- Email: [email protected]
Students’ perceptions of a blended learning pharmacy seminar course in a Caribbean school of pharmacy
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
Students’ perceptions of a blended learning pharmacy seminar course in a Caribbean school of pharmacy ⁎
Rian Marie Extavoura, , Gillian L. Allisonb a
School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Building 39, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad and Tobago Optometry Programme, Office of the Dean, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Building 39, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad and Tobago b
AR TI CLE I NF O
AB S T R A CT
Keywords: Blended learning Pharmacy education Public health Seminars
Background and purpose: Blended learning (BL) integrates face-to-face and online instructional methods, with applications in pharmacy education. This study aimed to assess pharmacy students’ perceptions of BL in a pharmacy seminar course at The University of the West Indies, St. Augustine campus, Trinidad and Tobago. Educational activity and setting: Topics based on the use of medicines and public health were presented by student groups during live seminars, supplemented with online activities. An online survey of students’ perceptions was administered at the end of the course. The usefulness of learning resources and course activities were assessed using 5-point Likert-like scales (1 = not helpful to 5 = very helpful). The effectiveness of the instructor, blended delivery, time value, and development of critical-thinking were rated on a 5-point Likert scale for agreement (1 = strongly disagree to 5 = strongly agree). Topics that were most instructive and additional topics of interest were also identified. Findings: Approximately 51% of students (37/72) completed the questionnaire; 73% were female and mean age was 24 years. The learning resources and most course activities were generally helpful (median = 4) in facilitating learning. There was strong agreement (median = 5) on the ease of navigating the online platform, and instructor encouraging interest in pharmacy issues. Students agreed (median = 4) that the course facilitated critical thinking, the BL approach was effective, and the time spent was worthwhile. The most instructive topics included medication errors, antibiotic resistance, and medicines in children and the elderly. Summary: BL in pharmacy seminars is a valuable approach to engage students learning about pharmacy and public health.
Background and purpose The integration of face-to-face and online communication in education is the underlying principle of blended learning (BL), which enables opportunities for collaborative and self-directing learning beyond the classroom setting.1,2 Potential benefits include flexibility in learning, collaboration, and interaction among students and instructors.3 BL has been applied in educational programming for the health professions, including pharmacy, over the past decade.4 In clinical health education, BL has been found to improve clinical competencies while bridging the gap between theory and practice.5 In assessing its role in pharmacy education in Spain,
⁎
Corresponding author. E-mail addresses: [email protected] (R.M. Extavour), [email protected] (G.L. Allison).
https://doi.org/10.1016/j.cptl.2017.12.007
1877-1297/ © 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Extavour, R.M., Currents in Pharmacy Teaching and Learning (2017), https://doi.org/10.1016/j.cptl.2017.12.007
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
R.M. Extavour, G.L. Allison
Sancho et al.6 reported positive outcomes, time reduction, and student satisfaction when BL was applied in the instruction of complex competencies within microbiology. In Australia, pharmacy students in a practical pharmaceutics course with face-to-face and online teaching reported positive experiences and preference for partial online teaching.7 Similarly, pharmacy students in Canada expressed enthusiasm for the BL approach when applied in a basic pharmacokinetics course.8 The University of the West Indies (The UWI), St. Augustine campus, is located in Trinidad and Tobago in the Caribbean. From 1995 until 2016, the Faculty of Medical Sciences of the St. Augustine campus was the only one among the three regional campuses to offer a Bachelor of Science (BSc) degree in Pharmacy. In 2004, the Campus Principal introduced a mandate for all courses to offer an online component to support learning. This initiative was integrated into The UWI's Strategic Plan 2012–2017, where BL was recognized as a strategy to make learning flexible, promote student engagement, and reduce the demand for classroom spaces.9 A BL policy was subsequently introduced with the goal that by September 2015, each faculty at St. Augustine would offer at least one blended program, whereby 50–75% of courses use a combination of online delivery with face-to-face teaching modes.10 To facilitate online teaching and learning, The UWI provides a learning management system (LMS) through a Moodle® platform, branded myeLearning. Via myeLearning, students and instructors may interact via online messaging, discussion forums, assignment submissions and feedback, wikis, calendars, and resource sharing (e.g., documents, web-sites). From 2004, use of the LMS has grown from 169 courses in 2005 to 3489 courses in 2011, indicating that instructors across the campus were using BL approaches.2 As part of the core curriculum, students in the final year of the BSc Pharmacy program at The School of Pharmacy of The UWI, St. Augustine campus enroll in a pharmacy seminar course. Prior to September 2015, the seminars were based on live student group presentations and discussions of pharmacy practice issues, where E-mail was the only online interface used for sharing documents and notices. The instructor noted that several non-presenting students would not be involved in the live discussion or read the material prior to the seminar. In order to increase the engagement of students throughout the semester, a BL approach was applied in September 2015, whereby internet-based resources and weekly asynchronous activities were introduced. No published studies describing students’ perceptions of BL at the UWI, St. Augustine or in pharmacy seminars in other schools have been found. Hence, this study aimed to understand students’ perceptions of a BL approach to pharmacy seminars and to identify relationships