- Email: [email protected]
Motivations, career aspiration, and learning experience of students in the pharmacy program at Kuwait University: A tool to guide curriculum development
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Experiences in Teaching and Learning
Motivations, career aspiration, and learning experience of students in the pharmacy program at Kuwait University: A tool to guide curriculum development ⁎
Abdelmoneim Awad , Asmaa Al-Haqan, Pierre Moreau Kuwait University, Safat 13110, Kuwait
A R T I C L E I N F O
ABSTRACT
Keywords: Pharmacy education curriculum motivation Kuwait
Purpose: To determine students’ motivating factors in the choice of pharmacy, career aspirations, and perceptions about learning experiences in the current pharmacy curriculum. Activity: A descriptive cross-sectional survey of pharmacy students was performed at Kuwait University Findings: The most common reason to pursue pharmacy was that they were not admitted to medicine or dentistry (40.5%). About half of students were seeing themselves employed in hospital pharmacies immediately after graduation. Over two-thirds of respondents ‘agreed’ or ‘strongly agreed’ that the pharmacy program developed their problem-solving skills (78.5%) and improved their communication skills (66.4%). Students also admitted that the teaching staff seemed more interested in testing memorization (72.5%), that feedback on student work was usually provided in the form of grades (66.4%), and that the workload is putting a lot of pressure on them (88%). Summary: The survey identifies key elements that needs to be improved in the next iteration of the program (entry-level PharmD).
Background and purpose Pharmacy education has been transformed dramatically over the last 20 years with the evolution of the practice philosophy from traditional tasks such as medication compounding and dispensing to a newer scope of practice including patient-centered care.1 In June 2005, this evolution led to the expiration of the baccalaureate degree in pharmacy (BS Pharmacy) in the United States of America (USA), with a transition to the Doctor of Pharmacy degree (PharmD).2 In contrast, baccalaureate degree programs remain the first professional degree to practice in most of the Middle Eastern countries.3 Now, as there is an upsurge in the transformation of pharmacy practice from focus on dispensing medicines to becoming a patient-centered profession in this region, faculties of pharmacy started to switch their system of pharmacy education to match the entry-level PharmD curriculum in the USA. The Faculty of Pharmacy of Kuwait University proposed a plan to start an entry-level PharmD program and pursue international review and accreditation after a visit by the Accreditation Council for Pharmacy Education (ACPE) delegation to Kuwait. It is a positive step in the right direction to graduate skilled and knowledgeable clinical pharmacists who can improve patient's health care. Hence, there is a demand to identify the key elements that needs to be improved in the next iteration of the program (entry-level PharmD). Students’ input is crucial in the development of educational policies and practices since they are at the center of pre-
⁎
Corresponding author: Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait. Tel.: +00965-24636065. E-mail addresses: [email protected] (A. Awad), [email protected] (A. Al-Haqan), [email protected] (P. Moreau).
http://dx.doi.org/10.1016/j.cptl.2016.11.018
1877-1297/ © 2016 Elsevier Inc. All rights reserved.
Please cite this article as: Awad, A., Currents in Pharmacy Teaching and Learning (2016), http://dx.doi.org/10.1016/j.cptl.2016.11.018
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
professional education. Students’ perception of their curriculum have been discussed widely in the literature. Results from such studies provided recommendations to further improve the educational environment and recruitment strategies.4–6 The paramount importance to survey students’ learning experience was also highlighted in the “Moving On II” project of the International Pharmaceutical Federation using the FIPEd-IPSF student learning experience questionnaire.7 The expanding role of pharmacists in today's society requires the enrolment of students who are able to accept the responsibility of providing direct patient care and to be more actively involved in their societies. Hence, it is crucial for our pharmacy program to identify students’ motivation and career preferences. Several studies were conducted to identify factors that motivate students to choose pharmacy as their academic major. Studies from the USA reported that positive motivating factors include the prospect of having many career opportunities, of helping others, of receiving encouragement by family members, pharmacists or pharmacy students. Motivational factors also included career prestige and earning potential.8–10 Studies investigated the career aspirations of graduating pharmacy students reported that most pharmacy students prefer a community-based or a hospital-based practice as their first career choice.3,11 The goals of this study were to identify students’ motivating factors in the choice of pharmacy, their career aspirations, and to determine students’ perceptions about their learning experience in the current pharmacy curriculum. Educational activity and setting A descriptive, cross-sectional, survey of pharmacy students was conducted at the Faculty of Pharmacy of Kuwait University. The study population consisted of four different student cohorts from professional years (second, third, fourth, and fifth year), and consisted of a total of 194 students. The ethical clearance for this study was obtained from the "Human Ethical Committee, Health Sciences Center, Kuwait University". The Faculty of Pharmacy at Kuwait University is the only public pharmacy school in Kuwait. It was established in 1996 and admitted its first cohort in September 1997. The Bachelor of Pharmacy (B.Pharm.) degree offered by the Faculty is a 10-semester program (total of 5 years) with the first two semesters spent in a common year with medical and dental students. Toward the end of this first year students are given the chance to elect their first, second, and third choice of the Faculty they wish to be admitted to through competitive application. During the first 3 semesters students enroll in pre-professional courses, followed by professional courses for the remaining 7 semesters. The Faculty's current curriculum is designed to foster students’ abilities to communicate effectively, solve problems, make rational judgments based upon sound scientific reasoning; and engender a caring attitude in their professional interactions with patients. The study questionnaire was adapted from validated surveys.7,12 It was pre-tested for content, design, readability, and comprehension on 15 pharmacy students, and modifications were made as necessary so that the questionnaire was simple to understand, yet provided accurate data. The final version of the questionnaire had three sections, and contained both open-ended and close-ended questions. The first section included items to provide information about the characteristics of the respondents (Table 1). Section two consisted of nine questions to provide information about the students’ motivating factors in the choice of pharmacy and their career aspirations. The first five questions were as follows: (i) Which of the following was the most important Table 1 General characteristics of respondents (n=85).
Gender Male Female Age (years) 18–19 20–22 23–27 Nationality Kuwaiti Non-Kuwaiti Year in Pharmacy School 2nd year 3rd year 4th year 5th year Marital status Single Married Having children Yes No Having a close family member or a friend who is a pharmacist Close family member Family friend
2
Frequency
Percentage (%)
23 162
12.4 87.6
22 122 41
11.9 65.9 22.2
166 19
89.7 10.3
36 49 56 44
19.4 26.5 30.3 23.8
160 25
86.5 13.5
13 172
7 93
57 86
30.8 46.5
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
Fig. 1. Career preferences of respondents immediately after graduation and in 10 years’ time. (n=185).
