- Email: [email protected]
Pharmacy residents as primary educators within a professional pharmacy elective
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Experiences in Teaching and Learning
Pharmacy residents as primary educators within a professional pharmacy elective ⁎
Meredith L. Howarda, , Taylor D. Steuberb, Alison M. Waltonc, Sarah A. Nislyd a
University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd., RES 435D, Fort Worth, TX 76107, United States Auburn University Harrison School of Pharmacy, 301 Governors Drive SW, Suite 357, Huntsville, AL 35801, United States Butler University College of Pharmacy and Health Sciences, 4600 Sunset Ave., Indianapolis, IN 46208, United States d Wingate University School of Pharmacy, 220 N Camden Rd, Wingate, NC 28174, United States b c
AR TI CLE I NF O
AB S T R A CT
Keywords: Residency training Professional elective Teaching
Background and purpose: The purpose of this study was to evaluate the impact of a course change from a faculty-led professional pharmacy elective to a primarily pharmacy resident-led course on student satisfaction and learning. Educational activity and setting: In 2014, pharmacy residents were transitioned into primary teaching roles in a drug-induced diseases elective to increase student exposure to residents and different teaching styles. Student learning roles did not change. Course evaluations and grades were compared between the resident-led year and prior year. Findings: There was no significant difference between overall course grades during the residentled year (94.2 ± 36.6 in 2014 vs. 94.1 ± 2.7 in 2013; p=0.975). Course evaluations were similar to the previous year and students provided favorable feedback. Discussion and summary: This pharmacy resident-led elective allowed for resident integration in to an interactive professional elective. Student satisfaction with the course remained similar to the previous year and overall course grades did not differ.
Background and purpose Teaching experiences, both didactic and experiential, are important components of residency programs. A growing number of available faculty positions and increased need for clinical faculty preceptors may prompt residents to pursue careers in academia or careers with substantial teaching components.1 Preparation strategies for residents include completion of teaching and learning certificate programs, participation in experiential precepting, and engagement within the classroom.2 To assist in the transition, the American College of Clinical Pharmacy (ACCP) has published commentaries and guidelines to help residents prepare for academic life. In 2011, one ACCP commentary laid a foundation for appropriate teaching experiences and suggested techniques for implementation.2 Use of self-assessment and reflections was noted as an important component of any teaching experience. Building on the 2011 framework, ACCP published guidelines for resident teaching experiences in 2013.3 These comprehensive guidelines provide expectations in setting goals, delivering lectures, small group facilitation, precepting, and teaching certificate standards. Most recently, ACCP has published minimum qualifications for clinical faculty, addressing residency training, certifications, and prior teaching experiences.4 Finally, the American Society of Health-System Pharmacists (ASHP) 2014 residency Accreditation Standards include a competency area in teaching, education, and dissemination of knowledge.5
⁎
Corresponding author. E-mail addresses: [email protected] (M.L. Howard), [email protected] (T.D. Steuber), [email protected] (A.M. Walton), [email protected] (S.A. Nisly). http://dx.doi.org/10.1016/j.cptl.2017.05.017
1877-1297/ © 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Howard, M.L., Currents in Pharmacy Teaching and Learning (2017), http://dx.doi.org/10.1016/j.cptl.2017.05.017
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
M.L. Howard et al.
Taken in sum, the importance of teaching experiences during residency training is evident, as is the need for structured mentoring and thoughtful preparation. To date, organized incorporation of pharmacy residents into a curricular course as primary educators has not been extensively described or evaluated. Messinger et al.6 described the development of a new ambulatory care professional elective by a post-graduate year two (PGY2) pharmacy resident. This elective was met with a favorable student response and improvement in ambulatory care knowledge via pre- and post-surveys. Unfortunately, as a new elective, there were no previous years with which to compare the elective and only one resident was involved in the course. Additionally, a letter to the editor by Zapantis et al.7 discussed successful incorporation of postgraduate trainees into an elective case-based classroom. Although this initiative was successful, it did not address residents or fellows serving in primary teaching roles beyond that of a discussion leader. Many pharmacy residents are interested in becoming involved with teaching. Additionally, many residents possess the fundamental tools to integrate into primary teaching roles within a pharmacy elective, such as knowledge base, presentation skills, and classroom engagement. Unfortunately, there is limited information on how pharmacy students’ perceptions and learning would respond to this technique. We present the transition of a faculty-led professional pharmacy elective to a primarily pharmacy residentled course and evaluate its impact on student satisfaction and learning. We also discuss the individual mentoring and development of pharmacy residents as primary educators within the course. Educational activity and setting Course design Drug-induced diseases (DID) is an elective three-credit hour course offered for third professional year (P3) pharmacy students each fall semester at Butler University College of Pharmacy and Health Sciences. The course meets once a week for three hours. This elective provides students exposure to common and relevant adverse reactions, focusing on identification of the responsible medication and subsequent alteration of the original treatment plan. It is a highly interactive course with a deep focus on student engagement and active learning that has been described previously.8 In addition to two consistent faculty co-coordinators, a PGY2 pharmacotherapy resident who is co-funded by both the college of pharmacy and a local healthcare system has served as a course coordinator each year for the past five years. Historically, most lectures were taught by these individuals. Intervention In fall 2014, pharmacy resident teaching within the course was increased based on student feedback from prior course evaluations and to provide the opportunity for residents to develop teaching skills in a small group setting. Implementation of this change started in summer 2014 with the incoming pharmacy residency class. A brief presentation of the course and expectations for lectures was provided to residents during the Butler University College of Pharmacy and Health Sciences longitudinal teaching program orientation. Interest in participation was elicited through teaching experience preference surveys. Lecture preference was provided to residents with split co-funding from the college of pharmacy and local healthcare systems, followed by non-cofunded PGY2 residents, then finally post-graduate year one (PGY1) residents. Residents participating in the course were held to contract standards for successful completion of the university longitudinal teaching program. Additionally, all residents in this program had either completed, or were in the process of completing the Indiana pharmacy teaching certificate program.9 As part of the program, residents are required to deliver two separate classroom lectures or educational sessions that are at least 60 min, participate in 15 hours of precepting activities, and develop a teaching portfolio. Teaching in the DID elective was one of many different opportunities available that allowed residents to fulfill part of the didactic teaching requirement. This forum provided the unique opportunity to practice developing active learning activities during a lecture, which may have appealed to residents. Course coordinators chose to offer all but three lectures to residents to allow for resident observation of lectures. Each resident selected preferred topics to lecture on that had been part of the course's original lecture list. Residents were expected to attend one class led by faculty at the beginning of the semester to obtain an idea of flow and global expectations for class session format. Each resident was partnered with a course coordinator to serve as a mentor for their class session. This involved guidance with