Using an interprofessional team to provide refugee healthcare in an academic medical centre.

INTRODUCTION: The International Family Medicine Clinic (IFMC) was established in 2002 by the University of Virginia Department of Family Medicine to provide comprehensive, timely, culturally sensitive and high-quality healthcare to the growing refugee and special immigrant population in Central Virginia, USA. METHODS: The purpose of this paper is to describe the IFMC, with a specific focus on interprofessional roles, interprofessional collaboration, community partnerships and the services and resources available to IFMC patients. RESULTS: The clinic has served over 3100 refugees from 60 countries in its 16-year history. In 2019, the clinic staff now includes 4 attending physicians, 2 nurse practitioners and 14 residents who have dedicated clinic time to see refugees; a registered nurse care coordinator and a social worker dedicated to the IFMC refugee population; 2 clinical psychologists and doctoral students in clinical psychology; and a clinical pharmacist. The IFMC also provides onsite psychiatric care. A process flow map depicts the interconnectivity of interprofessional team members working together with other specialty care providers within the medical centre and with community partners on behalf of refugee patients through the resettlement process. CONCLUSION: Individuals who arrive in the USA as refugees are a particularly vulnerable patient group and often require an interprofessional team approach. The IFMC may serve as a model for other institutions interested in starting a similar interprofessional, refugee-centred medical home.

A Randomized Crossover Comparison between Team-Based Learning and Lecture Format on Long-Term Learning Outcomes.

There are limited data evaluating the effectiveness of different teaching pedagogies to maintain gains in learning achieved over the short term. The purpose of this study is to compare long-term learning outcomes between two different teaching pedagogies, team-based learning (TBL) and lecture. Within a therapeutic elective course a randomized crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). Six months following completion of the course, 47 assessment questions (application and recall multiple-choice questions) were re-administered to 16 students from the class with no prior announcement of the assessment. The results showed no significant difference in long-term assessment scores between TBL and lecture formats (67 ± 14% vs. 63 ± 16%, p = 0.2, respectively). In addition, there was a significant (p < 0.0001) and similar decline in short-term gains for TBL (90 ± 9% vs. 67 ± 14%) and lecture (86 ± 11% vs. 63 ± 16%) in assessment scores. In conclusion, there was no advantage gained by employing an active-learning pedagogy when assessing multiple-choice questions six months following end of a therapeutics course in a limited sample size. Neither pedagogy was able to maintain short-term gains in learning outcomes as assessed by multiple-choice questions.

Experience with the script concordance test to develop clinical reasoning skills in pharmacy students.

BACKGROUND: The script concordance test (SCT) is used to assess clinical reasoning and was originally developed for medical learners. The Accreditation Council for Pharmacy Education (ACPE) endorses the need for pharmacy students to develop clinical reasoning skills, but there is little documentation of use of the SCT for pharmacy learners. EDUCATIONAL ACTIVITY: A script concordance test activity was designed for a diabetes and metabolic syndrome pharmacotherapy course. Twenty-five cases were created and evaluated by an expert panel of 20 practicing pharmacists. Ten cases were presented as a formative activity in class. The students, design team, teaching team, and expert panel evaluated the activity. CRITICAL ANALYSIS OF THE EDUCATIONAL ACTIVITY: The SCT was received positively from the students, design team, teaching team, and expert panel. The design team noted that case writing was different for this approach and that the inclusion of various perspectives from panelists was beneficial. Although the activity was formative in nature, the teaching team scored the students and this provided insight into areas where the students may struggle. SUMMARY: This report provides information on the formative use of the SCT in the classroom, as well as categories of items suitable for pharmacy. The SCT provides an approach to illustrate clinical reasoning and clinical decision making among content experts and can be used to stimulate clinical discussions among student learners and content experts. The SCT could help incorporate clinical reasoning skills in a pharmacy curriculum to meet ACPE standards.

Qualitative Analysis of Student Perceptions Comparing Team-based Learning and Traditional Lecture in a Pharmacotherapeutics Course.

Objective. To qualitatively compare students' attitudes and perceptions regarding team-based learning (TBL) and lecture. Design. Students were exposed to TBL and lecture in an elective pharmacotherapeutics course in a randomized, prospective, cross-over design. After completing the course, students provided their attitudes and perceptions through a written self-reflection and narrative questions on the end-of-course evaluation. Student responses were reviewed using a grounded theory coding method. Assessment. Students' responses yielded five major themes: impact of TBL on learning, perceptions about TBL learning methods, changes in approaches to learning, building skills for professional practice, and enduring challenges. Overall, students report TBL enhances their learning of course content (knowledge and application), teamwork skills, and lifelong learning skills. Conclusion. Students' attitudes and perceptions support TBL as a viable pedagogy for teaching pharmacotherapeutics.

A Randomized Crossover Comparison of Team-based Learning and Lecture Format on Learning Outcomes.

Objective. To compare learning outcomes and student confidence between team-based learning (TBL) and lecture. Methods. A crossover study was conducted with 30 students divided into two sections. Each section was taught six therapeutic topics (three TBL and three lecture). There were two assessments of 24 questions each. A survey (Likert scale) assessing student confidence and attitudes was administered at the end. Results. A significantly higher overall examination score was observed for TBL as compared to lecture. Students were more confident in providing therapeutic recommendations following TBL. Higher survey scores favoring TBL were also seen related to critical-thinking skills and therapeutic knowledge. Conclusion. Learning outcomes and student confidence in performing higher-order tasks were significantly higher with TBL. The findings of this novel crossover type design showed that TBL is an effective pedagogy.

Team-based learning to improve learning outcomes in a therapeutics course sequence.

OBJECTIVE: To compare the effectiveness of team-based learning (TBL) to that of traditional lectures on learning outcomes in a therapeutics course sequence. DESIGN: A revised TBL curriculum was implemented in a therapeutic course sequence. Multiple choice and essay questions identical to those used to test third-year students (P3) taught using a traditional lecture format were administered to the second-year pharmacy students (P2) taught using the new TBL format. ASSESSMENT: One hundred thirty-one multiple-choice questions were evaluated; 79 tested recall of knowledge and 52 tested higher level, application of knowledge. For the recall questions, students taught through traditional lectures scored significantly higher compared to the TBL students (88%±12% vs. 82%±16%, p=0.01). For the questions assessing application of knowledge, no differences were seen between teaching pedagogies (81%±16% vs. 77%±20%, p=0.24). Scores on essay questions and the number of students who achieved 100% were also similar between groups. CONCLUSION: Transition to a TBL format from a traditional lecture-based pedagogy allowed P2 students to perform at a similar level as students with an additional year of pharmacy education on application of knowledge type questions. However, P3 students outperformed P2 students regarding recall type questions and overall. Further assessment of long-term learning outcomes is needed to determine if TBL produces more persistent learning and improved application in clinical settings.