reason that you registered to study Pharmacy? “I would like to help sick people; I can make a lot of money by practicing pharmacy; My parents or family decided for me; I want people to look up to me as a professional; My first choice was medicine/dentistry but I was not accepted; and other reasons (please specify). (ii) Have you always wanted to be a pharmacist? (e.g., Did you consider becoming a pharmacist during high school?) (iii) Was pharmacy your first choice of university discipline). (iv) Are you happy to be studying pharmacy now? (v) Based on your experiences of the pharmacy program so far, do you consider it an easy program? The remaining four questions were as follows: (i) Would you prefer to work for the government or in the private sector? (Yes, no, no preference); (ii) After being graduated, what do see yourself doing immediately afterwards?; (iii) What do you see yourself doing in 10 years’ time?; and (iv) Do you hope to own your own retail/community pharmacy in the future? (Yes, no, unsure). Respondents have to select only one of the options provided for the second and third questions about career choices (Fig. 1). The last section was used to determine students’ perceptions about their learning experience in the current B.Pharm curriculum. A 5-point Likert scale (1=strongly disagree, 5=strongly agree) was used to measure students’ level of agreement with 34 items about the clarity of expectations for students, students’ skills development, students’ choices in the program, roles of teaching staff to support students’ success and general statements about the program (Table 2). One open-ended question was included at the end of the questionnaire for any further comments/suggestions regarding the current curriculum. The purpose of the study was briefly explained to students after major lectures in the second semester of the academic year 2014–2015, and the survey was distributed. The participants were asked to return the questionnaires anonymously. Confidentiality was guaranteed and students gave written consent to participate in the study. The survey distributed to the second year students did not include the last part about their learning experience in the current pharmacy curriculum because they have just started to study the professional pharmacy courses. Data were entered into the Statistical Package for Social Sciences version 23, and descriptive analysis conducted. The results were reported as percentage (95% confidence interval), mean (standard deviation) and median (interquartile range). The chi-squared test was used to test for association between the independent variables and the dependent variables. Statistical correlation analysis (Spearman's r) was used to measure the association between motivational factors and preferences of future workplace immediately after graduation and in 10 years’ time. The differences in the Likert scale median responses of the third, fourth, and fifth year students to the items assessing their learning experience in the pharmacy program were determined using Kurskal-Wallis test. P < 0.05 was considered statistically significant. Findings A total of 194 students were approached to be included in the study, 185 agreed to participate giving a response rate of 95.4%. Table 1 summarizes the demographic characteristics of respondents. Not being accepted in another health care discipline was the most common reason for studying pharmacy. Four out of 10 students (40.5%; 95% CI: 33.5–48.0) indicated their first choice was either medicine or dentistry but they didn’t meet the admission criteria and were accepted in pharmacy instead. The second common reason to enroll in pharmacy was a desire to help sick people (28.7%; 22.4–35.8). Other reasons included wanting to become a respected professional (13.5%; 9.1–19.5), perceptions of pharmacy as an easy program compared to medicine and dentistry (8.7%; 95% CI: 5.2–13.9), financial motive (4.9%; 2.4–9.3), and parental decision (3.8%; 1.7–8.0). More than one-third (34.1%; 27.4–41.4) of students stated that they have always wanted to be pharmacists, and that pharmacy was their first choice as a university major. However; the majority (61.6%; 54.2–68.6) of respondents indicated that they were happy to be studying pharmacy now. Helping sick people and wanting to be a professional as primary reasons for choosing pharmacy were found to be significantly prevalent among students who always wanted to be pharmacists and for whom pharmacy was the first 3
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
Table 2 Distribution of students’ responses regarding their learning experience with the undergraduate curriculum of pharmacy (n=149). Response values (%)a
Item
A. Clarity of Expectations for Students It is always easy to know the standard work expected for the course. You usually have a clear idea of what is expected of you. It is often hard to discover what's expected of you in this pharmacy program. Most of the teaching staff here make it clear right from the start what they expect from students. B. Students’ Skills Development This pharmacy program has helped me to develop problem-solving skills. This pharmacy program has sharpened my analytical skills. This pharmacy program has helped to develop my ability to work as a team member. This pharmacy program has improved my communication skills. This pharmacy program has helped me develop the ability to plan my own work. C. Students’ Choices in the Program Students have a great deal of choice over how they are going to learn in this pharmacy program. Students here are given a lot of choice in the work they have to do. There is very little choice in this pharmacy program in the ways you are assessed/evaluated. Students often discuss with their teaching staff how they are going to learn in the program. D. Roles of Teaching Staff to support Students’ Success Most of the teaching staff here motivate students to do their best work. Most of the teaching Staff here put a lot of time to comment on student's work. Most of the teaching staff seem more interested in testing what you have memorized than what you have understood. Most of the teaching staff here make a real effort to understand difficulties students may be having with their work. Feedback on student work is usually provided ONLY in the form of marks and grades. Most of the teaching staff here normally give helpful feedback on how you are doing. Most of the teaching staff here are extremely good at explaining things to us. Most of the teaching staff here work hard to make subjects interesting. Most of the teaching Staff here show no real interest in students` opinions/comments. E. General statements about the Pharmacy Program The aim and objectives of this pharmacy program are NOT very clear. The workload is too heavy. To do well on this pharmacy program all you really need is a good memory. It seems to me that the syllabus tries to cover too many topics. Students are generally given enough time to understand the things we have to learn. There is a lot of pressure on you as student here. It would be possible to do well in this pharmacy program just by working hard around exam times. The total amount of knowledge/ skills/ attitudes you have to learn in this pharmacy program means you can't understand it all completely. As a result of doing this pharmacy program, I feel more confident about dealing with unfamiliar problems. This pharmacy program really tries to get the best out of all its students. This pharmacy program has encouraged me to develop my own academic interests as far as possible. Overall, I am satisfied with the quality of this pharmacy program. a
Median (IQR)
Mean (SD)
1
2
3
4
5
11.4 10.7 5.4 12.1
38.9 32.2 24.2 27.5
29.5 26.2 20.8 26.2
17.4 27.5 38.3 28.2
2.7 3.4 11.4 6.0
2 (2–3) 3 (2–4) 3(2–4) 3(2–4)
2.6 2.8 3.3 2.9
(1.0) (1.1) (1.1) (1.1)
3.4 3.4 2.7 5.4 5.4
7.4 8.7 8.7 9.4 17.4
10.7 20.1 17.4 18.8 28.2
65.8 58.4 59.1 53.0 36.9
12.8 9.4 12.1 13.4 12.1
4 4 4 4 3
3.8 3.6 3.7 3.6 3.3
(0.9) (0.9) (0.9) (1.0) (1.1)
26.2
37.6
24.2
10.7
1.3
2 (1–3)
2.2 (1.0)
28.2 4.7 19.5
40.9 12.8 24.8
20.1 21.5 32.2
8.1 41.6 22.1
2.7 19.5 1.3
2 (1–3) 4 (3–4) 3 (2–3)
2.2 (1.0) 3.6 (1.1) 2.6 (1.1)
22.1 6.0 3.4
22.1 25.5 14.1
18.1 36.2 10.1
30.2 30.2 22.8
7.4 2.0 49.7
3 (2–4) 3 (2–4) 4 (3–5)
2.8 (1.3) 3.0 (0.9) 4.0 (1.2)
24.8
25.5
22.1
25.5
2.0
2 (1.5–4)
2.5 (1.8)
6.0 17.4 13.4 18.8 5.4
14.1 24.2 20.8 26.2 24.2
13.4 27.5 32.9 29.5 26.8
35.6 29.5 26.2 20.1 24.2
30.9 1.3 6.7 5.4 19.5
4 3 3 3 3
(3–5) (2–4) (2–4) (2–4) (2–4)
3.7 2.7 2.9 2.7 3.3
(1.2) (1.1) (1.1) (1.1) (1.2)
6.0 2.7 3.4 3.4 47.7 1.3 38.3
32.9 6.0 6.7 8.1 28.2 7.4 28.2
20.1 3.4 4.7 16.8 12.8 6.0 12.8
24.2 21.5 26.2 21.5 7.4 15.4 12.8
16.8 66.4 59.1 50.3 4.0 69.8 8.1
3 5 5 5 2 5 2
(2–4) (4–5) (4–5) (3–5) (1–2) (4–5) (1–3)
3.1 4.4 4.3 4.1 1.9 4.4 2.2
(1.2) (1.0) (1.1) (1.1) (1.1) (1.0) (1.3)
2.0
14.8
38.9
24.8
19.5
3 (3–4)
3.4 (1.0)
9.4
11.4
40.9
32.2
6.0
3 (3–4)
3.1 (1.0)
12.8 6.7
20.1 18.1
32.9 28.2
28.9 38.3
5.4 8.7
3 (2–4) 3 (2.5–4)
2.9 (1.1) 3.2 (1.1)
22.8
32.9
26.2
14.8
3.4
2 (2–3)
2.4 (1.1)
(4–4) (3–4) (3–4) (3–4) (3–4)
1= Strongly disagree; 2= disagree; 3=neutral; 4=agree; 5=strongly agree.
