Let’s ThinkAbout It

INSIDE THIS ISSUE

Communication Skills Comparison, P.2

A Pain Management Assignment, P.5

Let’s Think About It is published three times a year by the Center for the Advancement of Teaching and Learning (CATAL) in Mercer University’s College of Pharmacy and Health Sciences. The purpose of CATAL is to support and promote effective and innovative teaching that enhances learning at the College. CATAL’s vision is to create a learning- centered community that promotes a culture of excellence in teaching and learning.

Let’s Think About It has been the newsletter for the Center for the Advancement of Teaching and Learning (CATAL) since February 1997 when Issue 1, Volume 1

was published. For the last several years, Dr. Grady Strom has edited the newsletter.

Dr. Strom has personally contributed numerous articles to the newsletter and shared his

perspectives and vision of innovations in teaching. We are grateful to him for his able

guidance for many years to bring this newsletter to you. Starting with this issue of the

newsletter, Dr. Leisa Marshall will serve as the new editor, and I will assist Dr. Marshall

as the associate editor. Dr. Strom will still continue to provide guidance to the newsletter,

as part of his overall championship of CATAL activities and events, and as chair of CATAL.

The newsletter will continue to provide a forum for faculty to share their experiences in

teaching, and we will bring information from the literature to enhance teaching at the

College of Pharmacy and Health Sciences. We encourage our College of Pharmacy and Health

Sciences faculty to write for the newsletter and send your submissions to Dr. Marshall.

Your submissions can include, but are not limited to, short reflective essays about your

first one or two years teaching in the academy, reports of your pedagogical research,

innovative techniques and approaches that facilitate learning, what works in your class,

or summaries of educational books or articles. Each submission will be reviewed by

the editors and selected members of CATAL. Please consult the CATAL website at

mercer.edu/catal for previous issues of Let’s Think About It and for information about

programs offered by CATAL, such as the Journal Club and colloquy meetings.

This issue of the newsletter features two projects highlighting teaching and learning in the

classroom in the pharmacy program. The first article, authored by Drs. Lisa Lundquist,

Angela Shogbon and Kathryn Momary, provides a comparison of students’ perceptions

and faculty evaluation of students’ communication skills during an oral examination

in a therapeutics module. The second article, authored by Drs. Diane Nykamp and Leisa

Marshall, provides an example of using an existing electronic case study program on pain

management as the basis of an active learning activity in a therapeutics module.

Thank you and I hope you enjoy this issue of Let’s Think About It.

Ajay K. Banga, Ph.D.

Chair, Department of Pharmaceutical Sciences

Mercer University COPHS

Associate Editor

VOLUME 13 • ISSUE 1 • FALL 2011

BackgroundThe Center for the Advancement of Pharmaceutical

Education (CAPE) and the Accreditation Council

for Pharmacy Education (ACPE) both advocate for

patient-centered pharmaceutical care.1-3 The CAPE

Outcomes recommend that pharmacists must be

able to communicate and collaborate with pre-

scribers, patients, caregivers, and other involved

health care providers to engender a team approach

to patient care2 and that pharmacists must apply

effective communication skills in interprofessional

relationships to improve the clinical, economic,

and humanistic outcomes of patients.3

To date, there is little published literature on

communication skills assessment in pharmacy

education.4-5 In a description of the current

practices of communication skills assessment

in colleges of pharmacy, the focus was on com-

munication with patients, not with other health

care providers.4

There are many opportunities to reinforce students’

communication skills with patients in our College

of Pharmacy and Health Sciences through a

communications course, introductory pharmacy

practice experiences, mock patient counseling,

and oral examinations. Opportunities to strengthen

communication skills with health care providers

include introductory pharmacy practice experiences

and four classroom hours of instruction and

application of a framework for presenting clinical

recommendations regarding drug therapy and

specific communication skills to utilize. The majority

of opportunities to improve students’ communica-

tion skills with health care providers are not until

advanced pharmacy practice experiences. In an

effort to evaluate students’ communication skills

with health care providers, we compared second

professional year students’ perceptions and

faculty evaluation of performance of communication

skills during therapeutics oral examinations.

MethodsTwo patient case-based oral examinations were

given to all second professional year students

enrolled in the Cardiovascular/Renal III therapeutics

course. Students were provided with patient cases

prior to each oral examination to allow adequate

preparation time and the cases incorporated

disease states and pharmacotherapy previously

tested in written format. One oral examination

was given individually and one was a group oral

examination with groups of 4 students. During

the oral examinations, questions that were asked

were consistent with clinical practice. The stu-

dents served as the pharmacist developing and

communicating therapeutic recommendations

to the faculty members who served as another

health care provider.

