Medication histories to identify medication-related problems through the pharmacists' patient care process in a simulated ambulatory care laboratory.

BACKGROUND AND PURPOSE: Assessment of the Pharmacists' Patient Care Process (PPCP) in pharmacy curricula has been reported in a variety of contexts, but results have not described individual student performance in a controlled ambulatory care skills laboratory to purposefully identify medication-related problems (MRP) and develop plans for resolution. EDUCATIONAL ACTIVITY AND SETTING: One of five MRPs was embedded within standardized medication profiles to facilitate student completion of three graded ambulatory care medication history encounters in a third-year skills laboratory. Data analysis included student performance in aggregate and according to MRP type from the first to the third medication history encounter. FINDINGS: One hundred thirty-six students completed three medication histories for 408 encounters. Regardless of MRP, the total and subscale scores for adjusted marginal means were significantly higher in Sessions 2 and 3. Performance on MRP scenarios for drug interactions and adverse effects were significantly lower and higher, respectively. Successful collection of patient history significantly influenced marginal mean scores for respective MRPs. SUMMARY: Improvement in student application of PPCP Steps 1 through 3 may be evident using three simulated ambulatory care medication history patient encounters toward the end of the third professional year, with potential influences by MRP type, MRP repetition, and adequate collection of patient history. Repetition with individualized grading and formative feedback are essential for skill development to identify MRPs in this setting. Confirmation of findings and extension into experiential education with higher complexity are needed to develop consistent and effective application of the PPCP to patient care.

The emergence of remote laboratory courses in an emergency situation: University instructors' agency during the COVID-19 pandemic.

This study examines and describes how various online remote laboratory courses, necessitated by the COVID-19 pandemic, were implemented at Hankuk University in Korea in 2020. We compared four general undergraduate laboratory courses, one each for physics, chemistry, biology, and earth science, and two major-level laboratory courses taught during the spring and fall of 2020. Employing a sociocultural perspective, we examined how the changes in structures at the macro-, meso-, and micro-levels shaped the responses of educational authorities and impacted the agency of university instructors. Instructors implemented various remote laboratory courses in each content area dependent upon availability and access to material resources, including access to video of laboratory activities, and also based on the nature of experimental data associated with each content area. Drawing from survey responses and in-depth interviews with instructors and students, we share findings about how instructor practices impacted the interactions of students, the processes for evaluation, and student learning. We discuss how the global pandemic has re-ignited the debate about the role and value of experimental laboratory activities for undergraduate science majors and about the significance of hands-on versus minds-on science learning. Implications for how universities approach laboratory coursework in the post-COVID-19 are discussed, and questions for university science instruction are raised for future research.

Design and implementation of a program wide pharmaceutical compounding curriculum using the scaffold learning approach.

BACKGROUND AND PURPOSE: We evaluated the design and implementation of a program wide pharmaceutical compounding curriculum covering five modules over four years using the scaffold learning approach in a pharmacy degree program. EDUCATIONAL ACTIVITY AND SETTING: A programmatic approach was taken in the development of compounding expertise, which required moving away from a compartmentalized course design to a multi-course approach spanning all four years of the pharmacy program. FINDINGS: Since the intervention began in 2014, course failure rates, which were around 34% (2012-2014), have significantly decreased to 1.5% (2015-2019), and the percentage of students achieving distinction and above has increased four-fold from 20% (2012-2014) to 80% (2015-2019). SUMMARY: A program wide scaffold learning approach was more effective in the development of compounding skills throughout the pharmacy program than teaching compounding techniques in different modules without clear vertical integration.

On building cytomorphology skills: Influence of slide reviewing habits on diagnostic competency in cytology.

