A scoping review of health professional curricula: Implications for developing integration in pharmacy

The Association between Academic Performance and Entry-to-Practice Milestones within a Co-Operative Education PharmD Program

Research on associations between student performance in pharmacy programs and entry-to-practice milestones has been limited in Canada and in programs using a co-operative (co-op) education model. Co-op exposes students to a variety of opportunities both within direct patient care roles and in non-traditional roles for pharmacists, such as policy, advocacy, insurance, research, and the pharmaceutical industry. The purpose of this research is to analyze associations between student grades and evaluations achieved in the University of Waterloo (UW) Doctor of Pharmacy (PharmD) co-op program and success rates on entry-to-practice milestones, including the Pharmacy Examining Board of Canada (PEBC) Pharmacist Qualifying Examination and performance on final-year clinical rotations. Grades and evaluations from courses, co-op work terms, clinical rotations, and PEBC exam data from three graduating cohorts were obtained. A multiple regression analysis was performed to explore associations between student evaluations and PEBC Pharmacist Qualifying Examination and clinical rotation performance. Holding all other variables constant, grades in anatomy/physiology were negatively correlated with scores on the PEBC Pharmacist Qualifying Examination, while grades in one of the professional practice courses showed a positive relationship with the same examination. Students with higher grades in a problem-based learning capstone therapeutics course, in their first co-op work term, and in the direct patient care co-op work term tended to score higher on clinical rotations. Co-op performance was not significant in predicting PEBC performance. However, complimentary descriptive analysis underscored that students with a co-op rating of good or below were more likely to fail courses, midpoint evaluations, Objective Structured Clinical Examinations (OSCEs), and PEBC measures. Multiple predictors of performance on final-year clinical rotations and the PEBC Pharmacist Qualifying Examination were identified. This predictive model may be utilized to identify students at risk of underperforming and to facilitate early intervention and remediation programs, while also informing curricular revision.

Considerations for conducting a scoping review in pharmacy education

Interrogating the literature is among the first steps a researcher undertakes when actuating a research project or also when any scholar might seek to know what has been done in an area, best practices for conducting a certain activity, or simply to seek answers for a question ranging from one's own personal curiosity to those that might affect departmental or institutional guidance. Decisions on the type of review process to undertake is one that is not taken lightly. This methods commentary outlines the reasons for conducting a scoping review versus a systematic review for topics related to pharmacy education. Considerations for conducting the scoping review are outlined including considerations for writing a protocol prior to conducting a scoping review, to potential platforms to use for transparency of sharing data, processes related to guidelines for data extraction and types of search strategies utilized.

Enhancing academic performance and student engagement in health education: insights from Work Station Learning Activities (WSLA)

Making health science students aware of the importance of basic science knowledge for professional practice is a major educational challenge, especially during the early years of preclinical courses. Here, using an integrated curricular approach, we analyze whether Work Station Learning Activities (WSLA), which combine active learning methodologies for teaching basic science in clinical scenarios, can help to develop deeper learning and student engagement. In order to increase student motivation, we evaluated the effectiveness of WSLA using statistical analyses and an observation tool based on the ICAP (Interactive, Constructive, Active, and Passive) framework, which categorizes learning tasks based on the nature of student engagement. Statistical analyses revealed positive correlations between the different summative evaluations along the development of the activities, indicating the learning process inherent to WSLA progression and affirming the positive influence of WSLA on academic outcomes. Comparing the pre- and post-tests, students scored significantly higher on the post-test (statistically significant p < 0.001). WSLA promotes both constructivist and interactive learning, as validated by its alignment with the ICAP model. The study examines student engagement through systematic observation, revealing a relationship between student engagement and final grades. Students who exhibit constructive learning consistently earn higher grades, emphasizing the positive impact of active engagement. Thus, passive behavior profiles show a significant proportion of fails (40%), while constructive profiles stand out as the sole recipients of the coveted excellent rating. Ultimately, this study contributes to our understanding of the effectiveness of WSLA in promoting active learning and enhancing student engagement within integrated health education curricula. It highlights the importance of active learning behaviors for academic success and suggests avenues for further research to optimize integrated teaching methodologies in medical education.

