R-E-S-P-E-C-T Find Out What it Means to Me

By: Theresa Carboni, Pharm.D. PGY-1 Pharmacy Practice Resident, Baltimore VA Medical Center
I remember the day I received my acceptance letter to pharmacy school. “This was it!”  I told myself.  With the letter in hand, I was now well on my way to achieving my goal of becoming a pharmacist.  As I prepared to move 500 miles away, sacrifice 4 years of my life, and pull out a loan the size of a mortgage, I never thought I’d have to earn the respect of my professors (and future colleagues). I had been accepted to the school.  If I were unqualified, I wouldn’t be here, right? Well, on the very first day, I was quickly put in my place by one of my professors.  After I tried to clarify some of the course requirements, he stated, “You will do exactly what I say. Once you have your license in hand, then maybe I will consider what you have to say.”  This incident and a few similar situations, set the tone for the next 4 years with that professor.  And, unfortunately, with a few others too. Based of this experience, I wanted to understand the impact that respect between teacher and student has on learning.
Respect is defined as a state of honor or esteem wherein there is a demonstrated willingness to show consideration or appreciation.1  Respect is an important component of professionalism.2  A professional shows respect for patients and their families, peers, and other healthcare professionals.   Key documents in the pharmacy literature define the standards by which pharmacists and pharmacy students should demonstrate professional behavior and attitudes. These documents include the Code of Ethics for Pharmacists, Pledge of Professionalism, and Oath of a Pharmacist.2   The word respect is literally written into our professional codes of conduct, the standards by which both pharmacists and pharmacy students should live up to.  Shouldn’t these codes of conduct apply to the interactions between students and teachers in (and outside) the classroom?
Indeed, respect is clearly important and a requirement within the  standards for pharmacy education. According to the Accreditation Council for Pharmacy Education (ACPE) 2007 Standards for the Professional Degree Program in Pharmacy (Standard No. 25: Faculty and Staff – Qualitative Factors), “The college or school must have qualified faculty and staff who, individually and collectively, are committed to its mission and goals and respect their colleagues and students.”3 Additionally, it goes on to state that [faculty] “should provide strategies to develop consistent socialization, leadership, and professionalism in students throughout the curriculum.”3 If faculty are required to respect students and to ensure that students uphold the standards of professionalism, then it seems imperative that it be effectively demonstrated by everyone in the academic community (administrators, faculty, staff, and students).
If respect is important, how can teachers effectively demonstrated it?  What does respect look like?  In his book “What the Best College Teachers Do”, Kenneth Bain devotes an entire chapter on how the best teachers treat their students.4  He goes on to describe how the best teachers display an investment in their students. Moreover, the best teachers have a strong sense of trust in their students by believing that students want to learn, and assume, until proven otherwise, that they can.  Above all, the best teachers treat their students with simple decency.  Teachers should treat students in the same manner they would treat a colleague - with fairness, compassion, and concern.  Bain observed that the best teachers incorporated this approach into everything they did – including what they taught, how they taught, and even how they evaluated students. In other words, the best teachers did not use their power to bend students to their will but rather attempted to build common ground based on trust, decency, and respect for what each other brought to the classroom experience.4
Pharmacists and pharmacy students are bound by our Code of Ethics5 “to respect the values and abilities of colleagues and other health care professionals.” Since we commit as professionals to uphold these standards, I feel it is imperative we start when a student enters pharmacy school  … and not wait until graduation.

References:
1. Webster’s Dictionary for word respect. Accessed on December 15, 2010.
2. Hammer DP. Professional attitudes and behaviors: the “A’s and B’s” of professionalism. Am J Pharm Educ 2000; 64: 455-464
3. Accreditation Council for Pharmacy Education: Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Available at: http://www.acpeaccredit.org/pdf/ACPE_ Revised_ PharmD_ Standards_ Adopted_Jan152006.pdf. Accessed on December 15, 2010.
4. Bain K. What the Best College Teachers Do. Harvard University Press. Cambridge, Massachusetts.
5. Code of Ethics for Pharmacists. American Pharmacists Association. 1994 