choice of university program (p < 0.001 and p=0.03, respectively). Students who always wanted to be pharmacists and that pharmacy was their first choice of university course, and those who are happy to be studying pharmacy now showed the lowest score of studying pharmacy for financial reasons (p=0.04 and p < 0.001, respectively). When students were asked to indicate their preference between the private and the public sector, most of them preferred to work in the public sector (66.0%; 58.6–72.6). Fig. 1 shows the respondents’ preferences of their future workplace immediately after graduation and 10 years later. Three quarters of students considered future employment in hospital pharmacies (47.6%; 40.2–55.0) or studying for postgraduate qualifications (27.0%; 20.9–34.1) immediately after graduation. Ten years after graduation, the number of students expecting to be employed in hospital pharmacies was reduced by more than half (21.6%; 16.1–28.4), while there was an important interest in working within a university setting (35.7%; 28.9–43.1). Table 2 presents students' distribution of responses regarding their learning experience with the undergraduate curriculum of
4
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
pharmacy. In relation to the clarity of expectations, half the students (49.7%; 41.4–57.9) ‘agreed’ or ‘strongly agreed’ that it is often hard to discover what is expected from them in this program, while 30.9% (23.7–39.0) reported that they usually have clear idea about what is expected of them. Regarding skills development, a majority of students ‘agreed’ or ‘strongly agreed’ that the pharmacy program has helped to develop their problem-solving skills ( 78.5%; 70.9–84.7), their abilities to work as team members ( 71.1%; 63.1–78.1), their analytical skills (67.9%; 59.6–75.1), and their communication skills (66.4%; 58.2–73.8). About half of the students (49%; 40.857.3) reported having developed their abilities to plan their own work. Responses to the students’ choices in this program showed that less than one-quarter of them (23.5%; 17.1–31.3) ‘agreed’ or ‘strongly agreed’ that they often discuss with their teaching staff how they are going to learn. A minority (12.1%; 7.5–18.7) reported that they have a great deal of choice over how they are going to learn and that they are given a lot of choice in the work they have to do (8.7%; 5.2–13.9). Accordingly, a majority of students (61.1%; 52.7–68.9) admitted that there is very little choice in this program in the ways they are assessed. In the section about the roles of teaching staff to support their success, about two-thirds of students (72.5%; 64.5–79.3) ‘agreed’ or ‘strongly agreed’ that most of the teaching staff seem more interested in testing what they have memorized rather than what they have understood and that feedback on their work is usually provided only in the form of marks and grades (66.4%; 58.2–73.8). About a third of the students (32.9%; 25.6–41.12) ‘agreed’ or ‘strongly agreed’ that the academic staff was extremely good at explaining things to students, put a lot of time to comment on student's work (32.2%; 24.9–40.3) and normally give helpful feedback on how students are doing (30.9%; 23.7–39.0). Approximately one quarter of respondents (27.5%; 20.7–35.5) ‘agreed’ or ‘strongly agreed’ that most of the teaching staff make a real effort to understand difficulties students may be having with their learning and work hard to make subjects interesting (25.5%; 18.9–33.4). In relation to the general statements about the current pharmacy program, a clear majority of students ‘agreed’ or ‘strongly agreed’ that the workload was too demanding (87.9%; CI: 81.3–92.5), putting a lot pressure on them (85.2%; 78.3–90.3), that to do well in this program all they needed is a good memory (85.2%; 78.3–90.3). A majority of respondents felt that the curriculum tries to cover too many topics (71.8%; 63.8–78.7) and that they were not generally given enough time to understand the things they have to learn (75.8%; 68.0–82.3). The aim and objectives of this program are not very clear to 40% (33.1–49.3) of the students, but only 18.1% (12.5–25.5) of respondents indicated their overall satisfaction with the quality of the current pharmacy program. Comparative analysis of students’ responses between the three cohorts showed a significant difference in their perceptions regarding the amount of work expected for a course. Third year students found it easier compared to fourth and fifth years (p=0.03). This cohort also had a higher level of agreement on the amount of time devoted by the teaching staff on students’ work (p=0.04). There was also a significant difference in students’ perceptions of their skills development. Fifth year students highly agreed that the program has helped them to develop problem-solving skills (p < 0.001), analytical skills (p=0.008), and abilities to plan their own work (p=0.03) compared to third and fourth year students. Similarly, students in fifth and fourth years indicated a significantly higher level of agreement about the development of their confidence about dealing with unfamiliar problems compared with third year students (p=0.02). Discussion To our knowledge, this is the first known study to be conducted in Kuwait, and in the Middle Eastern countries to comprehensively determine pharmacy students’ motives to study pharmacy, their career aspiration, and their evaluation of the current pharmacy curriculum. The present findings highlighted the limitations of our learning environment, which included the admission criteria that may have forced students to register in a different major other than their choice, the difficulty students may encounter in order to discover what is expected from them in the current program, as well as the limited choices for students in the ways they are going to learn and be assessed and in the work they have to do. In addition, most of the teaching staff seem more interested in testing what students have memorized rather than what they have understood, feedback on student work is usually provided only in the form of marks and grades and not helpful comments regarding their performance, the curriculum tries to cover too many topics putting a lot of pressure on them, and they are generally not given enough time to comprehend the required material. Moreover, the aim and objectives of the program are not very clear to the students and a low overall satisfaction of the students with the quality of the current pharmacy program is observed. The present study showed that the most frequently reported reason for studying pharmacy is failure to be admitted to medicine or dentistry. Prevailing admission criteria may have forced student to register in a different major other than their choice. This may affect students’ academic progress as they will be learning subjects not related to their personal interest. For the last two academic years (students not in the survey), admission criteria have been changed to allow students to choose their major from the start based on the equivalent average system (combining the student's high school grades with the results of the university aptitude test). It will be interesting to perform the same analysis in these new cohorts. The second most reported reason for studying pharmacy was a desire to help sick people, identifying this element as the major drive to enroll in pharmacy. Other influences such as the desire of running own business, career prestige and influence from parents, that were previously reported,3,9 were not major motivational factors in this study. The present findings highlight the fact that the Faculty of pharmacy will have to make sure that students enrolled are motivated to become pharmacist and, for those enrolled because other options were not accessible, it must have an engaging curriculum to convert them into engaged pharmacists. The current findings revealed that students’ preference is toward the public sector. This could be explained by the fact that graduates from Kuwait University have to work in public facilities for a minimum of five years before they become illegible to work in 5
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