between age, sex, and previous pharmacy work experience. The objectives of the study were: 1. to describe students’ perceptions of the BL approach in pharmacy seminars; 2. to describe students’ perceptions of the effectiveness of course activities and resources in learning in pharmacy seminars; 3. to determine if previous pharmacy work experience, age and sex were associated with students’ evaluation of the course; and 4. to assess students’ interest in contemporary pharmacy and public health topics presented during seminars. Educational activity and setting Course aims and objectives The goal of the seminar course is to develop critical-thinking and communication skills of students, in the context of contemporary pharmacy practice and public health. The objectives of the course are to enable students to: 1. demonstrate enhanced verbal and written presentation skills; 2. develop analytical skills to think critically about contemporary pharmacy issues and public health; 3. demonstrate skills in providing peer evaluations; 4. work effectively as a diverse group; and 5. participate in self-directed learning and continuing professional development. Course delivery and assessment In September 2015, the course was redesigned from solely live presentations of articles or cases to include online discussions and quizzes. Students were randomly assigned to groups of three or four to develop team skills in diverse groups. Each group was required to select and present the findings of systematic reviews on the given topic. Each article was approved by the instructor, and subsequently posted to myeLearning one week prior to the seminar to allow non-presenting students to prepare for the live discussion. Online discussion forums visible to all students were used by presenting groups to post summaries of the articles prior to the seminar, inclusive of the implications for pharmacy practice and/or public health, and their recommendations. Members of a randomly assigned peer review group were required to comment on the extent to which the article's main points were captured by identifying any aspects of the summary that required clarification. Weekly seminars consisted of two group presentations highlighting the study background, design, findings, implications, and recommendations for local pharmacy practice and/or the use of medicines in public health. Presentations were followed by brief discussions based on questions from non-presenting students and the instructor. During the course, each group presented once, and reviewed an assigned peer group once. Students were assessed on verbal communication (presentation) skills, article summaries, and content (online quizzes). To promote student engagement in the topic, online quizzes (10-min) were administered following the seminar that all students were required to complete within four days. Students’ perceptions To determine perceptions, all students were invited to complete an online questionnaire (Appendix I) at the end of the course, prior to the publication of final course marks. The questionnaire was created by the course instructor and reviewed by a second instructor in the basic health sciences. It was administered using an independent platform (Google Forms®) to provide anonymity, 2
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
R.M. Extavour, G.L. Allison
which allowed participants to respond once. Prior to activation, the online version was piloted among eight students who reviewed it for face and content validity. Students were invited to participate via email, and reminders were sent one week and one day before the survey closed. No incentives were offered for participation. Five-point Likert scales (1 = strongly disagree to 5 = strongly agree) were used to assess students’ agreement with course features, usefulness of activities and resources in facilitating learning, critical thinking, if time spent was worthwhile, and the role of the instructor in developing interest in the issues. Five-point Likert-like scales (1 = not helpful to 5 = great help) were used to capture students’ ratings of the extent to which learning resources and activities facilitated learning, and the role of the instructor. The value of the various topics was determined by asking students to identify ‘the most helpful topic’. Open-ended questions were used to allow students to identify additional topics that may be relevant or interesting, and to provide recommendations for improvement. Data analysis Descriptive statistics used included proportions for categorical variables (e.g., sex, prior pharmacy work experience), mean and standard deviation for age of respondents, and medians and interquartile ranges (IQR) for scaled responses (e.g., item ratings, agreement). Spearman's rank correlation was used to identify relationships between age and students’ rating of their BL experience, facilitation of critical thinking, and time value. An independent samples Mann-Whitney U test was used to identify associations between sex (male/female), previous pharmacy experience (yes/no), and the students’ ratings of the BL approach, facilitation of critical thinking, and time value. All tests were based on an a-priori significance of 0.05. Statistical analyses were done using IBM SPSS version 21.0. This study was deemed exempt from ethical review by the Campus Ethics Committee of the University of the West Indies, St. Augustine. Findings Thirty-seven of 72 students completed the questionnaire (51.4%), with ages ranging from 21 to 49 (mean = 24.7, SD = 6.3). Twenty-seven were female (73.0%), and 24 (64.9%) had previous pharmacy work experience. Twenty-five students (67.6%) reported previous experience with BL, and 34 (91.9%) indicated that their computer skills were adequate. Ratings of resources, activities and course effectiveness All the learning resources were rated with medians of 4 (generally helpful), where instructor feedback received the highest upper quartile rating of 5 (very helpful), followed by instructor notes. Among the course activities, class discussions (median = 4), and preparing and presenting topics (median = 4) received the highest ratings for facilitating learning. Working with peers received the lowest median rating of the activities. Student agreement ratings were highest for the ease of navigating the LMS and the role the instructor played in encouraging interest, with median ratings of 5. Overall, students agreed that the online environment