A categorization scheme for assessing pharmacy students' levels of reflection during internships

Grading reflective essays: the construct validity and reliability of a newly developed Tool- GRE-9

BACKGROUND

The main objective of this study is to assess the construct validity and reliability of the Grading Reflective Essays-9 (GRE-9).

METHODS

This study took place in a major tertiary academic medical center in Beirut, Lebanon. 104 reflective essays written by years 1-3 residents in the department of Family Medicine at the American University of Beirut Medical Center (AUBMC) were graded by 2 trained raters who independently scored the essays using GRE-9. GRE-9 scores were then correlated with scores on communication skills OSCE stations and in-training examinations to investigate, respectively, convergent and divergent validity. One of the 2 raters scored the essays twice one month apart to assess the reliability of the GRE-9 using intra rater reliability and internal consistency.

RESULTS

There was a weak, non-significant correlation between GRE-9 score and In training examination (ITE) score (r = - .213, p = .395). There was a moderate, non-significant correlation between GRE-9 scores and the Objective structured clinical examination (OSCE) communication station scores (r = - .412 p = .162). The correlation coefficient between trails 1 and 2 was significant (r = .832, p = .000). Intra class correlation coefficient (ICC) analysis demonstrated almost perfect intra-rater agreement (0.819; 95% CI: 0.741-0.875) of the test ratings over time.

CONCLUSIONS

GRE-9, is a short, concise, easy-to-use reliable grading tool for reflective essays that has demonstrated moderate to substantial intra-rater reliability and evidence of divergent validity. The study found non-significant correlations between reflective writing scores OSCE communication scores demonstrating a lack of relationship between reflective writing and this measure of performance.

Peer feedback as a medium to facilitate reflective practice among pharmacy students in a case-based learning environment

INTRODUCTION

The ability to reflect is a key element in preparing pharmacy professionals to meet the challenges of a dynamic health care environment. This mixed-methods study explored the pedagogical benefits of peer feedback by designing, developing, and implementing a peer feedback activity to facilitate reflective practice among pharmacy students.

METHODS

Twenty second-year doctor of pharmacy (PharmD) students in a required pharmacotherapy course participated in a systematic peer feedback activity and five of these students volunteered for semi-structured interviews.

RESULTS

No significant correlation was found between perceived effectiveness of peer feedback and students' reflective thinking skills. Qualitative interview data revealed three major themes regarding PharmD students' perception of peer feedback as an instructional strategy to promote reflective practice: (1) the cognitive process of providing feedback, (2) the cognitive process after receiving peer feedback, and (3) perceptions of peer feedback as a tool to exercise reflective practice.

CONCLUSIONS

Although limited in sample size, important lessons were learned on how to design, develop, and implement a peer feedback activity.

Assessment tools for reflection in healthcare learners: A scoping review

Reflection has been integrated in many healthcare educations programs to achieve deeper learning and improve professional practice. A variety of evaluation tools are used to assess reflection, but few guides are available to inform educators in their choice of a relevant evaluation tool. The aim of this paper is to identify all existing evaluation tools published along with their strengths and weaknesses. A review strategy retrieved tools available in Medline, PsychInfo, CINALH and Eric databases. The procedures outlined by Munn and colleagues were used to synthetize the information. Additionally, the reflection dimensions assessed in each tool (when sufficient information was available) were analyzed deductively, using thematic analysis according to the Killion and Todnem framework. Subthemes were identified inductively. Forty-five papers were identified, reporting on 34 different tools. The tools were based on a variety of theoretical models. Some had evidence of adequate validity and fidelity. Eleven components of reflection were identified across tools. No tool encompassed all components, but most tools included between three and five components. Context surrounding evaluation should be carefully considered when choosing an evaluation tool for reflection. There is a need for further research to validate the psychometric properties of reflection evaluation tools.

Grading reflective essays: the reliability of a newly developed tool- GRE-9

BACKGROUND

The main objective of this study is the development of a short reliable easy-to-use assessment tool in the aim of providing feedback to the reflective writings of medical students and residents.