Faculty assessed students’ communication skills

using a scoring rubric in the areas of rapport

(confidence, non-verbal, tone of voice, eye contact)

and presentation of therapeutic recommenda-

tions (concise, pronunciation, well-prepared,

patient-focused). Immediately following each oral

examination, students were asked to rate their

own communication skills using the same rubric.

Communication skills were rated on a 4-point

Likert scale with 1=needs significant development,

2=needs improvement, 3=developing excellence,

and 4=accomplished. Student’s perception of

performance on communication skills during

each oral examination was compared with their

respective faculty’s communication evaluation.

In addition, student’s perceptions of performance

on communication on their respective individual

and group oral examinations were compared.

Faculty evaluation of each student’s communica-

tion performance on the individual and group oral

examinations were also compared.

All data collected were approved by Mercer Univer-

sity Institutional Review Board. Students voluntari-

ly signed informed consent prior to participation.

Students’ perceptions were compared to faculty

evaluation of their communication skills using de-

scriptive statistics and Wilcoxon Signed Ranks test.

ResultsA total of 136 (97.8%) students completed com-

munication self-assessments. Faculty’s evalua-

tion of students in both the individual and group

oral examinations, were statistically significantly

Communication Skills: a Comparison of Students’ Perception and Faculty Evaluation of Performance on Therapeutics Oral Examinations

Lisa M. Lundquist, Pharm.D., BCPS | Angela O. Shogbon, Pharm.D., BCPS | Kathryn M. Momary, Pharm.D., BCPS

Figure 1. Individual Oral Examination: Student Perception and Faculty Evaluation

2 3

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p <0.01

p <0.05*+

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*

*

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higher than the students’ self-assessment of

their communication skills in the following areas:

confidence, respectful tone, absence of obvious

nervousness, and concise and articulate. In ad-

dition, in the individual oral examination, faculty

rated students’ performance on ‘correct profes-

sional phraseology’ higher than the students’ self-

assessment (p<0.05). Students’ self-assessment

of communication increased from the individual

to the group oral examination in the following

areas: confidence, respectful tone, absence of ob-

vious nervousness, individualized approach, well-

prepared, and concise and articulate. Figures 1 – 4

illustrate the comparisons of student perceptions

and faculty evaluation of communication skills in

both the individual and group oral examinations.

DiscussionStudents’ perception of communication skills

were consistently lower than the evaluation scores

provided by faculty in both the individual and the

group oral examinations. A potential cause of stu-

dents’ lower perception of communication skills

may be a lack of practice in the verbal communica-

tion of clinical recommendations, which is sup-

ported by the increase in student perception with

the second oral examination. Another possible

explanation is that students tend to be their own

worst critics. In areas where students tended to be

particularly judgmental with themselves, examina-

tion of faculty evaluations could provide balance.

Students’ perceptions of communication skills

were higher in the group oral examination setting

when compared to the individual oral examina-

tion setting. Since the group oral examination

occurred after the individual oral examination,

confidence in skills and performance of commu-

nicating therapeutic recommendations may have

increased, and the students likely felt more self-

confident with the support of their peers.

Evaluation of students’ communication skills with

health care providers may contribute to a better

comprehension of the practice of pharmacy and

the integration of professional competence, clinical

aptitude and patient care. Greater use of this evalu-

ation method of communication skills may further

Figure 2. Group Oral Examination: Student Perception and Faculty Evaluation

Figure 3. Students’ Individual and Group Oral Examination Perceptions

2 3

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* *

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*+ + * +

contribute to improving student’s confidence and

competence in the verbal communication of clinical

recommendations to health care providers and

better prepare them for practice as future pharma-

cists. In addition, appropriate self-evaluation of

performance is a key component to professional

development. If you have the opportunity in your

course, we encourage you to consider incorporating

communication skills evaluation.

ConclusionStudents’ perceptions of communication skills

were consistently lower than faculty’s evaluation.

Greater utilization of formal case-based oral

examinations may help to improve student’s confi-

dence and perception of their communication skills.

References1. Accreditation Council for Pharmacy Education

(ACPE). Accreditation Standards and Guidelines

for the Professional Program in Pharmacy Leading

to the Doctor of Pharmacy Degree. Available at:

http://www.acpe-accredit.org/pdf/ACPE_Revised_

PharmD_Standards_Adopted_Jan152006.pdf. Ac-

cessed June 17, 2010.

2. Center for the Advancement of Pharmaceutical

Education (CAPE) Pharmacy Practice Supplemental

Educational Outcomes. Available at: http://www.

aacp.org/resources/education/Documents/Pharmacy-

PracticeDEC06.pdf. Accessed June 17, 2010.