OBJECTIVES: The specific aims of the study are to assess whether the amount of time a cytology learner spends reviewing slides correlates with increased diagnostic competency and to determine whether time spent reviewing slides immediately after the multi-head sessions correlates with a higher level of proficiency. The paper also seeks to explore the impacts of the time of day at which slides were reviewed on diagnostic learning outcome. METHODS: Data obtained through the cytology laboratory screening logs were reviewed, and the number of hours per day and the times of the day at which the students were present at the glass slide library were tabulated and compared against each of the seven-unit slide exam scores in the semester to explore possible relationships. RESULTS: There was a positive linear relationship (r = 0.29) between the number of hours students spent in the laboratory reviewing cases and competency. When the students' unit diagnostic test scores were classified into low and high categories for each test, there was a significant correlation (P = 0.008) between a lack of time spent screening slides in the lab and the number of times a student was ranked at the bottom of the class. Our data do not support a recency effect nor a difference in test scores between those who reviewed cases in the morning vs in the afternoon. CONCLUSIONS: While educating and training a strong cytology workforce may be challenging, our study provides new insights and sheds light on the importance of spending time reviewing slides, and provides guidance for struggling students on how best to improve. Inside this month's Cytopathology: The aims of this study are to assess whether the amount of time a cytology learner spent reviewing slides correlates with increased diagnostic competency, and to determine whether time spent reviewing slides immediately after the multi-head sessions correlates with a higher level of proficiency. The paper also seeks to explore the impacts of the time of day at which slides were reviewed on diagnostic learning outcome.

Implementation and sequencing of a compounded sterile preparation validation testing protocol for second- and third-year pharmacy students.

BACKGROUND AND PURPOSE: Incorporation of aseptic technique validation testing in a pharmacy curriculum consistent with United States Pharmacopeia Chapter 797 Standards is not well described. Validation testing is optimally placed prior to assignment to health-system introductory and advanced pharmacy practice experiences. EDUCATIONAL ACTIVITY AND SETTING: Environmental and engineering controls consistent with a segregated compounding area were implemented. Medium risk media fill and gloved fingertip test (GFT) testing were incorporated to achieve initial and subsequent training in the second and third curricular years, respectively. FINDINGS: For the graduating classes of 2018 through 2020, 234 students completed validation testing and knowledge assessment. Failure of the media fill test was uncommon. Failure of the initial GFT testing occurred in 16.1% to 22.1% of second-year students and 3.2% to 5.8% of third-year students. No significant differences were seen between three consecutive student classes. SUMMARY: Incorporation of validation testing was successful, with consistent results. Procedures and results provide guidance with respect to student class size, available facility/equipment needs, implementation of validation protocols, and associated resources. Each student is provided with documentation of annual training and validation testing consistent with existing standards for health-system pharmacy practice.

The varied experience of undergraduate students during the transition to mandatory online chem lab during the initial lockdown of the COVID-19 pandemic.

The radical global shift to online teaching that resulted from the initial lockdown of the COVID-19 pandemic forced many science educators into the predicament of translating courses, including teaching laboratories, that were based upon face-to-face or practical goals and conventions into ones that could be delivered online. We used this phenomenon at the scale of a research-intensive, land-grant public institution to understand the various ways that the switch was experienced by a large cohort of 702 undergraduate students taking General Chemistry Laboratory. Data was collected over 3 weeks with identical surveys involving four prompts for open-ended responses. Analysis involved sequential explanatory mixed methods where topic modeling, a machine learning technique, was used to identify 21 topics. As categories of experience, these topics were defined and further delineated into 52 dimensions by inductive coding with constant comparison. Reported strengths and positive implications tie predominantly to the topics of Time Management Across a Lab Activity and a Critique of Instruction. Consistent with other reports of teaching and learning during the pandemic, participants perceived Availability of the Teaching Assistant for Help as a positive implication. Perceptions of weakness were most associated with Having to Work Individually, the Hands On Experience, a Critique of Instruction, and Learning by Doing. Hands on Experience, which was interpreted as the lack thereof, was the only topic made up nearly entirely of weaknesses and negative implications. The topic of Learning by Doing was the topic of greatest occurrence, but was equally indicated as strengths, positive implication, weakness, and negative implication. Ramifications are drawn from the weaknesses indicated by students who identified as members of an underrepresented ethnic minority. The results serve as a reminder that the student experience must be the primary consideration for any educational endeavor and needs to continue as a principal point of emphasis for research and development for online science environments.

Assessment of Mapping the Brain, a Novel Research and Neurotechnology Based Approach for the Modern Neuroscience Classroom.