METHODS

This study took place in a major tertiary academic medical center in Beirut, Lebanon. Seventy-seven reflective essays written by 18 residents in the department of Family Medicine at the American University of Beirut Medical Center (AUBMC) were graded by 3 raters using the newly developed scale to assess the scale reliability. Following a comprehensive search and analysis of the literature, and based on their experience in reflective grading, the authors developed a concise 9-item scale to grade reflective essays through repeated cycles of development and analysis as well as the determination of the inter-rater reliability (IRR) using intra-class correlation coefficients (ICC) and Krippendorff's Alpha.

RESULTS

The inter-rater reliability of the new scale ranges from moderate to substantial with ICC of 0.78, 95% CI 0.64-0.86, p < 0.01 and Krippendorff's Alpha was 0.49.

CONCLUSIONS

The newly developed scale, GRE-9, is a short, concise, easy-to-use reliable grading tool for reflective essays that has demonstrated moderate to substantial inter-rater reliability. This will enable raters to objectively grade reflective essays and provide informed feedback to residents and students.

Evaluation of the effect of items' format and type on psychometric properties of sixth year pharmacy students clinical clerkship assessment items

BACKGROUND

Examinations are the traditional assessment tools. In addition to measurement of learning, exams are used to guide the improvement of academic programs. The current study attempted to evaluate the quality of assessment items of sixth year clinical clerkships examinations as a function of assessment items format and type/structure and to assess the effect of the number of response choices on the characteristics of MCQs as assessment items.

METHODS

A total of 173 assessment items used in the examinations of sixth year clinical clerkships of a PharmD program were included. Items were classified as case based or noncase based and as MCQs or open-ended. The psychometric characteristics of the items were studied as a function of the Bloom's levels addressed, item format, and number of choices in MCQs.

RESULTS

Items addressing analysis skills were more difficult. No differences were found between case based and noncase based items in terms of their difficulty, with a slightly better discrimination in the latter. Open-ended items were easier, yet more discriminative. MCQs with higher number of options were easier. Open-ended questions were significantly more discriminative in comparison to MCQs as case based items while they were more discriminative as noncase based items.

CONCLUSION

Item formats, structure, and number of options in MCQs significantly affected the psychometric properties of the studied items. Noncase based items and open-ended items were easier and more discriminative than case based items and MCQs, respectively. Examination items should be prepared considering the above characteristics to improve their psychometric properties and maximize their usefulness.

Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care

INTRODUCTION

Self-reflection has become recognised as a core skill in dental education, although the ability to self-reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self-reflective ability of adults studying or working within any setting, not just health care.

MATERIALS AND METHODS

A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost.

RESULTS

A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self-reported scales and observed behaviour.

CONCLUSIONS

Three types of instrument were identified to assess the ability to self-reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self-reflect, and how this should be managed.

Can a reflective rubric be applied consistently with raters globally? A study across three countries

INTRODUCTION

Reflection is a powerful tool for assisting students to develop the skills to make better informed decisions. As a pharmacy competency standard, reliable and fair assessment strategies are required to measure reflective skills and support students in developing their reflective capacity. The aim of this research was to explore whether we can extend the applicability of a previously tested rubric to a range of educational settings, to account for diversity of pharmacy educators and curricula internationally.

METHODS

Four raters from three countries applied a reflective rubric to assess a sample (n = 43) of reflective accounts, representing 41% of a cohort of 105 second-year undergraduate pharmacy students. The interrater reliability (IRR) was measured utilizing the intra-class correlation coefficient (ICC), using a two-way random effects model with absolute agreement, to determine the level of agreement between the raters' absolute scores. Generalizability Theory analysis was used to estimate generalizability of raters and stages.

RESULTS

Results indicated agreement of raters for (i) each of the seven stages of reflection and (ii) overall score for the reflective account, with moderate to substantial agreement (ICC = 0.55-0.69, p < 0.001); and high agreement for all raters for the overall score (ICC = 0.96, p < 0.001), respectively. The G-Study estimated a relative error coefficient of 0.78.

CONCLUSION

This additional analysis further confirms the reliability and applicability of the rubric to a range of rater academic backgrounds.