An overview of Instructional approaches and decision-making strategies to curtail curricular overload

OBJECTIVES

Curriculum overload often occurs when content is kept in the curriculum that may no longer be necessary to prepare students for professional practice. The overload becomes compounded by the addition of new content from the ever-changing professional practice needs and updates to accreditation standards. Challenges may occur when programs must first determine the "level" of proficiency a new graduate should attain and then determine the appropriate breadth and depth of educational outcomes in relation to proficiency, while examining what content should be retained from past curricula. Thus, the purpose of this manuscript is to summarize institutional approaches for making content delivery more effective and efficient with the goal of curtailing curriculum expansion.

FINDINGS

Four key elements were consistently identified in the literature as important considerations to address curriculum overload - 1) communication and coordination among faculty, 2) incorporation of active learning strategies, 3) effective utilization of technology, and 4) minimizing faculty and student workload and cognitive burden.

SUMMARY

Each pharmacy program will need to take an individualized approach in addressing curriculum overload; however, consideration of the aforementioned key elements can assist in making these decisions. With increased student engagement in the classroom, intentional design to reduce content and student workload, enhanced communication among faculty, and appropriate technology utilization, curriculum overload can be addressed at every level of pharmacy education.

Advancing Pharmacy Education by Moving From Sequenced "Integration" to True Curricular Integration

OBJECTIVES

Traditional pharmacy education focuses on teaching content, which is affectionately known as "silos". Each topic area or discipline includes a course or an individual class session designed to impart knowledge, skills, or abilities needed for the student pharmacist to become a practice-ready, team-ready pharmacist. With expanding content and educational standards, there have been calls to simplify and streamline content. Truly "integrated" curricula (sequenced, coordinated, and collaboratively taught) where silos are removed to foster student integrative learning and build connections across disciplines (foundational, clinical, and social or administrative sciences) could be one such approach. Thus, the objectives of this integrative review are to provide recommendations for decreasing curriculum overload by moving to truly integrated curricula, explore integrated approaches, discuss challenges and barriers, and propose next steps for creating integrated curricula that decrease content overload.

FINDINGS

Although there are different approaches to curricular integration, most curricular integration occurs through sequenced courses or integrated cases. In order to truly streamline content and foster connections across disciplines, integration must move beyond simply sequencing of content to content that includes all the disciplines taught seamlessly. When taught together, curricular integration offers the opportunity to cover medication classes quickly and efficiently with multiple opportunities for reinforcement.

SUMMARY

There remains limited data and examples of these types of true integration approaches. Thus, it is important for the Academy to determine if the integration of content improves curricular outcomes, positively affects students' learning, and addresses curriculum overload by increasing efficiency and streamlining curricula.

Bridging vascular physiology to vascular medicine: an integrative laboratory class

Vascular diseases of the legs are highly prevalent and constitute an important part of medical curricula. The understanding of these diseases relies on strongly interwoven aspects of vascular physiology and vascular medicine. We aimed to connect these within a horizontally integrated laboratory class on vascular physiology of the leg that was designed in cooperation between the departments of physiology and vascular surgery. Conceptually, we applied examination techniques of vascular medicine to visualize physiological parameters that are altered by the most frequent diseases. This facilitates integrative discussions on malfunctions, trains diagnostic skills, and bridges to vascular medicine. In four experiments, we use oscillometry and impedance venous occlusion plethysmography to address key aspects of the arterial and venous system of the legs: 1) arterial pulse wave, 2) arterial systolic blood pressure, 3) venous capacitance and venous outflow, and 4) reactive hyperemia. After the experiments, physiological vascular function, the associated diseases, their impact on the recorded parameters, and diagnostic options are discussed. To allow reproduction, we describe the course structure and the experimental setup in detail. We present the experimental data of a cohort of medical students and document learning success and student satisfaction. All experiments were feasible and provided robust data on physiologically and clinically relevant vascular functions. The activity was perceived positively by the students and led to a substantial improvement of knowledge. With this work, we offer a template for reproduction or variation of a proven concept of horizontally integrated teaching of vascular physiology of the leg.NEW & NOTEWORTHY This article presents an integrative laboratory class on vascular physiology bridging to vascular medicine. The four experiments rely on oscillometry and venous occlusion plethysmography. We describe in detail this new class regarding structure, experimental setup, and experimental procedure, and we give insight into the applied materials. Moreover, we present the experimental data of 74 students and a quantitative evaluation of the students' learning success and acceptance.