the private sector. Interestingly, the present study showed that fewer number of students wish to work in community pharmacy in the future. This could be explained by the type of practice performed in each setting. The career expectations 10 years after graduation were found to be working in a hospital or a university setting being the most preferred employment sites. The current results suggest that work has to be done with the Ministry of Health to expand the scope of practice of pharmacist, both at the community and hospital levels, in order for our graduates to see their professional practice as a likely career ten years down the road. It is our interpretation that the current desire to engage in university careers in such a high percentage is a symptom of the modest work satisfaction of the pharmacy workforce in the country. Most of the students in this study believed that the pharmacy program at Kuwait University improved their problem-solving and analytical skills, especially with older cohorts. However, students felt that the workload was too dense with little feedback received from the teaching staff. A Previous study in the USA has also showed that students perceived that pharmacy is linked with heavy workload and difficult coursework.5 These results highlight the need for better communication and more interaction between students and academic staff in order to reassure students about their progress and clarify the work expected from them. Based on the responses about memorization and feedback and dealing with unfamiliar problems, the current findings illustrate the students’ dissatisfaction by being exposed to a large amount of surface learning and lack of time and teacher interest in deeper learning. Considering that the work of a pharmacist is to be able to deal with all sorts of unexpected situations related to pharmacotherapy, the current B.Pharm. does not prepare them well for this professional uncertainty.13 The low satisfaction of the respondents towards the current curriculum, which is knowledge and lecture-based, warrants a profound reevaluation of our learning environment to apply innovative teaching methods that actively promote critical thinking and provide students with ample opportunity to develop the clinical knowledge foundation and effective communication skills that are the cornerstone of direct patient care. As alluded by Noble C, et al.,13 we cannot consider only tinkering with knowledge and skills but we need to truly transform pharmacy education. Indeed, previous studies have shown that a more active learning environment will be associated with better outcomes.14,15 The assessment framework, including appropriate feedback, will also have to be revisited to be more aligned with student expectations and best practice. Studies have shown that comprehensive evaluation of pharmacy curriculum could identify areas for improvement in the learning experience and teaching outcomes.4,5,16 As the Faculty of Pharmacy is preparing an entry-level PharmD, the present findings provided valuable information to guide its development in anticipation of the demands for a more patient-focused practice. Three committees were established by the Dean of the Faculty with mandates in relation to assessment strategies, innovative active learning methods, and development of a competency-based curriculum. Focus group interviews with stakeholders were conducted to identify the gaps between education and practice. These interviews helped to assess the need of the practice, community and the population and to create a roadmap to improve pharmacy practice in Kuwait. Moreover, interventions such as active collaboration with the Ministry of Health is now stronger than before in order to recognize the clinical role of the pharmacist in real practice. Indeed, as pharmacy services are being developed to use the full potential of pharmacist, education has to remain the foundation of the extended scope of practice. We suggest the use of our method by other institutions in the region to study the motivation and career aspiration of their students and to review their current pharmacy curriculum based on students’ learning experience to adopt a new approach to education. Summary This survey clearly highlights the limitations of our current learning environment and will guide our curriculum development to move towards an entry-level PharmD that will aim at developing professional and transversal knowledge and competencies by engaging students in active learning activities. Conflict of interest None. Financial disclosure statements The authors do not have any financial competing interests to disclose. Specific contribution to literature To our knowledge, this is the first known study to be conducted in Kuwait, and in the Middle Eastern countries to comprehensively determine pharmacy students’ motives to study pharmacy, their career aspiration, and their evaluation of the current pharmacy curriculum as a tool to identify limitations of the learning environment and to guide curriculum development. The method used to explore these issues is appropriate. The findings of the present study clearly highlights the limitations of our current learning environment and will guide our curriculum development to move towards an entry-level PharmD. Also the manuscript discussed these limitations and described the interventions being implemented. The publication of this manuscript could inspire other institutions in the region and other developing countries to use our method for the identification of the limitations of their learning environment and to adopt a new approach to education. It is of interest to the international community because of the contribution it makes to the global relevance of pharmacy education in developing countries. 6
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
References 1. International Pharmaceutical Federation. Standards for Quality for Pharmacy Services - Good Pharmacy Practice. 〈https://www.fip.org/files/fip/Statements/ latest/Dossier%20004%20total.PDF〉; 2016 Accessed January 21, 2017. 2. Taylor DA, Taylor JN. The pharmacy student population: applications received 2011-12, degrees conferred 2011–12, fall 2012 enrollments. Am J Pharm Educ. 2013;77(6) [Article S3]. 3. Kheir N, Zaidan M, Younes H, El Hajj M, Wilbur K, Jewesson PJ. Pharmacy education and practice in 13 Middle Eastern countries. Am J Pharm Educ. 2008;72(6) [Article 133]. 4. El-Awady el SE, Moss S, Mottram D, O'Donnell J. Student perspectives on pharmacy curriculum and instruction in Egyptian schools. Am J Pharm Educ. 2006;70(1) [Article 9]. 5. Keshishian F, Brenton BP. Pharmacy students' perceptions of their curriculum and profession: implications for pharmacy education. Pharm Educ. 2011;11(1):194–200. 6. Chanakit T, Low BY, Wongpoowarak P, Moolasarn S, Anderson C. A survey of pharmacy education in Thailand. Am J Pharm Educ. 2014;78(9) [Article 161]. 7. International Pharmaceutical Federation.2013/14 FIPEd - IPSF Student Learning Experience Questionnaire. 〈http://www.codegnet.org.uk/moII_2013/〉; 2016 Accessed January 21, 2017. 8. Keshishian F. Factors influencing pharmacy students' choice of major and its relationship to anticipatory socialization. Am J Pharm Educ. 2010;74(4) [Article 75]. 9. Anderson DC, Sheffield MC, Hill AM, Cobb HH. Influences on pharmacy students' decision to pursue a doctor of pharmacy degree. Am J Pharm Educ. 2008;72(2) [Article 22]. 10. Lobb WB, Shah M, Kolassa EM. Factors influencing the selection of a major: a comparison of pharmacy and nonpharmacy undergraduate students. J Pharm Teach. 2004;11(2):45–64. 11. Savage LM, Beall JW, Woolley TW. Factors that influence the career goals of pharmacy students. Am J Pharm Educ. 2009;73(2) [Article 28]. 12. Ball D, Norris P, Enlund H, Tagwireyi H, Awad A. Diversity amongst international pharmacy students. Pharm Educ. 2007;7(4):379–386. 13. Noble C, Shaw PN, Nissen L, Coombes I, O'Brien M. Curriculum for uncertainty: certainty may not be the answer. Am J Pharm Educ. 2011;75(1) [Article 13]. 14. Waldrop M. The science of teaching science. Nature. 2015;523(7559):272–274. 15. Cone C, Godwin D, Salazar K, Bond R, Thompson M, Myers O. Incorporation of an explicit critical-thinking curriculum to improve pharmacy students' criticalthinking skills. Am J Pharm Educ. 2016;80(3) [Article 41]. 16. Utsumi M, Hirano S, Fujii Y, Yamamoto H. Evaluation of the pharmacy practice program in the 6-year pharmaceutical education curriculum in Japan: community pharmacy practice program. J Pharm Health Care Sci. 2015;1:27.
