Problem-based learning in pharmaceutical education: a systematic review and meta-analysis

Exploratory study on student perception on the use of chat AI in process-driven problem-based learning

INTRODUCTION

With the increasing prevalence of artificial intelligence (AI) technology, it is imperative to investigate its influence on education and the resulting impact on student learning outcomes. This includes exploring the potential application of AI in process-driven problem-based learning (PDPBL). This study aimed to investigate the perceptions of students towards the use of ChatGPT) build on GPT-3.5 in PDPBL in the Bachelor of Pharmacy program.

METHODS

Eighteen students with prior experience in traditional PDPBL processes participated in the study, divided into three groups to perform PDPBL sessions with various triggers from pharmaceutical chemistry, pharmaceutics, and clinical pharmacy fields, while utilizing chat AI provided by ChatGPT to assist with data searching and problem-solving. Questionnaires were used to collect data on the impact of ChatGPT on students' satisfaction, engagement, participation, and learning experience during the PBL sessions.

RESULTS

The survey revealed that ChatGPT improved group collaboration and engagement during PDPBL, while increasing motivation and encouraging more questions. Nevertheless, some students encountered difficulties understanding ChatGPT's information and questioned its reliability and credibility. Despite these challenges, most students saw ChatGPT's potential to eventually replace traditional information-seeking methods.

CONCLUSIONS

The study suggests that ChatGPT has the potential to enhance PDPBL in pharmacy education. However, further research is needed to examine the validity and reliability of the information provided by ChatGPT, and its impact on a larger sample size.

Effects of problem-based learning on delivering medical and nursing education: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

There is still a lack of high-level evidence on the effects of problem-based learning (PBL) in general medical and nursing education.

AIMS

We aimed to summarize current evidence on the effects of PBL in delivering medical and nursing education from randomized controlled trials (RCTs).

METHODS

A systematic search was performed in MEDLINE, EMBASE, Cochrane Central Library, and CINAHL Complete. RCTs that assessed the effects of a PBL module in delivering medical education were eligible. Outcomes included knowledge, performance, and satisfaction. The risk of bias was assessed according to Cochrane handbook guidelines. Standardized mean differences with 95% confidence intervals of each outcome between PBL and control groups were pooled using a random-effects model.

RESULTS

In all, 22 RCTs with 1969 participants were included. Both pooled analyses of changes in scores compared with baseline and absolute post-interventional scores favored PBL module in knowledge and performance. The satisfaction degree was also higher in participants receiving PBL methods. Publication bias might exist in satisfaction; however, not in knowledge and performance. Eleven of the 22 studies were assessed as having a high risk of bias.

LINKING EVIDENCE TO ACTION

Compared with traditional lecture-based modules, PBL delivered medical education in different medical science specialities more efficiently from both theoretical knowledge and practice skill perspectives. The feedback from participants receiving PBL methods was more positive than that from those receiving traditional methods. However, the high heterogeneity and low quality of the included studies prevented drawing definite conclusions.

Development and Implementation of Workshops to Optimize the Delivery of Vaccination Services in Community Pharmacies: Thinking beyond COVID-19

Vaccines are widely recognized as the most economically efficient strategy to combat infectious diseases. Community pharmacists, being highly accessible healthcare professionals, have the potential to significantly contribute to the promotion and facilitation of vaccination uptake. In Canada, the jurisdiction of healthcare falls under provincial legislation, leading to variations in the extent of pharmacist practice throughout the country. While some pharmacists in Canada already functioned as immunizers, Québec pharmacists gained the authority to prescribe and administer vaccines in March 2020 amidst the COVID-19 pandemic. Our workshop aimed to equip pharmacists in Québec with the necessary guidance to optimize vaccinations, emphasizing the importance of maintaining and expanding immunization services beyond influenza and COVID-19 vaccines in the future. During the workshop, pharmacists had the opportunity to exchange valuable insights and best practices regarding workflow optimization, identifying areas for improvement in competency, effectively reaching vulnerable population groups, and integrating allied team members into their practice. Participants were also asked to develop a plan of action to help implement practice change beyond the workshop. Interactive workshops centered around discussions like these serve as catalysts for advancing the pharmacy profession, uniting professionals with a collective aim of enhancing patient care.