Neuroscience research is changing at an incredible pace due to technological innovation and recent national and global initiatives such as the BRAIN initiative. Given the wealth of data supporting the value of course-based undergraduate research experiences (CUREs) for students, we developed and assessed a neurotechnology CURE, Mapping the Brain. The goal of the course is to immerse undergraduate and graduate students in research and to explore technological advances in neuroscience. In the laboratory portion of the course, students pursued a hypothesis-driven, collaborative National Institutes of Health (NIH) research project. Using chemogenetic technology (Designer Receptors Exclusively Activated by Designer Drugs-DREADDs) and a recombinase-based intersectional genetic strategy, students mapped norepinephrine neurons, and their projections and explored the effects of activating these neurons in vivo. In lecture, students compared traditional and cutting-edge neuroscience methodologies, analyzed primary literature, designed hypothesis-based experiments, and discussed technological limitations of studying the brain. Over two consecutive years in the Program at North Carolina State University, we assessed student learning and perceptions of learning based on Society for Neuroscience's (SfN) core concepts and essential principles of neuroscience. Using analysis of student assignments and pre/post content and perception-based course surveys, we also assessed whether the course improved student research article analysis and neurotechnology assessment. Our analyses reveal new insights and pedagogical approaches for engaging students in research and improving their critical analysis of research articles and neurotechnologies. Our data also show that our multifaceted approach increased student confidence and promoted a data focused mentality when tackling research literature. Through the integration of authentic research and a neurotechnology focus, Mapping the Brain provides a unique model as a modern neuroscience laboratory course.

Student Outcomes From a Large-Enrollment Introductory Course-Based Undergraduate Research Experience on Soil Microbiomes.

In recent years, national reports have called for undergraduate laboratory education that engages students in authentic research experiences. As a result, a number of course-based undergraduate research experiences (CUREs) have been developed in biological sciences and some specifically in microbiology. Students benefit from CUREs much like in traditional mentored research experiences, where students carry out independent projects in faculty laboratories. These benefits include increased self-efficacy in research skills, enhanced identification as scientists, and higher graduation rates in science, technology, engineering, and mathematics majors. Because mentored research experiences are not readily available to every student, CUREs represent a potential mechanism to democratize the research experience by providing such opportunities to all students. However, many of existing CUREs described in the literature are designed for advanced undergraduates or are limited to a small number of students. Here, we report student outcomes from a large-enrollment introductory CURE on soil microbiomes that engages students in a real-world context with microbiology. In pre- and post-course surveys, students reported significant gains in self-efficacy on a number of research skills. These results are triangulated with post-course survey data on project ownership, sense of community, and CURE design elements such as collaboration, iteration, discovery, and relevance.

Respiratory Auscultation Lab Using a Cardiopulmonary Auscultation Simulation Manikin.

Introduction: Mastery of respiratory auscultation skills is fundamental for clinicians to develop. We created a case-based educational session utilizing a high-fidelity simulator to teach lung sound auscultation to medical students at our institution. We employed a hypothesis-driven approach and deliberate practice to enhance students' learning experience and retention of acquired skills. Methods: We developed the session to teach second-year medical students how to discriminate between normal and pathological respiratory sounds within the context of clinical vignettes. Faculty facilitators, in conjunction with near-peer educators, made use of a high-fidelity auscultation manikin to guide students through case-based problem sets. Students were given the opportunity to auscultate the manikin while being observed and receiving feedback from the faculty. Results: We introduced the manikin in 2016, with a total of 759 second-year medical students from four class years having participated in the session since then. Students evaluated the session through an end-of-the-week and end-of-unit survey. The survey showed an overall improvement in learner satisfaction over previous years. Survey results and feedback were used to make adjustments to the session. Discussion: Our respiratory auscultation session was well received overall. Proper faculty development is crucial for implementing the session. Because of the focus on deliberate practice, adequate time must be allotted to hold the session. This program is reproducible with similar high-fidelity simulators.

Development, application, and evaluation of a problem-based learning method in clinical laboratory education.