Medicinal chemistry: The key to critical thinking in pharmacotherapy

INTRODUCTION

Medicinal chemistry is a polarizing subject for pharmacy students where, if not embraced, future pharmacists may be limited in their role as drug experts. An understanding of medicinal chemistry and its structure-activity relationships creates a strong foundation upon which our knowledge of pharmacotherapy is built.

PERSPECTIVE

As the field of pharmacy has shifted to an increasingly clinical role, with an emphasis on patient care as a member of the interprofessional team, pharmacy has also seen an increase in postgraduate training, specifically residencies and fellowships. Pharmacy students noting this trend may depreciate medicinal chemistry early in the curriculum and place more focus on therapeutics and clinical rotations. However, forgoing the fundamental understanding of medicinal chemistry may hinder pharmacy students' current breadth and understanding, and the ability to rationalize future developments in their practice. Medicinal chemistry empowers pharmacists with the ability to reason through medications' impact versus simply memorizing their actions. Pharmacists play a unique role as drug experts, with advanced problem-solving and critical thinking skills that set them apart from drug references and search engines.

IMPLICATIONS

As the field moves towards pharmacists as a member of the clinical team, the faculty should integrate medicinal chemistry throughout the doctor of pharmacy curricula. Faculty without this ability for a curriculum change should consider integration in their content. The field of pharmacy must take care to not allow clinical knowledge to significantly overshadow the importance of medicinal chemistry or run the risk of saturating the field with underprepared pharmacists.

High-level curricular integration in pharmacy schools: A systematic literature review

BACKGROUND

Pharmacy school accreditors recommend curricular integration. With today's complex health care system, there is also a need for more intentional and seamless blending, characterizing what we propose as "high-level curricular integration" (i.e. intentional "weaving" of multiple disciplines to form a coherent whole). Despite accreditors' recommendations, the practical definition and implementation guidelines of high-level curricular integration are not clear. We aimed to describe high-level curricular integration practices in pharmacy schools by systematically reviewing the literature addressing four elements of high-level curricular integration. These were (1) organizational thread, (2) pedagogies, (3) evaluation strategies, and (4) barriers.

METHODS

A PRISMA-guided (preferred reporting items for systematic reviews and meta-analyses) literature search strategy was conducted to examine the scientific literature. Inclusion criteria were English written literature related to one or more of the four elements of high-level curricular integration in pharmacy schools.

RESULTS

After screening titles, abstracts, and full texts, 28 articles were included. The most used organizational thread was disease-oriented (n = 8, 28.5%), and the most reported pedagogy was case studies (n = 11, 39%). Over half of the studies reported how the integration experience was evaluated. Most studies addressed barriers (n = 21, 75%), with the most reported barriers being time (n = 12, 42%) and workload (n = 12, 42%).

IMPLICATIONS

This review aimed to define and describe high-level integration within schools of pharmacy through four elements. Numerous and diverse trends were identified, and these four elements should be considered when planning, implementing, evaluating, and reporting curriculum integration experiences.

Integration of Clinical and Scientific Principles in the Teaching of Drug-Drug Interactions

Evaluation of drug-drug interactions (DDIs) is an integral part of pharmacy practice worldwide. An understanding of the scientific mechanisms behind and the clinical implications of DDIs is important for proper management of pharmacotherapy. Here, we describe an integrated approach to teaching both aspects of DDIs as a standalone module in diverse course settings. These include on-campus and online delivery to international and local audiences in small and large classes. We describe the scientific, clinical, and integrated learning objectives of the module, and we show how these can be achieved through group projects based on published DDI case reports.

Development of Professional Attributes through Integration of Science and Practice at First-Year Pharmacy Level

The design, implementation and evaluation of a year 1 pharmacy-integrated learning component, using the World Health Organisation’s (WHO) analgesic ladder as a scaffold for case-based learning, is described. A novel aspect of the integrated component is the mapping of the cases to the national Core Competency Framework (CCF) for Pharmacists in Ireland and to the school’s own cross-cutting curricular integration themes. The integrated cases were student led and delivered through peer-to-peer teaching for 68 first-year pharmacy students. The integrated cases mapped strongly to three of the CCF’s domains, namely, personal skills, organisation and management skills and supply of medicines. With regard to the school’s curricular integrative themes, the cases mapped strongly to the curricular integration themes of professionalism and communications; medicines sourcing, production and use; and safe and rational use of medicines. Highlights from an anonymous online student survey were the recognition by students of the importance of core science knowledge for practice, the enabling of integrated learning and the suitability of the integrated component for entry-level. While a majority of students were found to favour individual work over group work, future iterations will need to consider a greater degree of group work with a view to reducing the volume of content and time required to complete the cases.

