Learning Outcomes and Student Preferences with Flipped vs Lecture/Case Teaching Model in a Block Curriculum.

Objective. To assess the impact of using a flipped classroom instructional approach on Doctor of Pharmacy (PharmD) students' learning outcomes and instructional preferences in a pharmacotherapy course within a block curriculum. Methods. Select topics in a gastrointestinal and liver pharmacotherapy course were taught using a flipped classroom method that required students to view lecture modules and respond to self-assessment questions prior to class. Classroom time included quizzes, application exercises, and discussion. The following year, teaching of these topics was switched back to a lecture/case format, and different topics were taught in the flipped classroom format, Student performance under each teaching method was examined, and student preferences and study habits were collected via a survey administered before and after experiencing the flipped classroom. Results. Combined mean formal assessment scores were higher for all four topics taught using the flipped classroom format compared to the lecture/case format. This pattern persisted when topics were examined individually, except for scores on one review topic. Survey responses reflected acknowledgement by about half of the students that the flipped format was more beneficial than traditional methods, but they still clearly preferred live lectures over prerecorded lectures. The majority of students reported that the amount of preparation time required for the flipped classroom was appropriate and that they had a positive or neutral experience with the flipped classroom overall. Conclusion. This study supports use of the flipped classroom method for teaching standard pharmacotherapy topics within a block curriculum, but underscores some of the resistance expressed by students despite understanding the potential benefits of the flipped format.

Characterization of Use of the Pharmacy Curriculum Outcomes Assessment Across Accredited Colleges of Pharmacy.

Objective. To characterize use of the Pharmacy Curriculum Outcomes Assessment (PCOA) in terms of timing, manner of delivery, and application of the results by accredited colleges of pharmacy. Methods. Accredited pharmacy programs were surveyed regarding PCOA administration, perceived benefits, and practical application of score reports. Survey items were comprised of new items developed from a literature review and items from prior studies. The survey addressed five domains: program demographics, administration, student preparation, use of results, and recommendations to improve the utility of the PCOA. Results. Responses were received from 126 of 139 (91%) surveyed programs. The majority of respondent programs administered PCOA in one session on a single campus. Most indicated PCOA results had limited use for individual student assessment. Almost half reported that results were or could be useful in curriculum review and benchmarking. Considerable variability existed in the preparation and incentives for PCOA performance. Differences in some results were found based on prior PCOA experience and between new vs older programs. Open-ended responses provided suggestions to enhance the application and utility of PCOA. Conclusion. The intended uses of PCOA results, such as for student assessment, curricular review, and programmatic benchmarking, are not being implemented across the academy. Streamlining examination logistics, providing additional examination-related data, and clarifying the purpose of the examination to faculty members and students may increase the utility of PCOA results.

Designing professional program instruction to align with students' cognitive processing.

BACKGROUND AND PURPOSE: In health professional programs, training for educators in instructional design is sparse and may be absent altogether. Implementing evidence-based, systematic instructional design can improve pharmacy curricula. This paper describes Gagné's instructional design model which is particularly effective because the instructional steps align with learners' cognitive processes. The model is applied to the teaching of liver pharmacotherapeutics in a pharmacy curriculum. EDUCATIONAL ACTIVITY AND SETTING: Second-year pharmacy students completed 25 hours of liver pharmacotherapeutics instruction that was developed using Gagné's nine instructional events: gain attention, inform about objectives, stimulate recall of prior information, present information, provide guidance, elicit performance, provide feedback, assess performance, and enhance retention. FINDINGS: Students completed individual and team-based assessments including SOAP notes, recorded case presentations, web-based quizzes, a pre- and post-knowledge assessment, and midterm and final exam multiple-choice test. Students demonstrated significant improvement in liver pharmacotherapeutics knowledge from the pre- to post-knowledge assessment. Student course instructor evaluations also reflected effectiveness of the format. SUMMARY: Evidence-based instructional design strategies, such as Gagné's model, can enhance learning of challenging pharmacotherapeutics concepts using a systematic framework that aligns with cognitive processing.