selecting readings, creating new learning objectives, developing unique lecture outlines and handouts, and planning active learning activities. In addition to these course coordinator mentors, residents could consult their formal teaching certificate program mentors, although this was not required. Course coordinators provided comprehensive lecture mentorship for the residents. An individualized approach was taken for the mentoring of each resident. No defined checklist was developed; however, residents received the same preliminary information about the lectures. Each lecture was unique and developed by the residents for this specific course. Open lines of communication were kept between the course coordinators, residents, and residents’ program directors to ensure deadlines were being met and that residents could keep their commitment. Following completion of the assigned lectures, residents verbally selfassessed the lecture, student engagement, and their performance with the course coordinators. Additionally, each resident received verbal feedback from all course coordinators and written feedback, utilizing the teaching certificate evaluation tool, from the assigned mentor as well as written feedback from students. Student roles in the course did not change with the intervention, except for resident feedback provision. Assessment strategies remained the same and included assignments, quizzes, and oral case-based presentations. Course faculty remained responsible for course grades, although resident participants helped create and provide feedback on assignments and quizzes. The emphasis on active learning and classroom engagement also persisted. 2
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Table 1 Learning outcomes. Student Learning Outcomes Apply knowledge and skills to make appropriate decisions regarding the safe and effective use of medications or the need for referral to other health care providers. These decisions should include consideration of social, economic and cultural factors. Find, understand, analyze, evaluate and use information to make informed and rational decisions. Effectively communicate pharmaceutical and health-related information and collaborate with other healthcare professionals to ensure the provision of quality patient care. Practice independent learning and modify ideas and behaviors based on newly acquired knowledge. Demonstrate ethical conduct in personal and professional settings and respect and exhibit empathy for patients’ differences, values, and preferences. Promote health improvement, wellness, and disease prevention. Course Learning Objectives Interpret and evaluate various patient case scenarios for a possible identification of a drug induced disease. Explain the mechanism and rationale for specific medication classes inducing selected disease states. Understand and explain the pathophysiology of selected disease states. Identify appropriate criteria for alteration versus continuation of offending medication. Create and verbally communicate patient cases to other students and instructors. Expand verbal communication skills with both patients and health care professionals. Utilize drug knowledge from previous courses (Therapeutics, Self-care, etc.) in order to further develop the working drug knowledge base of the student.
Objectives and evaluation The primary objective of this intervention was to continue providing a quality elective course to students that allowed them to develop their critical thinking and communication skills while providing a variety of teaching styles in the classroom. Student learning outcomes as determined by the college and course learning objectives (Table 1) as determined by course faculty remained the same during fall 2014 even though the methods used to integrate residents varied from previous years. To assess continued course quality, both student learning and course satisfaction was measured and compared from the fall 2013 (control) semester to the fall 2014 (intervention) semester. Student learning was assessed via mean course grades, which included case-based presentations, quizzes, assignments, and participation points, as the course grading scheme did not change between years. To determine consistency in student course satisfaction, standard end of course evaluations for the university through the IDEA service, Student Ratings of Instruction System (SRI), were compared.10 Students utilize a standard IDEA form to assess teaching effectiveness through evaluation of 20 teaching methods, 12 learning objectives, two measures rating the instructor as an excellent teacher and course as excellent, and lastly providing open comments. Additional objectives included to increase the diversity of course lectures, increase student exposure to pharmacy residents, and provide residents an opportunity to develop a lecture with an emphasis on creativity and active learning. A final objective included allowing faculty coordinators to transition from a primary lecturing role to a mentoring role within the course. To assess resident teaching, qualitative resident lecturer feedback was solicited from students immediately following their class via an anonymous survey. Students received evaluation points towards their final grade for completion of this activity, which was different from previous years in that it replaced some course participation points. After each session, it was reinforced to the students that the residents were seeking constructive feedback. Additionally, students were notified that they would be awarded points regardless of the nature of their responses. Each survey contained the following wording and short answer questions: “This is an anonymous way for you to provide feedback to the resident regarding their lecture. Please provide constructive feedback regarding one thing about the lecture that went well or was beneficial and one potential area of improvement. Once the feedback is completed points will be applied to your assessment grade. We welcome your feedback and will work to incorporate changes as appropriate. 1. Please provide one area that the resident excelled at: 2. Please provide one area of improvement for the resident:” Statistical analysis Mean course grades and individual category grades (case-based exams, quizzes/assignments, and participation points) were compared from the fall 2013 semester to the fall 2014 semester using the independent samples t-test. Overall course evaluation and selected questions related to course objectives for fall 2013 and fall 2014 were compared using the Mann-Whitney U test. Statistical analysis was completed using SPSSv22. This study was approved by the university's institutional review board. Findings Eight residents were scheduled to teach eight of 11 classes during the semester with faculty course coordinators teaching the remaining three lectures. Two PGY2 residents scheduled to lecture had to withdraw based on overall performance and changing 3
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Table 2 Course schedule. Date
Topic
Leader
Class 1
Introduction/Factors Contributing to Drug Induced Disease and Drug Allergy vs. Pseudoallergy Class 2 Heart Failure **QUIZ** Class 3 Temperature Dysregulation **ASSIGNMENT** Class 4 Blood Pressure Alterations Class 5 Cognitive Disorders **QUIZ** Exam Exam 1 Class 6 Acute Kidney Injury **ASSIGNMENT** Class 7 Psychiatric Disorders Class 8 Endocrine Disorders Class 9 Diarrhea & Constipation **QUIZ** Exam Exam 2 Class 10 Musculoskeletal Disorders **QUIZ** Class 11 Anemia and Thrombocytopenia Exam Exam 3
Faculty/PGY2 Pharmacotherapy Faculty PGY2 Pharmacotherapy Faculty PGY2 Ambulatory Care – PGY1 Pharmacotherapy PGY2 Psychiatric PGY1 Pharmacy Practice/PGY1 Pharmacy Practice (co-lecture) PGY2 Pharmacotherapy /PGY1 Pharmacotherapy (co-lecture) – Faculty PGY2 Pharmacotherapy –
PGY2= Post-graduate year two; PGY1=Post-graduate year one