supported learning, the course aided in critical-thinking, the BL approach was effective, and the time spent was worthwhile (medians = 4). Table 1 presents the medians and interquartile ranges of students’ ratings. Tests of associations No significant correlations were found between age and students’ ratings of critical-thinking facilitation (rho = −0.71, p = 0.68), BL approach (rho = −0.1, p = 0.56), and time value (rho = 0.09, p = 0.60). There were no associations identified between previous pharmacy experience and students’ agreement with facilitation of critical-thinking (p = 0.46), effectiveness of the BL approach (p = 0.56), or time value (p = 0.91). Similarly, no associations were found between respondent sex and facilitation of critical-thinking (p = 0.85), effectiveness of BL approach (p = 0.96), or time value (p = 0.55). Topics of interest and students’ recommendations The most helpful topics to students were medication errors and quality assurance (37.8%) followed by antibiotic use and resistance (13.5%) and medication use in the elderly and children (13.5%). See Table 2 for additional detail. Eight students identified additional topics of interest, with advances in pharmaceutical technologies as the most frequently requested topic. Thirteen students identified areas for improvement, including additional time to complete online quizzes, and the need for additional supervision of students taking quizzes (Appendix II). Discussion Participating students found the BL approach to seminars to be useful, particularly aspects that facilitated interaction with peers and the instructor. The combination of online activities and learning resources with synchronous discussions may have encouraged participation and facilitated greater flexibility in learning than before, through opportunities for interaction with content and peers prior to, during, and after seminars. This approach may have been particularly valuable among students with different learning styles. 3
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
R.M. Extavour, G.L. Allison
Table 1 Students’ ratings of resources, activities, and course effectiveness in facilitating learning. Features rated by students (n = 37)
Median
IQR
4.0 4.0 4.0 4.0
4.0–5.0 4.0–4.5 3.0–4.0 3.0–4.0
4.0 4.0 4.0 4.0 4.0 3.0
4.0–4.5 3.5–4.5 3.0–4.0 3.0–4.0 3.0–4.0 3.0–4.0
5.0 4.0 5.0 4.0 4.0 4.0
4.0–5.0 3.0–4.0 4.0–5.0 4.0–5.0 4.0–4.0 3.0–4.0
a
Learning resources To what extent did the following resources facilitate your learning? Instructor feedback Notes posted by instructor Review articles Course outline or syllabus Course activitiesa To what extent did the following activities facilitate your learning? Discussing topics in class Preparing and presenting pharmacy topics Writing the article summary Reviewing another group's summary Online quizzes Working with peers Course effectivenessb Please indicate your agreement with the following The course management system (myeLearning) was easy to navigate The online environment supported my learning The instructor encouraged my interest in contemporary pharmacy issues This course helped me to think critically about contemporary pharmacy issues The combination of face-to-face and online activities was effective in helping me achieve the learning outcomes The time spent on course activities has been worthwhile in consideration of learning achieved
Key: CI: confidence interval; IQR: interquartile range. a Rating scale: 1 = not helpful, 2 = a little helpful, 3 = somewhat helpful, 4 = generally helpful, 5 = great help (very helpful). b Agreement scale: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree. Table 2 Students’ selection of ‘most helpful topics’ presented in blended pharmacy seminars. Topic
Frequency
Percent
Medication Errors and Quality Assurance Antibiotic Use and Resistance Medication Use in Children and Elderly Adverse Drug Events Vaccine Safety and Immunization Health Literacy and Pharmacy Pharmacists and Public Health Prescription Drug Abuse Pharmaceutical Promotion Investigating Drug Utilization Total
14 5 5 4 4 3 1 1 0 0 37
37.8 13.5 13.5 10.8 10.8 8.1 2.7 2.7 0 0 100
For instance, online activities may have enabled introverted students to present their views outside of the classroom, in a less intimidating environment whereas live seminars may have allowed more outgoing students to articulate their views. All the learning resources were generally helpful to students with identical median ratings. Although students, with supporting materials and discussions, led the seminars, the instructor's role remained a valuable learning resource to respondents. With the exception of working with peers, the course activities were generally helpful to respondents. The utility of interactive activities (class discussions, presentations, reviews), along with the favorable view of the role of the instructor (feedback, notes, encouraging interest), aligns with the value of the “social presence” aspect of BL as described by Garrison and Kanuka.1 The application of BL does not shift the responsibility away from the instructor, but may make interaction with students even more essential to learning in this context. This finding aligns with a study of student satisfaction with BL environments in Taiwan, where effective interaction and instructors were influential.11 Similarly, Edginton and Holbrook8 found that students in a blended pharmacokinetics course in Canada preferred face-to-face interactions with peers and the instructor over online communications. Although most of the group activities were helpful in facilitating learning, the lower median rating of working with peers (somewhat helpful) indicates that this was the least popular among respondents. This moderate rating may have been due to unresolved team conflicts, which indicates a need for guidance to students working in groups. The most helpful topics to students were primarily related to medication safety, specifically medication errors, medication use in children and elderly, antibiotic use, adverse events, and vaccine safety. These topics may be valued due to the absence of dedicated courses in these areas and/or students’ perception of their relevance to pharmacy practice and public health. The inclusion of these topics in future seminars may increase knowledge in the area pharmaceutical policy, practice and public health, whereby pharmacists 4
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
R.M. Extavour, G.L. Allison