PBL teaching in ultrasonography resident standardization training in the COVID-19 pandemic

OBJECTIVE

To study the effect of the problem-based learning (PBL) method in ultrasonography (US) resident standardization training during the COVID-19 pandemic.

METHODS

Fifty residents were divided into two groups to participate in a 30-day US training program. The residents in the observation group underwent PBL combined with the lecture-based learning (LBL) method, while the residents in the control group experienced the LBL method alone, with 25 residents in each group. A basic theoretical test, practical examination, and questionnaire were used to evaluate the teaching effect of the PBL + LBL method and the LBL method alone.

RESULTS

The basic theoretical pretest score of the observation group was not significantly different from that of the control group. However, the posttest theoretical score and practical score were significantly higher in the observation group than in the control group (P < 0.01). The results of the questionnaire showed that the resident satisfaction level in the observation group with PBL combined with the LBL method was 96%, which was significantly higher than that of the control group with the LBL method alone (80%) (P < 0.05).

CONCLUSION

The combination of PBL with the LBL method has obvious advantages over the LBL method alone in regard to the training of US residents during the COVID-19 pandemic.

Reflection on the development of a patient case in twine

PURPOSE

With technology becoming an essential component in classrooms, it is becoming more crucial for pharmacy faculty to explore innovative active learning strategies that engage students inside and outside the classroom. This manuscript discusses how two fourth-year students and their preceptor developed interactive patient cases using an open-source software application called Twine (www.twinery.org).

DESCRIPTION

Two different cases were developed in Twine. The first patient case story was created by the fourth-year students and will be implemented in the future. The second patient case, consisting of two Twine stories, was created by the faculty preceptor and was implemented during new student orientation.

ANALYSIS/INTERPRETATION

Resources for development as well as advantages and disadvantages of developing and implementing Twine stories into the curriculum are discussed. Implementation of the faculty's Twine stories into the pharmacy curriculum is also discussed.

CONCLUSIONS

Twine is a user-friendly application and has the potential to be utilized in healthcare programs as an effective and engaging teaching strategy that both professor and students enjoy.

IMPLICATIONS

While development of a Twine story could be time-consuming, the benefit of increasing student engagement outweighs the cost. Active learning is an essential component in the classroom, and finding new and innovative ways to enhance student learning is imperative.

Improving Medical Education: A Narrative Review

With the advancement in basic and clinical sciences, medical education is also constantly evolving. The Accreditation Council for Graduate Medical Education (ACGME) has endorsed six core competencies to improve teaching and learning. This narrative review was conducted after searching the article databases (PubMed, PubMed Central, Embase, and Scopus) about the core competencies such as medical knowledge (problem-based learning), interpersonal communication, patient care, professionalism, practice-based learning and improvement, and system-based care endorsed by ACGME. We included randomized and quasi-experimental trials, cohorts, and case-control studies in this narrative review. In a problem-based learning modality, a real-life scenario is allocated to a group of students. Studies have shown that it is more effectively demonstrated by a better post-test score, improved concentration, and application of knowledge. Interpersonal communication skills promote collaboration with interdisciplinary teams, work quality, and patient adherence to treatment. Professionalism is a human attribute that creates a pleasant work environment and is an essential trait that improves patients' adherence to treatment. In system-based care, patients are benefitted through a well-structured plan of care. Finally, in practice-based learning, medical trainees learn to systematically evaluate the pattern of care and practice the best modality to improve the overall patient care and physician satisfaction. These core competencies need to be incorporated into all levels of medical training.

Enhancing Student Knowledge of Diabetes through Virtual Choose Your Own Adventure Patient Case Format

Educational strategies to teach pharmacy students about diabetes are necessary to prepare future pharmacists to manage complex patients. The Choose Your Own Adventure (CYOA) patient case format is an innovative activity that presents a patient case in an engaging way. The objectives of this study were (1) to describe the development of the innovative teaching activity and (2) to assess its effect on student knowledge and confidence in outpatient management of diabetes. The CYOA patient case activity was designed by transforming a traditional paper patient case involving outpatient diabetes management into an interactive format utilizing an online platform. The activity was conducted with 186 second-year pharmacy students in a skills-based course. This activity was administered virtually through a combination of small group work and large group discussion. After completion of the activity, students completed an online self-assessment questionnaire. Of 178 completed questionnaires, there was a statistically significant difference in students’ self-ratings after versus before the activity for all survey items (p < 0.001). The CYOA activity improved self-reported knowledge of outpatient diabetes management and increased self-reported confidence in clinical decision-making skills. This format shows promise as an educational tool that may be adapted for other disease states to enhance clinical decision-making skills.