7
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Experiences in Teaching and Learning
Motivations, career aspiration, and learning experience of students in the pharmacy program at Kuwait University: A tool to guide curriculum development ⁎
Abdelmoneim Awad , Asmaa Al-Haqan, Pierre Moreau Kuwait University, Safat 13110, Kuwait
A R T I C L E I N F O
ABSTRACT
Keywords: Pharmacy education curriculum motivation Kuwait
Purpose: To determine students’ motivating factors in the choice of pharmacy, career aspirations, and perceptions about learning experiences in the current pharmacy curriculum. Activity: A descriptive cross-sectional survey of pharmacy students was performed at Kuwait University Findings: The most common reason to pursue pharmacy was that they were not admitted to medicine or dentistry (40.5%). About half of students were seeing themselves employed in hospital pharmacies immediately after graduation. Over two-thirds of respondents ‘agreed’ or ‘strongly agreed’ that the pharmacy program developed their problem-solving skills (78.5%) and improved their communication skills (66.4%). Students also admitted that the teaching staff seemed more interested in testing memorization (72.5%), that feedback on student work was usually provided in the form of grades (66.4%), and that the workload is putting a lot of pressure on them (88%). Summary: The survey identifies key elements that needs to be improved in the next iteration of the program (entry-level PharmD).
Background and purpose Pharmacy education has been transformed dramatically over the last 20 years with the evolution of the practice philosophy from traditional tasks such as medication compounding and dispensing to a newer scope of practice including patient-centered care.1 In June 2005, this evolution led to the expiration of the baccalaureate degree in pharmacy (BS Pharmacy) in the United States of America (USA), with a transition to the Doctor of Pharmacy degree (PharmD).2 In contrast, baccalaureate degree programs remain the first professional degree to practice in most of the Middle Eastern countries.3 Now, as there is an upsurge in the transformation of pharmacy practice from focus on dispensing medicines to becoming a patient-centered profession in this region, faculties of pharmacy started to switch their system of pharmacy education to match the entry-level PharmD curriculum in the USA. The Faculty of Pharmacy of Kuwait University proposed a plan to start an entry-level PharmD program and pursue international review and accreditation after a visit by the Accreditation Council for Pharmacy Education (ACPE) delegation to Kuwait. It is a positive step in the right direction to graduate skilled and knowledgeable clinical pharmacists who can improve patient's health care. Hence, there is a demand to identify the key elements that needs to be improved in the next iteration of the program (entry-level PharmD). Students’ input is crucial in the development of educational policies and practices since they are at the center of pre-
⁎
Corresponding author: Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait. Tel.: +00965-24636065. E-mail addresses: [email protected] (A. Awad), [email protected] (A. Al-Haqan), [email protected] (P. Moreau).
http://dx.doi.org/10.1016/j.cptl.2016.11.018
1877-1297/ © 2016 Elsevier Inc. All rights reserved.
Please cite this article as: Awad, A., Currents in Pharmacy Teaching and Learning (2016), http://dx.doi.org/10.1016/j.cptl.2016.11.018
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
professional education. Students’ perception of their curriculum have been discussed widely in the literature. Results from such studies provided recommendations to further improve the educational environment and recruitment strategies.4–6 The paramount importance to survey students’ learning experience was also highlighted in the “Moving On II” project of the International Pharmaceutical Federation using the FIPEd-IPSF student learning experience questionnaire.7 The expanding role of pharmacists in today's society requires the enrolment of students who are able to accept the responsibility of providing direct patient care and to be more actively involved in their societies. Hence, it is crucial for our pharmacy program to identify students’ motivation and career preferences. Several studies were conducted to identify factors that motivate students to choose pharmacy as their academic major. Studies from the USA reported that positive motivating factors include the prospect of having many career opportunities, of helping others, of receiving encouragement by family members, pharmacists or pharmacy students. Motivational factors also included career prestige and earning potential.8–10 Studies investigated the career aspirations of graduating pharmacy students reported that most pharmacy students prefer a community-based or a hospital-based practice as their first career choice.3,11 The goals of this study were to identify students’ motivating factors in the choice of pharmacy, their career aspirations, and to determine students’ perceptions about their learning experience in the current pharmacy curriculum. Educational activity and setting A descriptive, cross-sectional, survey of pharmacy students was conducted at the Faculty of Pharmacy of Kuwait University. The study population consisted of four different student cohorts from professional years (second, third, fourth, and fifth year), and consisted of a total of 194 students. The ethical clearance for this study was obtained from the "Human Ethical Committee, Health Sciences Center, Kuwait University". The Faculty of Pharmacy at Kuwait University is the only public pharmacy school in Kuwait. It was established in 1996 and admitted its first cohort in September 1997. The Bachelor of Pharmacy (B.Pharm.) degree offered by the Faculty is a 10-semester program (total of 5 years) with the first two semesters spent in a common year with medical and dental students. Toward the end of this first year students are given the chance to elect their first, second, and third choice of the Faculty they wish to be admitted to through competitive application. During the first 3 semesters students enroll in pre-professional courses, followed by professional courses for the remaining 7 semesters. The Faculty's current curriculum is designed to foster students’ abilities to communicate effectively, solve problems, make rational judgments based upon sound scientific reasoning; and engender a caring attitude in their professional interactions with patients. The study questionnaire was adapted from validated surveys.7,12 It was pre-tested for content, design, readability, and comprehension on 15 pharmacy students, and modifications were made as necessary so that the questionnaire was simple to understand, yet provided accurate data. The final version of the questionnaire had three sections, and contained both open-ended and close-ended questions. The first section included items to provide information about the characteristics of the respondents (Table 1). Section two consisted of nine questions to provide information about the students’ motivating factors in the choice of pharmacy and their career aspirations. The first five questions were as follows: (i) Which of the following was the most important Table 1 General characteristics of respondents (n=85).
Gender Male Female Age (years) 18–19 20–22 23–27 Nationality Kuwaiti Non-Kuwaiti Year in Pharmacy School 2nd year 3rd year 4th year 5th year Marital status Single Married Having children Yes No Having a close family member or a friend who is a pharmacist Close family member Family friend
2
Frequency
Percentage (%)
23 162
12.4 87.6
22 122 41
11.9 65.9 22.2
166 19
89.7 10.3
36 49 56 44
19.4 26.5 30.3 23.8
160 25
86.5 13.5
13 172
7 93
57 86
30.8 46.5
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
Fig. 1. Career preferences of respondents immediately after graduation and in 10 years’ time. (n=185).
