Effect of an Individualized Post-Examination Instructor Remediation on Pharmacy Student Performance in a Biochemistry Course

Perceptions of Remediation Policies and Procedures in Pharmacy Education

OBJECTIVE

This study aimed to (1) explore the perceptions of current remediation processes among pharmacy program administrators and faculty, and (2) identify factors surrounding successful or unsuccessful remediation in a pharmacy program.

METHODS

This qualitative study used the following 3 stakeholder focus groups with distinct perspectives: didactic faculty, experiential faculty, and administrators. A screening survey was used to identify eligible participants, and quota sampling was used to represent various institution types and stakeholder experience. Focus groups were conducted using structured interview questions by an expert interviewer who was not part of the research team. Data were coded using the constant comparison method until consensus was achieved on the identified themes.

RESULTS

Three themes associated with remediation were identified with 12 coded categories. The codes discussed by all 3 stakeholder groups included methods to identify students who need remediation, types of remediation, remediation challenges, consequences of remediation, remediation effectiveness, and necessary improvements to the remediation process. The didactic and experiential faculty groups discussed the management of remediation plans, methods of remediation prevention, and lessons learned from remediation. The timing of remediation was discussed by didactic faculty. The experiential faculty noted the need for preceptor development to provide timely feedback and ensure successful remediation. All 3 groups mentioned having clear policies and procedures for successful remediation.

CONCLUSION

Overall, faculty and administrators had similar perceptions regarding remediation practices. The differences in concerns about remediation were most notable between the experiential and didactic faculty. While all 3 groups believed that remediation may be useful and necessary, challenges remain and monitoring is needed to determine the most effective practices, particularly in experiential education.

Evaluation of an individual examination remediation policy in a professional pharmacy course

INTRODUCTION

Maintaining institutional remediation policies is required for pharmacy education accreditation, but specific policies and students' perceptions of remediation are not well described in the literature. The purpose of this research was to determine whether the individual examination remediation policy utilized in a biomedical literature evaluation course was a viable approach to ensuring positive student experiences and success.

METHODS

This study utilized a pre-/post-quantitative survey design. An 11-item pre-remediation questionnaire was offered to all students enrolled in the course in 2022. A matched post-survey was administered to students eligible to remediate individual examinations. Survey items were assessed using a five-point Likert rating. Remediation examination grades were analyzed in aggregate. Descriptive statistics were utilized as appropriate.

RESULTS

One hundred of the 108 (92.5%) enrolled students completed the pre-remediation survey. Students strongly agreed they would prefer to remediate individual examinations instead of taking one cumulative course remediation examination (median 5) and that remediating would improve their understanding of course material (median 5). Nineteen (44%) of 43 students eligible for individual examination remediation chose to remediate, and 16 (37%) responded to the post-remediation survey. Among those eligible, the most common reason for remediating was desire to receive a better score. Significantly more students improved their examination scores through remediation.

CONCLUSIONS

Students in the course preferred to remediate individual examinations, but only 44% of students eligible to remediate chose to do so. Future studies with larger sample sizes and course outcome data are warranted to further explore examination remediation in professional pharmacy courses.

Implementation of a Clinical Problem-Solving Course for Students Challenged by Early Pharmacy Curriculum

OBJECTIVE

This study evaluates the impact of offering a clinical decision-making and problem-solving course to students academically challenged in early required clinical and pharmaceutical calculation courses on improving their ability to identify and solve drug-related problems.

METHODS

Faculty designed a course with a main objective for students with grades of C or lower in any of the 5 required first-year courses to gain plentiful practice with a systematic approach to identifying and solving drug therapy problems. Students' performance on course-embedded assessments mapped to problem-solver subdomain, a pre-Advanced Pharmacy Practice Experience (APPE) competency on the ability to identify drug-related problems, and performance on Pharmacy Curriculum Outcomes Assessment were compared to a control group of students from 2 previous cohorts who did not take the course but had a subpar academic performance. Pearson chi-square test and independent samples t test were utilized for categorical and continuous data, respectively.

RESULTS

The clinical decision-making and problem-solving course significantly improved student performance on pre-APPE competency to identify drug-related problems (first-attempt pass rate of 96% vs 30% when compared to a historic cohort), but not on Pharmacy Curriculum Outcomes Assessment. Student performance on case-based questions mapped to problem-solver subdomain exceeded internally set standard by 13.72% points.

CONCLUSION

Students demonstrated learning problem-solving and clinical decision-making, which improved their performance on course-embedded assessments and pre-APPE competency in identifying drug-related problems.

Pharmacy student reflections and perceptions of competency and predictors of success in remediation

INTRODUCTION

Pharmacy programs employ a variety of remediation methods intended to bring underperforming students to a level of competency. Our objective was to evaluate pharmacy students' perceptions of eligibility criteria and academic outcomes of remediation and potential predictors for lack of success in the original and remediated course.