Impact of a problem-based learning elective on performance in non-problem-based learning required courses

BACKGROUND AND PURPOSE

Use of problem-based learning (PBL) in health professions education has limited data supporting improved exam performance and confidence in problem solving, primarily within courses converted to a PBL format. This study aimed to demonstrate a similar benefit in simultaneous and subsequent required, non-PBL courses that involved critical thinking.

EDUCATIONAL ACTIVITY AND SETTING

This retrospective cohort study included students who were enrolled in the pharmacotherapeutics and case studies/laboratory course sequences in the second and third professional (P3) years. We compared performance across both course sequences of students who took a PBL elective course in the fall of the P3 year (PBL students) and students who did not take the elective course (non-PBL students).

FINDINGS

There was a statistically significant difference favoring PBL students in performance in both the therapeutics and case/lab courses offered simultaneously with the PBL elective. There was no significant difference noted between PBL and non-PBL student performance in the subsequent therapeutics and case/lab courses; however, results within individual cohorts differed strikingly from the aggregate analysis. Performance in the PBL elective had no impact on the outcomes of the study.

SUMMARY

This study demonstrated an overall benefit for students who participated in a PBL course on performance in simultaneous, critical thinking courses that did not incorporate PBL. However, the aggregate did not show a difference in performance in subsequent critical thinking, non-PBL courses. Further studies are needed to elucidate the true benefit of the PBL approach in other non-PBL courses that require advanced clinical reasoning.

Analysis of a novel enrichment strategy for an integrated medicinal chemistry and pharmacology course

INTRODUCTION

Study and application of integrated medicinal chemistry and pharmacology content affords opportunities for students to discuss and develop life-long learning skills.

METHODS

Five thematic enrichment activities were developed (problem solving, metacognition, reading comprehension, case-based problem solving, and structure-based therapeutic evaluation), each containing a self-study and live session featuring unit-specific content. Voluntary, longitudinal sessions were administered to 139 s professional year pharmacy students at the end of each unit of the first course of an integrated pharmacology and medicinal chemistry sequence (academic quarter system). Students provided five-point Likert-item feedback at the beginning of the course, after the first activity, and at course conclusion. Survey questions were linked to self-assessment domains of metacognition, content relevance, confidence, and affective response to content.

RESULTS

Survey responses indicated significant improvement in initial confidence (3.7 [1.1] to 4.2 [1.1]) and metacognition (3.2 [1] to 3.8 [1.1]) domains at course conclusion and significant, sustained improvement in affective domain following the first session (3.5 [1.1] to 4.1 [1.2] to 4.2 [1.2]). Perceived relevance of content did not change significantly (4.3 [1] to 4 [1.1] to 4.1 [1.2]).

CONCLUSIONS

Survey results were consistent with the notion that targeted learning interventions have a significant impact on content perception, which may be especially important for disciplines perceived by students as challenging. Introduction of learning topics with concurrent application may positively influence affective response to learning, which may beneficially impact latent student confidence and self-awareness.

Pharmacy Students Perceptions of Their Distance Online Learning Experience During the COVID-19 Pandemic: A Cross-Sectional Survey Study

INTRODUCTION

The COVID-19 pandemic imposed dramatic changes on educational practices worldwide. Many universities and schools have moved into the delivery of their courses and educational programs utilizing fully electronic online modes. This study aims to evaluate the pharmacy student distance online learning experience during the COVID-19 pandemic.

METHODS

A cross-sectional survey was utilized where a 3-domain survey questionnaire focused on preparedness, attitude and barriers was distributed to students at the time of conclusion of the semester. Each domain consists of multiple questions that made up a score that reflects their preparedness, attitude as well as barriers relevant to distance online learning experience. The survey was voluntarily, and all data were collected and recorded via google forms with maintaining anonymity.