priorities within their programs. A faculty member lectured on one of the open lecture dates and two residents already involved delivered the remaining lecture as a team. Ultimately, six residents taught seven lectures within the course. Table 2 provides a layout of lecture topics, lecturers, and general course schedule. As per course requirements, residents provided highly interactive classes. Examples of student activities created by residents throughout the semester varied from previous years and included interactive drug information questions, Bristol Stool Scale grading with “stool samples” made from household materials, an educational version of Family Feud, taste-tests of over-the-counter products, progressive cases with interactive patients, educational debates, and acting out drug mechanisms through skits. The DID elective enrolled 12 students in fall 2013 and 14 students in fall 2014. Overall course grades and individual oral casebased presentation grades did not significantly differ from the control course in 2013 to the intervention course in 2014. There was also no difference in other quiz and assignment grades. A summary of course grades, individual case-based presentation grades, and other quiz and assignment grades are highlighted in Table 3. Regarding course evaluations, IDEA scores of progress on relevant objectives and on overall excellent course were similar between fall 2013 and fall 2014 (Table 4). Student free text comments were also reviewed related to pharmacy resident contributions to the course (Table 5). Overall, the course was well received with the inclusion of pharmacy residents. In addition to formally evaluating the course via IDEA forms, students also evaluated resident teaching as previously described. Specific feedback comments for residents is included in Table 6. Discussion To our knowledge, this is one of the few primarily pharmacy resident-led courses described in the literature, and the only one described that incorporates additional active learning strategies other than cases by multiple residents. Transitioning pharmacy residents into primary teaching roles in the DID elective allowed for increased student exposure to residents and a variety of teaching styles. Course instruction remained interactive and students appreciated the opportunity to interact with pharmacy residents from different healthcare systems. Throughout the course, students were exposed to unique teaching styles and a variety of active learning techniques during the seven resident-led lectures. From a student standpoint, they could relate to residents as they were typically closer in age and graduation dates. They enjoyed the variability in teaching styles and active learning opportunities which reflected the diverse background and training from the group of residents. Throughout the semester, students actively participated in a wide variety of active learning activities, which helped keep students engaged and excited about class. Table 3 Course grades. Graded item
Fall 2013 mean grade (percent ± SD)
Fall 2014 mean grade (percent ± SD)
p-value
Case-based presentation 1 (possible 50 points) Case-based presentation 2 (possible 50 points) Case-based presentation 3 (possible 50 points) Quizzes/Assignments (possible 25 points) Participation, assessment, and evaluation points (possible 40 points) Overall course grade (possible 215 points)
93.1 ± 3.5 94.9 ± 2.9 90.6 ± 7.1 94.5 ± 4.5 98.7 ± 3.6
93.1 ± 3.4 92.4 ± 4.8 92.4 ± 2.6 95.1 ± 3.7 99.3 ± 1.2
0.329 0.115 0.946 0.750 0.547
94.1 ± 2.7
94.2 ± 3.6
0.975
SD=standard deviation
4
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Table 4 DID course evaluation.
Overall, I rate this course as excellent. Objective: Learning to apply course material (to improve thinking, problem solving, and decisions Objective: Learning how to find and use resources for answering or solving problems
Fall 2013 median (IQR)
Fall 2014 median (IQR)
p-value
5 (4.25-5) 5 (4-5)
5 (4-5) 5 (4-5)
0.667 0.860
5 (5-5)
4 (4-5)
0.374
IQR= Interquartile Range; DID=Drug-induced diseases Learning Objective Rating Scale: 1= No apparent progress, 2= Slight progress; I made small gains on this objective, 3= Moderate progress; I made some gains on this objective, 4= Substantial progress; I made large gains on this objective, 5= Exceptional progress; I made outstanding gains on this objective Excellent Course Rating Scale: 1= definitely false, 2= more false than true, 3= in between, 4= more true than false, 5= definitely true
Student satisfaction in the course is reflected in course evaluations and resident feedback, though this could have been potentially influenced by the fact that students received points for providing resident feedback. We attempted to minimize this by keeping feedback anonymous and reinforced that constructive feedback was welcome. Comments not only represent course satisfaction, but also the students' ability to provide real-time feedback, an important skill. Residents highly valued the students’ feedback to help develop their teaching skills. Course evaluations reflected the same satisfaction represented in resident feedback as there was no change from previous years. Additionally, there was no statistically significant difference in any course grades during the resident-led year, suggesting no change in overall student learning. From a resident standpoint, this course provided an opportunity to improve various skills, including development and incorporation of active learning strategies. These skills are especially important for residents seeking positions in academia and will undoubtedly be utilized in future faculty roles. In a survey conducted by Stewart et al.,11 the authors observed that active learning strategies are commonly (87%) employed by faculty members and younger faculty are more likely to incorporate active learning in their classrooms. In the DID elective, multiple residents had the opportunity to receive feedback on their implementation of active learning strategies. Given the wide use of active learning among faculty members, receiving feedback as a trainee is beneficial. Additionally, participants gained skills including flexibility and adaptability, innovation through case and activity development, rephrasing questions based on student responses, reacting quickly to unexpected answers, self-assessment, and soliciting participation of students when their concentration is slipping. Creating a lesson plan for the class also served as a great way to enhance time management skills as class preparation began weeks in advance. Finally, this change offered a unique opportunity for faculty members to serve primarily as a course coordinator and mentor for residents, resulting in a smaller teaching time commitment compared with previous years. Many of the residents that participated in the course had a baseline interest or experience with teaching in the classroom setting. Although time was still spent mentoring residents and attending class, less time was spent on actual preparation. Although this provided neutral results in relation to time commitment, this reallocation of time allowed faculty to transition from the role of lecturer to mentor, a necessary change to make this intervention successful. Taking on mentoring roles proved to be an enriching experience for course faculty. The transition of the DID elective to a primarily resident-led course was easy to accomplish. There are many residents in the surrounding metropolitan area, several of which are co-funded by colleges of pharmacy. Soliciting interest was straightforward and involved emailing program directors and announcing the opportunity at the longitudinal teaching program orientation. There was a large amount of interest in participation, so much that there was not availability for some residents to participate in the course. Selecting residents to teach could be based on several factors; however, we gave priority to PGY2 and co-funded residents. Incorporating this model into other courses should be relatively simple; however, certain obstacles may arise and should be considered. One possible barrier to implementing this initiative at another college is the number of residents it requires to execute. A balance in the number of lectures in the semester and number of interested residents is necessary. Additionally, time for adequate mentoring must be provided to ensure residents provide high-quality instruction. Programs that do not offer a teaching certificate may encounter additional mentoring challenges if residents do not have prior teaching experience. Conversely, many schools or colleges of pharmacy are associated with large academic medical centers and offer teaching certificate programs or teaching opportunities for residents. In these cases, it is likely that there would be enough interested residents. Integrating residents into college of pharmacy courses is straightforward from the standpoint of scheduling and course coordination. Although course modifications proved successful and rewarding, changing to a primarily resident-led course was not without challenges. With numerous residents committed to lecture periods, there was a greater margin for error. For example, during the
Table 5 DID student IDEA course comments related to pharmacy residents. Student
Comment
1 2 3
“I liked the idea of having different residents teach, but some were not very confident or did not hold attention of the class.” “I also liked the variety of being taught by different faculty members and residents.” “Debate class was the best of all, the [PGY1 Pharmacotherapy]/[PGY2 Pharmacotherapy Resident's] diarrhea/constipation [class].”
