Learning bridge: curricular integration of didactic and experiential 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.

A decade of faculty development for health professions educators: lessons learned from the Macy Faculty Scholars Program

Faculty development (FD) programs are critical for providing the knowledge and skills necessary to drive positive change in health professions education, but they take many forms to attain the program goals. The Macy Faculty Scholars Program (MFSP), created by the Josiah Macy Jr. Foundation (JMJF) in 2010, intends to develop participants as leaders, scholars, teachers, and mentors. After a decade of implementation, an external review committee conducted a program evaluation to determine how well the program met its intended goals and defined options for ongoing improvement.The committee selected Stufflebeam's CIPP (context, input, process, products) framework to guide the program evaluation. Context and input components were derived from the MFSP description and demographic data, respectively. Process and product components were obtained through a mixed-methods approach, utilizing both quantitative and qualitative data obtained from participant survey responses, and curriculum vitae (CV).The evaluation found participants responded favorably to the program and demonstrated an overall increase in academic productivity, most pronounced during the two years of the program. Mentorship, community of practice, and protected time were cited as major strengths. Areas for improvement included: enhancing the diversity of program participants, program leaders and mentors across multiple sociodemographic domains; leveraging technology to strengthen the MFSP community of practice; and improving flexibility of the program.The program evaluation results provide evidence supporting ongoing investment in faculty educators and summarizes key strengths and areas for improvement to inform future FD efforts for both the MFSP and other FD programs.

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.

Experiential Education in Pharmacy Curriculum: The Lebanese International University Model

Experiential education is an essential component of pharmacy education in order to allow intern students to experience real conditions and training opportunities in different inpatient and outpatient settings. This paper provides a description of the pharmacy practice experiences (PPEs) in the Lebanese International University (LIU) 5-year bachelor of pharmacy (BPharm) and postgraduate doctor of pharmacy (PharmD) programs; focuses on the opportunities and challenges encountered; and presents a model for experiential education in Lebanon. Learning outcomes and thus students’ acquisition of predefined competencies are evaluated in actual practice settings through assessment tools. Our experiential education program aligns with the accreditation/certification criteria set by the Accreditation Council for Pharmacy Education (ACPE) and equips future pharmacists with the knowledge and skills to become major components in the healthcare team.

A Modeling Exercise to Identify Predictors of Student Readiness for Advanced Pharmacy Practice Experiences

Objective. To model the relationship of common pharmacy education assessment data including student demographics, pre-pharmacy performance, core didactic performance, and external testing measures to identify predictors of student readiness for advanced pharmacy practice experiences (APPEs). Methods. The associations between 23 predictive covariates from 226 graduating students from 2015-2018 (5786 observations) and APPE readiness as measured by midpoint core APPE scores were modeled. Multiple linear and Poisson regression models with backward selection were used. A selection criterion of p >.10 was used for covariate elimination from the model. Three models were evaluated: average of all midpoint core APPE rotation scores; average of midpoint acute care pharmacy practice and ambulatory care APPE rotation scores; and number of midpoint core clerkship failing scores. Results. The average age of the population at admission was 25.4±4.5 years, 47% were female, and 75.2% had prior degrees. Across the three prediction models, knowledge-retention covariates were the strongest predictors. Total score on the Pharmacy Curriculum Outcomes Assessment was a modest yet consistent predictor across the models. All other significant predictors were unique to the various models. Conclusion. This four-year, population-based modeling study of the relationship of common pharmacy education assessment data to APPE midpoint scores shows a modest correlation with knowledge-based measures. There is a need for greater innovation in this area of research.

Integrating Competency-Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model

The aim of this study was to evaluate the feasibility and preliminary outcomes of immersive integrated experiential and didactic courses in strengthening competency-based global health learning in dental education. To address global inequities in oral health and student interest in global health, the Harvard School of Dental Medicine introduced two global health courses in 2017-18. The first was a didactic course in the core predoctoral curriculum, and the second, in collaboration with the Inter-American Center for Global Health, was a five-day elective experiential learning course in rural Costa Rica. The experiential course was an extension of the didactic course. All 33 second-year dental students completed the didactic course, and three of those students completed the experiential course. A pre-post survey and a six-month follow-up survey on self-reported knowledge based on course learning objectives were administered. The experiential course students also completed journals and interviews for qualitative analysis. Thirty-two students completed the pre-post didactic course surveys, for a response rate of 94%. There was a 100% response rate on the pre-post didactic surveys by those students who participated in the experiential learning course. While the experiential learning group scored similarly to the class average before the didactic course, they had higher scores than the class averages both immediately after and at the six-month follow-up. All three students reported that the experiential learning course was "extremely effective" in building on what they learned in the didactic course. Qualitative analysis of the journals and interviews suggested enhanced learning from the combination of didactic and experiential methods. These preliminary results support the Global Health Learning Helix Model, a theoretical competency-based teaching model for ethical student global health engagement to better prepare the future generation in tackling oral health disparities both locally and worldwide.