may contribute to developing policies and interventions to minimize medication-related harm.12 Overall, students found that the BL approach facilitated critical thinking, which confirms achievement of one of the primary learning objectives of the course. In addition, the overall agreement with the effectiveness of the BL approach and time value supports its continued application in the course. Although less than half of respondents provided recommendations, the mixed reviews are informative and provide insight with respect to the administration of the course. Based on the concerns expressed about allotted quiz time and the need for supervision, the administration of online quizzes may need closer review. The introduction of quizzes based on the articles or material presented by groups was novel, as this was not previously assessed in the traditional delivery. This feature facilitated assessment of individual students, and allowed students to earn marks independent of the group's work. Proctoring applications for quizzes or shorter periods for quiz completion may be needed to minimize sharing of quiz content reported. In a non-proctored online assessment screen-sharing is possible, but with this may be deterred by reducing the time for completion, as this action would lead to delays. It is not known if these sharing actions improved students’ scores as this was beyond the scope of the study. Additional explanations of the nature of the online quiz and the encouragement of ethical conduct may be needed, and/or the use of examination software such as ExamSoft® to minimize cheating. The use of a search tool to scan articles for keywords may have been used by students to answer questions that asked about basic facts stated in the article. This may limit the students’ learning about the content but may be minimized by the use of more comprehension-type and application-type questions. This study describes a novel application of BL in pharmacy education, as earlier studies describe its use within instructor-led courses, such as pharmacokinetics, and microbiology.6,8 Its findings may provide insight into BL application and possible pitfalls to instructors and educational technologists who may be developing similar courses in pharmacy and public health. The topics of interest and learning preferences identified by respondents in our study may be applied to pharmacy students in other programs in The UWI and the Caribbean. There are a few limitations of this study to note. The suboptimal response rate may have introduced non-response bias where students with very positive (or very negative) experiences may opt to participate. The class size also limited the number of students involved in the pilot and the type of statistical analyses possible, thereby limiting full validation of the questionnaire and generalizability of the findings. However, the profile of respondents reflects the age and gender distribution of fourth year students in the School of Pharmacy, where the mean age is 23.9 years and 72% were females.13 The absence of a comparator group is another limitation of the cross-sectional design, as there were no earlier or concurrent studies of students’ experiences or perceptions of the traditional teaching modalities of the course. To demonstrate the impact of BL on student performance, further research is needed comparing student performance in blended courses with non-blended courses. Further, the nature of the course limited the ability to assess performance over time, as different topics and/or concepts were presented each week. Nonetheless, the findings may guide future course design, administration and delivery. Summary Blended learning in student-led pharmacy seminars is a novel and valuable approach for engaging students, and for developing critical thinking skills in pharmacy practice and public health. The instructor's role and the inclusion of activities that support a social presence remain important to the success of this approach. Conflicts of interest None. Disclosure statements None. Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.cptl.2017.12. 007. References 1. 2. 3. 4. 5. 6. 7. 8.
Garrison DR, Kanuka H. Blended learning: uncovering its transformative potential in higher education. Internet Higher Ed. 2004;7(2):95–105. Thurab-Nkosi D. Blended learning at the University of the West Indies, St. Augustine: a first look at policy implementation. Caribb Teaching Schol. 2013;3(1):81–92. Ellaway R, Masters K. AMEE Guide 32: e-learning in medical education Part 1: learning, teaching and assessment. Med Teach. 2008;30(5):455–473. Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Instructional design variations in internet-based learning for health professions education: a systematic review and meta-analysis. Acad Med. 2010;85(5):909–922. Rowe M, Frantz J, Bozalek V. The role of blended learning in the clinical education of healthcare students: a systematic review. Med Teach. 2012;34(4):e216–e221. Sancho P, Corral R, Rivas T, González MJ, Chordi A, Tejedor C. A blended learning experience for teaching microbiology. Am J Pharm Educ. 2006;70(5):120. Benino D, Girardi A, Czarniak P. Incorporating online teaching in an introductory pharmaceutical practice course: a study of student perceptions within an Australian University. Pharm Pract. 2011;9(4):252–259. Edginton A, Holbrook J. A blended learning approach to teaching basic pharmacokinetics and the significance of face-to-face interaction. Am J Pharm Educ.
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R.M. Extavour, G.L. Allison
2010;74(5):88. 9. The University of the West Indies. The University of the West Indies Strategic Plan 2012–2017. Mona, Jamaica: The University Office of Planning and Development; 2012. 10. The University of the West Indies. The Blended Learning Policy of the St. Augustine Campus. St. Augustine. Trinidad: The University of the West Indies, Instructional Development Unit; 2012. 11. Wu J-H, Tennyson RD, Hsia T-L. A study of student satisfaction in a blended e-learning system environment. Comput Ed. 2010;55(1):155–164. 12. World Health Organization. Drug and Therapeutics Committees: A Practical Guide; Published 2003. Available at: 〈http://apps.who.int/medicinedocs/en/d/ Js4882e/〉. Accessed 23 December 2017. 13. The University of the West Indies St Augustine. School of Pharmacy. The Self-Assessment Report for Quality Review Visit. Champs Fleurs: The University of the West Indies, St. Augustine; 2012.
