional exam data in a clinical-science module. THE INNOVATION: In didactic coursework, quizzes are a common instructional strategy. However, individual contexts/instructors can vary quiz use formatively and/or summatively. Second-year PharmD students took a clinical-science course, wherein a 5-week module focused on cardiovascular therapeutics. Generalizability Theory (G-Theory) combined seven quizzes leading to an exam into one module-level reliability, based on a model where students were crossed with items nested in eight fixed testing occasions (mGENOVA used). Furthermore, G-Theory decision-studies were planned to illustrate changes in module-grade reliability, where the number of quiz-items and relative-weighting of quizzes were altered. CRITICAL ANALYSIS: One-hundred students took seven quizzes and one exam. Individually, the exam had 32 multiple-choice questions (MCQ) (KR-20 reliability=0.67), while quizzes had a total of 50MCQ (5-9MCQ each) with most individual quiz KR-20s less than or equal to 0.54. After combining the quizzes and exam using G-Theory, estimated reliability of module-grades was 0.73; improved from the exam alone. Doubling the quiz-weight, from the syllabus' 18% quizzes and 82% exam, increased the composite-reliability of module-grades to 0.77. Reliability of 0.80 was achieved with equal-weight for quizzes and exam. NEXT STEPS: Expectedly, more items lent to higher reliability. However, using quizzes predominantly formatively had little impact on reliability, while using quizzes more summatively (i.e., increasing their relative-weight in module-grade) improved reliability further. Thus, depending on use, quizzes can add to a course's rigor.

Practical Team-Based Learning from Planning to Implementation.

Team-based learning (TBL) helps instructors develop an active teaching approach for the classroom through group work. The TBL infrastructure engages students in the learning process through the Readiness Assessment Process, problem-solving through team discussions, and peer feedback to ensure accountability. This manuscript describes the benefits and barriers of TBL, and the tools necessary for developing, implementing, and critically evaluating the technique within coursework in a user-friendly method. Specifically, the manuscript describes the processes underpinning effective TBL development, preparation, implementation, assessment, and evaluation, as well as practical techniques and advice from authors' classroom experiences. The paper also highlights published articles in the area of TBL in education, with a focus on pharmacy education.

Irritable bowel syndrome: a concise review of current treatment concepts.

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders causing patients to seek medical treatment. It is relatively resource intensive and the source of significant morbidity. Recent insights into the pathophysiology and treatment of IBS has given clinicians more options than ever to contend with this disorder. The purpose of our paper is to review older, "classic" treatments for IBS as well as newer agents and "alternative" therapies. We discuss the evidence base of these drugs and provide context to help develop appropriate treatment plans for IBS patients.

Effects of depressive and other psychiatric disorders on anticoagulation control in a pharmacist-managed anticoagulation clinic.

BACKGROUND: The impact of psychiatric disorders on International Normalized Ratio (INR) control and adverse events for patients receiving warfarin has not been fully elucidated. OBJECTIVE: To determine the effect of depressive and other psychiatric disorders on anticoagulation control in a pharmacist-managed anticoagulation clinic. METHODS: A retrospective chart review evaluated outcomes of patients with no history of psychiatric disorders and compare it with that of patients with either a history of depression or any form of psychiatric disorder. Data was obtained from patient medical records over a 24-month period. The primary outcome was a comparison of time in therapeutic range, calculated using 3 separate methods (percentage of INRs in therapeutic range, a modified Rosendaal's linear interpolation, and mean INR in goal). RESULTS: A total of 151 patients met the inclusion criteria (control = 79, psychiatric disorders = 72 patients). Control patients had a significantly greater proportion of INRs in the goal range compared with either the depression or psychiatric disorders groups (control, 55.7%; depression, 43.5%; psychiatric, 45.8%). Utilizing the Rosendaal's method, patients with psychiatric disorders were in the goal range significantly less often than those in the control group (53.0% vs 61.3%). No differences were seen when adjusting for multiple comparisons or when comparing the control and depression groups (54.5% vs 61.3%). There was no difference between the groups when comparing percentages of patients with a mean INR in their goal range. CONCLUSIONS: Patients with psychiatric disorders who take warfarin may spend less time in the therapeutic range.