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.

SAFE QI - a framework to overcome the challenges of implementing a quality improvement curriculum into a residency program

Quality improvement (QI) is an essential component of medical practice. Medical students and residents must learn the skills to conduct clinical QI during their educational programs. Medical educators must create and implement a curriculum in QI to empower their students to develop this skill and knowledge. However, developing and implementing a QI curriculum may be challenging for some residency programs. Residency programs with a relatively short duration of training - for example, only 2 years - may be unable to implement an extensive QI curriculum without siphoning away time for other learning objectives. Small residency programs may lack faculty with expertise to teach this topic. Residency programs with only a few residents may find it difficult to evaluate the success of a QI curriculum using robust statistical analysis. These residency programs need a QI curriculum with several features. The curriculum must be deliverable in a short period of time. There must be tools to assess the residents' attainment of the curricular objectives. The curriculum must give the residents practical skills to develop their own QI initiatives. Finally, there must be simple methods to evaluate the curriculum's effectiveness. To address these goals, we developed the SAFE QI (QI curriculum which is short, assessed, functional, and effective) framework for the 2-year subspecialty respirology residency program at the University of Alberta. There are 2-3 entrants per year for a total of 4-6 residents. This framework helps medical educators overcome the challenges of implementing a QI curriculum into their educational programs. This article illustrates how this framework was used to develop and deliver an institution's own QI curriculum.

Curriculum renewal: Alignment of introductory pharmacy practice experiences with didactic course content

BACKGROUND AND PURPOSE

The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) used the opportunity of curriculum renewal to integrate knowledge and skills learned from didactic courses into the introductory pharmacy practice experiences (IPPEs) occurring simultaneously. This paper describes and evaluates the meaningful application of course content into IPPEs, and evaluates the success using qualitative feedback.

EDUCATIONAL ACTIVITY AND SETTING

Students entering the renewed curriculum starting in fall 2012 were provided a list of pharmacy skills and activities from didactic course directors that reinforced course content for that semester. The skills and activities were to be completed during the students' IPPE visits in the community or health systems settings, depending on the program year and semester.

FINDINGS

Students successfully completed course assignments during their IPPE course program. Not all activities could be completed as designed, and many required modification, including simulated experiences. Feedback from faculty and preceptor members of the school's experiential education committee demonstrated that these activities were valuable and improved learning of course material, but were challenging to implement.

DISCUSSION AND SUMMARY

A renewed curriculum that mapped course assignments for completion in experiential settings was successfully established, after some modifications. The program was modified at regular intervals to improve the ability of preceptors to complete these activities in their individual practice environment. A balance between the school providing guidance on what activities students should perform and allowing unstructured independent learning with the preceptor is needed for an optimal experience.

Pharmacy student perspectives regarding curricular renewal with experiential alignment

BACKGROUND AND PURPOSE

To evaluate pharmacy students' ability to perform and perspectives regarding a purposeful mapping of curricular content into experiential settings for application.

EDUCATIONAL ACTIVITY AND SETTING

Students were given a list of activities developed by their curricular course directors that were to be completed during their introductory pharmacy practice experiences (IPPEs). Students were tasked with completing each assignment at their community or health system pharmacy site, and verify completion with their preceptor. Students were surveyed regarding their completion of these activities, who the tasks were performed on, and the value students perceived from the exercises.

FINDINGS

Students ranked that the curricular mapping to experiential courses were successful. Average student responses reflected that the activities had value and positively impacted their learning. Many students struggled to find specific patient examples to complete the activities the way the course designed them. Changes to the structure of these activities was necessary for student success.

DISCUSSION AND SUMMARY

Students felt that the curricular mapping of assignments into IPPEs was meaningful and improved their learning. Not all students were able to complete assignments as described.

Forecasting academic success through implementation of an online prerequisite review tutorials program for first year pharmacy students

OBJECTIVE

Online prerequisite review (OPR) tutorials were designed and implemented to reinforce foundational scientific material in order to protect in-class time, foster self-directed learning, and ensure all students have similar baseline knowledge.

METHODS

Twenty-one tutorials covering undergraduate prerequisite material were developed by faculty and organized into six core modules, comprising basic biology, chemistry, and physiology topics. A quiz on this material was given on the first day of each course. This score was correlated with the final exam score at course completion. Additional student and faculty feedback was collected through surveys.