PGY1= Post-graduate year one; PGY2=Post-graduate year two; DID=Drug-induced diseases
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Table 6 Student evaluations of resident teaching. Please provide one area that the resident excelled at: “[The resident] did a really great job emphasizing the important points for each of the causes of hyperthermia that we covered. Sometimes it can be overwhelming when we get a lot of new information at once, and I really appreciated her repeating the important points at the end to really bring it all together. She also did a good job of being helpful in assisting us with finding the answers on our own without being condescending or just giving us the answers.” “I thought the [drug information (DI)] activity was great. DI is something I really don't enjoy, but something I need work in. She picked difficult questions that didn't necessarily have a straight answer and required a lot of searching and how to ‘correctly word’ in PubMed search bar. She was very helpful in showing us where to look & explaining to extrapolate.” “I really enjoyed this class. The kidney is very complicated and I thought he did a great job explaining. I really enjoyed his drawing of the nephron and showing where these drugs are actually causing the issues.” “You presented the information well and organized the class so that it wasn't boring. I enjoyed the game a lot; it was fun and a good summary of what we have learned today. The class in general was one of the favorites of the semester.” Please provide one area of improvement for the resident: “At times, she talked too fast and it was difficult for me to keep up with the discussion while also typing notes. This did not happen too often, but when presenting lots of new information to students, keep in mind that they need time to absorb it.” “The group work projects were pretty short and easy– maybe have more complex patient cases where we find alternatives instead of just finding which medications were potential causes for delirium. Overall, [the resident] did a great job though!” “The lecture could have been broken up with maybe one more activity because going through all the different types of kidney injury was a little bit exhausting without a break. I was really excited to finally get to the patient cases.” “[The resident] could improve on encouraging students to speak up and engage in class discussions without giving students the answer.”
semester two residents were unable to fulfill the time commitment necessary to complete their lecture. Because of constant contact with residents and their program directors, this challenge was identified and resolved early in the semester. Continuous discussion with the residents and their program directors is necessary to ensure that withdrawal from lecturing is preplanned and timely. In this case a faculty member and the two residents closely involved with the course prepared and led the remaining lectures. It is important to have support from residents’ program directors as well as continuous communication surrounding residents’ goals and progress. Residency program directors are generally supportive of these activities provided they can balance responsibilities at their practice site.12 Back-up plans should exist for unplanned situations such as resident inability to complete requirements. An additional challenge included having multiple residents with different teaching styles leading class. Although this provided course diversity, there was the potential for inconsistency in class that may have been frustrating for students. Some residents taught from a handout or slides whereas others led a discussion-based class without additional materials. Certain residents asked many questions of students throughout class to facilitate learning, while others only asked preplanned questions at set points. Additionally, the level of comfort leading class varied, as indicated by student feedback. Though sometimes confusing, these differences in teaching styles encouraged students to adapt to a wide variety of teaching methods that they will continue to encounter throughout their careers. Although the change to a primarily resident-led course resulted in similar course grades and evaluations, there are some considerations. The use of two different student cohorts can be a challenging comparison. However, the same faculty completed grading for oral case-based presentations via an identical rubric during 2013 and 2014, potentially alleviating any inflation of grades. Differences in perceptions inherent to each student cohort could have influenced results of course evaluations. However, the evaluation form and directions on how to fill them out did not change from 2013 to 2014, keeping the process as consistent as possible. We have developed a plan for future improvements to the course based on our first year of experience. Modifications include limiting lecture opportunities to college of pharmacy co-funded residents. These residents typically have a greater interest in teaching, have direct connections to course coordinators through residency program directors, and may have more accountability being part of a co-funded residency program. Lecture opportunities could also be given to residents from programs with strong or longstanding relationships with the school or college. To address suggestions from residents and students in the course, we have considered developing a template for lecture format to increase consistency among class periods. In addition, we have incorporated a formal written document containing clear expectations to hold residents more accountable and to disclose what the responsibility entails prior to committing.
Summary This pharmacy resident-led DID elective allowed for resident integration into a highly interactive elective course. Student satisfaction with the course remained similar to previous years and overall course grades remained unchanged. Students developed real-time feedback skills and noted an appreciation for resident interaction. The development of this resident-led course offered a unique opportunity for residents and faculty members to diversify their roles, responsibilities, and skillset and would be easily transferable to other programs.
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Conflicts of interest None. Financial disclosures None. References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
Beardsley R, Matzke GR, Rospond R, et al. Factors influencing the pharmacy faculty workforce. Am J Pharm Educ. 2008;72(2):Article 34. Aistrope DS, Attridge RT, Bickley AR, et al. Strategies for developing pharmacy residents as educators. Pharmacotherapy. 2011;31(5):e65–e70. Havrda DE, Engle JP, Anderson KC, et al. Guidelines for resident teaching experiences. Pharmacotherapy. 2013;33(7):e147–e161. Engle JP, Erstad BL, Anderson DC, et al. Minimum qualifications for clinical pharmacy practice faculty. Pharmacotherapy. 2014;34(5):e38–e44. American Society of Health-System Pharmacists. Residency accreditation. Available at: 〈https://www.ashp.org/Professional-Development/ResidencyInformation/Residency-Program-Directors/Residency-Accreditation〉. Accessed June 8, 2017. Messinger NJ, Buring SM. Development of an ambulatory care pharmacy elective by a second-year pharmacy resident. Curr Pharm Teach Learn. 2015;7(5):676–683. Zapantis A, Singh-Franco D. Elective course for pharmacy students on practice-based learning taught by pharmacy residents and fellows. Am J Health Syst Pharm. 2013;70(8):658–660. Walton AM, Isaacs AN, McFarland AT, Czosnowski L, Nisly SA. Design of a drug-induced diseases elective utilizing active learning. Curr Pharm Teach Learn. 2016;8(1):90–95. Gonzalvo JD, Ramsey DC, Sheehan AH, Sprunger TL. Redesign of a statewide teaching certificate program for pharmacy residents. Am J Pharm Educ. 2013;77(4):Article 79. IDEA Student Ratings of Instruction. Available at: 〈http://www.ideaedu.org/services/student-ratings-of-instruction〉. Accessed June 8, 2017. Stewart DW, Brown SD, Clavier CW, Wyatt J. Active-learning processes used in US pharmacy education. Am J Pharm Educ. 2011;75(4):Article 68. Korte C, Smith A, Pace H. Residency program directors' view on the value of teaching. J Pharm Pract. 2016;29(4):415–420.