Pick Me! I Was a Pharmacy Technician

by Kasey Dumas, Pharm.D., PGY1 Pharmacy Practice Resident, Sibley Memorial Hospital 
Many universities consider previous pharmacy work experience to be a predictor of better academic performance in pharmacy school.  Attesting to this fact is that some pharmacy schools include information on their websites implying that work experience may enhance an applicant’s chance of acceptance.  For example, the University of Maryland School of Pharmacy website states, “Work experience is not required for admission.  However, it can show commitment to the field of pharmacy or can demonstrate the well-roundedness of an applicant.”1 The Virginia Commonwealth University’s School of Pharmacy website states that previous work experience is not required but, “exposure to pharmacy practice is desirable” and “ideally, successful candidates have some exposure to the health care system and patient care involvement.”2  This is a interesting hypothesis, but what needs to be tested is whether previous pharmacy-related work experience results in improved academic outcomes.
A study conducted in April 2010 at the Touro University College of Pharamacy evaluated the impact of previous pharmacy work experience on academic success.  This study was looking at both academic and clinical performance.  A survey was used to determine the type and quantity of pharmacy work experience.  The survey results from 206 responding students were then correlated with grade point average (GPA), high-stakes examination grades, and advanced pharmacy practice experience (APPE) grades.  The researchers also stratified the data by student demographics.  The results of this study showed no difference in academic performance between students with previous work experience and those without previous work experience.3 
Unfortunately, the results of this study may not be generalizable to other pharmacy schools (or health professional disciplines).  The average age of respondents in the Touro study was 26 years in respondents with no work experience and 27.3 years in respondents with work experience.  Some institutions accept students immediately from high school into 6-year programs.  Thus, the effects of work experience may be different if the average age is much younger (or older).  Also, assessment strategies and grading methodologies differ between institutions.  Finally, surveys in general have poor response rates and may not accurately represent the entire student body.
One explanation as to why work experience does not translate into better academic outcomes is that working as a technician or intern teaches you technical skills, but not clinical skills, which are now the focus of pharmacy curriculums.3  Although academic performance does not appear to be effected by work experience, previous experience in a pharmacy may indicate that a perspective student is more sure of their future and may be more dedicate to the profession.1,2  In the future, it may be beneficial for researchers to examine other benefits that previous work experience may confer.
Previous work experience may be a useful way to select between students and it may predict some other desirable attribute(s).  In my experience, working as a pharmacy technician made me more confident when I entered pharmacy school, more certain that I had made the best career choice, and made studying for many of the technical aspects easier, such as learning brand and generic names of medications.  Also, during my clinical experiences, I was already comfortable interacting with members of the pharmacy team and speaking with physicians and nurses.
In conclusion, although experience has not been shown to improve academic performance, other benefits may be afforded to students (and the schools that accept them) who have previous work experience.  I believe that universities should continue to use previous work experience as one the criteria to select applicants but we need further studies to better understand how previous pharmacy-related experience impacts short and long-term outcomes.

References
1.      University of Maryland School of Pharmacy.  PharmD Admissions: Prerequisites.  Accessed: Dec 2010.
2.      Virginia Commonwealth University School of Pharmacy.  Pharm. D. Program FAQ: Academic info.  Accessed: Dec 2010.
3.      Mar E, Barnett MJ, Tang TTL, Sasaki-Hill D, Kuperberg JR, Knapp K.  Impact of previous pharmacy work experience on pharmacy school academic performance.  American Journal of Pharmaceutical Education.  2010; 74 (3): Article 42.

Social Networking and Professional Education

By Nicole Hahn, Pharm.D., PGY2 Ambulatory Care Pharmacy Practice Resident, University of Maryland
There is no doubt that the popularity of social media sites has boomed in the last few years and with it has come new ways to communicate to and among students.  The London School of Business and Finance Global M.B.A. decided to capitalize on the success of Facebook by using the site as a vehicle to advertise their online M.B.A. program.  Students will be able to sign up for the program just as they join any other group by sharing their name, profile picture, Facebook ID, and list of friends.  Short (15 minute) online video presentations, Facebook discussions, and case study materials are provided for each course.  Unique to this program is the way in which tuition is paid.  Students have free access to all of the online study and collaboration tools and only pay when they want to take exams.   Similarly to other Facebook groups, students post comments on each other’s “walls” and this mechanism is used to provide feedback about courses.
As instructors, we are encouraged to recognize the different learning styles and preferences of our students.  And we should strive to structure our lesson plans to incorporate all of them.  What we sometimes fall short in accomplishing is appealing to what our students’ interests are.  It is amazing how people can remember every single word to a song on the radio they haven’t heard in years but struggle to remember concepts from a lecture they sat through just yesterday.  Or a student athlete who struggles in the classroom due to a learning disability but as the quarterback of his team, remembers and calls every offensive play.   So what is the difference described in these two examples?  A favorite song, a passion for playing a sport are activities that these individuals enjoy doing.