METHODS

Palm Beach Atlantic University School of Pharmacy revised its remediation policy in fall 2017, shifting from a course-centric to student-centric policy. Pharmacy students (N = 265) were surveyed in spring 2019 regarding eligibility criteria and academic outcomes of remediation. Enrolled students who remediated under the revised policy were surveyed on the lack of success in the original course and the remediation process.

RESULTS

Students viewed remediation as an opportunity to prevent delayed graduation. They agreed with the revised, student-centric eligibility criteria and with the new approach allowing all courses to be remediated. First-year students provided lower scores, whereas students who never failed a course gave higher scores. Students agreed that remediation produces proficient students who are as competent as those who passed the original course. The main reason for failing the original course was lack of study time. Students who failed remediation tended to spend more time on external activities and used less remediation resources.

CONCLUSIONS

A student-centric approach to remediation with active involvement from students and faculty support was successful in producing students who are viewed just as proficient and competent as students who passed the original course. Predictors for success were study time and the use of remediation resources.

Improving the Remediation Process for Skills-based Laboratory Courses in the Doctor of Pharmacy Curriculum

When students fail to meet minimum competence standards on summative pharmacy skills-based assessments, remediation can be used to ensure student readiness for progression. Skills-based remediation is challenging as a high volume of resources is required to develop an action plan that addresses the heterogeneity in student needs and to create and execute another assessment equivalent to the initial assessment. Although many Doctor of Pharmacy (PharmD) programs face these same challenges, there is no consensus on how to best address them. Recently, faculty from six PharmD programs convened to share ideas and approaches to overcoming these challenges. This commentary aims to define remediation as it pertains to summative skills-based assessments, share our consensus views regarding remediation best practices, and highlight areas where there is more work to be done. Our intent is to advance the ongoing conversation and empower institutions to develop their own effective and impactful skills-based remediation policies, procedures, and activities.

Remediation and reassessment methods in pharmacy education: A systematic review

BACKGROUND

Colleges of pharmacy are currently required to implement a remediation program within their curricula, but no specifications are provided on the ideal methodology. While the need for successful remediation strategies continues to grow, literature describing positive or negative outcomes of different approaches is significantly lacking. The objective of this literature review was to describe and evaluate remediation methodologies in pharmacy education.

METHODS

This literature review was completed following PRISMA criteria. A search of the PubMed, Cochrane Library, Cumulative Index of Nursing and Allied Health, Academic Search Complete, PsycInfo, Scopus, and ProQuest Central databases was conducted in July 2019. Studies were included if they involved pharmacy student education and described either remediation or reassessment.

RESULTS

The evaluated studies discussed a range of course types being remediated, a large variety of remediation strategies and timeframes, and differing overall outcomes. No studies provided comparison of remediation techniques or provided details on the implementation of their chosen approaches. A consistent finding within the evaluated studies was the inclusion of prevention strategies to attempt to avoid the need for remediation preemptively. Overall outcomes for each remedial program were inconsistent and no clear patterns were evident other than an improvement in student performance following remediation.

IMPLICATIONS

Remediation strategies included course repetition, summer restudy, reassessment, and individualized plans. Outcomes varied significantly between studies, making methodology comparisons difficult. Future studies that include more detail and consistency in the reported outcomes would be beneficial to students and help clarify remediation for colleges of pharmacy.

Getting Rigor Right

A colleague of mine once shared a story he heard of an organic chemistry teacher who would tell people he had one of the most important, lifesaving jobs in the world. Why? Because he made sure academically unprepared premed students never made it to medical school. Teachers can have many possible motivations for maintaining high academic standards in their courses. A desire to ensure future health practitioners are adequately prepared to engage in the intellectual rigor of their profession may be just one of them.

The use of exam wrappers to promote metacognition

INTRODUCTION

Self-directed learning, self-awareness, and metacognition are becoming more heavily emphasized in healthcare education. Metacognitive activities may be used to promote self-awareness and development of effective self-directed learning strategies. Exam wrappers (wrappers) are a metacognitive tool utilized in other areas of higher education that offer students the ability to learn from exam performance by reviewing missed items in a reflective manner. Wrappers encourage structured reflection and planning for future learning.

METHODS

Pharmacy students enrolled in a pathophysiology course were provided structured exam reviews with an opportunity to utilize a wrapper. A baseline questionnaire was given two weeks before the first exam to assess baseline characteristics. Wrappers were provided before Exams 2, 3, 4, and 5, and the effects on exam performance were measured. Mixed effects modeling was utilized for final analysis of effect on student performance.

RESULTS

Exam wrapper vs. non-wrapper groups were self-selected, with 53 students participating in at least one wrapper and 35 never utilizing a wrapper. Mixed effects modeling analysis found a non-significant increase in average exam performance (p = 0.142).

CONCLUSION

Wrappers have potential as an additional metacognitive tool for exam review. Further studies are needed to evaluate the effectiveness and impact more broadly in pharmacy education.