7
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Experiences in Teaching and Learning
Pharmacy residents as primary educators within a professional pharmacy elective ⁎
Meredith L. Howarda, , Taylor D. Steuberb, Alison M. Waltonc, Sarah A. Nislyd a
University of North Texas System College of Pharmacy, 3500 Camp Bowie Blvd., RES 435D, Fort Worth, TX 76107, United States Auburn University Harrison School of Pharmacy, 301 Governors Drive SW, Suite 357, Huntsville, AL 35801, United States Butler University College of Pharmacy and Health Sciences, 4600 Sunset Ave., Indianapolis, IN 46208, United States d Wingate University School of Pharmacy, 220 N Camden Rd, Wingate, NC 28174, United States b c
AR TI CLE I NF O
AB S T R A CT
Keywords: Residency training Professional elective Teaching
Background and purpose: The purpose of this study was to evaluate the impact of a course change from a faculty-led professional pharmacy elective to a primarily pharmacy resident-led course on student satisfaction and learning. Educational activity and setting: In 2014, pharmacy residents were transitioned into primary teaching roles in a drug-induced diseases elective to increase student exposure to residents and different teaching styles. Student learning roles did not change. Course evaluations and grades were compared between the resident-led year and prior year. Findings: There was no significant difference between overall course grades during the residentled year (94.2 ± 36.6 in 2014 vs. 94.1 ± 2.7 in 2013; p=0.975). Course evaluations were similar to the previous year and students provided favorable feedback. Discussion and summary: This pharmacy resident-led elective allowed for resident integration in to an interactive professional elective. Student satisfaction with the course remained similar to the previous year and overall course grades did not differ.
Background and purpose Teaching experiences, both didactic and experiential, are important components of residency programs. A growing number of available faculty positions and increased need for clinical faculty preceptors may prompt residents to pursue careers in academia or careers with substantial teaching components.1 Preparation strategies for residents include completion of teaching and learning certificate programs, participation in experiential precepting, and engagement within the classroom.2 To assist in the transition, the American College of Clinical Pharmacy (ACCP) has published commentaries and guidelines to help residents prepare for academic life. In 2011, one ACCP commentary laid a foundation for appropriate teaching experiences and suggested techniques for implementation.2 Use of self-assessment and reflections was noted as an important component of any teaching experience. Building on the 2011 framework, ACCP published guidelines for resident teaching experiences in 2013.3 These comprehensive guidelines provide expectations in setting goals, delivering lectures, small group facilitation, precepting, and teaching certificate standards. Most recently, ACCP has published minimum qualifications for clinical faculty, addressing residency training, certifications, and prior teaching experiences.4 Finally, the American Society of Health-System Pharmacists (ASHP) 2014 residency Accreditation Standards include a competency area in teaching, education, and dissemination of knowledge.5
⁎
Corresponding author. E-mail addresses: [email protected] (M.L. Howard), [email protected] (T.D. Steuber), [email protected] (A.M. Walton), [email protected] (S.A. Nisly). http://dx.doi.org/10.1016/j.cptl.2017.05.017
1877-1297/ © 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Howard, M.L., Currents in Pharmacy Teaching and Learning (2017), http://dx.doi.org/10.1016/j.cptl.2017.05.017
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
M.L. Howard et al.
Taken in sum, the importance of teaching experiences during residency training is evident, as is the need for structured mentoring and thoughtful preparation. To date, organized incorporation of pharmacy residents into a curricular course as primary educators has not been extensively described or evaluated. Messinger et al.6 described the development of a new ambulatory care professional elective by a post-graduate year two (PGY2) pharmacy resident. This elective was met with a favorable student response and improvement in ambulatory care knowledge via pre- and post-surveys. Unfortunately, as a new elective, there were no previous years with which to compare the elective and only one resident was involved in the course. Additionally, a letter to the editor by Zapantis et al.7 discussed successful incorporation of postgraduate trainees into an elective case-based classroom. Although this initiative was successful, it did not address residents or fellows serving in primary teaching roles beyond that of a discussion leader. Many pharmacy residents are interested in becoming involved with teaching. Additionally, many residents possess the fundamental tools to integrate into primary teaching roles within a pharmacy elective, such as knowledge base, presentation skills, and classroom engagement. Unfortunately, there is limited information on how pharmacy students’ perceptions and learning would respond to this technique. We present the transition of a faculty-led professional pharmacy elective to a primarily pharmacy residentled course and evaluate its impact on student satisfaction and learning. We also discuss the individual mentoring and development of pharmacy residents as primary educators within the course. Educational activity and setting Course design Drug-induced diseases (DID) is an elective three-credit hour course offered for third professional year (P3) pharmacy students each fall semester at Butler University College of Pharmacy and Health Sciences. The course meets once a week for three hours. This elective provides students exposure to common and relevant adverse reactions, focusing on identification of the responsible medication and subsequent alteration of the original treatment plan. It is a highly interactive course with a deep focus on student engagement and active learning that has been described previously.8 In addition to two consistent faculty co-coordinators, a PGY2 pharmacotherapy resident who is co-funded by both the college of pharmacy and a local healthcare system has served as a course coordinator each year for the past five years. Historically, most lectures were taught by these individuals. Intervention In fall 2014, pharmacy resident teaching within the course was increased based on student feedback from prior course evaluations and to provide the opportunity for residents to develop teaching skills in a small group setting. Implementation of this change started in summer 2014 with the incoming pharmacy residency class. A brief presentation of the course and expectations for lectures was provided to residents during the Butler University College of Pharmacy and Health Sciences longitudinal teaching program orientation. Interest in participation was elicited through teaching experience preference surveys. Lecture preference was provided to residents with split co-funding from the college of pharmacy and local healthcare systems, followed by non-cofunded PGY2 residents, then finally post-graduate year one (PGY1) residents. Residents participating in the course were held to contract standards for successful completion of the university longitudinal teaching program. Additionally, all residents in this program had either completed, or were in the process of completing the Indiana pharmacy teaching certificate program.9 As part of the program, residents are required to deliver two separate classroom lectures or educational sessions that are at least 60 min, participate in 15 hours of precepting activities, and develop a teaching portfolio. Teaching in the DID elective was one of many different opportunities available that allowed residents to fulfill part of the didactic teaching requirement. This forum provided the unique opportunity to practice developing active learning activities during a lecture, which may have appealed to residents. Course coordinators