Today people of all ages enjoy keeping up with friends and family on social networking sites such as Facebook.  The online M.B.A. program at The London School of Business and Finance combines a social networking conduit with scholarly activity – joining an activity people enjoy doing to one they may struggle to motivate themselves to accomplish.  One of the most important steps in developing a lesson, course, or degree program is providing feedback.  Constructive feedback is very important for a teacher and being able to “post” on Facebook is a great incentive to get students to actually write meaningful feedback.  Educators in this program discovered that students began posting feedback without even prompting them to do so.

As we look ahead and postulate how online social networking can be applied to ourselves as educators, we should do so with caution.  There exists a very thin line in managing your own personal life and your professional career when using sites such as Twitter, Facebook, and MySpace.  It takes some effort to prevent these two lives from crossing one another, but it is not impossible.  When used effectively, social networking sites may be appealing and useful to both to the educator and the learner.

Reference
Guttenplan DD. (2010 Nov 28). Poking, Tagging and Now Landing an M.B.A. The New York Times (New York, NY). 

A Different Small Group Learning Method - POGIL

by Amy Nathanson, Pharm.D., PGY1 Community Pharmacy Practice Resident, University of Maryland School of Pharmacy
Small group learning with an active component is incorporated in many curricula today. Have you been in a class where you had small group breakout sessions to discuss a case or apply learned concepts?  Many of us would answer yes.  Have you been enrolled in a course which was taught exclusively using a small group learning method?  Likely fewer would say yes.  Have you heard of or been enrolled in a process-oriented guided-inquiry learning (POGIL) course?
POGIL is a student-centered small group method of education.  The goal of this educational method is geared to develop the learner’s critical thinking and communication skills while keeping the student actively engaged in the learning process.  Students work in teams of four.  Using course materials and equipped with “guided” questions from the instructor, students explore an idea, (hopefully) grasp a concept, and then apply it.1  The instructor’s role is to serve as a facilitator and, therefore, will not answer questions if s/he believes the students have enough information to come to a conclusion.2
This method of learning was initially developed for science courses and was prompted by an understanding the needs of industrial employers.3  A survey was conducted and concluded that “employers would like chemistry-trained employees whose education includes greater preparation in communication, team skills, relating applications to scientific principles, and problem solving, without sacrificing thorough preparation in basic science concepts and experimental skills.”3
I am fortunate to have participated in a POGIL course taught by one of the founders of this methdology.  It was an introduction to chemistry course taught at Franklin & Marshall College.  Reflecting back on the course, I remember it was very different from the typical lecture-base courses and, at the time, only a few courses were taught in this manner.  I enjoyed working with other students and remember favoring certain roles over others.  As a group we taught ourselves the key concepts of chemistry.
After discussing various small group teaching methods during the Educational Theory and Practice course, I have been reflecting on my experiences in this course and how it is unique.  POGIL utilizes carefully crafted learning materials to provide information to students systematically with leading questions to promote critical thinking to arrive at the best conclusion.  In each small group students have defined roles and responsibility that rotate weekly.  The roles include:
Manager- delegates responsibilities and keeps team focused, resolves disputes and ensures full member participation
Recorder- writes up group answers to turn in
Spokesperson/presenter- presents report to class
Analyst/reflector- identifies strategies and methods for problem solving, identifies positive attributes of the team
Every student is expected to learn the material on a daily basis and ensure that all group members have learned it too.
Unlike other small group learning environments such as Problem Based Learning (PBL), POGIL is more structured.  Every member of the group has an assigned role.  PBL is less structured and requires more independence of each student.1 There are never lectures in a POGIL course, whereas occasionally there is a lecture in a PBL course.
This method of learning is rewarding to students because it actively engages them in the learning process. It’s more rewarding to the instructors as well because there is constant feedback from students.  Instructors have greater awareness of how the class is doing by getting this feedback.4
In my pharmacy education at University of Maryland we have small group case-based learning activities.  These cases often included leading questions to encourage critical thinking and further application of knowledge and guidelines of disease states and therapies.  However, the groups were often too large, consisting of 10-12 students, making it difficult to effectively work as a team.  And as is typical with most group work, certain people become the leaders or “managers” for every session, and other members of the group assumed roles that they were naturally comfortable with.  This is a problem that POGIL addresses by creating small working groups and assigning student roles.
These small group learning activities take a substantial time commitment from instructors and more effort on the part of the student too.  This likely explains why small group facilitated learning is not commonplace.  However there is a place for this methodology and I believe it can be used more in pharmacy education.  The skills POGIL works to enhance are necessary skills in pharmacy:  communication and team work with patients and other health professionals are critical skills that every pharmacist should master. 