BACKGROUND: There is a big gap between theory and real clinical practice with respect to the structure of clinical laboratory medicine (CLM) education in China. An integrated teaching method is urgently required, to improve student competency and prepare students to deal with complex challenges in the working environment. METHODS: A total of 122 fourth-year CLM students studying at Hubei University between 2018 and 2019 were randomly assigned to a traditional teaching methods group or a problem-based learning (PBL) group. In the PBL group students were instructed to exchange their thoughts, identify information gaps, rehearse and perform simulated clinical scenarios, and incorporate the new information into cases in small groups. Theory tests, questionnaires, and clinical performance assessments were used to evaluate the effectiveness of PBL and compare it with that of traditional teaching methods. RESULTS: PBL resulted in significantly better theory test scores, better student feedback scores, and clinical performance assessments, and a higher rate of satisfaction among students and teachers. CONCLUSION: PBL is an effective way to help CLM students develop comprehensive abilities to deal with real clinical laboratory work. It is a promising education method and should be generalized to all subtypes of clinical laboratory curriculums in the future.

A Multimedia Educational Module for Teaching Early Medical Neuroanatomy.

Introduction: As the global burden of neurological disorders continues to rise, physicians' need for a solid understanding of neuroanatomy is becoming more important. Traditional neuroanatomy curricula offer a limited approach to educating a diverse profile of learning styles. In an attempt to incorporate recent literature addressing diverse learning formats, we developed and evaluated two new image-based resources for the neuroscience curriculum. Methods: We created narrated videos demonstrating the brain dissections that students were to perform in the laboratory and quiz-style, postdissection review slides for later self-guided study. These were offered as optional study aids to two classes of preclerkship medical students at the Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine. Effectiveness was evaluated through examination questions, and a survey was administered to one of the classes to assess usage of and satisfaction with the materials. Results: Mean scores on the practical examination questions were 83% and 89% for the two classes of students given the resources. Notably, 100% of respondents used the review slides after the laboratory, and more than 99% found them very helpful or extremely helpful for learning relevant concepts. Discussion: Our results support the usefulness of these resources as learning tools for neuroanatomy. These resources were meant to augment various traditional resources (textbooks, lecture) to provide a broad range of study options in line with current research. Our experience suggests that similar tools could be developed for application in other visually based content areas of the preclerkship curriculum.

Perineal Laceration and Episiotomy Repair Using a Beef Tongue Model.

Introduction: Declining rates of operative vaginal deliveries and routine episiotomy in obstetric practice, along with rising cesarean section rates, have decreased OB/GYN resident experience with episiotomy repair and obstetric anal sphincter injuries (OASIS). Simulation models are valuable educational tools in procedural training. Several models have been reported, each with its own limitations and benefits. Methods: We developed a 1-hour workshop to teach novice OB/GYN residents perineal laceration repair skills on a modified beef tongue model. The model required 5-10 minutes to assemble following written and video instruction, and learners had 30-50 minutes to practice using learner instructions. Learners were evaluated using a procedure checklist and global objective structured assessment of technical skills. To evaluate the session, we surveyed current faculty and residents, as well as residency graduates. Results: Between 2008 and 2017, an estimated 82 OB/GYN residents participated in this activity, and 95 participants and facilitators received the survey. Forty-one (59%) respondents agreed that this model was similar to repairing OASIS in clinical practice. Our trainees reported that the optimal time for simulated OASIS repair was the R2 and R3 years; however, 90% of respondents felt residents should be offered this simulation yearly. Discussion: Based on our survey of trainees, graduates, and faculty, we created a realistic simulated OASIS repair training, despite the limitation that the model lacked a rectum. Learners reported an interest in repeating the simulation frequently during residency to augment their clinical experience and increase perceived competence in third- and fourth-degree laceration repair by their graduation.

Is Community Relevance Enough? Civic and Science Identity Impact of Microbiology CUREs Focused on Community Environmental Justice.