chose to offer all but three lectures to residents to allow for resident observation of lectures. Each resident selected preferred topics to lecture on that had been part of the course's original lecture list. Residents were expected to attend one class led by faculty at the beginning of the semester to obtain an idea of flow and global expectations for class session format. Each resident was partnered with a course coordinator to serve as a mentor for their class session. This involved guidance with selecting readings, creating new learning objectives, developing unique lecture outlines and handouts, and planning active learning activities. In addition to these course coordinator mentors, residents could consult their formal teaching certificate program mentors, although this was not required. Course coordinators provided comprehensive lecture mentorship for the residents. An individualized approach was taken for the mentoring of each resident. No defined checklist was developed; however, residents received the same preliminary information about the lectures. Each lecture was unique and developed by the residents for this specific course. Open lines of communication were kept between the course coordinators, residents, and residents’ program directors to ensure deadlines were being met and that residents could keep their commitment. Following completion of the assigned lectures, residents verbally selfassessed the lecture, student engagement, and their performance with the course coordinators. Additionally, each resident received verbal feedback from all course coordinators and written feedback, utilizing the teaching certificate evaluation tool, from the assigned mentor as well as written feedback from students. Student roles in the course did not change with the intervention, except for resident feedback provision. Assessment strategies remained the same and included assignments, quizzes, and oral case-based presentations. Course faculty remained responsible for course grades, although resident participants helped create and provide feedback on assignments and quizzes. The emphasis on active learning and classroom engagement also persisted. 2
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Table 1 Learning outcomes. Student Learning Outcomes Apply knowledge and skills to make appropriate decisions regarding the safe and effective use of medications or the need for referral to other health care providers. These decisions should include consideration of social, economic and cultural factors. Find, understand, analyze, evaluate and use information to make informed and rational decisions. Effectively communicate pharmaceutical and health-related information and collaborate with other healthcare professionals to ensure the provision of quality patient care. Practice independent learning and modify ideas and behaviors based on newly acquired knowledge. Demonstrate ethical conduct in personal and professional settings and respect and exhibit empathy for patients’ differences, values, and preferences. Promote health improvement, wellness, and disease prevention. Course Learning Objectives Interpret and evaluate various patient case scenarios for a possible identification of a drug induced disease. Explain the mechanism and rationale for specific medication classes inducing selected disease states. Understand and explain the pathophysiology of selected disease states. Identify appropriate criteria for alteration versus continuation of offending medication. Create and verbally communicate patient cases to other students and instructors. Expand verbal communication skills with both patients and health care professionals. Utilize drug knowledge from previous courses (Therapeutics, Self-care, etc.) in order to further develop the working drug knowledge base of the student.
Objectives and evaluation The primary objective of this intervention was to continue providing a quality elective course to students that allowed them to develop their critical thinking and communication skills while providing a variety of teaching styles in the classroom. Student learning outcomes as determined by the college and course learning objectives (Table 1) as determined by course faculty remained the same during fall 2014 even though the methods used to integrate residents varied from previous years. To assess continued course quality, both student learning and course satisfaction was measured and compared from the fall 2013 (control) semester to the fall 2014 (intervention) semester. Student learning was assessed via mean course grades, which included case-based presentations, quizzes, assignments, and participation points, as the course grading scheme did not change between years. To determine consistency in student course satisfaction, standard end of course evaluations for the university through the IDEA service, Student Ratings of Instruction System (SRI), were compared.10 Students utilize a standard IDEA form to assess teaching effectiveness through evaluation of 20 teaching methods, 12 learning objectives, two measures rating the instructor as an excellent teacher and course as excellent, and lastly providing open comments. Additional objectives included to increase the diversity of course lectures, increase student exposure to pharmacy residents, and provide residents an opportunity to develop a lecture with an emphasis on creativity and active learning. A final objective included allowing faculty coordinators to transition from a primary lecturing role to a mentoring role within the course. To assess resident teaching, qualitative resident lecturer feedback was solicited from students immediately following their class via an anonymous survey. Students received evaluation points towards their final grade for completion of this activity, which was different from previous years in that it replaced some course participation points. After each session, it was reinforced to the students that the residents were seeking constructive feedback. Additionally, students were notified that they would be awarded points regardless of the nature of their responses. Each survey contained the following wording and short answer questions: “This is an anonymous way for you to provide feedback to the resident regarding their lecture. Please provide constructive feedback regarding one thing about the lecture that went well or was beneficial and one potential area of improvement. Once the feedback is completed points will be applied to your assessment grade. We welcome your feedback and will work to incorporate changes as appropriate. 1. Please provide one area that the resident excelled at: 2. Please provide one area of improvement for the resident:” Statistical analysis Mean course grades and individual category grades (case-based exams, quizzes/assignments, and participation points) were compared from the fall 2013 semester to the fall 2014 semester using the independent samples t-test. Overall course evaluation and selected questions related to course objectives for fall 2013 and fall 2014 were compared using the Mann-Whitney U test. Statistical analysis was completed using SPSSv22. This study was approved by the university's institutional review board. Findings Eight residents were scheduled to teach eight of 11 classes during the semester with faculty course coordinators teaching the remaining three lectures. Two PGY2 residents scheduled to lecture had to withdraw based on overall performance and changing 3
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Table 2 Course schedule. Date
Topic
Leader
Class 1
Introduction/Factors Contributing to Drug Induced Disease and Drug Allergy vs. Pseudoallergy Class 2 Heart Failure **QUIZ** Class 3 Temperature Dysregulation **ASSIGNMENT** Class 4 Blood Pressure Alterations Class 5 Cognitive Disorders **QUIZ** Exam Exam 1 Class 6 Acute Kidney Injury **ASSIGNMENT** Class 7 Psychiatric Disorders Class 8 Endocrine Disorders Class 9 Diarrhea & Constipation **QUIZ** Exam Exam 2 Class 10 Musculoskeletal Disorders **QUIZ** Class 11 Anemia and Thrombocytopenia Exam Exam 3
