Building critical reflection skills for lifelong learning in the emergent landscape of a national registration and accreditation scheme

Scaffolding in Health Sciences Education Programmes: An Integrative Review

The complexity of health sciences programmes justifies scaffolding to support students in becoming competent health professionals. This article reports on an integrative review that aimed to describe the application of scaffolding in health sciences programmes. Twenty-nine sources, inclusive of theoretical and empirical studies, were reviewed. The sequencing of educational activities, the application of scaffolding tools or resources, frameworks for applying scaffolding, modelling, and fading represented the application of scaffolding in health sciences programmes. Awareness of the application of scaffolding in health sciences programmes could contribute to enhancing competence development among students when applied across all learning platforms.

Standards for Scaffolding in Health Sciences Programmes: A Delphi Consensus Study

Introduction

Health sciences programmes operate in complex, unpredictable contexts, underscoring the need for comprehensive scaffolding of the learning processes. Yet, the scaffolding approaches remain fragmented, and lack a shared approach to how programmes could integrate scaffolding across the curricula. The literature argues that standards result in the comprehensive implementation of educational practices. There are no reported standards related to scaffolding practices in these programmes.

OBJECTIVES

To develop standards for scaffolding in health sciences programmes utilising a consensus approach through a modified Delphi Technique.

METHODS

Following the recommendations on Conducting and REporting of DElphi Studies (CREDES), an online modified Delphi technique was applied. Evidence on the application of scaffolding in health sciences programmes, obtained through an integrative review, was synthesised to draft standards. Using purposive and snowball sampling, an international panel from diverse geographical and professional backgrounds refined and validated the standards. Descriptive statistics was utilised to analyse demographic data and consensus agreements to include standards and criteria. Qualitative analysis of textual comments ensured the synthesis and inclusion of critical divergent views and additions.

RESULTS

A total of 22 experts from around the globe agreed to participate in the study and one did not complete Delphi surveys. Most experts (n = 18) held a PhD; and an average of 19 years of teaching in health sciences programmes. Four standards and 27 criteria were included after achieving consensus during the two Delphi surveys rounds. The included standards focused on four areas: structuring and sequencing educational activities, resources/tools for scaffolding, structuring the programme and instructional strategies to support learning.

CONCLUSION

The principle-based standards developed in this study could direct and support scaffolding practices in health sciences programmes. The standards' emphases on macro-, meso- and micro-scaffolding present numerous opportunities for designing and applying contextually sensitive scaffolding strategies at every level of curriculum implementation.

A structured reflective process supports student awareness of employability skills development in a science placement module

Placements are often an extra‐curricular activity of a science degree. This study reports on the outcomes of a final‐year credit‐bearing 6‐week placement module that was specifically designed to develop and enhance students’ employability skills. A key element of this module was that the student placements were not only evaluated from a science perspective, but also evaluated with an emphasis on meaningful reflection and evaluation of employability skills development. Students recorded their levels of confidence in skills before, during and after the placement via an Online Reflective Log, as part of a module’s summative assessment. The results showed that taking part in the placement and conducting their own independent research helped students to make connections between their scientific knowledge, otherwise constrained within the walls of the undergraduate science laboratory, and the wider impact of their research on society. Another theme that emerged concerned career choices and aspirations, and the placement experiences either confirmed prior choices or opened new horizons. The Online Reflective Log helped students to feel supported by their university supervisor who were at a distance. Feedback on their tasks prompted students to reflect on the scientific and personal skills while being engaged in scientific activities during placement. Students agreed that they had further developed their employability skills during the placement and acknowledged that it was challenging to acquire evidence of skill development. However, students appreciated the usefulness of this reflection in relation to their future career development.

Experiential Learning in a Gamified Pharmacy Simulation: A Qualitative Exploration Guided by Semantic Analysis

Experiential learning is an important component of pharmacist education and is primarily achieved through supervised placement or simulation. This study explored senior pharmacy students' experiential learning in an extended, immersive, gamified simulation, conducted as a capstone learning activity toward the end of their final year of study, consolidating all prior learning and preparing students for intern practice. The simulation aimed to enhance student confidence, competence and collaboration. The three-week activity involved student teams competitively managing simulated pharmacies, assuming the role of pharmacists to complete all scaffolded assessments, including dispensing prescriptions, clinical cases, verbal counselling, simulated patient cases, interprofessional collaboration, and assignments. Assessments were marked continuously, with consequences of practice acknowledged through gain or loss of 'patients' for the pharmacy. From 2016 to 2018, 123 students completed multiple individual reflective journals (n = 733). Reflective journals were analyzed to explore the student experience, using a mixed methods approach. Initial Leximancer® 4.51 semantic analysis guided thematic analysis, conducted in NVivo® 12. The major themes that emerged were teamwork, patient-centeredness, medicines provision, future practice, and the learning experience. Student participants reported an intense and emotional experience in the gamified simulation, with many students revealing transformation in their skills, behaviors and attitudes over its duration.