RESULTS

The response rate was about 75% (n = 309). The results' analysis revealed no gender differences in any of these domains. However, there were some variable responses among different educational levels. The average preparedness score was 32.8 ± 7.2 (Max 45), the average attitude score was 66.8 ± 16.6 (Max 105), and the average barrier score was 43.6 ± 12.0 (Max 75). There was statistical significance difference in both preparedness score and attitude scores between different professional years (P-value <.05). However, there was no difference in barrier scores among all professional years. The results indicated that about 61.4% of the students agreed on that college of pharmacy was well-prepared and ready for the online education during the emerging COVID-19 pandemic with complete transition into online education. The results also indicated that 49.2% of the students showed positive attitude toward the provided online learning. The results indicated that about 34% of the students identify some barriers toward the provided online learning. Finally, there were strong association between the need for training on how to receive online courses and preparedness and barriers scores.

DISCUSSION AND CONCLUSION

E-learning experience pose challenges and presents opportunities during emergency situations. The need for training for students and faculty was highly associated with the preparedness and barriers domains rather than the infrastructure or computer literacy, so the school can improve their experience by addressing these needs.

A review to identify key perspectives in PBL meta-analyses and reviews: trends, gaps and future research directions

In the past 50 years, the original McMaster PBL model has been implemented, experimented, revised, and modified, and is still evolving. Yet, the development of PBL is not a series of success stories, but rather a journey of experiments, failures and lessons learned. In this paper, we analyzed the meta-analyses and systematic reviews on PBL from 1992 to present as they provide a focused lens on the PBL research in the past 5 decades. We identified three major waves in the PBL research development, analyzed their impact on PBL research and practice, and offered suggestions of research gaps and future directions for the field. The first wave of PBL research (polarization: 1990-mid 2000) focused on answering the question "Does PBL work?" and the outcomes. The results were conflicting. The researchers took polarizing positions and debated over the merits of PBL throughout this wave. However, the contradictory results and the debates in fact pushed the researchers to look harder for new directions to solve the puzzle. These efforts resulted in the second wave (from outcomes to process: mid 2000-mid 2010) that focused on the question "How does PBL work?" The second wave of PBL research targeted at investigating the effects of implementation constituents, such as assessment formats or single versus curriculum wide implementations. The third wave (specialization: mid 2010 and onward) of PBL research focused on "How does PBL work in different specific contexts?" These research widened our perspectives by expanding our understanding of how PBL manifests itself in different contexts. Given the diversification of PBL and more hybrid PBL models, we suggest "Why does PBL with particular implementation characteristics for specific outcomes work or not work in the condition where it is implemented?" to be the question to answer in the next wave of PBL research.

Effectiveness of problem-based learning on the professional communication competencies of nursing students and nurses: A systematic review

The objective of this systematic review was to estimate the effectiveness of problem-based learning (PBL) in developing the professional communication competences of nursing students and nurses. We have searched PubMed, EMBASE, MEDLINE, PsycINFO, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Database for Chinese Technical Periodicals to identify all the English and Chinese language studies that used PBL to determine the effectiveness of developing professional communication competences of nursing students and nurses. Then two reviewers independently assessed eligibility and extracted data. Quality assessment using the Cochrane Collaboration's risk of bias tool for randomized controlled trials and Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for quasi-experimental studies. A total of 12 studies were included, all of which were inclined to low bias. Eleven articles showed that PBL developed the communication skills of nursing students or nurses, while only one article revealed no significant difference between PBL and the traditional method. Owing to differences in experimental design and the method and duration of intervention, some of these studies combined PBL with other methods, and the evaluation tools were different. This systematic review cautiously supports the outcomes of PBL compared with traditional learning.

Developing Cognitive Skills Through Active Learning: A Systematic Review of Health Care Professions

Objective

To systematically review current literature to determine whether active learning is more successful than passive learning at producing cognitive skills in health care professions students.

Data Sources

An electronic search was conducted in 4 databases: EBSCO-CINAHL, EBSCO-Sport Discus, Educational Resources Information Center, and PubMed. Search terms included: millennial AND health education, active learning AND knowledge retention, flipped classroom AND learning outcomes, problem based learning AND learning outcomes, problem based learning AND student confidence, active learning AND critical thinking, higher order thinking AND active learning.

Study Selection

We included studies if they were published in English between 2007 and 2017 and evaluated outcomes of an active learning intervention. Studies of nonhealth care disciplines, practicing health care practitioners, or studies that did not address the primary research questions were excluded.

Data Extraction

Study design, health care discipline, intervention used, assessment measures, outcome(s) measures, main results, and conclusions were extracted from each article, as appropriate.