RESULTS

2372 quiz-exam pairings were collected over three consecutive fall semesters. A one point increase in the quiz score was associated with a 3.6 point (95% confidence interval 3.1-4.0) higher exam score, as well as a greater probability of passing the exam (P<0.0001). Furthermore, simple linear regression revealed a positive correlation between quiz and exam scores (P<0.0001). Three full years of student survey data revealed an overwhelmingly positive perception of the OPR tutorials, and surveyed faculty reported better use of class time and improved student competency and participation.

CONCLUSIONS

Implementation of OPR tutorials may give faculty more efficient use of class time, and their associated quizzes serve as an early indicator for students at-risk of not passing who are candidates for early interventions. Furthermore, the OPR tutorial design gives it great transferability to biomedical post-graduate programs.

Integration of Basic and Clinical Science Courses in US PharmD Programs

Objective. To determine the current status of and faculty perceptions regarding integration of basic and clinical science courses in US pharmacy programs. Methods. A 25-item survey instrument was developed and distributed to 132 doctor of pharmacy (PharmD) programs. Survey data were analyzed using Mann-Whitney U test or Kruskal-Wallis test. Thematic analysis of text-based comments was performed using the constant comparison method. Results. One hundred twelve programs responded for a response rate of 85%. Seventy-eight (70%) offered integrated basic and clinical science courses. The types of integration included: full integration with merging disciplinary contents (n=25), coordinated delivery of disciplinary contents (n=50), and standalone courses with integrated laboratory (n=3). Faculty perceptions of course integration were positive. Themes that emerged from text-based comments included positive learning experiences as well as the challenges, opportunities, and skepticism associated with course integration. Conclusion. The results suggest wide variations in the design and implementation of integrated courses among US pharmacy programs. Faculty training and buy-in play a significant role in successful implementation of curricular integration.

Survey of Pharmacy Schools' Approaches and Attitudes toward Curricular Integration

Objective. To identify ways in which curricular integration is addressed in US pharmacy schools, the structure of therapeutics and foundational science courses, and perceptions of the effects current curricular integration methods have on student learning. Methods. An electronic survey was sent to academic leaders representing 131 pharmacy schools in the United States. Frequency data was tabulated and demographic analysis was performed. Results. Respondent data represents 94 schools of pharmacy. Arranging similar content from various disciplines in a course, a skills laboratory and pharmacy practice experiences were the most common methods for achieving curricular integration. More than one half of the schools indicated that foundational sciences were integrated with therapeutics. The most common reported challenge to curricular integration was logistics. Conclusion. Pharmacy education in the United States has evolved in addressing curricular integration in the curricula, which is consistent with changes in accreditation standards. Most pharmacy schools reported a variety of methods for achieving the intent of curricular integration.

Social Media and Mentoring in Biomedical Research Faculty Development

PURPOSE

To determine how effective and collegial mentoring in biomedical research faculty development may be implemented and facilitated through social media.

METHOD

The authors reviewed the literature for objectives, concerns, and limitations of career development for junior research faculty. They tabularized these as developmental goals, and aligned them with relevant social media strengths and capabilities facilitated through traditional and/or peer mentoring.

RESULTS

The authors derived a model in which social media is leveraged to achieve developmental goals reflected in independent and shared projects, and in the creation and expansion of support and research networks.

CONCLUSIONS

Social media may be successfully leveraged and applied in achieving developmental goals for biomedical research faculty, and potentially for those in other fields and disciplines.

Educational outcomes necessary to enter pharmacy residency training

It is the position of the American College of Clinical Pharmacy (ACCP) that formal postgraduate residency training, or equivalent experience, is required to enter direct patient care practice. Therefore, it is important to align professional degree educational outcomes with the knowledge, skills, and attitudes needed to enter residency training. This position statement addresses the outcomes necessary in the professional degree program curriculum to ensure the ability of pharmacy graduates to transition effectively into postgraduate year one residency training. Five key outcome areas are identified: communication, direct patient care, professionalism, research, and practice management. The position statement examines how performance in each of the five outcome areas should be addressed by professional degree programs. The ACCP believes that for the student to achieve the clinical proficiency necessary to enter residency training, the professional degree program should emphasize, assess, and provide adequate opportunities for students to practice: communication with patients, caregivers, and members of the health care team in direct patient care environments; provision of direct patient care in a wide variety of practice settings, especially those involving patient-centered, team-based care; professionalism under the supervision and guidance of faculty and preceptors who model and teach the traits of a health care professional; application of principles of research that engender an appreciation for the role of research and scholarship in one's professional development; and application of practice management, including documentation of direct patient care activities that affect drug-related outcomes.