Student Pharmacists' Use of Patient-Centered Communication Skills During an Introductory Pharmacy Practice Experience

Objective. To assess how Doctor of Pharmacy (PharmD) students use patient-centered communication (PCC) during a community pharmacy introductory pharmacy practice experience (IPPE). Methods. All first-year student pharmacists at the University of Arkansas for Medical Sciences completed a required course in patient-centered communication that included training in motivational interviewing. After subsequently completing their first IPPE, the students submitted written reflections on their use of PCC during the experience. The reflections were de-identified and template analysis was conducted. With this method, predetermined codes are established, and a constant comparison method is used to finalize overarching themes. The students' overall level of reflection was assessed and each reflection was coded. Discrepancies were resolved through in-depth discussion and negotiated consensus. Results. Of the 116 student reflections submitted, 951 codes were applied. Six overarching themes were identified: acknowledgement of motivational interviewing skills/components; philosophy of patient-centeredness; barriers to using PCC or motivational interviewing; benefits from use of PCC; demonstration of good general communication skills; and perceptions of patient encounters. Approximately 46% of students reflected at a level three or higher (ie, personal insight or intended behavior change). Conclusion. First-year student pharmacists successfully used PCC skills during their IPPE. These findings demonstrate the impact that a PCC course can have on students' overall patient-centeredness and highlights barriers that students struggle to overcome. Other pharmacy schools may benefit from implementing a similar PCC course. Activities that reiterate these skills and provide additional opportunities to practice PCC are necessary throughout the curriculum.

A Retrospective Study on Students' and Teachers' Perceptions of the Reflective Ability Clinical Assessment

Objective. To evaluate student and teacher perceptions of the utility of the Reflective Ability Clinical Assessment (RACA) in an undergraduate pharmacy curriculum at an Australian university. Methods. A mixed-method study comprising the administration of a 7-item student survey on a 6-point Likert-type scale and a 45-minute focus group/phone interview with teachers. Results. Student (n=199) and teaching staff respondents (n=3) provided their perceptions of the implementation of the new educational tool. Student responses showed significant positive correlations between self-directed learning, counseling skills, relevance to future practice, and performance in an oral examination. Seven key themes emerged from the teacher interviews. Conclusion. The study revealed both students and teachers perceive the RACA as an effective educational tool that may enhance skill development for future clinical practice.

The Effect of Reflective Activities on Reflective Thinking Ability in an Undergraduate Pharmacy Curriculum

Objective. To determine the effectiveness of integrating reflective practice activities into a second-year undergraduate pharmacy curriculum and their impact on reflective thinking ability. Design. A cross-over design with repeated measures was employed. Newly developed reflective modules based on real hospital and community pharmacy cases were integrated into the second-year pharmacy practice curriculum. A novel strategy, the Reflective Ability Clinical Assessment (RACA), was introduced to enhance self- and peer reflection. Assessment. Student responses (n=214) to the adapted Kember et al(1) Reflective Thinking Questionnaire (RTQ) were compared before and after reflective activities were undertaken. Significant improvement in three indicators of reflective thinking was shown after students engaged in reflective activities. Conclusion. Integration of reflective activities into a pharmacy curriculum increased the reflective thinking capacity of students. Enhancing reflective thinking ability may help students make better informed decisions and clinical judgments, thus improving future practice.

Using reflection to evaluate student learning in ambulatory care IPPEs

PURPOSE

Gather insight from student pharmacists about what they learned and whether objectives of an introductory pharmacy practice experience (IPPE) were achieved in an academic-based ambulatory care site.

METHODS

Students wrote post-reflective essays after their first ambulatory care-site visit. They reflected upon their previous assumptions of ambulatory care, and the roles and skills required of pharmacists in this setting. Additionally, students ranked their interest in ambulatory care pre- and post-IPPE. Post-reflection essays were analyzed for recurring themes using a constant comparison method and a respondent validation method was employed to confirm these findings. Wilcoxon signed-rank sum test was used to analyze student interest in ambulatory care and descriptive statistics were used, as appropriate.

RESULTS

Overall, 70 reflection articles were analyzed. Assumptions of ambulatory care were either incorrect or proved to be more than what was expected for 60% of students. Based on the themes identified, students learned most about the collaborative practice model, chronic disease state management, and the time commitment necessary for outcomes. Regarding skills required of a pharmacist, students discussed the need for a strong knowledge base, communication, and ability to transfer these skills from one setting to another. Interest in ambulatory care increased after the site visit (p <0.01) and 90% of students who wrote these reflections strongly agreed or agreed with the above findings.

CONCLUSIONS

With intentional reflection, ambulatory care IPPEs can serve as a meaningful outlet for learning while also achieving IPPE objectives.

A Model for Assessing Reflective Practices in Pharmacy Education

OBJECTIVE. To research the literature and examine assessment strategies used in health education that measure reflection levels and to identify assessment strategies for use in pharmacy education. METHODS. A simple systematic review using a 5-step approach was employed to locate peer-reviewed articles addressing assessment strategies in health education from the last 20 years. RESULTS. The literature search identified assessment strategies and rubrics used in health education for assessing levels of reflection. There is a significant gap in the literature regarding reflective rubric use in pharmacy education. CONCLUSION. Two assessment strategies to assess levels of reflection, including a reflective rubric tailored for pharmacy education, are proposed.

Reflective practice and its implications for pharmacy education

Pharmacy students require critical-thinking and problem-solving skills to integrate theory learned in the classroom with the complexities of practice, yet many pharmacy students fall short of acquiring these skills.(1-2) Reflective practice activities encourage learning from the student's own experiences and those of others, and offer a possible solution for the integration of knowledge-based curricula with the ambiguities of practice, as well as enhance communication and collaboration within a multidisciplinary team. Although reflective practices have been embraced elsewhere in health professions education, their strengths and shortcomings need to be considered when implementing such practices into pharmacy curricula. This review provides an overview of the evolution of theories related to reflective practice, critically examines the use of reflective tools (such as portfolios and blogs), and discusses the implications of implementing reflective practices in pharmacy education.