Implementation of a Continuing Professional Development Course in a Longitudinal Didactic Curriculum for Pharmacy Students

Objective. To implement a continuous professional development (CPD) program in the didactic curriculum of a three-year Doctor of Pharmacy (PharmD) program, and evaluate associated outcomes. Methods. The initial CPD program was implemented in the didactic curriculum of the PharmD program in 2014-2015. Barriers were identified and strategies adopted to overcome the barriers. A revised CPD curriculum was implemented in the 2015-2016 academic year. Student and faculty evaluations of the course were conducted, and students' perceived capabilities in the various skills related to professional development were measured. Results. The student ratings of the course were acceptable (ranging from 3.3 to 4.2 on a 5-point Likert scale). First-year students rated the course higher than second-year students did. The majority of faculty members found the CPD curriculum valuable for students. Students perceived that their skills in oral, written and interprofessional communication, leadership, and time management had significantly improved after completing the course. Conclusion. Implementation of a CPD process during the didactic curriculum for PharmD students is feasible and beneficial to students' professional development. This CPD model provided students with an opportunity to develop self-directed lifelong learning skills and prepared them to transition to practice-based learning in their final year of the program.

Pharmacy Students' Utilization of an Online Tool for Immediate Formative Feedback on Reflective Writing Tasks

Objective. To assess pharmacy students' perceptions of the benefits and utility of a novel online reflective-writing tool. Methods. After completing a required Academic Writing Analytics (AWA) workshop, Master of Pharmacy students submitted a reflective writing assignment in the AWA web application. A six-item survey was administered to students prior to and immediately after using AWA. Results. Sixty students volunteered to participate in the study; however, only 39 students provided a pseudonym that allowed their pretest and posttest to be matched. A comparison of students' responses on the pretest with those on the posttest, which was administered four weeks after the workshop, suggest a noticeable increase in agreement with AWA's benefits as an effective, online tool for improving their reflective learning skills. Conclusion. This novel online tool has the potential to assist pharmacy students with self-critiquing and improving their reflective writing assignments prior to submission. Furthermore, as the elements of reflection are transferable, this tool has the potential to be used in other educational contexts.

A Hospital-based Pharmacy Internship Program in Jordan

Objective. To develop a hospital-based pharmacy internship program in a comprehensive cancer care center in Jordan and review its outcomes over a 10-year period.Methods. King Hussein Cancer Center developed a two-year internship program for pharmacy students in Jordanian universities. The program included training in operational and clinical settings during the academic year and school holidays. In addition, the students completed rotation-related assignments and met weekly with the program director. During the rotations and at the end of the program, interns were asked to assess their level of satisfaction with the program and to comment on its content and structure. Results. From a pilot phase with only three interns and a simple training structure, the two-year internship program has become more structured now training six interns annually. During the first 10 years of the program, 51 students from four universities in Jordan enrolled in the program, with six current interns, 34 graduates, and 11 withdrawals. Graduates reported improved academic performance and satisfaction with the program's structure and the skills obtained. Their main challenge was time management during the academic year. Conclusion. A hospital-based pharmacy internship program is feasible and sustainable. Participation in the program improves interns' academic performance and clinical and professional skills, despite the challenges of highly demanding conditions on both the hospital and the students.

Assessing a Longitudinal Reflection Curriculum: A Case Study Of Student Self-Awareness Expressed Through Rotation Goal Achievement

The Center for the Advancement of Pharmacy Education 2013 Affective Domain mandates students develop self-awareness of personal attributes affecting professional growth. Students should self-identify needs, create and implement goals, and evaluate success. This case study describes the qualitative and quantitative findings of an intentional reflection assignment prompting students to engage in a cycle of goal writing - monitoring - reflection - new goal writing, during an immersive clinical practice experience. A blinded review of 144 student assignments is presented in the context of a curricular review of the Reflective Practitioner Program (RPP), a longitudinal reflective thread spanning four years of professional pharmacy training. Evidence gathered in the assignment review indicates that students are sufficiently capable of establishing meaningful goals and describing why the goal is important to their professional development. In contrast, students struggle with articulating strategies for goal achievement and emotions experienced during goal monitoring. In consideration of these findings, RPP faculty identified three major themes when discussing key aspects of the RPP curricular design: 1) students need to articulate strategies for goal achievement in addition to stated aims, 2) students hesitate to identify emotions when reflecting, and 3) reflection needs to be both retrospective and prospective in nature. This case study has resulted in meaningful changes to RPP curricular design and illustrates how programs may approach assessment of the Affective Domain via common curricular elements.