reason that you registered to study Pharmacy? “I would like to help sick people; I can make a lot of money by practicing pharmacy; My parents or family decided for me; I want people to look up to me as a professional; My first choice was medicine/dentistry but I was not accepted; and other reasons (please specify). (ii) Have you always wanted to be a pharmacist? (e.g., Did you consider becoming a pharmacist during high school?) (iii) Was pharmacy your first choice of university discipline). (iv) Are you happy to be studying pharmacy now? (v) Based on your experiences of the pharmacy program so far, do you consider it an easy program? The remaining four questions were as follows: (i) Would you prefer to work for the government or in the private sector? (Yes, no, no preference); (ii) After being graduated, what do see yourself doing immediately afterwards?; (iii) What do you see yourself doing in 10 years’ time?; and (iv) Do you hope to own your own retail/community pharmacy in the future? (Yes, no, unsure). Respondents have to select only one of the options provided for the second and third questions about career choices (Fig. 1). The last section was used to determine students’ perceptions about their learning experience in the current B.Pharm curriculum. A 5-point Likert scale (1=strongly disagree, 5=strongly agree) was used to measure students’ level of agreement with 34 items about the clarity of expectations for students, students’ skills development, students’ choices in the program, roles of teaching staff to support students’ success and general statements about the program (Table 2). One open-ended question was included at the end of the questionnaire for any further comments/suggestions regarding the current curriculum. The purpose of the study was briefly explained to students after major lectures in the second semester of the academic year 2014–2015, and the survey was distributed. The participants were asked to return the questionnaires anonymously. Confidentiality was guaranteed and students gave written consent to participate in the study. The survey distributed to the second year students did not include the last part about their learning experience in the current pharmacy curriculum because they have just started to study the professional pharmacy courses. Data were entered into the Statistical Package for Social Sciences version 23, and descriptive analysis conducted. The results were reported as percentage (95% confidence interval), mean (standard deviation) and median (interquartile range). The chi-squared test was used to test for association between the independent variables and the dependent variables. Statistical correlation analysis (Spearman's r) was used to measure the association between motivational factors and preferences of future workplace immediately after graduation and in 10 years’ time. The differences in the Likert scale median responses of the third, fourth, and fifth year students to the items assessing their learning experience in the pharmacy program were determined using Kurskal-Wallis test. P < 0.05 was considered statistically significant. Findings A total of 194 students were approached to be included in the study, 185 agreed to participate giving a response rate of 95.4%. Table 1 summarizes the demographic characteristics of respondents. Not being accepted in another health care discipline was the most common reason for studying pharmacy. Four out of 10 students (40.5%; 95% CI: 33.5–48.0) indicated their first choice was either medicine or dentistry but they didn’t meet the admission criteria and were accepted in pharmacy instead. The second common reason to enroll in pharmacy was a desire to help sick people (28.7%; 22.4–35.8). Other reasons included wanting to become a respected professional (13.5%; 9.1–19.5), perceptions of pharmacy as an easy program compared to medicine and dentistry (8.7%; 95% CI: 5.2–13.9), financial motive (4.9%; 2.4–9.3), and parental decision (3.8%; 1.7–8.0). More than one-third (34.1%; 27.4–41.4) of students stated that they have always wanted to be pharmacists, and that pharmacy was their first choice as a university major. However; the majority (61.6%; 54.2–68.6) of respondents indicated that they were happy to be studying pharmacy now. Helping sick people and wanting to be a professional as primary reasons for choosing pharmacy were found to be significantly prevalent among students who always wanted to be pharmacists and for whom pharmacy was the first 3
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
Table 2 Distribution of students’ responses regarding their learning experience with the undergraduate curriculum of pharmacy (n=149). Response values (%)a
Item
A. Clarity of Expectations for Students It is always easy to know the standard work expected for the course. You usually have a clear idea of what is expected of you. It is often hard to discover what's expected of you in this pharmacy program. Most of the teaching staff here make it clear right from the start what they expect from students. B. Students’ Skills Development This pharmacy program has helped me to develop problem-solving skills. This pharmacy program has sharpened my analytical skills. This pharmacy program has helped to develop my ability to work as a team member. This pharmacy program has improved my communication skills. This pharmacy program has helped me develop the ability to plan my own work. C. Students’ Choices in the Program Students have a great deal of choice over how they are going to learn in this pharmacy program. Students here are given a lot of choice in the work they have to do. There is very little choice in this pharmacy program in the ways you are assessed/evaluated. Students often discuss with their teaching staff how they are going to learn in the program. D. Roles of Teaching Staff to support Students’ Success Most of the teaching staff here motivate students to do their best work. Most of the teaching Staff here put a lot of time to comment on student's work. Most of the teaching staff seem more interested in testing what you have memorized than what you have understood. Most of the teaching staff here make a real effort to understand difficulties students may be having with their work. Feedback on student work is usually provided ONLY in the form of marks and grades. Most of the teaching staff here normally give helpful feedback on how you are doing. Most of the teaching staff here are extremely good at explaining things to us. Most of the teaching staff here work hard to make subjects interesting. Most of the teaching Staff here show no real interest in students` opinions/comments. E. General statements about the Pharmacy Program The aim and objectives of this pharmacy program are NOT very clear. The workload is too heavy. To do well on this pharmacy program all you really need is a good memory. It seems to me that the syllabus tries to cover too many topics. Students are generally given enough time to understand the things we have to learn. There is a lot of pressure on you as student here. It would be possible to do well in this pharmacy program just by working hard around exam times. The total amount of knowledge/ skills/ attitudes you have to learn in this pharmacy program means you can't understand it all completely. As a result of doing this pharmacy program, I feel more confident about dealing with unfamiliar problems. This pharmacy program really tries to get the best out of all its students. This pharmacy program has encouraged me to develop my own academic interests as far as possible. Overall, I am satisfied with the quality of this pharmacy program. a
Median (IQR)
Mean (SD)
1
2
3
4
5
11.4 10.7 5.4 12.1
38.9 32.2 24.2 27.5
29.5 26.2 20.8 26.2
17.4 27.5 38.3 28.2
2.7 3.4 11.4 6.0
2 (2–3) 3 (2–4) 3(2–4) 3(2–4)
2.6 2.8 3.3 2.9
(1.0) (1.1) (1.1) (1.1)
3.4 3.4 2.7 5.4 5.4
7.4 8.7 8.7 9.4 17.4
10.7 20.1 17.4 18.8 28.2
65.8 58.4 59.1 53.0 36.9
12.8 9.4 12.1 13.4 12.1
4 4 4 4 3
3.8 3.6 3.7 3.6 3.3
(0.9) (0.9) (0.9) (1.0) (1.1)
26.2
37.6
24.2
10.7
1.3
2 (1–3)
2.2 (1.0)
28.2 4.7 19.5
40.9 12.8 24.8
20.1 21.5 32.2
8.1 41.6 22.1
2.7 19.5 1.3
2 (1–3) 4 (3–4) 3 (2–3)
2.2 (1.0) 3.6 (1.1) 2.6 (1.1)
22.1 6.0 3.4
22.1 25.5 14.1
18.1 36.2 10.1
30.2 30.2 22.8
7.4 2.0 49.7
3 (2–4) 3 (2–4) 4 (3–5)
2.8 (1.3) 3.0 (0.9) 4.0 (1.2)
24.8
25.5
22.1
25.5
2.0
2 (1.5–4)
2.5 (1.8)
6.0 17.4 13.4 18.8 5.4
14.1 24.2 20.8 26.2 24.2
13.4 27.5 32.9 29.5 26.8
35.6 29.5 26.2 20.1 24.2
30.9 1.3 6.7 5.4 19.5
4 3 3 3 3
(3–5) (2–4) (2–4) (2–4) (2–4)
3.7 2.7 2.9 2.7 3.3
(1.2) (1.1) (1.1) (1.1) (1.2)
6.0 2.7 3.4 3.4 47.7 1.3 38.3
32.9 6.0 6.7 8.1 28.2 7.4 28.2
20.1 3.4 4.7 16.8 12.8 6.0 12.8
24.2 21.5 26.2 21.5 7.4 15.4 12.8
16.8 66.4 59.1 50.3 4.0 69.8 8.1
3 5 5 5 2 5 2
(2–4) (4–5) (4–5) (3–5) (1–2) (4–5) (1–3)
3.1 4.4 4.3 4.1 1.9 4.4 2.2
(1.2) (1.0) (1.1) (1.1) (1.1) (1.0) (1.3)
2.0
14.8
38.9
24.8
19.5
3 (3–4)
3.4 (1.0)
9.4
11.4
40.9
32.2
6.0
3 (3–4)
3.1 (1.0)
12.8 6.7
20.1 18.1
32.9 28.2
28.9 38.3
5.4 8.7
3 (2–4) 3 (2.5–4)
2.9 (1.1) 3.2 (1.1)
22.8
32.9
26.2
14.8
3.4
2 (2–3)
2.4 (1.1)
(4–4) (3–4) (3–4) (3–4) (3–4)
1= Strongly disagree; 2= disagree; 3=neutral; 4=agree; 5=strongly agree.