References
1. Eberlein T, Kampmeier J, Minderhout V, Moog RS, Platt T, Varma-Nelson P, White HB.  Pedagogies of Engagement in Science: A Comparison of PBL, POGIL and PLTL. BAMBED. 2008; 36(4):262-73. 
2. POGIL Guided Inquiry Classroom [Internet]. Lancaster: Franklin & Marshall College. The POGIL Project. C2010 [Cited 2010 Nov 19]
3. Hanson DM. Instructor’s Guide to Process-Oriented Guided-Inquiry Learning. Lisle, IL: Pacific Crest. 2006. [Cited 2010 Nov 19] 
4. POGIL [Internet]. Lancaster: Franklin & Marshall College. The POGIL Project. C2010 [Cited 2010 Nov 17]

Interprofessional Education: Building a Bridge to Interprofessional Cooperation

By Susan Montenegro, Pharm.D., PGY1 Pharmacy Practice Resident, Union Memorial Hospital
Many schools boast having an “interprofessional culture,” which (apparently) they define as having more than one health professional school located on the same campus. But simply having schools across the street from each other, sharing a cafeteria, and hosting a few campus-wide social events, does not come close to building the relationships needed for optimal patient care. Many students in the health professions are taught a structured approach to managing a patient. So interprofessional education (IPE) shouldn’t be so difficult – should it? How can educators from different schools build bridges and encourage students to make the journey? How do we encourage the healthcare system to sustain these bridges?
I envision the answer to this question to be a three step process analogous to constructing a bridge to connect two places. Step 1 is putting together a blue print and building a structure.  As with any improvement process, first you need to put everything down on paper so everyone can see it. How will the bridge be built? Who will build it? Who will pay for it? Why is the bridge necessary? What are the benefits? A plan must be made and a proposal submitted to garner the support of the university, and secure the funds needed, to build the structure. Once these things are secured, those in charge of the project can begin to lay the foundations.
The American College of Clinical Pharmacy (ACCP) released a White Paper on IPE which describes considerations relevant to IPE.1  Fundamentally, it is important for students to understand the knowledge and skills that other members of the healthcare team possess. Students must also realize that different professions take different approaches to patient problems in terms of assessment and evaluation. The paper describes several examples of IPE models.  Each approach has its strengths and future IPE programs can be optimized by building on these examples.
Creighton University Medical Center in Omaha, Nebraska has a number of IPE initiatives.2 Collaborative Care Seminars are held one half-day each semester and involve students in dentisty, medicine, nursing, occupational therapy, pharmacy, physical therapy, and social work.  During these seminars, students are encouraged to reflect on what their own profession’s contributes to patient care and how to work together and understand what other professions have to offer. The Medical Center also offers a clinical conference and grand rounds series during which case-based discussions are led by panelists from the various health professions. This allows students to learn and observe how to participate in similar discussions once they start clinical training.
Step 2 is convincing the students to take the journey across the bridge. Students will only make the journey if they understand the importance of arriving at the destination. Where are they going? Why are they being asked to cross into unknown territory and away from familiar and safe ground? What are the benefits?
Another example from Kings College in London involves pairing a fourth year pharmacy student and a third year medical student to work together.3  Both students are starting their clinical year of training, so they have similar amounts of clinical experience and knowledge of therapeutics. Each student pair is assigned a patient with the objective of obtaining a medical and medication history.  The student pair is then instructed to organize the information and present it to a group of faculty and students.  They are expected to summarize the patient problems, the rationale and appropriateness of the treatment regimen, and how to monitor the patient for efficacy and adverse effects.  The results of this activity have been positive, with the medical students learning how to be more proficient at collecting the medical history of a patient and the pharmacy students being more proficient at collecting and managing the patient’s medication history. This type of activity is promising to demonstrating to health professionals early during their training how to maximize patient care by relying on the strengths of different professions.
A post-course questionnaire administered after the student pair activity found that 95% of pharmacy and medical students agreed or strongly agreed that it was useful to learn with other disciplines; 88% agreed or strongly agreed that there were equal contributions from both students; and 83% agreed or strongly agreed that more sessions were needed.3  This data shows that, given the opportunity, students are willing to meet other professions half-way and see the benefit in doing so.
Step 3 is ensuring that the destination (on the other side of the bridge) exists ... developing and continuing to foster the types of working environments where recent graduates can continue to use the skills they learned during IPE. This may require more time to develop as it will require holistic support. Not all clinicians have experienced IPE and many may feel threatened by the changes it will require. However as more programs move in the direction of IPE and as more workplaces emphasize the importance of inter-professional teams, the bridge built by educators will become stronger, producing a brighter and more promising future to optimize patient care.
In 2001, the Institute of Medicine released a report addressing the gaps in health care in the U.S. and how to redesign the health system. Titled, “Crossing the Quality Chasm: A New Health System for the 21st Century,” this report stated that health care needs to be safe, effective, patient-centered, timely, efficient, and equitable.4  Included in the report were 10 general principles meant to guide improvements to meet these health care needs. One principle, stated quite simply and directly, “Cooperation among clinicians is a priority.” Thus, it is clear that our healthcare system needs to move towards interprofessional cooperation and that IPE will play an important role in making that future a reality.