Faculty/PGY2 Pharmacotherapy Faculty PGY2 Pharmacotherapy Faculty PGY2 Ambulatory Care – PGY1 Pharmacotherapy PGY2 Psychiatric PGY1 Pharmacy Practice/PGY1 Pharmacy Practice (co-lecture) PGY2 Pharmacotherapy /PGY1 Pharmacotherapy (co-lecture) – Faculty PGY2 Pharmacotherapy –
PGY2= Post-graduate year two; PGY1=Post-graduate year one
priorities within their programs. A faculty member lectured on one of the open lecture dates and two residents already involved delivered the remaining lecture as a team. Ultimately, six residents taught seven lectures within the course. Table 2 provides a layout of lecture topics, lecturers, and general course schedule. As per course requirements, residents provided highly interactive classes. Examples of student activities created by residents throughout the semester varied from previous years and included interactive drug information questions, Bristol Stool Scale grading with “stool samples” made from household materials, an educational version of Family Feud, taste-tests of over-the-counter products, progressive cases with interactive patients, educational debates, and acting out drug mechanisms through skits. The DID elective enrolled 12 students in fall 2013 and 14 students in fall 2014. Overall course grades and individual oral casebased presentation grades did not significantly differ from the control course in 2013 to the intervention course in 2014. There was also no difference in other quiz and assignment grades. A summary of course grades, individual case-based presentation grades, and other quiz and assignment grades are highlighted in Table 3. Regarding course evaluations, IDEA scores of progress on relevant objectives and on overall excellent course were similar between fall 2013 and fall 2014 (Table 4). Student free text comments were also reviewed related to pharmacy resident contributions to the course (Table 5). Overall, the course was well received with the inclusion of pharmacy residents. In addition to formally evaluating the course via IDEA forms, students also evaluated resident teaching as previously described. Specific feedback comments for residents is included in Table 6. Discussion To our knowledge, this is one of the few primarily pharmacy resident-led courses described in the literature, and the only one described that incorporates additional active learning strategies other than cases by multiple residents. Transitioning pharmacy residents into primary teaching roles in the DID elective allowed for increased student exposure to residents and a variety of teaching styles. Course instruction remained interactive and students appreciated the opportunity to interact with pharmacy residents from different healthcare systems. Throughout the course, students were exposed to unique teaching styles and a variety of active learning techniques during the seven resident-led lectures. From a student standpoint, they could relate to residents as they were typically closer in age and graduation dates. They enjoyed the variability in teaching styles and active learning opportunities which reflected the diverse background and training from the group of residents. Throughout the semester, students actively participated in a wide variety of active learning activities, which helped keep students engaged and excited about class. Table 3 Course grades. Graded item
Fall 2013 mean grade (percent ± SD)
Fall 2014 mean grade (percent ± SD)
p-value
Case-based presentation 1 (possible 50 points) Case-based presentation 2 (possible 50 points) Case-based presentation 3 (possible 50 points) Quizzes/Assignments (possible 25 points) Participation, assessment, and evaluation points (possible 40 points) Overall course grade (possible 215 points)
93.1 ± 3.5 94.9 ± 2.9 90.6 ± 7.1 94.5 ± 4.5 98.7 ± 3.6
93.1 ± 3.4 92.4 ± 4.8 92.4 ± 2.6 95.1 ± 3.7 99.3 ± 1.2
0.329 0.115 0.946 0.750 0.547
94.1 ± 2.7
94.2 ± 3.6
0.975
SD=standard deviation
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Table 4 DID course evaluation.
Overall, I rate this course as excellent. Objective: Learning to apply course material (to improve thinking, problem solving, and decisions Objective: Learning how to find and use resources for answering or solving problems
Fall 2013 median (IQR)
Fall 2014 median (IQR)
p-value
5 (4.25-5) 5 (4-5)
5 (4-5) 5 (4-5)
0.667 0.860
5 (5-5)
4 (4-5)
0.374
IQR= Interquartile Range; DID=Drug-induced diseases Learning Objective Rating Scale: 1= No apparent progress, 2= Slight progress; I made small gains on this objective, 3= Moderate progress; I made some gains on this objective, 4= Substantial progress; I made large gains on this objective, 5= Exceptional progress; I made outstanding gains on this objective Excellent Course Rating Scale: 1= definitely false, 2= more false than true, 3= in between, 4= more true than false, 5= definitely true
Student satisfaction in the course is reflected in course evaluations and resident feedback, though this could have been potentially influenced by the fact that students received points for providing resident feedback. We attempted to minimize this by keeping feedback anonymous and reinforced that constructive feedback was welcome. Comments not only represent course satisfaction, but also the students' ability to provide real-time feedback, an important skill. Residents highly valued the students’ feedback to help develop their teaching skills. Course evaluations reflected the same satisfaction represented in resident feedback as there was no change from previous years. Additionally, there was no statistically significant difference in any course grades during the resident-led year, suggesting no change in overall student learning. From a resident standpoint, this course provided an opportunity to improve various skills, including development and incorporation of active learning strategies. These skills are especially important for residents seeking positions in academia and will undoubtedly be utilized in future faculty roles. In a survey conducted by Stewart et al.,11 the authors observed that active learning strategies are commonly (87%) employed by faculty members and younger faculty are more likely to incorporate active learning in their classrooms. In the DID elective, multiple residents had the opportunity to receive feedback on their implementation of active learning strategies. Given the wide use of active learning among faculty members, receiving feedback as a trainee is beneficial. Additionally, participants gained skills including flexibility and adaptability, innovation through case and activity development, rephrasing questions based on student responses, reacting quickly to unexpected answers, self-assessment, and soliciting participation of students when their concentration is slipping. Creating a lesson plan for the class also served as a great way to enhance time management skills as class preparation began weeks in advance. Finally, this change offered a unique opportunity for faculty members to serve primarily as a course coordinator and mentor for residents, resulting in a smaller teaching time commitment compared with previous years. Many of the residents that participated in the course had a baseline interest or experience with teaching in the classroom setting. Although time was still spent mentoring residents and attending class, less time was spent on actual preparation. Although this provided neutral results in relation to time commitment, this reallocation of time allowed faculty to transition from the role of lecturer to mentor, a necessary change to make this intervention successful. Taking on mentoring roles proved to be an enriching experience for course faculty. The transition of the DID elective to a primarily resident-led course was easy to accomplish. There are many residents in the surrounding metropolitan area, several of which are co-funded by colleges of pharmacy. Soliciting interest was straightforward and involved emailing program directors and announcing the opportunity at the longitudinal teaching program orientation. There was a large amount of interest in participation, so much that there was not availability for some residents to participate in the course. Selecting residents to teach could be based on several factors; however, we gave priority to PGY2 and co-funded