Promoting direct patient care services at community pharmacies through advanced pharmacy practice experiences

OBJECTIVES

To determine the relative benefits of three different models of advanced pharmacy practice experience (APPE) in successfully integrating the delivery of direct patient care into students' final year community pharmacy clerkships.

METHODS

All fourth-year pharmacy students at the University of British Columbia were divided into one of three study arms for their community APPE: a 2 × 4-week rotation in a traditional format, a 1 × 8-week rotation where their preceptors had experienced a 2-day education course and a 1 × 8-week rotation with both preceptor education plus a 5-day pre-APPE in-store orientation and peer debriefing.

KEY FINDINGS

All 123 students conducted patient consultations and documented their care. Students in the pre-APPE + preceptor education arm provided nearly double the number of direct patient consultations than did students in the preceptor-education-only arm or the traditional 2 × 4-week arm. Numbers of drug-related problems identified and interventions performed per patient consult did not differ across study arms.

CONCLUSIONS

Pre-APPE orientation activities provided an enhanced learning environment, promoted greater student engagement, provided care to more patients, increased preceptor preparedness and enhanced in-store patient-centred care practice. Certain of these learning activities can also form part of third- and fourth-year introductory pharmacy practice experiences to prepare students for their final-year APPE.

Curricular integration in pharmacy education

This article reviews the concepts of curricular integration and integrative learning. These concepts have reemerged in contemporary higher education reforms and are crucial in pharmacy programs where students are expected to acquire the knowledge, skills, and abilities needed for competent practice in a complex environment. Enhancing integration requires negotiating obstacles, including institutional traditions of disciplinary structures and disciplinary differences in understandings of knowledge and approaches to teaching and learning; investing the time and effort to design and implement integrated curricula; and using learning-centered pedagogical strategies. Evidence supporting the value of such efforts is not compelling, as much because of insufficient research as lackluster findings. Future avenues of scholarly inquiry are suggested to evaluate curricular integration, distinguishing between the curriculum espoused by planners, the curriculum enacted by instructors, and the curriculum experienced by students.

An active-learning assignment requiring pharmacy students to write medicinal chemistry examination questions

OBJECTIVES

To implement and assess the effectiveness of an assignment requiring doctor of pharmacy (PharmD) students to write examination questions for the medicinal chemistry sections of a pharmacotherapeutics course.

DESIGN

Students were divided into groups of 5-6 and given detailed instructions and grading rubrics for writing multiple-choice examination questions on medicinal chemistry topics. The compiled student-written questions for each examination were provided to the entire class as a study aid. Approximately 5% of the student-written questions were used in course examinations.

ASSESSMENT

Student appreciation of and performance in the medicinal chemistry portion of the course was significantly better than that of the previous year's class. Also, students' responses on a qualitative survey instrument indicated that the assignment provided students' guidance on which concepts to focus on, helped them retain knowledge better, and fostered personal exploration of the content, which led to better performance on examinations.

CONCLUSION

Adding an active-learning assignment in which students write examination questions for the medicinal chemistry portion of a pharmacotherapeutics course was an effective means of increasing students engagement in the class and knowledge of the course material.

Chinese baccalaureate nursing students' readiness for self-directed learning

This descriptive cross-sectional study was conducted with 536 Chinese nursing students to explore students' readiness for self-directed learning (SDL). The Self-Directed Learning Readiness (SDLR) Scale for nursing education (Chinese translation version) was used. The value of the content validity index tested by five experts was 0.915. A measure of internal consistency (Cronbach's alpha) was 0.925 on the total scale. Students possessed readiness for SDL with a mean score of 157.72 (S.D.=15.08, 62.3% in high level, and 37.7% in low level). The attributes of Chinese students, such as a strong sense of responsibility and perseverance, due diligence and rigorous self-discipline, enable students to take the initiative and responsibility for their own learning. The existing variation in students' readiness for SDL is helpful in identifying student characteristics that might be used to modify learning activities for these students. Senior students had higher scores for SDLR than junior students. This finding likely reflects the maturational process of developing self-directedness. Promoting SDL skills is a challenging process for faculty members and students. It is helpful if nurse educators assess the learning styles and preferences of their students in order to determine the level of SDL activities to include from year to year in the curriculum.