References
1.  American College of Clinical Pharmacy. ACCP white paper. Interprofessional education: principles and application. A framework for clinical pharmacy. Pharmacotherapy 2009; 29: 145e-164e. [Accessed September 26, 2010].
2.  Interprofessional Education. Creighton University Medical Center. [Accessed: November 22, 2010]
3.  Greene RJ, Cavell GF, Jackson SHD. Interprofessional clinical education of medical and pharmacy students. Medical Education. 1996;30:129-133.
4.  Institute of Medicine.  Crossing the Quality Chasm: A New Health System for the Twenty-first Century.  Washington, D.C.: National Academy Press, 2001.

Taking Learning Outside the Classroom

by Olabode Ogundare, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy
Do you remember those schools days when the weather was so nice outside and you wish your class was also outside so you could really enjoy the fresh outdoors as well as learn? How about those last days of spring semester when your school still had the heat on and it was unbearable for you to learn anything … but if you were outside it probably would have improved your attention span? Well, if you agree with these statements, then taking learning outside of the classroom might be just what you need to help improve your learning experience!
Outdoor education is relevant to educational theory and practice because it is an instructional method. Outdoor education is a type of instructional style that dates back to the early 1940s. It involves the use of outdoor learning settings to cover subject matter through hands on learning experiences. Outdoor education is still practiced in today’s educational system and can involve educational activities outside of the classroom such as field trips, field work, camping, or simple observation of the environment. What differentiates outdoor education from the more ‘traditional’ instructional methods is that it incorporates several of the different learning styles into its teaching method, thus allowing students to have an individualized learning experience that correlates with how they learn.  Outdoor education plays a significant role in shaping the education of children and may help enhance their learning.1
In an article from Education.com titled, Environmental Education Programs Help Kids Connect to the Earth, Peter Bergstrom discussed how many adults feel that there is a steady decline of appreciation for nature in recent years. He emphasized that it is important especially for children to get in touch with nature because in his words, “fundamental to discovering who you really are, that you are not a person apart from nature, but a part of nature." If take a look at our education system, the amount of outdoor time children are allotted gradually declines overtime as they progress through their education. I think being able to connect with nature helps to develop critical skills that are not taught in the classroom setting. Outdoor educational programs similar to Bergstrom’s, help “kids recognize that they are smart in a different way from classroom smart,” which highlights that outdoor learning helps students engage beyond the norms of the classroom and enhance their learning experience.2

A study by the California Department of Education showed that six graders’ science knowledge test improved by 27% after participating in an outdoor educational program. Feedback received from the students showed that a majority of them felt that their participation in the outdoor education program actually changed them. When one student was asked whether he benefited from the program, the student responded, “Yes, because I learned more; I like science a lot because it helped me to protect the environment even more.” This demonstrates that outdoor educational programs really can enhance one’s learning experience and help students perform better academically.3,4

The study entitled Effects of Outdoor Educational Programs on Children clearly demonstrates the potential role outdoor education may have on shaping the education system in years to come.4 Educators need to realize the students they encounter have different learning styles and it may not excel when traditional classroom-based methods are used.  Outdoor education is an alternative for students who seek to be engaged and have an active role in their learning experience. Most importantly, outdoor education programs have shown to improve academic performance in students.  Educators should be inclined to incorporate this instructional method as part of their teaching style to enhance their students’ learning.