Data Synthesis

Articles were categorized based on capacity to answer 1 or both of the research questions. Conclusions were summarized according to the learning technique used and its effectiveness in regard to studied learning outcome. Out of 85 studies on lower-order cognition, 61 (72%) indicated active learning techniques were effective at achieving improved recall, understanding, and/or application of course material. Of 69 studies on higher-order cognition, 58 (84%) supported active learning over passive instruction for improving students' confidence in or performance of analytical, evaluative, and creative skills.

Conclusions

Active learning produces gains to both lower- and higher-order cognition at levels equal to, and more often, greater than the use of passive learning methods. Despite this evidence, we believe more high-quality, well-designed prospective studies using validated assessment measures are needed to endorse the value of these methods in producing cognitive skills.

Entrustable Professional Activities as a Novel Framework for Pharmacy Education

Entrustable professional activities (EPAs) are units of measure for a particular profession that describe the professional's unique abilities and work. EPAs can be used in two ways: as a link between individual competencies for mastery and overall professional responsibilities in practice; and as a mechanism for faculty to assess the student's progression using levels of decreasing supervision. Currently used in medical education, implementation and utilization of EPAs within pharmacy education has potential benefits and challenges. This article will describe, highlight benefits of, and share mitigation strategies for implementing EPAs within pharmacy education.

Faculty motivations to use active learning among pharmacy educators

INTRODUCTION

Faculty motivations to use active learning have been limited to surveys evaluating faculty perceptions within active learning studies. Our objective in this study was to evaluate the relationship between faculty intrinsic motivation, extrinsic motivation, and demographic variables and the extent of active learning use in the classroom.

METHODS

An online survey was administered to individual faculty members at 137 colleges and schools of pharmacy across the United States. The survey assessed intrinsic and extrinsic motivations, active learning strategies, classroom time dedicated to active learning, and faculty development resources. Bivariate associations and multivariable stepwise linear regression were used to analyze the results.

RESULTS

In total, 979 faculty members completed the questionnaire (23.6% response rate). All motivation variables were significantly correlated with percent active learning use (p < 0.001). Intrinsic motivation demonstrated the highest correlation (r = 0.447) followed by current extrinsic motivations (r = 0.245) and ideal extrinsic motivations (r = 0.291). Variables associated with higher intrinsic motivation included the number of resources used (r = 0.233, p < 0.001) and the number of active learning methods used in the last year (r = 0.259, p < 0.001). Years of teaching experience was negatively associated with intrinsic motivation (r = -0.177, p < 0.001). Regression analyses confirmed the importance of intrinsic and extrinsic motivations in predicting active learning use.

DISCUSSION AND CONCLUSIONS

Our results suggest that faculty members who are intrinsically motivated to use active learning are more likely to dedicate additional class time to active learning. Furthermore, intrinsic motivation may be positively associated with encouraging faculty members to attend active learning workshops and supporting faculty to use various active learning strategies in the classroom.

Effectiveness of problem-based learning in Chinese pharmacy education: a meta-analysis

BACKGROUND

This review provides a critical overview of problem-based learning (PBL) practices in Chinese pharmacy education. PBL has yet to be widely applied in pharmaceutical education in China. The results of those studies that have been conducted are published in Chinese and thus may not be easily accessible to international researchers. Therefore, this meta-analysis was carried out to review the effectiveness of PBL.

METHODS

Databases were searched for studies in accordance with the inclusion criteria. Two reviewers independently performed the study identification and data extraction. A meta-analysis was conducted using Revman 5.3 software.

RESULTS

Sixteen randomized controlled trials were included. The meta-analysis revealed that PBL had a positive association with higher theoretical scores (SMD = 1.17, 95% CI [0.77, 11.57], P < 0.00001). The questionnaire results show that PBL methods are superior to conventional teaching methods in improving students' learning interest, independent analysis skills, scope of knowledge, self-study, team spirit, and oral expression.

CONCLUSIONS

This meta-analysis indicates that PBL pedagogy is superior to traditional lecture-based teaching in Chinese pharmacy education. PBL methods could be an optional, supplementary method of pharmaceutical teaching in China. However, Chinese pharmacy colleges and universities should revise PBL curricula according to their own needs, which would maximize the effectiveness of PBL.