Improving Pharmacy Calculations Using an Instructional Design Model.

Objective. To describe an evidence-based instructional design to improve performance and foster retention of pharmacy students' calculation skills longitudinally across the curriculum. Methods. Gagne's nine events of instructional design were employed in a longitudinal pharmacy calculations curriculum. Mean pharmacy calculation examination scores from four courses spanning the didactic curriculum for four different academic years (before and after the redesign) were compared. Results. Students demonstrated more stable outcomes with consistently higher means after the redesign, which may indicate improved retention. Additionally, the post-redesign classes have experienced fewer failures (score of <80%). Conclusion. Using an instructional design model to optimize immediate instructional outcomes is an effective method of enhancing retention of calculation skills over time.

An analysis of the use of Pharmacy Curriculum Outcomes Assessment (PCOA) scores within one professional program.

OBJECTIVE: The Pharmacy Curriculum Outcomes Assessment (PCOA) is a recent assessment requirement for US pharmacy professional programs. This study analyses PCOA scores for uses described in the 2016 Standards with data from one professional program. METHODS: PCOA data were analyzed for two consecutive classes (n=215) of pharmacy students at the end of their didactic curriculum to explore relationships among PCOA scores, grade point average (GPA), and North American Pharmacist Licensure Examination (NAPLEX) scores utilizing regression analyses. RESULTS: Decisions about student learning based on PCOA scores and GPA indicated remediation would have been prescribed for approximately 7% of students. In comparison, NAPLEX scores revealed a 1% failure rate among the study sample. Relationships between PCOA scores and GPA (r=0.47) and NAPLEX (r=0.51) were moderate to large, respectively. GPA explained a larger portion of unique variance (14%) than PCOA (8%) in NAPLEX scores. CONCLUSIONS: In this sample of students, academic decisions would have varied depending upon the learning assessment, which is consistent with a moderate correlation between GPA and PCOA scores. Although PCOA scores correlate with GPA and NAPLEX, PCOA scores explained a smaller portion of unique variance in NAPLEX scores than GPA. The ongoing establishment of validity evidence of PCOA scores is important for meaningful interpretation of scores for the intended uses.

Teachable Moments Matter for: An analysis of the use of Pharmacy Curriculum Outcomes Assessment (PCOA) scores within one professional program.

Editors Note: The Teachable Moments Matter category of articles is designed to offer readers insight into a methodological issue identified within a companion article. Written in collaboration with one of these authors, these articles provide an opportunity to focus on a challenge experienced by the authors and, in the process, provide one or more perspectives as to how to successfully navigate this issue. Notably, this "issue" is not necessarily a problem (as this first paper in this series demonstrates). The Journal hopes this case-based approach will help highlight an issue nuance in context, something that might get "lost" in the entirety of a full-length article. This article discusses the importance of communicating a conceptual framework (i.e., theory) as a basis for scholarly articles. A specific example in the companion article is use of validity theory. In our community of researchers, we need to better communicate a conceptual framework as a basis to allow others to build on and grow our knowledge in pharmacy education.

Student-led co-curricular medical Spanish training in a pharmacy professional program.

BACKGROUND AND PURPOSE: This paper describes a student-led co-curricular training program to increase pharmacy student proficiency with medical Spanish terminology. Western University of Health Sciences (WesternU) pharmacy students frequently can interact with Spanish-speaking patients in experiential rotations. Moreover, the clear majority of program graduates remain in California, a state with a high Spanish-speaking population. Developing foundational knowledge of medical Spanish terminology can enhance communication with Spanish-speaking patients, who may have limited English proficiency and experience a lack of language concordance when interacting with the healthcare system. Providing training in medical terminology in another language is important because communication barriers have been associated with adverse medical outcomes, such as poor medication adherence. EDUCATIONAL ACTIVITY AND SETTING: The development of the training logistics and materials are described for replication of the process, whether with medical Spanish or other languages. Students in the pharmacy program developed the medical Spanish training that is now a robust co-curricular activity with over 100 students participating in the training each semester. An important aspect of the WesternU co-curricular activity is that students develop materials, create learning activities, and facilitate training.