choice of university program (p < 0.001 and p=0.03, respectively). Students who always wanted to be pharmacists and that pharmacy was their first choice of university course, and those who are happy to be studying pharmacy now showed the lowest score of studying pharmacy for financial reasons (p=0.04 and p < 0.001, respectively). When students were asked to indicate their preference between the private and the public sector, most of them preferred to work in the public sector (66.0%; 58.6–72.6). Fig. 1 shows the respondents’ preferences of their future workplace immediately after graduation and 10 years later. Three quarters of students considered future employment in hospital pharmacies (47.6%; 40.2–55.0) or studying for postgraduate qualifications (27.0%; 20.9–34.1) immediately after graduation. Ten years after graduation, the number of students expecting to be employed in hospital pharmacies was reduced by more than half (21.6%; 16.1–28.4), while there was an important interest in working within a university setting (35.7%; 28.9–43.1). Table 2 presents students' distribution of responses regarding their learning experience with the undergraduate curriculum of
4
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
pharmacy. In relation to the clarity of expectations, half the students (49.7%; 41.4–57.9) ‘agreed’ or ‘strongly agreed’ that it is often hard to discover what is expected from them in this program, while 30.9% (23.7–39.0) reported that they usually have clear idea about what is expected of them. Regarding skills development, a majority of students ‘agreed’ or ‘strongly agreed’ that the pharmacy program has helped to develop their problem-solving skills ( 78.5%; 70.9–84.7), their abilities to work as team members ( 71.1%; 63.1–78.1), their analytical skills (67.9%; 59.6–75.1), and their communication skills (66.4%; 58.2–73.8). About half of the students (49%; 40.857.3) reported having developed their abilities to plan their own work. Responses to the students’ choices in this program showed that less than one-quarter of them (23.5%; 17.1–31.3) ‘agreed’ or ‘strongly agreed’ that they often discuss with their teaching staff how they are going to learn. A minority (12.1%; 7.5–18.7) reported that they have a great deal of choice over how they are going to learn and that they are given a lot of choice in the work they have to do (8.7%; 5.2–13.9). Accordingly, a majority of students (61.1%; 52.7–68.9) admitted that there is very little choice in this program in the ways they are assessed. In the section about the roles of teaching staff to support their success, about two-thirds of students (72.5%; 64.5–79.3) ‘agreed’ or ‘strongly agreed’ that most of the teaching staff seem more interested in testing what they have memorized rather than what they have understood and that feedback on their work is usually provided only in the form of marks and grades (66.4%; 58.2–73.8). About a third of the students (32.9%; 25.6–41.12) ‘agreed’ or ‘strongly agreed’ that the academic staff was extremely good at explaining things to students, put a lot of time to comment on student's work (32.2%; 24.9–40.3) and normally give helpful feedback on how students are doing (30.9%; 23.7–39.0). Approximately one quarter of respondents (27.5%; 20.7–35.5) ‘agreed’ or ‘strongly agreed’ that most of the teaching staff make a real effort to understand difficulties students may be having with their learning and work hard to make subjects interesting (25.5%; 18.9–33.4). In relation to the general statements about the current pharmacy program, a clear majority of students ‘agreed’ or ‘strongly agreed’ that the workload was too demanding (87.9%; CI: 81.3–92.5), putting a lot pressure on them (85.2%; 78.3–90.3), that to do well in this program all they needed is a good memory (85.2%; 78.3–90.3). A majority of respondents felt that the curriculum tries to cover too many topics (71.8%; 63.8–78.7) and that they were not generally given enough time to understand the things they have to learn (75.8%; 68.0–82.3). The aim and objectives of this program are not very clear to 40% (33.1–49.3) of the students, but only 18.1% (12.5–25.5) of respondents indicated their overall satisfaction with the quality of the current pharmacy program. Comparative analysis of students’ responses between the three cohorts showed a significant difference in their perceptions regarding the amount of work expected for a course. Third year students found it easier compared to fourth and fifth years (p=0.03). This cohort also had a higher level of agreement on the amount of time devoted by the teaching staff on students’ work (p=0.04). There was also a significant difference in students’ perceptions of their skills development. Fifth year students highly agreed that the program has helped them to develop problem-solving skills (p < 0.001), analytical skills (p=0.008), and abilities to plan their own work (p=0.03) compared to third and fourth year students. Similarly, students in fifth and fourth years indicated a significantly higher level of agreement about the development of their confidence about dealing with unfamiliar problems compared with third year students (p=0.02). Discussion To our knowledge, this is the first known study to be conducted in Kuwait, and in the Middle Eastern countries to comprehensively determine pharmacy students’ motives to study pharmacy, their career aspiration, and their evaluation of the current pharmacy curriculum. The present findings highlighted the limitations of our learning environment, which included the admission criteria that may have forced students to register in a different major other than their choice, the difficulty students may encounter in order to discover what is expected from them in the current program, as well as the limited choices for students in the ways they are going to learn and be assessed and in the work they have to do. In addition, most of the teaching staff seem more interested in testing what students have memorized rather than what they have understood, feedback on student work is usually provided only in the form of marks and grades and not helpful comments regarding their performance, the curriculum tries to cover too many topics putting a lot of pressure on them, and they are generally not given enough time to comprehend the required material. Moreover, the aim and objectives of the program are not very clear to the students and a low overall satisfaction of the students with the quality of the current pharmacy program is observed. The present study showed that the most frequently reported reason for studying pharmacy is failure to be admitted to medicine or dentistry. Prevailing admission criteria may have forced student to register in a different major other than their choice. This may affect students’ academic progress as they will be learning subjects not related to their personal interest. For the last two academic years (students not in the survey), admission criteria have been changed to allow students to choose their major from the start based on the equivalent average system (combining the student's high school grades with the results of the university aptitude test). It will be interesting to perform the same analysis in these new cohorts. The second most reported reason for studying pharmacy was a desire to help sick people, identifying this element as the major drive to enroll in pharmacy. Other influences such as the desire of running own business, career prestige and influence from parents, that were previously reported,3,9 were not major motivational factors in this study. The present findings highlight the fact that the Faculty of pharmacy will have to make sure that students enrolled are motivated to become pharmacist and, for those enrolled because other options were not accessible, it must have an engaging curriculum to convert them into engaged pharmacists. The current findings revealed that students’ preference is toward the public sector. This could be explained by the fact that graduates from Kuwait University have to work in public facilities for a minimum of five years before they become illegible to work in 5
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