Course-based undergraduate research experiences (CUREs) often involve a component where the outcomes of student research are broadly relevant to outside stakeholders. We wanted to see if building courses around an environmental justice issue relevant to the local community would impact students' sense of civic engagement and appreciation of the relevance of scientific research to the community. In this quasi-experimental study, we assessed civic engagement and scientific identity gains (N = 98) using pre- and post-semester surveys and open-ended interview responses in three different CUREs taught simultaneously at three different universities. All three CURES were focused on an environmental heavy metal pollution issue predominantly affecting African-Americans in Birmingham, Alabama. While we found increases in students' sense of science efficacy and identity, our team was unable to detect meaningful changes in civic engagement levels, all of which were initially quite high. However, interviews suggested that students were motivated to do well in their research because the project was of interest to outside stakeholders. Our observations suggest that rather than directly influencing students' civic engagement, the "broadly relevant" component of our CUREs engaged their pre-existing high levels of engagement to increase their engagement with the material, possibly influencing gains in science efficacy and science identity. Our observations are consistent with broader community relevance being an important component of CURE success, but do not support our initial hypothesis that CURE participation would influence students' attitudes toward the civic importance of science.

Cardiac Auscultation Lab Using a Heart Sounds Auscultation Simulation Manikin.

Introduction: Cardiac auscultation skills are essential to the development of a competent physician. We created a hypothesis-driven cardiac auscultation laboratory session utilizing a high-fidelity simulator to teach these skills to second-year medical students at our institution. This program was grounded in deliberate practice opportunities to aid in the acquisition of cardiac auscultation skills. Methods: This session aimed to help students identify and discriminate between normal and pathologic heart sounds in the context of a clinical vignette. Faculty facilitators guided students through unknown patient cases and utilized the auscultation manikin to simulate corresponding heart sounds. Time was also allotted for students to auscultate the manikins and practice their cardiac physical examination skills. Results: This program has been in place at our institution since 2016 and has been well received by students and facilitators. Since its initial introduction in 2016, 183 second-year medical students have completed the cardiac auscultation lab session each year, for a total of 549 students. Evaluations of the session have improved as faculty have become more familiar with the mechanics of operating the auscultation manikin. Discussion: The cardiac exam and heart sounds lab can be adapted to any simulator model that is capable of producing heart sounds and can be done in a large- or small-group format. Enough time should be allotted to adequately work through all components of the laboratory. Student and faculty feedback has helped us further refine the session since its initial introduction to the curriculum.

What everybody should know about postural changes.

Posture changes have been known for a long time to influence the concentration of many analytes in blood especially macromolecules. It is very clear that when someone switches from supine to sitting or standing or from sitting to standing a hemoconcentration is induced. Similarly, when someone switches from standing to sitting or lying a hemodilution occurs. In the context of clinical chemistry, rules have been issued to buffer the impact of postural changes close to the blood specimen collection (e.g. 15 min of seated rest before the blood puncture). A big work has then been performed to educate the personnel concerned by blood specimen collection (medical doctors, nurses, phlebotomists, pharmacists, clinical researchers, scientists, etc.) through professional training to standardize the puncture and the collection procedures. Official procedures and guidelines have been published. Nevertheless, there is still a long way to go and too often standardization of posture before the blood collection is not properly performed. Maybe, this relative failure could be overcome by using new strategies in forwarding the message on the impact of posture changes in the outcome of blood tests and the importance of controlling this factor when blood specimens are taken. Some possible actions are presented concerning the improvement of the education of medical and paramedical personnel especially during their primary training, and also to educate the patients and the whole population in general.

Views from academia and industry on skills needed for the modern research environment.

Reports from employers of higher education graduates indicate the existence of a considerable gap between the skills required by employers and those possessed by recent graduates. As a first step toward closing this gap, this study aims to determine its origin. Interviews with nine research-active biochemistry professionals were used to identify the most important skills for biochemistry students to succeed in research positions postgraduation. The results of these interviews were used to develop a survey, which was then administered to a larger group of biochemistry faculty and industry professionals. The output of the survey was a list of 52 skills valued by biochemistry professionals and rated by perceived importance. Importantly, the survey results also afford a comparative look at the prioritization of skills by two key populations: the academic faculty training students and the industry professionals hiring them. While there are many areas of agreement between these two populations, the survey also reveals areas were priorities diverge. The discrepancies found here suggest that the skills gap manifest at the point of employment may stem directly from differences in prioritization between the academic and industrial environments. This article aims to provide insight into the needs and requirements of the modern biochemical research environment, and invites debate concerning the preparation students receive in academia. Moreover, the results presented herein point to a need for further exploration of the possible misalignment of these two critical environments for young scientists.