Student perceptions of the impact and value of incorporation of reflective writing across a pharmacy curriculum

INTRODUCTION

To assess student perceptions regarding the impact and value of incorporating written reflection across a pharmacy curriculum.

METHODS

Throughout the first three years of the pharmacy curriculum, students use the "What, So What, Now What" format to write 18 reflections within five didactic and six experiential courses. For the 93 students in the class of 2015, individual course evaluation questions measuring perceptions of the impact of reflective writing on their achievement of curricular outcomes were analyzed. Student perceptions of reflective writing's value and impact on their professional development were obtained via a survey administered to the class of 2015 after their third professional year.

RESULTS

Students identified reflection (100%) and written reflection (98%) as having some degree of importance to their professional development. However, only 42% of students felt that reflective writing had an appreciable or significant impact on their professional development. Most students indicated that reflective writing had a positive impact on their sensitivity to specific patient populations, ethical behavior, interpersonal skills, and ability to provide patient-centered, interprofessional care.

CONCLUSION

This study found that most students found some value in reflective writing, felt that reflective writing positively impacted their self-awareness and professional behaviors, and were able to identify benefits of the reflective writing program.

Impact of Instruction and Feedback on Reflective Responses during an Ambulatory Care Advanced Pharmacy Practice Experience

Objective. To investigate whether instruction and feedback on reflective responses are beneficial in developing pharmacy students to become more reflective practitioners. Methods. Students on an advanced pharmacy practice experience answered weekly reflection questions and were randomly assigned to either an intervention (received instruction and feedback on reflection) or control group. The final week's responses were de-identified and two blinded faculty members independently categorized them as reflective or nonreflective. The primary outcome measure was comparing the number of "reflective" responses in each group. Results. The responses were classified as reflective in 83.3% of students in the intervention group (n=18) compared to 37.5% of the control group (n=16). The odds that the response was categorized as reflective were 8.3 times higher in the intervention group. Conclusion. Providing instruction and feedback to students improved the likelihood that their work was reflective.

Qualitative Analysis of Written Reflections during a Teaching Certificate Program

OBJECTIVE

To evaluate the success of a teaching certificate program by qualitatively evaluating the content and extent of participants' reflections.

METHODS

Two investigators independently identified themes within midpoint and final reflection essays across six program years. Each essay was evaluated to determine the extent of reflection in prompted teaching-related topic areas (strengths, weaknesses, assessment, feedback).

RESULTS

Twenty-eight themes were identified within 132 essays. Common themes encompassed content delivery, student assessment, personal successes, and challenges encountered. Deep reflection was exhibited, with 48% of essays achieving the highest level of critical reflection. Extent of reflection trended higher from midpoint to final essays, with significant increases in the strengths and feedback areas.

CONCLUSION

The teaching certificate program fostered critical reflection and self-reported positive behavior change in teaching, thus providing a high-quality professional development opportunity. Such programs should strongly consider emphasizing critical reflection through required reflective exercises at multiple points within program curricula.

On Critical Reflection

In this article, we review empirical studies that research critical reflection based on Mezirow’s definition. The concepts of content, process, and premise reflection have often been cited, and operationalizing Mezirow’s high-level transformative learning theory and its components has been the endeavor of adult education and human resource development (HRD) researchers. By conducting a literature review, we distill 12 research studies on critical reflection that we dissect, analyze, and compare. Discovering different approaches, assessment processes, and outcomes leads us to the conclusion that there is little agreement on how to operationalize reflection. We suggest four improvements: (a) integrating different critical reflection traditions, (b) using multiple data collection pathways, (c) opting for thematic embedding, and (d) attending to feelings. By implementing these improvements, we hope to stimulate closer alignment of approaches in critical reflection research across adult education and HRD researchers.