the private sector. Interestingly, the present study showed that fewer number of students wish to work in community pharmacy in the future. This could be explained by the type of practice performed in each setting. The career expectations 10 years after graduation were found to be working in a hospital or a university setting being the most preferred employment sites. The current results suggest that work has to be done with the Ministry of Health to expand the scope of practice of pharmacist, both at the community and hospital levels, in order for our graduates to see their professional practice as a likely career ten years down the road. It is our interpretation that the current desire to engage in university careers in such a high percentage is a symptom of the modest work satisfaction of the pharmacy workforce in the country. Most of the students in this study believed that the pharmacy program at Kuwait University improved their problem-solving and analytical skills, especially with older cohorts. However, students felt that the workload was too dense with little feedback received from the teaching staff. A Previous study in the USA has also showed that students perceived that pharmacy is linked with heavy workload and difficult coursework.5 These results highlight the need for better communication and more interaction between students and academic staff in order to reassure students about their progress and clarify the work expected from them. Based on the responses about memorization and feedback and dealing with unfamiliar problems, the current findings illustrate the students’ dissatisfaction by being exposed to a large amount of surface learning and lack of time and teacher interest in deeper learning. Considering that the work of a pharmacist is to be able to deal with all sorts of unexpected situations related to pharmacotherapy, the current B.Pharm. does not prepare them well for this professional uncertainty.13 The low satisfaction of the respondents towards the current curriculum, which is knowledge and lecture-based, warrants a profound reevaluation of our learning environment to apply innovative teaching methods that actively promote critical thinking and provide students with ample opportunity to develop the clinical knowledge foundation and effective communication skills that are the cornerstone of direct patient care. As alluded by Noble C, et al.,13 we cannot consider only tinkering with knowledge and skills but we need to truly transform pharmacy education. Indeed, previous studies have shown that a more active learning environment will be associated with better outcomes.14,15 The assessment framework, including appropriate feedback, will also have to be revisited to be more aligned with student expectations and best practice. Studies have shown that comprehensive evaluation of pharmacy curriculum could identify areas for improvement in the learning experience and teaching outcomes.4,5,16 As the Faculty of Pharmacy is preparing an entry-level PharmD, the present findings provided valuable information to guide its development in anticipation of the demands for a more patient-focused practice. Three committees were established by the Dean of the Faculty with mandates in relation to assessment strategies, innovative active learning methods, and development of a competency-based curriculum. Focus group interviews with stakeholders were conducted to identify the gaps between education and practice. These interviews helped to assess the need of the practice, community and the population and to create a roadmap to improve pharmacy practice in Kuwait. Moreover, interventions such as active collaboration with the Ministry of Health is now stronger than before in order to recognize the clinical role of the pharmacist in real practice. Indeed, as pharmacy services are being developed to use the full potential of pharmacist, education has to remain the foundation of the extended scope of practice. We suggest the use of our method by other institutions in the region to study the motivation and career aspiration of their students and to review their current pharmacy curriculum based on students’ learning experience to adopt a new approach to education. Summary This survey clearly highlights the limitations of our current learning environment and will guide our curriculum development to move towards an entry-level PharmD that will aim at developing professional and transversal knowledge and competencies by engaging students in active learning activities. Conflict of interest None. Financial disclosure statements The authors do not have any financial competing interests to disclose. Specific contribution to literature To our knowledge, this is the first known study to be conducted in Kuwait, and in the Middle Eastern countries to comprehensively determine pharmacy students’ motives to study pharmacy, their career aspiration, and their evaluation of the current pharmacy curriculum as a tool to identify limitations of the learning environment and to guide curriculum development. The method used to explore these issues is appropriate. The findings of the present study clearly highlights the limitations of our current learning environment and will guide our curriculum development to move towards an entry-level PharmD. Also the manuscript discussed these limitations and described the interventions being implemented. The publication of this manuscript could inspire other institutions in the region and other developing countries to use our method for the identification of the limitations of their learning environment and to adopt a new approach to education. It is of interest to the international community because of the contribution it makes to the global relevance of pharmacy education in developing countries. 6
Currents in Pharmacy Teaching and Learning (xxxx) xxxx–xxxx
A. Awad et al.
References 1. International Pharmaceutical Federation. Standards for Quality for Pharmacy Services - Good Pharmacy Practice. 〈https://www.fip.org/files/fip/Statements/ latest/Dossier%20004%20total.PDF〉; 2016 Accessed January 21, 2017. 2. Taylor DA, Taylor JN. The pharmacy student population: applications received 2011-12, degrees conferred 2011–12, fall 2012 enrollments. Am J Pharm Educ. 2013;77(6) [Article S3]. 3. Kheir N, Zaidan M, Younes H, El Hajj M, Wilbur K, Jewesson PJ. Pharmacy education and practice in 13 Middle Eastern countries. Am J Pharm Educ. 2008;72(6) [Article 133]. 4. El-Awady el SE, Moss S, Mottram D, O'Donnell J. Student perspectives on pharmacy curriculum and instruction in Egyptian schools. Am J Pharm Educ. 2006;70(1) [Article 9]. 5. Keshishian F, Brenton BP. Pharmacy students' perceptions of their curriculum and profession: implications for pharmacy education. Pharm Educ. 2011;11(1):194–200. 6. Chanakit T, Low BY, Wongpoowarak P, Moolasarn S, Anderson C. A survey of pharmacy education in Thailand. Am J Pharm Educ. 2014;78(9) [Article 161]. 7. International Pharmaceutical Federation.2013/14 FIPEd - IPSF Student Learning Experience Questionnaire. 〈http://www.codegnet.org.uk/moII_2013/〉; 2016 Accessed January 21, 2017. 8. Keshishian F. Factors influencing pharmacy students' choice of major and its relationship to anticipatory socialization. Am J Pharm Educ. 2010;74(4) [Article 75]. 9. Anderson DC, Sheffield MC, Hill AM, Cobb HH. Influences on pharmacy students' decision to pursue a doctor of pharmacy degree. Am J Pharm Educ. 2008;72(2) [Article 22]. 10. Lobb WB, Shah M, Kolassa EM. Factors influencing the selection of a major: a comparison of pharmacy and nonpharmacy undergraduate students. J Pharm Teach. 2004;11(2):45–64. 11. Savage LM, Beall JW, Woolley TW. Factors that influence the career goals of pharmacy students. Am J Pharm Educ. 2009;73(2) [Article 28]. 12. Ball D, Norris P, Enlund H, Tagwireyi H, Awad A. Diversity amongst international pharmacy students. Pharm Educ. 2007;7(4):379–386. 13. Noble C, Shaw PN, Nissen L, Coombes I, O'Brien M. Curriculum for uncertainty: certainty may not be the answer. Am J Pharm Educ. 2011;75(1) [Article 13]. 14. Waldrop M. The science of teaching science. Nature. 2015;523(7559):272–274. 15. Cone C, Godwin D, Salazar K, Bond R, Thompson M, Myers O. Incorporation of an explicit critical-thinking curriculum to improve pharmacy students' criticalthinking skills. Am J Pharm Educ. 2016;80(3) [Article 41]. 16. Utsumi M, Hirano S, Fujii Y, Yamamoto H. Evaluation of the pharmacy practice program in the 6-year pharmaceutical education curriculum in Japan: community pharmacy practice program. J Pharm Health Care Sci. 2015;1:27.
7