Integration of basic sciences in health's courses

Concepts from disciplines such as Biochemistry, Genetics, Cellular and Molecular Biology are essential to the understanding and treatment of an elevated number of illnesses, but often they are studied separately, with no integration between them. This article proposes a model for basic sciences integration based on problem-based learning (PBL) and compares failure rate, global final grade, approved student final grade, grade distribution and students' satisfaction with teacher conduction between integrated curriculum and traditional learning in health courses from Anhembi Morumbi University-a private institution from Brazil. Comparison between integrated and traditional curriculum was based on students' records obtained from first-year health sciences students. A total of 1,697 records from 2005 to 2007 (nonintegrated curriculum) and 785 records from 2008 (integrated curriculum) were selected for this study and they were necessary to get information about students' grades. Moreover, a questionnaire was applied in order to cover student's satisfaction with teacher conduction. The data presented in this study indicated that the integrated curriculum based on PBL was related to an improvement in student's grades and satisfaction compared with traditional teaching. We believe that the effectiveness in health education will be a combination of "classical" presentation of contents associated to actively involved students in the educational process and methodology based on problems in order to create the stimulus for the undergraduates continue to integrate basic and clinical investigation.

WITHDRAWN: The relationship between self-directed learning readiness and problem solving in Chinese baccalaureate nursing students

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Geriatric care as an introductory pharmacy practice experience

OBJECTIVE

To describe the design, delivery, and impact of a geriatric introductory pharmacy practice experience (IPPE) to develop students' skills related to consultant pharmacists' roles and patient care responsibilities.

DESIGN

A required 2-unit geriatric IPPE, involving 40 hours in a geriatric-care facility, 5 reflection hours, and 12 classroom-discussion hours, was developed for first- and second-year pharmacy students. Students interviewed patients and caregivers, reviewed patient charts, triaged patient needs, prepared care plans, and performed quality-assurance functions.

ASSESSMENT

After completing the IPPE, students' geriatric- and patient-care abilities were enhanced, based on review of their interactions, care plans, reflections, and examinations, and they demonstrated cognitive, affective, and psychomotor-domain learning skills. Students' care plans and quality assurance activities revealed positive patient outcomes, opportunities for measurable patient health improvement, and a positive impact on quality assurance activities. Student evaluations and feedback from health workers at the facilities also were positive.

CONCLUSIONS

This geriatric IPPE in which students cared for a specific patient and interacted with other health care providers is an innovative approach to enhancing students' abilities to serve the growing geriatric population.

Learning bridge tool to improve student learning, preceptor training, and faculty teamwork

OBJECTIVES

To implement a Learning Bridge tool to improve educational outcomes for pharmacy students as well as for preceptors and faculty members.

DESIGN

Pharmacy faculty members collaborated to write 9 case-based assignments that first-year pharmacy (P1) students worked with preceptors to complete while at experiential sites.

ASSESSMENT

Students, faculty members, and preceptors were surveyed about their perceptions of the Learning Bridge process. As in our pilot study,(1) the Learning Bridge process promoted student learning. Additionally, the Learning Bridge assignments familiarized preceptors with the school's P1 curriculum and its content. Faculty teamwork also was increased through collaborating on the assignments.

CONCLUSIONS

The Learning Bridge assignments provided a compelling learning environment and benefited students, preceptors, and faculty members.

Interface between problem-based learning and a learner-centered paradigm

BACKGROUND

Problem-based learning (PBL) has made a major shift in support of student learning for many medical school curricula around the world. Since curricular development of PBL in the early 1970s and its growth in the 1980s and 1990s, there have been growing numbers of publications providing positive and negative data in regard to the curricular effectiveness of PBL. The purpose of this study was to explore supportive data for the four core objectives of PBL and to identify an interface between the objectives of PBL and a learner-centered paradigm.

METHODS

The four core PBL objectives, ie, structuring of knowledge and clinical context, clinical reasoning, self-directed learning, and intrinsic motivation, were used to search MEDLINE, the Education Resources Information Center, the Educator's Reference Complete, and PsycINFO from January 1969 to January 2011. The literature search was facilitated and narrowed if the published study included the following terms: "problem-based learning", "medical education", "traditional curriculum", and one of the above four PBL objectives.

RESULTS

Through a comprehensive search analysis, one can find supportive data for the effectiveness of a PBL curriculum in achieving the four core objectives of PBL. A further analysis of these four objectives suggests that there is an interface between PBL objectives and criteria from a learner-centered paradigm. In addition, this review indicates that promotion of teamwork among students is another interface that exists between PBL and a learner-centered paradigm.

CONCLUSION

The desire of medical schools to enhance student learning and a need to provide an environment where students construct knowledge rather than receive knowledge have encouraged many medical schools to move into a learner-centered paradigm. Implementation of a PBL curriculum can be used as a prevailing starting point to develop not only a learner-centered paradigm, but also to facilitate a smooth curricular transition from a teacher-centered paradigm to a learner-centered paradigm.