6
Contents lists available at ScienceDirect
Currents in Pharmacy Teaching and Learning journal homepage: www.elsevier.com/locate/cptl
Experiences in Teaching and Learning
Students’ perceptions of a blended learning pharmacy seminar course in a Caribbean school of pharmacy ⁎
Rian Marie Extavoura, , Gillian L. Allisonb a
School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Building 39, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad and Tobago Optometry Programme, Office of the Dean, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Building 39, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad and Tobago b
AR TI CLE I NF O
AB S T R A CT
Keywords: Blended learning Pharmacy education Public health Seminars
Background and purpose: Blended learning (BL) integrates face-to-face and online instructional methods, with applications in pharmacy education. This study aimed to assess pharmacy students’ perceptions of BL in a pharmacy seminar course at The University of the West Indies, St. Augustine campus, Trinidad and Tobago. Educational activity and setting: Topics based on the use of medicines and public health were presented by student groups during live seminars, supplemented with online activities. An online survey of students’ perceptions was administered at the end of the course. The usefulness of learning resources and course activities were assessed using 5-point Likert-like scales (1 = not helpful to 5 = very helpful). The effectiveness of the instructor, blended delivery, time value, and development of critical-thinking were rated on a 5-point Likert scale for agreement (1 = strongly disagree to 5 = strongly agree). Topics that were most instructive and additional topics of interest were also identified. Findings: Approximately 51% of students (37/72) completed the questionnaire; 73% were female and mean age was 24 years. The learning resources and most course activities were generally helpful (median = 4) in facilitating learning. There was strong agreement (median = 5) on the ease of navigating the online platform, and instructor encouraging interest in pharmacy issues. Students agreed (median = 4) that the course facilitated critical thinking, the BL approach was effective, and the time spent was worthwhile. The most instructive topics included medication errors, antibiotic resistance, and medicines in children and the elderly. Summary: BL in pharmacy seminars is a valuable approach to engage students learning about pharmacy and public health.
Background and purpose The integration of face-to-face and online communication in education is the underlying principle of blended learning (BL), which enables opportunities for collaborative and self-directing learning beyond the classroom setting.1,2 Potential benefits include flexibility in learning, collaboration, and interaction among students and instructors.3 BL has been applied in educational programming for the health professions, including pharmacy, over the past decade.4 In clinical health education, BL has been found to improve clinical competencies while bridging the gap between theory and practice.5 In assessing its role in pharmacy education in Spain,
⁎
Corresponding author. E-mail addresses: [email protected] (R.M. Extavour), [email protected] (G.L. Allison).
https://doi.org/10.1016/j.cptl.2017.12.007
1877-1297/ © 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Extavour, R.M., Currents in Pharmacy Teaching and Learning (2017), https://doi.org/10.1016/j.cptl.2017.12.007
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
R.M. Extavour, G.L. Allison
Sancho et al.6 reported positive outcomes, time reduction, and student satisfaction when BL was applied in the instruction of complex competencies within microbiology. In Australia, pharmacy students in a practical pharmaceutics course with face-to-face and online teaching reported positive experiences and preference for partial online teaching.7 Similarly, pharmacy students in Canada expressed enthusiasm for the BL approach when applied in a basic pharmacokinetics course.8 The University of the West Indies (The UWI), St. Augustine campus, is located in Trinidad and Tobago in the Caribbean. From 1995 until 2016, the Faculty of Medical Sciences of the St. Augustine campus was the only one among the three regional campuses to offer a Bachelor of Science (BSc) degree in Pharmacy. In 2004, the Campus Principal introduced a mandate for all courses to offer an online component to support learning. This initiative was integrated into The UWI's Strategic Plan 2012–2017, where BL was recognized as a strategy to make learning flexible, promote student engagement, and reduce the demand for classroom spaces.9 A BL policy was subsequently introduced with the goal that by September 2015, each faculty at St. Augustine would offer at least one blended program, whereby 50–75% of courses use a combination of online delivery with face-to-face teaching modes.10 To facilitate online teaching and learning, The UWI provides a learning management system (LMS) through a Moodle® platform, branded myeLearning. Via myeLearning, students and instructors may interact via online messaging, discussion forums, assignment submissions and feedback, wikis, calendars, and resource sharing (e.g., documents, web-sites). From 2004, use of the LMS has grown from 169 courses in 2005 to 3489 courses in 2011, indicating that instructors across the campus were using BL approaches.2 As part of the core curriculum, students in the final year of the BSc Pharmacy program at The School of Pharmacy of The UWI, St. Augustine campus enroll in a pharmacy seminar course. Prior to September 2015, the seminars were based on live student group presentations and discussions of pharmacy practice issues, where E-mail was the only online interface used for sharing documents and notices. The instructor noted that several non-presenting students would not be involved in the live discussion or read the material prior to the seminar. In order to increase the engagement of students throughout the semester, a BL approach was applied in September 2015, whereby internet-based resources and weekly asynchronous activities were introduced. No published studies describing students’ perceptions of BL at the UWI, St. Augustine or in pharmacy seminars in other schools have been found. Hence, this study aimed to understand students’ perceptions of a BL approach to pharmacy seminars and to identify relationships