3. Center for the Advancement of Pharmaceuti-

cal Education (CAPE), Social and Administrative

Sciences Supplemental Educational Outcomes.

Available at: http://www.aacp.org/resources/educa-

tion/Documents/SocialandAdminDEC06.pdf. Ac-

cessed June 17, 2010.

4. Kimberlin CL. Communicating with patients:

skills assessment in US colleges of pharmacy.

Am J Pharm Educ. 2006 Jun 15;70(3): article 67.

5. Beardsley RS. Communication skills development in

colleges of pharmacy. Am J Pharm Educ. 2001;65:307-14.

Figure 4. Faculty’s Individual and Group Oral Examination Evaluations

4 5

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p <0.05*+

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BackgroundIncorporation of varied active learning

techniques has been shown to increase

learning in students enrolled in Doctor of

Pharmacy programs.1-3 Characteristics of

active learning include: students who are

involved in more than listening, student

involvement in higher-order thinking such

as analysis, synthesis, and evaluation, and

students who are engaged in activities, e.g.

reading, discussing, writing.4 All of these

characteristics are needed to meet the Com-

mission to Implement Change in Pharma-

ceutical Education (CAPE) outcomes and

the Accreditation Council on Pharmaceutical

Education (ACPE) standards.5,6 With active

learning, emphasis is placed on exploration

by the students of their own attitudes, values,

and skill development with less emphasis on

transmitting information.4 Didactic lectures

used alone may limit students’ retention

rates.7 A goal of active learning is to hold

students responsible for their own learning

by providing them with opportunities

to practice or utilize concepts and skills

learned in the classroom. Active learning

assignments may be incorporated into the

large classroom setting, allowing students

to demonstrate problem solving or critical

thinking skills after instruction inside or

outside the classroom.3,4 Three components

suggested as necessary for successful active

learning are: explanation of the context of

the activity, student engagement in the

activity, and activity closure via some form

of reflection.3 Barriers or limitations to

active learning assignments include large

class size, lack of technology or faculty

resources, and the time needed to develop

and implement activities.3,4 Faculty use of

previously developed case study programs,

including continuing education programs,

can minimize the faculty resource and time

A Pain Management Assignment Incorporating an Electronic Learning Program

Diane Nykamp, Pharm.D. Leisa L. Marshall, Pharm.D.

barrier. Formats for continuing education

activities available on the Internet include live

webcast, video with slides, short interactive.

case studies, conference coverage, posters

and abstracts, journal articles and practice

guidelines. A variety of these programs can

be used to supplement course content in

the didactic setting.8-11 Most are available

without a fee and are readily accessible to

faculty and students.

This article describes a Pain Management

Activity (PMA) using a professionally devel-

oped Continuing Medical Education (CME)

electronic learning case study program

available on the Internet. The CME case

study program was coupled with a faculty

developed assignment and break-out discus-

sion session designed to incorporate and

assess student problem solving skills in pain

management in a required pharmacotherapy

module, Disorders of the Musculoskeletal

System and Pain Management.

Learning objectives of the PMA included

developing proficiency in:

• recommendingappropriatemedication

therapy and monitoring parameters,

considering patient specific parameters

presented;

• identifyingadversedrugreactionstotherapy;

• identifyingfollow-upplansthatdemon-

strate appropriate and effective practices

for patient care;

• identifyingtreatmentplansthat

demonstrate effective strategies to

overcome or manage treatment-related

side effects.

MethodsThe program used in this project was a CME

program from BiMark Center for Medical

EducationTM entitled CME IDOL (Improve-

ment Demonstration Outcomes Leaders).11

Permission was obtained to use the program

in an educational class setting. The case

study program consisted of clinical reviews of

three patients with chronic pain syndromes.

Student learning and achievement of the

PMA learning objectives were assessed via

performance on the PMA. An 18-item active

learning assignment was developed by faculty

using questions from the medical educa-

tion program, with the addition of questions

focusing on proper medication use and

monitoring, adverse reaction identification,

and proper follow-up and treatment plan

identification. A graded rubric and detailed

answer key for the 18-item assignment were

also developed. Student impression of the active

learning activity was assessed using a faculty

developed 10-item survey and open- ended re-

sponses to three guided questions. The project

was approved by the Institutional Review Board

of Mercer University.