References:
1.  Outdoor and Environmental Education. [Internet]. [Online: Education.com, Inc]; [Periodically updated; cited 2010 Nov 10] 
2.  Boutis, Nick.; Krisko, Beth. A Life Shaping Week: The Outdoor Education Experience [Internet]. [Online: Education.com, Inc]; [Periodically updated; cited 2010 Nov 8]
3.  What Does Environmental Education do for Children [Internet]. [Online: Education.com, Inc]; [Periodically updated; cited 2010 Nov 10]
4. Effects of Outdoor Education Programs for Children in California. American Institutes for Research. January 31st 2005: 33-41


What is the Target?

by Angela L. Bingham, Pharm.D., PGY1 Pharmacy Practice Resident, Johns Hopkins Hospital
What is the target?  To answer this question, student pharmacists must be given a clear description of what they should be able to do after completing a learning experience.  Regardless of the field of study, instructors should give their students explicit instructional objectives.
In the “Required and Elective Educational Outcomes, Goals, and Objectives for PGY1 Pharmacy Residency Programs,” the American Society of Health-System Pharmacists (ASHP) defines educational goals, educational objectives and instructional objectives.1  Educational goals are “broad sweeping statements of abilities.”  Achievement of educational goals is determined by assessing the learner’s ability to perform educational objectives.  Instructional objectives further narrow the focus by outlining the “knowledge and skills required for successful performance of the educational objective.”  Instructional objectives are helpful to educators and students by identifying areas for improvement to meet educational objectives.1
Beyond providing students direction, instructional objectives help improve quality and efficiency.  According to Dr. Louis Vontver, “Instructional objectives should delineate specifically what the student is expected to do or know in terms of the student’s ability to demonstrate his skill or knowledge.”2  Objectives can only be measured effectively if they are simple.3  Measurement of complex outcomes and goals can be problematic because of the multi-factorial nature of the assessment needed.  Instructional objectives narrow the focus and help control for variables.
The Accreditation Council for Pharmacy Education (ACPE) also highlights the importance of objectives to facilitate learning.  ACPE states, “specific criteria should be developed to enable faculty and students to assess progress midway through the experience and at its completion. Students should be provided the opportunity to demonstrate achievement of stated competencies as assessed through the use of reliable, validated criteria.”4
When I was a student pharmacist, I was involved in a project that examined the role of self-assessment tool to evaluate the value of instructional objectives.  During this research project, a self-assessment tool was constructed using educational objective and instructional objective statements from the “Required and Elective Educational Outcomes, Goals, and Objectives for PGY1 Pharmacy Residency Programs.”5  Students performed self-assessments using this tool and their responses were compared to scores assigned by the preceptor for educational objectives and instructional objectives.
Twenty 3rd-year Doctor of Pharmacy candidates participated in the study.5  When comparing students’ self-assessment to the preceptor’s scores on the educational objectives, students were more likely to rate themselves higher for “accurately assess the patient’s progress toward the therapeutic goal.”  A significant difference was also seen when comparing “display initiative in preventing, identifying, and resolving pharmacy-related patient-care problems.”  In contrast, using instructional objectives improved the accuracy of student self-assessment.  There was no significant difference between student and preceptor scores for any of the instructional objectives.
As a result of this research project I concluded that, in order for students to understand course expectations, course syllabi must clearly outline the knowledge and skills needed to meet the educational objectives.5  Providing instructional objectives to students enable self-directed learners to achieve desired expectations.5 The learner and preceptor share a mutual understanding of the knowledge and skills required to meet an educational objective. 5
In addition to giving students greater clarity, instructional objectives also aid the instructor.5  When the learner and instructor understand the expectations, confrontation may be avoided at the time of evaluation.5
In an experiment conducted at the University of Washington Hospital in Seattle, Washington, medical students completing nights on obstetric call were provided with specific instructional objectives.2  Medical students were issued a document outlining objectives prior to nights on call.2  The medical students were instructed to read the document several times before each scheduled night and again during on-call period.2  The following morning, the students were expected to demonstrate fulfillment of the objectives.  Before implementation of objectives, the performance of the medical students during morning rounds were “highly erratic.”  After instructional objectives were provided as well as some instruction on how to use them, the students performed much better.  They were often able to fulfill all of the expectations after only one night in the delivery room.  Beyond guiding medical students, the instructional objectives also prevented misunderstanding by other members of the health-care team by clarifying the students’ responsibilities.2
When educators provide instructional objectives, students are more likely to find the target.  Well-written instructional objectives enable self-directed learners to achieve desired expectations.  Also, instructors may find assessment easier when clear instructional objectives are available.  Thus, instructional objectives are vital tools to both educators and students.