residents. Incorporating this model into other courses should be relatively simple; however, certain obstacles may arise and should be considered. One possible barrier to implementing this initiative at another college is the number of residents it requires to execute. A balance in the number of lectures in the semester and number of interested residents is necessary. Additionally, time for adequate mentoring must be provided to ensure residents provide high-quality instruction. Programs that do not offer a teaching certificate may encounter additional mentoring challenges if residents do not have prior teaching experience. Conversely, many schools or colleges of pharmacy are associated with large academic medical centers and offer teaching certificate programs or teaching opportunities for residents. In these cases, it is likely that there would be enough interested residents. Integrating residents into college of pharmacy courses is straightforward from the standpoint of scheduling and course coordination. Although course modifications proved successful and rewarding, changing to a primarily resident-led course was not without challenges. With numerous residents committed to lecture periods, there was a greater margin for error. For example, during the
Table 5 DID student IDEA course comments related to pharmacy residents. Student
Comment
1 2 3
“I liked the idea of having different residents teach, but some were not very confident or did not hold attention of the class.” “I also liked the variety of being taught by different faculty members and residents.” “Debate class was the best of all, the [PGY1 Pharmacotherapy]/[PGY2 Pharmacotherapy Resident's] diarrhea/constipation [class].”
PGY1= Post-graduate year one; PGY2=Post-graduate year two; DID=Drug-induced diseases
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Table 6 Student evaluations of resident teaching. Please provide one area that the resident excelled at: “[The resident] did a really great job emphasizing the important points for each of the causes of hyperthermia that we covered. Sometimes it can be overwhelming when we get a lot of new information at once, and I really appreciated her repeating the important points at the end to really bring it all together. She also did a good job of being helpful in assisting us with finding the answers on our own without being condescending or just giving us the answers.” “I thought the [drug information (DI)] activity was great. DI is something I really don't enjoy, but something I need work in. She picked difficult questions that didn't necessarily have a straight answer and required a lot of searching and how to ‘correctly word’ in PubMed search bar. She was very helpful in showing us where to look & explaining to extrapolate.” “I really enjoyed this class. The kidney is very complicated and I thought he did a great job explaining. I really enjoyed his drawing of the nephron and showing where these drugs are actually causing the issues.” “You presented the information well and organized the class so that it wasn't boring. I enjoyed the game a lot; it was fun and a good summary of what we have learned today. The class in general was one of the favorites of the semester.” Please provide one area of improvement for the resident: “At times, she talked too fast and it was difficult for me to keep up with the discussion while also typing notes. This did not happen too often, but when presenting lots of new information to students, keep in mind that they need time to absorb it.” “The group work projects were pretty short and easy– maybe have more complex patient cases where we find alternatives instead of just finding which medications were potential causes for delirium. Overall, [the resident] did a great job though!” “The lecture could have been broken up with maybe one more activity because going through all the different types of kidney injury was a little bit exhausting without a break. I was really excited to finally get to the patient cases.” “[The resident] could improve on encouraging students to speak up and engage in class discussions without giving students the answer.”
semester two residents were unable to fulfill the time commitment necessary to complete their lecture. Because of constant contact with residents and their program directors, this challenge was identified and resolved early in the semester. Continuous discussion with the residents and their program directors is necessary to ensure that withdrawal from lecturing is preplanned and timely. In this case a faculty member and the two residents closely involved with the course prepared and led the remaining lectures. It is important to have support from residents’ program directors as well as continuous communication surrounding residents’ goals and progress. Residency program directors are generally supportive of these activities provided they can balance responsibilities at their practice site.12 Back-up plans should exist for unplanned situations such as resident inability to complete requirements. An additional challenge included having multiple residents with different teaching styles leading class. Although this provided course diversity, there was the potential for inconsistency in class that may have been frustrating for students. Some residents taught from a handout or slides whereas others led a discussion-based class without additional materials. Certain residents asked many questions of students throughout class to facilitate learning, while others only asked preplanned questions at set points. Additionally, the level of comfort leading class varied, as indicated by student feedback. Though sometimes confusing, these differences in teaching styles encouraged students to adapt to a wide variety of teaching methods that they will continue to encounter throughout their careers. Although the change to a primarily resident-led course resulted in similar course grades and evaluations, there are some considerations. The use of two different student cohorts can be a challenging comparison. However, the same faculty completed grading for oral case-based presentations via an identical rubric during 2013 and 2014, potentially alleviating any inflation of grades. Differences in perceptions inherent to each student cohort could have influenced results of course evaluations. However, the evaluation form and directions on how to fill them out did not change from 2013 to 2014, keeping the process as consistent as possible. We have developed a plan for future improvements to the course based on our first year of experience. Modifications include limiting lecture opportunities to college of pharmacy co-funded residents. These residents typically have a greater interest in teaching, have direct connections to course coordinators through residency program directors, and may have more accountability being part of a co-funded residency program. Lecture opportunities could also be given to residents from programs with strong or longstanding relationships with the school or college. To address suggestions from residents and students in the course, we have considered developing a template for lecture format to increase consistency among class periods. In addition, we have incorporated a formal written document containing clear expectations to hold residents more accountable and to disclose what the responsibility entails prior to committing.
Summary This pharmacy resident-led DID elective allowed for resident integration into a highly interactive elective course. Student satisfaction with the course remained similar to previous years and overall course grades remained unchanged. Students developed real-time feedback skills and noted an appreciation for resident interaction. The development of this resident-led course offered a unique opportunity for residents and faculty members to diversify their roles, responsibilities, and skillset and would be easily transferable to other programs.
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Conflicts of interest None. Financial disclosures None. References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
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