The PMA occurred during the third week of the

four-week module, following didactic lecture

presentations on medicinal chemistry, pharma-

cology, and therapeutic management of acute

and chronic pain. The exercise included an

in-class preview of the electronic learning site

and three cases, student work outside of class

to review the cases and complete the 18-question

assignment, mid-sized group (23-24 students)

break-out case discussion meetings with faculty

facilitators the next day, and voluntary survey

completion. The electronic learning program

cases were: 1) a 70-year-old female with

neuropathic pain, 2) a 48- year-old male with

renal cell carcinoma and hip pain, and 3) a

35-year-old male with a 6-month history of

chronic back pain.11

Faculty facilitators used the provided answer

key and grading rubric for case facilitation and

to begin assignment grading. Course coordina-

tors finished grading the assignment. During

the break-out session, mimicking the American

Idol television show™, students chose, by vote,

the care plan that demonstrated the most

effective patient care practices and the care

plan that provided the most effective strategies

to manage treatment related side effects and

provide proper follow-up care. After the final

results were tallied, the winning results were

announced in class. The voluntary survey

assessing the students’ perceptions of the

activity was administered after the final voting.

Student learning was assessed using student

performance on the 18-item assignment.

Results One hundred percent of the students enrolled

in the course completed the assignment and

attended their assigned break-out case session.

This activity was worth a possible 1% of the

grade in the course. Student performance on

the activity (18 items graded) was good with a

mean of 90.6 (SD 9.26), n=146.

Of the 146 third-year students enrolled in the

course that year, 86 (58.9%) completed the

voluntary questionnaire regarding their

perceptions of the PMA. Several students

failed to answer all 10 items on the survey.

4 5

Mean responses (Table 1) ranged from 2.75

(SD =0.99) to 3.35(SD=1.05), based on a 5-point

Likert scale (1= strongly disagree, 2= disagree,

3=neutral, 4= agree, and 5= strongly agree).

Forty-one (48.8%) students agreed or strongly

agreed that the activity actively challenged

them to think critically about their approach to

pain management. Fifty-three (61.6%) agreed or

strongly agreed that the activity involved them

in the learning process. However, only 28 (33.

7%) agreed or strongly agreed that the activity

was a useful learning tool, and only 18 (22.3%)

agreed or strongly agreed that the active learning

activity would help them to become a competent

pharmacist. The three open-ended survey ques-

tions were: what was the most valuable aspect

of the activity, the least valuable aspect of the

activity, and how would you improve the activity?

Students indicated the use of real live patients

and the opportunity to practice problem solving

skills via patient cases to be the two most valu-

able components, whereas the use of unfamiliar

medical terminology in the cases and taking

time away from studying to complete the activity

were the two least valuable components. The

two suggestions for improvement most often

given were to provide the cases in text, as well

as on the Internet, and to give students more

time to complete the assignment.

DiscussionIn our experience, electronic learning case based

programs can easily be integrated into a pharma-

cotherapy module as one type of active learning

activity. This professionally developed program

designed for health care professionals, physicians,

and pharmacists was chosen as it included content

and pain management guidelines relevant to course

content and learning objectives. Furthermore,

the current generation of students generally like

multi media entertainment, so an electronic

program mimicking the American Idol™ format

had appeal.12,13 The use of other types of game

formats, such as Trivial Pursuit™, Jeopardy™,

and Hollywood Squares™ to analyze and present

patient cases, have been successfully incorporated

into required pharmacotherapy modules with

16-20 student group sections.14 Our students

reported that on demand access to the electronic

program allowed them the opportunity to review

information at their own pace after didactic lectures,

prior to completing the assignment and attending

the discussion session the next day. Students

reported that they appreciated the opportunity

to practice problem solving skills using patient

scenarios based upon real patients, whether

working alone or with other students.

This project was not without limitations, notably

the results of the voluntary student survey (Table

1). According to the Likert Scale, success would

be defined as 4 or 5. The highest ranked question

from this survey was 3.35. The remaining 9 ques-

tions received scores of 2.75 to 3.13. This activity,

however, was the last of 5 graded active learning

activities in the course that year. Four of the five

activities occurred in weeks 3 and 4 of a 4-week

block. The block scheduling of this course, where

class meets 18 hours a week for 4 weeks, presents

time-constraint challenges. Students in the

course may have perceived the activity as extra

work outside of class without value added ben-

efits. Furthermore, two hours of didactic instruc-

tion on pain management was deleted in order

to allow time to have the break-out patient case

discussion sessions. Students were responsible

for reading materials that were not covered in

lecture. As a final limitation, the project design

did not include an assessment of mastery of

learning objectives in the area of pain manage-

ment comparing traditional lecture to the PMA

with a shortened lecture and additional required

outside reading.

ConclusionAn existing electronic case study program can

easily be used as the basis for an active learning

Survey Items

The PMA helped me to learn pain-related subject matter in this course.