REFERENCES
1. Required and Elective Educational Outcomes, Goals, and Objectives for PGY1 Pharmacy Residency Programs. American Society of Health-System Pharmacists. 2008.  Available at: http://www.ashp.org/s_ashp/docs/files/
RTP_PGY1GoalsObjectives.doc. Accessed November 15, 2010.  
2.  Vontver LA. A Use of Instructional Objectives To Increase Learning Efficiency. Journal of Medical Education. 1974;49:453-454. 
3.  Norman HG. Schmidt GR. Effectiveness of Problem-Based Learning Curricula: Theory, Practice, and Paper Darts. Medical Education. 2000; 34(9):721-728.
4.  Accreditation Council for Pharmacy Education: Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Available at: http://www.acpeaccredit.org/pdf/ACPE_ Revised_ PharmD_ Standards_ Adopted_Jan152006.pdf. Accessed November 15, 2010.
5.  Bingham AL, Hess MM. Self Assessment as a Tool to Evaluate the Value of Instructional Objectives. ACCP Annual Meeting. Anaheim, CA. October 18, 2009.

Pay Attention to the External Realities

by Kathleen Fuller, Pharm.D., PGY2 Pharmacotherapy Resident, University of Maryland
With the recent midterm elections, public education reform has again been the center of much media buzz. The documentary Waiting for Superman1, directed by Academy Award-winning director Davis Guggenheim, identifies some of the major problems with the current American public education system, while also offering a glimpse of possible solutions. The film highlights the success of public charter school programs including the Harlem Children Zone (HCZ)2 and the Knowledge is Power Program (KIPP)3. These programs are built on the concept that education must extend beyond the school day to correct for the external factors that influence how learning occurs in the classroom. While these programs have been developed for primary education, they offer lessons that are applicable to both adult and patient education.
The Knowledge is Power Program

"Every day KIPP students across the nation
 are proving that demographics do not define destiny."3
Started as single school in 1994 by Mike Feinberg and Dave Levin, the KIPP network now consists of 99 schools in underprivileged areas of 20 cities nationwide enrolling 26,000 students. The program is based on five pillars: high expectations, choice and commitment, more time, power to lead and focus on results. The programs are rigorous and both the school days and the academic years are extended. Curriculum is built around character, leadership and community involvement, as well as traditional subjects. But what may be most important, high expectations are placed on children who may otherwise not be expected to graduate high school or attend college.3
Over 85% of KIPP students enroll in college, compared to less than 40% of low-income students nationally. And 100% of KIPP 8th grade classes do better on state tests for math and language arts than their district averages.3

The Harlem Children’s Zone
"A child is more than just the test scores they get inside a classroom.
They live in families and communities. And where those families
and communities are struggling we have a responsibility
to help those children."2 – Geoffrey Canada

Recognizing that the unique struggles the children of Harlem, NY faced were contributing factors to the poor performance of the schools in that district, Geoffrey Canada founded the HCZ in 1997. The HCZ targets a 100 block area and serves over 10,000 children. Using a community based approach the program aims to "give poor children the things middle-class children take for granted".4 This includes programs that educate expectant and new mothers, pre-K programs, after school programs, fitness and nutrition education, internship placement, college preparatory programs with one-on-one counseling sessions, and public health initiatives.2

One of the public health initiatives provided free asthma screening in the HCZ and then deployed case managers to visit the homes of children identified as having asthma to educate on medical assistance programs and environmental trigger control. Counselors went as far as to assist tenants in contacting the building managers of apartment buildings to demand necessary repairs and rodent extermination.5 Far-reaching, all-encompassing interventions, such as this, characterize the work of the HCZ and impact every aspect of life for the children enrolled in this program.

An independent study compared winners of the HCZ enrollment lottery to those that entered the lottery but did not win. They concluded that "the effects in middle school are enough to reverse the black-white achievement gap in mathematics."6

Application to Adult and Health Education

While adult learners may not be as impressionable as the students targeted by the HCZ and KIPP programs, external factors certainly impact their educational performance.  The theories applied in these programs can be extended to adult education.
How many of the students in your program are the primary caregiver for children or parents? How many have jobs outside of your program? How many do not have the technological literacy or access to the technology necessary for your program? Ask adult learners to reflect on their experiences to identify perceived barriers to achievement.
Develop a technology primer course. Distribute literature regarding child or elder care services in your area. Create flexible deadlines that can accommodate rigorous work schedules. And finally the strategies need to be implemented and assessed.
The principles are even more important when educating patients. Patients present from tremendously varied backgrounds and living situations. It may be easy to tell your patient with heart failure to avoid prepackaged foods with high salt content. But it is harder to walk down the aisles at the discount grocery store and find such foods in the same price range. As the HCZ asthma program illustrates, educating patients to recognize environmental triggers is different than walking through their homes and coaching them on strategies to realistically modify these triggers.
While you or I may not be in a position to implement the types of sweeping change we have seen from Geoffrey Canada, Mike Feinberg and Dave Levin, each of us can start small by analyzing the students and patients we teach to identify how their external lives affect our educational efforts.