Implementation and evaluation of activities to foster a sense of community among pharmacy students.

INTRODUCTION: The purpose of this study was to investigate the association of a series of team-based instructional activities on students' sense of community for pharmacy students assigned to the main and distance program sites. MATERIALS AND METHODS: In conjunction with a teaching objective structured clinical examination (OSCE) conducted at the program's distance site, several team-based sense of community activities were completed. The classroom and school community inventory (CSCI) was adapted and administered to students prior to and following all learning activities to measure course and program sense of community. RESULTS: Pre- and post-surveys were completed by 116 students. Course and program sense of community significantly increased among students at the distance site (p = 0.007 and p = 0.008, respectively). No significant changes were found for students assigned to the main site. CONCLUSION: For programs with multiple sites, activities designed to enhance sense of community and conducted at the distance site are effective for students assigned to the distance site.

Symptom recognition and healthcare experiences of young women with acute myocardial infarction.

BACKGROUND: Prompt recognition of acute myocardial infarction symptoms and timely care-seeking behavior are critical to optimize acute medical therapies. Relatively little is known about the symptom presentation and care-seeking experiences of women aged ≤55 years with acute myocardial infarction, a group shown to have increased mortality risk as compared with similarly aged men. Understanding symptom recognition and experiences engaging the healthcare system may provide opportunities to reduce delays and improve acute care for this population. METHODS AND RESULTS: We conducted a qualitative study using in-depth interviews with 30 women (aged 30-55 years) hospitalized with acute myocardial infarction to explore their experiences with prodromal symptoms and their decision-making process to seek medical care. Five themes characterized their experiences: (1) prodromal symptoms varied substantially in both nature and duration; (2) they inaccurately assessed personal risk of heart disease and commonly attributed symptoms to noncardiac causes; (3) competing and conflicting priorities influenced decisions about seeking acute care; (4) the healthcare system was not consistently responsive to them, resulting in delays in workup and diagnosis; and (5) they did not routinely access primary care, including preventive care for heart disease. CONCLUSIONS: Participants did not accurately assess their cardiovascular risk, reported poor preventive health behaviors, and delayed seeking care for symptoms, suggesting that differences in both prevention and acute care may be contributing to young women's elevated acute myocardial infarction mortality relative to men. Identifying factors that promote better cardiovascular knowledge, improved preventive health care, and prompt care-seeking behaviors represent important target for this population.

Does health status differ between men and women in early recovery after myocardial infarction?

BACKGROUND: Although much attention has been given to survival after myocardial infarction (MI), little is known about sex differences in health status (symptoms, function, and quality of life). A particularly critical moment to assess health status following an MI is early after discharge when patients have resumed routine activities and when additional treatments may be offered to those with residual angina or quality of life limitations. METHODS: We used multivariable Poisson and linear regression models to examine differences in 30-day health status by sex in a cohort of 2096 MI patients enrolled in a 19-center Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER). RESULTS: Women (32% of the cohort) were older and less likely to be white, married, or treated with coronary revascularization. They were more likely to have had a non-ST segment elevation MI, diabetes, hypertension, heart failure, chronic lung disease, and worse health status at admission. Risk-adjusted multivariable models suggest women were slightly more likely to have angina (RR 1.06, 95% CI 1.0, 1.14, p = 0.06), worse quality of life (difference in SAQ score = -4.36 points, 95% CI -5.44, -3.27 points, p = <0.001) and poorer physical functioning (difference in SF-12 PCS = -2.55 points, 95%CI = -3.62, -1.48 points, p = <0.001) at 30 days than men. CONCLUSIONS: One in four patients experienced angina 1 month after their MI, and women had a slightly greater prevalence than men. The physical function and quality of life of women 30 days after an MI is similar to or worse than that of men.