The PMA served as a useful supplement to the information provided during the course.

The PMA enhanced my problem-solving skills.

The PMA challenged me to think critically about my approach to pain management.

The PMA involved me in the learning process.

The PMA will help me to prepare for Advanced Practice Experiences.

The PMA will help me to become a competent pharmacist.

The quality of the electronic learning medical education was excellent.

The PMA was a useful learning tool.

The PMA should be made available to future students.

5Strongly Agree, %

1.3

2.5

1.2

3.6

3.5

2.6

2.5

1.2

1.2

2.4

4Agree,

%

33.8

40.7

26.8

45.2

58.1

23.4

19.8

28.4

32.5

34.9

3Neutral,

%

24.7

18.5

35.4

21.4

17.4

42.9

40.7

38.3

36.1

27.7

2Disagree,

%

26.0

25.9

23.2

20.2

11.6

18.2

24.7

21.0

20.5

26.5

1Strongly Disagree,

%

14.3

12.3

13.4

9.5

9.3

13.0

12.3

11.1

9.6

8.4

Average

2.82

2.95

2.79

3.13

3.35

2.84

2.75

2.88

2.95

2.96

6 7

Table 1.

activity to involve students in the learning process.

Further work is needed comparing student

competency in selected topics when graded

active learning activities are employed versus

traditional lecture format.

References1. Brandt BF. Effective teaching and learning

strategies. Pharmacotherapy. 2000; 20 (10):

307S-316S.

2. Kerr, RA. Curricular integration to enhance

education outcomes. Pharmacotherapy. 2000;20

(10): 292S-296S.

3.Van Amburgh JA, Devlin JW, Kirwin JL, Qualters

DM. A tool for measuring active learning in the

classroom. Am J Pharm Educ. 2007; 71 (5):

Article 85.

4. Bonwell C. Eison J. Active Learning: Creating

Excitement in the Classroom. ASHE-ERIC High-

er Education Report No 1. Washington D.C.: The

George Washington University, School of Educa-

tion and Human Development; 1991.

5. American Association of Colleges of Pharmacy,

Center for the Advancement of Pharmaceutical

Education. Available at: http://www.aacp.org/

resources/education/Documents/CAPE 2004.pdf .

Accessed June 18, 2010.

6. Accreditation Council for Pharmacy Education

(ACPE). Accreditation Standards and Guidelines

for the Professional Program in Pharmacy Lead-

ing to the Doctor of Pharmacy Degree. Available

at: http://www.acpe-accredit.org. Accessed 2010

June 18.

7. Machemer PL, Crawford P. Student perceptions

of active learning in a large cross-disciplinary

classroom. Active Learn Higher Education 2007; 8:9-

30.

8. Medscape. Available at: http://www.medscape.

com/pharmacists. Accessed Sept 1, 2009.

9. Free CME. Available at: http://www.freecme.

com/gindex.php. Accessed Sept 1, 2009.

10. Princeton Media Associates. Available at:

http://www.princetoncme.com. Accessed Sept 1,

2009.

11. Optimizing Pain Management, Bimark Center

for Medical Education. Available at: www.bcme-

online.com/cmeidol. Accessed Sept 1, 2009.

12. Gardner SF. Preparing for the nexters. Am J

Pharm Educ 2006; 70(4): Article 87.

13. Grover TP, Groscurth CR. Principles for teach-

ing the millennial generation: innovative practic-

es of U-M faculty. University of Michigan Center

for Research on Learning and Teaching Occa-

sional Papers 2009; Paper No. 26. Available at:

http://www.crlt.umich.edu/publinks/CRLT_no26.

pdf. Accessed Jan 28, 2010.

14. Patel J. Using game format in small group

classes for pharmacotherapeutics case studies.

Am J Pharm Educ. 2008; 72(1): Article 21.

PublisherHewitt “Ted” Matthews, Ph.D.

Dean and Senior Vice President for the Health Sciences

EditorLeisa L. Marshall, Pharm.D.

Associate EditorAjay Banga, Ph.D.

Editorial and Production ManagerDavid Hefner

Graphic Designers Terry Menard

Jenifer Cooper, CooperWorks Inc.

6 7

College of Pharmacy and Health SciencesMercer University3001 Mercer University DriveAtlanta, GA 30341-4155678.547.6232cophs.mercer.edu

Let’s Think About ItPromoting

Effectiveand Innovative

TeachingA Newsletter by Mercer University’s College of Pharmacy and Health Sciences

INSIDE THIS ISSUE

Communication Skills Comparison, P.2

A Pain Management Assignment, P.5