Making a Curricular Commitment to Continuing Professional Development in Doctor of Pharmacy Programs

As outlined in the Accreditation Council for Pharmacy Education (ACPE) Standards 2016, colleges and schools of pharmacy must provide an environment and culture that promotes self-directed lifelong learning. Continuing professional development (CPD) serves as a model that can foster and support self-directed, lifelong learning. The benefits of adopting a CPD model include assistance with attaining Center for the Advancement of Pharmaceutical Education (CAPE) 2013 Outcomes, such as self-awareness. This model can also support the individualization of experiential learning and student action on feedback from curricular-level assessments. The major skills involved in CPD, such as reflection and documentation, are frequently addressed in pharmacy curricula. However, these skills may be developed in isolation or exercised for purposes other than learning. The aim of this statement is to aid schools in creating "CPD ready" practitioners by defining the skill sets involved in CPD and making recommendations for advancing CPD in curricula.

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.

The Redesign of a Community Pharmacy Internship Program

Background:

Pharmacy internships provide students with practical experiences that lead to enhancement of clinical skills and personal growth.

Objective:

To describe the design and implementation of a structured 10-week summer pharmacy internship program in a supermarket chain pharmacy.

Methods:

The pharmacy leadership team developed and piloted a new format of the pharmacy internship during the summer of 2013. Pharmacy students in professional year 1 (P1), 2 (P2), and 4 (P4) were invited to apply for a paid internship. Pharmacy students were recruited from all colleges of pharmacy in the state of Michigan. The goal of the new program was to create a focused learning opportunity that encouraged students to develop knowledge, skills, and abilities about patient care, pharmacy management, and working within a team.

Results:

A total of 19 interns were recruited (P1 = 7, P2 = 7, and P4 = 5). Students practiced 40 hours per week and participated in the medication dispensing process and employee biometrics screening program. Interns provided approximately 500 assessments on pharmacy employees and all P1 and P2 interns completed a patient care project.

Conclusions:

The restructured internship program provided pharmacy students with a 10-week program that exposed them to many aspects of community pharmacy practice. The program needs future refinement and assessment measures to verify interns improve skills throughout the program.

Reflective writing and its impact on empathy in medical education: systematic review

PURPOSE

Medical schools are increasingly aware of the ways in which physician empathy can have a profound impact on patients' lives and have developed humanities initiatives to address this concern. Reflective writing in particular is more commonly promoted in medical curricula, but there is limited research on the impact of reflective writing on medical student empathy levels. It aims to find the emotional effects of reflective writing interventions on medical and healthcare students by systemic review.

METHODS

Two investigators independently reviewed educational publications for critical analysis. This review focused systematically on quantitative papers that measure the impact of reflective writing on empathy.

RESULTS

Of the 1,032 studies found on Medline and CINAHL, only 8 used quantitative measures pre- and postwritten reflection to measure any impact on empathy outcomes. The outcomes measured included impact of reflective writing exercises on student wellness, aptitude, and/or clinical skills. Of these studies, a significant change in student empathy was observed in 100% of the studies, demonstrating a significant change in outcomes.

CONCLUSION

Although the lack of homogeneity in outcome measurement in the literature limits possible conclusion from this review, the overwhelmingly positive reporting of outcomes suggests that reflective writing should be considered in any medical curriculum.

Service-learning-based instruction enhances students' perceptions of their abilities to engage in evidence-based practice

ABSTRACT Education leaders in occupational therapy (OT) propose that active learning is one means to developing critical thinking skills essential for successful integration of knowledge into evidence-based practice. This study examines the impact of one type of active learning, service-learning, on students' perceptions of their knowledge, skills, and confidence in their abilities to provide OT services to adults with neurological conditions. Change in OT students' (n == 43) perceptions before and after engagement in service-learning were assessed using quantitative and qualitative data in a triangulation mixed-methods design. Results support previous studies indicating that service-learning can influence positive gains in student knowledge and confidence.

Communications training in pharmacy education, 1995-2010

The role of the pharmacist as a "communicator" of information and advice between patients, other healthcare practitioners, and the community is recognized as a vital component of the responsibilities of a practicing pharmacist. Pharmacy education is changing to reflect this, although the difficulty is in designing a curriculum that is capable of equipping students with the necessary knowledge and skills, using activities that are effective in promoting communication competency. The objective of this review was to identify published, peer-reviewed articles concerning communication training in pharmacy education programs, and describe which communication skills the structured learning activities aimed to improve and how these learning activities were assessed. A systematic literature search was conducted and the articles found were analyzed and divided into categories based on specific communication skills taught and type of learning activity used. Oral interpersonal communication skills targeted at patients were the most common skill-type described, followed by clinical writing skills. Common teaching methods included simulated and standardized patient interactions and pharmacy practice experience courses. Most educational interventions were assessed by subjective measures. Many interventions were described as fragments, in isolation of other learning activities that took place in a course, which impedes complete analysis of study results. To succeed in communication training, integration between different learning activities and progression within pharmacy educations are important.