between age, sex, and previous pharmacy work experience. The objectives of the study were: 1. to describe students’ perceptions of the BL approach in pharmacy seminars; 2. to describe students’ perceptions of the effectiveness of course activities and resources in learning in pharmacy seminars; 3. to determine if previous pharmacy work experience, age and sex were associated with students’ evaluation of the course; and 4. to assess students’ interest in contemporary pharmacy and public health topics presented during seminars. Educational activity and setting Course aims and objectives The goal of the seminar course is to develop critical-thinking and communication skills of students, in the context of contemporary pharmacy practice and public health. The objectives of the course are to enable students to: 1. demonstrate enhanced verbal and written presentation skills; 2. develop analytical skills to think critically about contemporary pharmacy issues and public health; 3. demonstrate skills in providing peer evaluations; 4. work effectively as a diverse group; and 5. participate in self-directed learning and continuing professional development. Course delivery and assessment In September 2015, the course was redesigned from solely live presentations of articles or cases to include online discussions and quizzes. Students were randomly assigned to groups of three or four to develop team skills in diverse groups. Each group was required to select and present the findings of systematic reviews on the given topic. Each article was approved by the instructor, and subsequently posted to myeLearning one week prior to the seminar to allow non-presenting students to prepare for the live discussion. Online discussion forums visible to all students were used by presenting groups to post summaries of the articles prior to the seminar, inclusive of the implications for pharmacy practice and/or public health, and their recommendations. Members of a randomly assigned peer review group were required to comment on the extent to which the article's main points were captured by identifying any aspects of the summary that required clarification. Weekly seminars consisted of two group presentations highlighting the study background, design, findings, implications, and recommendations for local pharmacy practice and/or the use of medicines in public health. Presentations were followed by brief discussions based on questions from non-presenting students and the instructor. During the course, each group presented once, and reviewed an assigned peer group once. Students were assessed on verbal communication (presentation) skills, article summaries, and content (online quizzes). To promote student engagement in the topic, online quizzes (10-min) were administered following the seminar that all students were required to complete within four days. Students’ perceptions To determine perceptions, all students were invited to complete an online questionnaire (Appendix I) at the end of the course, prior to the publication of final course marks. The questionnaire was created by the course instructor and reviewed by a second instructor in the basic health sciences. It was administered using an independent platform (Google Forms®) to provide anonymity, 2
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
R.M. Extavour, G.L. Allison
which allowed participants to respond once. Prior to activation, the online version was piloted among eight students who reviewed it for face and content validity. Students were invited to participate via email, and reminders were sent one week and one day before the survey closed. No incentives were offered for participation. Five-point Likert scales (1 = strongly disagree to 5 = strongly agree) were used to assess students’ agreement with course features, usefulness of activities and resources in facilitating learning, critical thinking, if time spent was worthwhile, and the role of the instructor in developing interest in the issues. Five-point Likert-like scales (1 = not helpful to 5 = great help) were used to capture students’ ratings of the extent to which learning resources and activities facilitated learning, and the role of the instructor. The value of the various topics was determined by asking students to identify ‘the most helpful topic’. Open-ended questions were used to allow students to identify additional topics that may be relevant or interesting, and to provide recommendations for improvement. Data analysis Descriptive statistics used included proportions for categorical variables (e.g., sex, prior pharmacy work experience), mean and standard deviation for age of respondents, and medians and interquartile ranges (IQR) for scaled responses (e.g., item ratings, agreement). Spearman's rank correlation was used to identify relationships between age and students’ rating of their BL experience, facilitation of critical thinking, and time value. An independent samples Mann-Whitney U test was used to identify associations between sex (male/female), previous pharmacy experience (yes/no), and the students’ ratings of the BL approach, facilitation of critical thinking, and time value. All tests were based on an a-priori significance of 0.05. Statistical analyses were done using IBM SPSS version 21.0. This study was deemed exempt from ethical review by the Campus Ethics Committee of the University of the West Indies, St. Augustine. Findings Thirty-seven of 72 students completed the questionnaire (51.4%), with ages ranging from 21 to 49 (mean = 24.7, SD = 6.3). Twenty-seven were female (73.0%), and 24 (64.9%) had previous pharmacy work experience. Twenty-five students (67.6%) reported previous experience with BL, and 34 (91.9%) indicated that their computer skills were adequate. Ratings of resources, activities and course effectiveness All the learning resources were rated with medians of 4 (generally helpful), where instructor feedback received the highest upper quartile rating of 5 (very helpful), followed by instructor notes. Among the course activities, class discussions (median = 4), and preparing and presenting topics (median = 4) received the highest ratings for facilitating learning. Working with peers received the lowest median rating of the activities. Student agreement ratings were highest for the ease of navigating the LMS and the role the instructor played in encouraging interest, with median ratings of 5. Overall, students agreed that the online environment