Perspectives of pharmacists on facilitating experiential learning placements for pharmacy students in non-patient facing settings

INTRODUCTION

Recently, the model of pharmacy education in Ireland changed to a five-year pharmacy degree, with three distinct blocks of experimental placements dispersed throughout the degree. The United Kingdom is also considering the introduction of a similar five-year pharmacy degree, while the United States is looking to further expand non-clinical experiential learning opportunities. This study was carried out to ascertain the perspectives of pharmacists working in non-patient facing roles on the barriers to and facilitators of placements to aid in identifying placement recruitment strategies for non-patient facing placements.

METHODS

A questionnaire was distributed to pharmacists employed in non-patient facing settings, including in pharmaceutical industry, education, and regulation. Quantitative responses were analyzed using descriptive statistics, while qualitative questions were analyzed thematically.

RESULTS

Regardless of experience in the practice setting or supervision, the majority expressed a preference for offering paid placements of six months' duration. There was divided opinion regarding whether students should be given study leave, whether the student's supervisor should be a pharmacist, and whether students should undertake specialized postgraduate training. The main barriers to placements were time, the placement structure, availability of suitable projects or supervisors, and awareness of placement opportunities. Prior experience in the practice area, developing the talent pipeline, and personal interests were all placement facilitators.

CONCLUSIONS

Given the increasing roles for pharmacists in non-patient facing practice settings, this study highlights the importance of stakeholder involvement during the implementation of a new model of education to ensure that placements in all settings are feasible.

Impact of Curricular Integration Between Patient Care Laboratory and Introductory Pharmacy Practice Experience on Documentation

Objective. To assess the impact of curricular changes made through vertical integration between Patient Care Laboratory and Introductory Pharmacy Practice Experience (IPPE) courses on documentation outcomes. Methods. Curricular changes to address student pharmacist documentation deficiencies were developed by laboratory and experiential faculty members. A documentation activity using subjective, objective, assessment, plan (SOAP) notes completed in one IPPE rotation block, pre-intervention, were graded and compared to SOAP notes from the same IPPE rotation block in the subsequent year, post-intervention, using a standard checklist. Chi square test (or Fisher exact test when appropriate) was used to evaluate the relationship between each question's score and different timepoints. Wilcoxon rank sum test was used to compare total scores between the two groups of students. Results. Significant improvement among student pharmacists' SOAP note scores were observed in the post-intervention cohort (n=52) compared to pre-intervention cohort (n=52) following curricular changes. Specific SOAP note components that revealed significant improvements between years were drug therapy problem identified, proposed drug therapy problem resolution, follow-up plan identified, overall impression, and addressing a pharmacist-specific intervention. Conclusion. Collaboration between laboratory and experiential education faculty members are integral to the identification of gaps in student pharmacists' application of simulated activities into actual experiences and in the achievement of educational outcomes. Curricular quality improvements can be implemented and assessed quickly through vertically integrated courses.

Design and Implementation of an Integrated Competency-Focused Pharmacy Programme: A Case Report

This paper describes the design and implementation of elements of an integrated competency-focused pharmacy programme in the School of Pharmacy and Pharmaceutical Sciences (SoPPS), Trinity College Dublin (TCD), Ireland. Following a national review of pharmacy education and training in Ireland in 2010, and subsequent publication of legislation in 2014, the School has implemented a five-year integrated programme of pharmacy education and training, leading to the award of a Master's degree in Pharmacy (M. Pharm.). Curricular integration has been achieved by underpinning the new programme with a national competency framework for pharmacists and through the utilisation of curricular integration themes. Programme integration also encompasses embedded experiential learning placements in Years 2, 4 and 5 of the five-year programme. The new five-year integrated pharmacy programme, which commenced in 2015, replaced the 4 + 1 model of education and training where a four-year Bachelor's degree was followed by a one-year internship, which was a distinct and separate element of the students' training.