Use of SMART learning objectives to introduce continuing professional development into the pharmacy curriculum

OBJECTIVE

To determine whether a 2-year continuing professional development (CPD) training program improved first-year (P1) and second-year (P2) pharmacy students' ability to write SMART (specific, measurable, achievable, relevant, and timed) learning objectives.

DESIGN

First-year students completed live or online CPD training, including creating portfolios and writing SMART objectives prior to their summer introductory pharmacy practice experience (IPPE). In year 2, P1 and P2 students were included. SMART learning objectives were graded and analyzed.

ASSESSMENT

On several objectives, the 2011 P1 students (n = 130) scored higher than did the P2 cohort (n = 105). In 2011, P2 students outscored their own performance in 2010. In 2011, P1 students who had been trained in online modules performed the same as did live-session trainees with respect to SMART objectives.

CONCLUSION

With focused online or live training, students are capable of incorporating principles of CPD by writing SMART learning objectives.

Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing

PURPOSE

Reflective writing (RW) curriculum initiatives to promote reflective capacity are proliferating within medical education. The authors developed a new evaluative tool that can be effectively applied to assess students' reflective levels and assist with the process of providing individualized written feedback to guide reflective capacity promotion.

METHOD

Following a comprehensive search and analysis of the literature, the authors developed an analytic rubric through repeated iterative cycles of development, including empiric testing and determination of interrater reliability, reevaluation and refinement, and redesign. Rubric iterations were applied in successive development phases to Warren Alpert Medical School of Brown University students' 2009 and 2010 RW narratives with determination of intraclass correlations (ICCs).

RESULTS

The final rubric, the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT), consisted of four reflective capacity levels ranging from habitual action to critical reflection, with focused criteria for each level. The rubric also evaluated RW for transformative reflection and learning and confirmatory learning. ICC ranged from 0.376 to 0.748 for datasets and rater combinations and was 0.632 for the final REFLECT iteration analysis.

CONCLUSIONS

The REFLECT is a rigorously developed, theory-informed analytic rubric, demonstrating adequate interrater reliability, face validity, feasibility, and acceptability. The REFLECT rubric is a reflective analysis innovation supporting development of a reflective clinician via formative assessment and enhanced crafting of faculty feedback to reflective narratives.

Swedish students' and preceptors' perceptions of what students learn in a six-month advanced pharmacy practice experience

OBJECTIVE

To identify what pharmacy students learn during the 6-month advanced pharmacy practice experience (APPE) in Sweden.

METHODS

Semi-structured interviews were conducted with 18 pharmacy APPE students and 17 pharmacist preceptors and analyzed in a qualitative directed content analysis using a defined workplace learning typology for categories.

RESULTS

The Swedish APPE provides students with task performance skills for work at pharmacies and social and professional knowledge, such as teamwork, how to learn while in a work setting, self-evaluation, understanding of the pharmacist role, and decision making and problem solving skills. Many of these skills and knowledge are not accounted for in the curricula in Sweden. Using a workplace learning typology to identify learning outcomes, as in this study, could be useful for curricula development.

CONCLUSIONS

Exploring the learning that takes place during the APPE in a pharmacy revealed a broad range of skills and knowledge that students acquire.

Peer- and self-grading compared to faculty grading

OBJECTIVES

To determine the reliability and value of peer- and self -reported evaluations in the grading of pharmacy students.

METHODS

Mean student peer- and self- reported grades were compared to faculty grades in the advanced pharmacy practice experience (APPE) and seminar presentation courses. Responses from pharmacy school alumni regarding curricular peer- and self-reported evaluations were solicited using an online survey tool.

RESULTS

Self-reported student grades were lower than the faculty-reported grade overall and for the formal presentation component of the APPE course grading rubric. Self-reported grades were no different than faculty-reported grades for the seminar course. Students graded their peers higher than did faculty members for both the seminar and APPE courses on all components of the grading rubric. The majority of pharmacy alumni conducted peer- and self-evaluations (64% and 85%, respectively) at least annually and considered peer- and self-evaluations useful in assessing students' work in group projects, oral presentations, and professional skills.