supported learning, the course aided in critical-thinking, the BL approach was effective, and the time spent was worthwhile (medians = 4). Table 1 presents the medians and interquartile ranges of students’ ratings. Tests of associations No significant correlations were found between age and students’ ratings of critical-thinking facilitation (rho = −0.71, p = 0.68), BL approach (rho = −0.1, p = 0.56), and time value (rho = 0.09, p = 0.60). There were no associations identified between previous pharmacy experience and students’ agreement with facilitation of critical-thinking (p = 0.46), effectiveness of the BL approach (p = 0.56), or time value (p = 0.91). Similarly, no associations were found between respondent sex and facilitation of critical-thinking (p = 0.85), effectiveness of BL approach (p = 0.96), or time value (p = 0.55). Topics of interest and students’ recommendations The most helpful topics to students were medication errors and quality assurance (37.8%) followed by antibiotic use and resistance (13.5%) and medication use in the elderly and children (13.5%). See Table 2 for additional detail. Eight students identified additional topics of interest, with advances in pharmaceutical technologies as the most frequently requested topic. Thirteen students identified areas for improvement, including additional time to complete online quizzes, and the need for additional supervision of students taking quizzes (Appendix II). Discussion Participating students found the BL approach to seminars to be useful, particularly aspects that facilitated interaction with peers and the instructor. The combination of online activities and learning resources with synchronous discussions may have encouraged participation and facilitated greater flexibility in learning than before, through opportunities for interaction with content and peers prior to, during, and after seminars. This approach may have been particularly valuable among students with different learning styles. 3
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Table 1 Students’ ratings of resources, activities, and course effectiveness in facilitating learning. Features rated by students (n = 37)
Median
IQR
4.0 4.0 4.0 4.0
4.0–5.0 4.0–4.5 3.0–4.0 3.0–4.0
4.0 4.0 4.0 4.0 4.0 3.0
4.0–4.5 3.5–4.5 3.0–4.0 3.0–4.0 3.0–4.0 3.0–4.0
5.0 4.0 5.0 4.0 4.0 4.0
4.0–5.0 3.0–4.0 4.0–5.0 4.0–5.0 4.0–4.0 3.0–4.0
a
Learning resources To what extent did the following resources facilitate your learning? Instructor feedback Notes posted by instructor Review articles Course outline or syllabus Course activitiesa To what extent did the following activities facilitate your learning? Discussing topics in class Preparing and presenting pharmacy topics Writing the article summary Reviewing another group's summary Online quizzes Working with peers Course effectivenessb Please indicate your agreement with the following The course management system (myeLearning) was easy to navigate The online environment supported my learning The instructor encouraged my interest in contemporary pharmacy issues This course helped me to think critically about contemporary pharmacy issues The combination of face-to-face and online activities was effective in helping me achieve the learning outcomes The time spent on course activities has been worthwhile in consideration of learning achieved
Key: CI: confidence interval; IQR: interquartile range. a Rating scale: 1 = not helpful, 2 = a little helpful, 3 = somewhat helpful, 4 = generally helpful, 5 = great help (very helpful). b Agreement scale: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree. Table 2 Students’ selection of ‘most helpful topics’ presented in blended pharmacy seminars. Topic
Frequency
Percent
Medication Errors and Quality Assurance Antibiotic Use and Resistance Medication Use in Children and Elderly Adverse Drug Events Vaccine Safety and Immunization Health Literacy and Pharmacy Pharmacists and Public Health Prescription Drug Abuse Pharmaceutical Promotion Investigating Drug Utilization Total
14 5 5 4 4 3 1 1 0 0 37
37.8 13.5 13.5 10.8 10.8 8.1 2.7 2.7 0 0 100
For instance, online activities may have enabled introverted students to present their views outside of the classroom, in a less intimidating environment whereas live seminars may have allowed more outgoing students to articulate their views. All the learning resources were generally helpful to students with identical median ratings. Although students, with supporting materials and discussions, led the seminars, the instructor's role remained a valuable learning resource to respondents. With the exception of working with peers, the course activities were generally helpful to respondents. The utility of interactive activities (class discussions, presentations, reviews), along with the favorable view of the role of the instructor (feedback, notes, encouraging interest), aligns with the value of the “social presence” aspect of BL as described by Garrison and Kanuka.1 The application of BL does not shift the responsibility away from the instructor, but may make interaction with students even more essential to learning in this context. This finding aligns with a study of student satisfaction with BL environments in Taiwan, where effective interaction and instructors were influential.11 Similarly, Edginton and Holbrook8 found that students in a blended pharmacokinetics course in Canada preferred face-to-face interactions with peers and the instructor over online communications. Although most of the group activities were helpful in facilitating learning, the lower median rating of working with peers (somewhat helpful) indicates that this was the least popular among respondents. This moderate rating may have been due to unresolved team conflicts, which indicates a need for guidance to students working in groups. The most helpful topics to students were primarily related to medication safety, specifically medication errors, medication use in children and elderly, antibiotic use, adverse events, and vaccine safety. These topics may be valued due to the absence of dedicated courses in these areas and/or students’ perception of their relevance to pharmacy practice and public health. The inclusion of these topics in future seminars may increase knowledge in the area pharmaceutical policy, practice and public health, whereby pharmacists 4
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may contribute to developing policies and interventions to minimize medication-related harm.12 Overall, students found that the BL approach facilitated critical thinking, which confirms achievement of one of the primary learning objectives of the course. In addition, the overall agreement with the effectiveness of the BL approach and time value supports its continued application in the course. Although less than half of respondents provided recommendations, the mixed reviews are informative and provide insight with respect to the administration of the course. Based on the concerns expressed about allotted quiz time and the need for supervision, the administration of online quizzes may need closer review. The introduction of quizzes based on the articles or material presented by groups was novel, as this was not previously assessed in the traditional delivery. This feature facilitated assessment of individual students, and allowed students to earn marks independent of the group's work. Proctoring applications for quizzes or shorter periods for quiz completion may be needed to minimize sharing of quiz content reported. In a non-proctored online assessment screen-sharing is possible, but with this may be deterred by reducing the time for completion, as this action would lead to delays. It is not known if these sharing actions improved students’ scores as this was beyond the scope of the study. Additional explanations of the nature of the online quiz and the encouragement of ethical conduct may be needed, and/or the use of examination software such as ExamSoft® to minimize cheating. The use of a search tool to scan articles for keywords may have been used by students to answer questions that asked about basic facts stated in the article. This may limit the students’ learning about the content but may be minimized by the use of more comprehension-type and application-type questions. This study describes a novel application of BL in pharmacy education, as earlier studies describe its use within instructor-led courses, such as pharmacokinetics, and microbiology.6,8 Its findings may provide insight into BL application and possible pitfalls to instructors and educational technologists who may be developing similar courses in pharmacy and public health. The topics of interest and learning preferences identified by respondents in our study may be applied to pharmacy students in other programs in The UWI and the Caribbean. There are a few limitations of this study to note. The suboptimal response rate may have introduced non-response bias where students with very positive (or very negative) experiences may opt to participate. The class size also limited the number of students involved in the pilot and the type of statistical analyses possible, thereby limiting full validation of the questionnaire and generalizability of the findings. However, the profile of respondents reflects the age and gender distribution of fourth year students in the School of Pharmacy, where the mean age is 23.9 years and 72% were females.13 The absence of a comparator group is another limitation of the cross-sectional design, as there were no earlier or concurrent studies of students’ experiences or perceptions of the traditional teaching modalities of the course. To demonstrate the impact of BL on student performance, further research is needed comparing student performance in blended courses with non-blended courses. Further, the nature of the course limited the ability to assess performance over time, as different topics and/or concepts were presented each week. Nonetheless, the findings may guide future course design, administration and delivery. Summary Blended learning in student-led pharmacy seminars is a novel and valuable approach for engaging students, and for developing critical thinking skills in pharmacy practice and public health. The instructor's role and the inclusion of activities that support a social presence remain important to the success of this approach. Conflicts of interest None. Disclosure statements None. Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.cptl.2017.12. 007. References 1. 2. 3. 4. 5. 6. 7. 8.
Garrison DR, Kanuka H. Blended learning: uncovering its transformative potential in higher education. Internet Higher Ed. 2004;7(2):95–105. Thurab-Nkosi D. Blended learning at the University of the West Indies, St. Augustine: a first look at policy implementation. Caribb Teaching Schol. 2013;3(1):81–92. Ellaway R, Masters K. AMEE Guide 32: e-learning in medical education Part 1: learning, teaching and assessment. Med Teach. 2008;30(5):455–473. Cook DA, Levinson AJ, Garside S, Dupras DM, Erwin PJ, Montori VM. Instructional design variations in internet-based learning for health professions education: a systematic review and meta-analysis. Acad Med. 2010;85(5):909–922. Rowe M, Frantz J, Bozalek V. The role of blended learning in the clinical education of healthcare students: a systematic review. Med Teach. 2012;34(4):e216–e221. Sancho P, Corral R, Rivas T, González MJ, Chordi A, Tejedor C. A blended learning experience for teaching microbiology. Am J Pharm Educ. 2006;70(5):120. Benino D, Girardi A, Czarniak P. Incorporating online teaching in an introductory pharmaceutical practice course: a study of student perceptions within an Australian University. Pharm Pract. 2011;9(4):252–259. Edginton A, Holbrook J. A blended learning approach to teaching basic pharmacokinetics and the significance of face-to-face interaction. Am J Pharm Educ.
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2010;74(5):88. 9. The University of the West Indies. The University of the West Indies Strategic Plan 2012–2017. Mona, Jamaica: The University Office of Planning and Development; 2012. 10. The University of the West Indies. The Blended Learning Policy of the St. Augustine Campus. St. Augustine. Trinidad: The University of the West Indies, Instructional Development Unit; 2012. 11. Wu J-H, Tennyson RD, Hsia T-L. A study of student satisfaction in a blended e-learning system environment. Comput Ed. 2010;55(1):155–164. 12. World Health Organization. Drug and Therapeutics Committees: A Practical Guide; Published 2003. Available at: 〈http://apps.who.int/medicinedocs/en/d/ Js4882e/〉. Accessed 23 December 2017. 13. The University of the West Indies St Augustine. School of Pharmacy. The Self-Assessment Report for Quality Review Visit. Champs Fleurs: The University of the West Indies, St. Augustine; 2012.
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