CONCLUSION

The combination of self-, peer-, and faculty-assessments using a detailed grading rubric offers an opportunity to meet accreditation standards and better prepare pharmacy students for their professional careers.

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

In 2010 many of the health disciplines in Australia will be involved in national registration and accreditation, to ensure a more sustainable and flexible health workforce for the future. To this end, in each of the health professions, there is an increasing emphasis on reflective practice and lifelong learning to maintain practice competency. This research focuses on academic teaching and learning in the Pharmacy undergraduate curriculum to develop an indicator tool of graduate practice skills before the student enters the practice internship year. The Graduated Descriptors Competency Tool was developed by means of state, territory, and national stakeholder collaboration. The aim of the project was to assist the scaffolding processes around undergraduate practice teaching and learning. Students on experiential placements have used the tool to demonstrate their current practice skills and the learning required to attain competency during their internship year. Students are guided to develop critical reflection skills for deep understanding and insight into the continued learning and professional development required to maintain long-term health care expertise.

Self-assessment in pharmacy and health science education and professional practice

Self-assessment is an important skill necessary for continued development of a health care professional from student pharmacist throughout their professional career. This paper reviews the literature on student and practitioner self-assessment and whether this skill can be improved upon. Although self-assessment appears to be a skill that can be improved, both students and professionals continue to have difficulty with accurate self-assessment. Experts' external assessment of students should remain the primary method of testing skills and knowledge until self-assessment strategies improve. While self-assessment is important to lifelong learning, external assessment is also important for practitioners' continuing professional development.

Factors associated with reflection among students after an advanced pharmacy practice experience (APPE) in Sweden

OBJECTIVE

To identify individual and social factors associated with pharmacy students' level of reflection in an advanced pharmacy practice experience (APPE).

METHODS

A postal questionnaire, including a reflective assignment, was sent to all pharmacy interns (n=262) at Uppsala University, Sweden, for 4 semesters in 2005-2007.

RESULTS

In a univariate analysis, 7 factors were found to be associated with students' level of reflection. After controlling for covariates, 3 social factors were found to be independently associated with reflection: having a formal preceptor (OR=5.3), being at a small pharmacy (OR=19.8), and students' perception of the importance of discussing critical thinking with the preceptor (OR=1.2). No correlation could be observed between level of reflection and critical thinking, nor learning style.

CONCLUSION

Social components seem to be of higher importance than individual components in students' reflective levels after pharmacy internship experience. Trained preceptors are important to foster reflection skills.

Keys to successful implementation of interprofessional education: learning location, faculty development, and curricular themes

Although there is evidence to support implementing interprofessional education (IPE) in the health sciences, widespread implementation in health professions education is not yet a reality. Challenges include the diversity in location and settings of schools and colleges, ie, many are not located within an academic health center. Faculty members may not have the necessary skill set for teaching in an IPE environment. Certain topics or themes in a pharmacy curriculum may be more appropriate than others for teaching in an IPE setting. This paper offers solutions to teaching IPE in diverse settings, the construct for implementing a faculty development program for IPE, and suggested curricular topics with their associated learning objectives, potential teaching methods, and timelines for implementation.

Adherence to treatment: what is done in Sweden? Practice, education and research

OBJECTIVE

The objective of this review was to identify the practice, education and research of pharmacists in Sweden in regard to adherence to treatment.

METHODS

Medline was searched up to the end of February 2008. In addition to the Medline search performed, other available sources were also used to identify relevant articles.

RESULTS

No adherence-specific programs have been implemented in Swedish pharmacies. No adherence-specific courses are provided in Swedish Universities educating pharmacists. The adherence-related research has so far mainly focused on refill non-adherence, primary non-adherence and patient reported non-adherence and readiness to treatment.

CONCLUSIONS

Adherence-related practice and education of pharmacists will probably change due to the deregulation of the pharmacy market that will take place in the near future in Sweden. Research on adherence will need to be strengthened in the sense that it has so far not been guided by adherence-related theoretical frameworks, despite the fact that there are several theories to hand that try to explain adherence.