1. Guggenheim D (director). Waiting for Superman [Movie]. Paramount Pictures; 2010.
2. Harlem Children’s Zone [Internet]. New York (NY): Harlem Children’s Zone. Updated 2009.
3. Knowledge is Power Program [Internet]. San Francisco (CA): KIPP Foundation.
4. Sayles M. Geoffrey Canada [Internet]. New York (NY): The New York Times; 2010 Oct 12.
5. Perez-Pena R. An Everyday Struggle for Breath; Childhood Asthma Project Reaches out in Harlem. New York (NY): The New York Times; 2003 May 1.
6. Whitehurst GJ, Croft M. The Harlem Children’s Zone, Promise Neighborhoods and the Broader, Bolder Approach to Education. Washington (DC): The Brookings Institution; 2010 Jul 20.

Inspiring Students - My Path Towards Nuclear Pharmacy

by Amber Mae Todd, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy
If someone had told me in my first year of school that I was going to choose nuclear pharmacy for my career, I would not have believed them. I would have never guessed that I would spend the next two summers learning how to elute technetium from a generator at 2 am, or discussing the properties of medronate while watching the sunrise. What could have happened that changed my perspective so much. I went from having no clue about where I wanted to go, to falling in love with any drug that sets off a Geiger counter. There had to be one very inspiring teacher in my life for this to transpire.

I have often wondered what qualities an inspiring teacher possesses. What does it take to inspire a student? One study by van der Zee and de Jung entitled “Teachers as a Source of Inspiration in Catholic Schools”, defines inspiration in the following way:
… inspiration may be regarded as mental causation of perlocutionary effects that, through the outstanding qualities of the source of inspiration, may motivate people, on the basis of suitable aptitudes, to have certain thoughts and desires and to perform certain actions.1
In other words, inspiring teachers, using the special qualities that they possess, can change the actions and perceptions of their student(s). In my opinion, this is the definition of what it means to teach. A teacher should always leave a lasting impression on their students' perceptions. I believe the student should walk away from the experience changed in some positive and profound way. It was certainly the case for me; I was never the same after crossing paths with my teacher.
What qualities make a teacher inspiring? Certainly enthusiasm, patience, empathy, and the ability to explain a subject proficiently are important qualities.1  van der Zee and Jung describe the teacher as a leader. They contend that a teacher must inspire their students in the same way a leader of an organization would inspire their followers.  Some of the leadership qualities that they point out include: vision, charisma, promoting intellectual stimulation (challenging a student), and being a role model. I do not believe a teacher must have all these attributes to inspire. However, having a few of these characteristics are probably necessary. In my case, my teacher was enthusiastic, patient, and proficient at explaining details. He challenged me and he was an excellent role model. His enthusiasm helped me to see the significance and life-changing nature of every radiopharmaceutical we made.
There are other factors that can affect the inspiration process. In Barbara Davis’ chapter entitled “Motivating Students” in the book Tools for Teaching, she points out several classroom strategies that can help motivate learning and inspire students.2 These include: making students active participants in learning, hold high but realistic expectations of your students, help students set goals for themselves, and explaining to students what they need to do to succeed.  These methods can help boost student confidence and help students to begin working and thinking independently.
My teacher inspired me. His proficiency at explaining concepts was amazing; this included his patience in repeating points where I was confused. A teacher who can explain things clearly is easier to follow. This will provide a greater understanding that leads to confidence and the ability to complete tasks successfully. Challenging a student can help increase that student’s confidence, as well as teach them to “work outside the box.” Challenges can show them that they can apply their understanding to new and stressful situations.  Lastly, my teacher was a role model.  The purpose of a role model is “to trigger a thought, an assurance, a vision, a character and a way of life, which can serve as the impetus for a students' personal and professional growth.”3 My teacher did that.  He showed me night after night what a great nuclear pharmacist could look like. It’s an image I took to heart.
It is no small thing to change a student’s perceptions.  Often, an inspired student will remember the lessons the teacher bestowed on them for the rest of his/her life. It takes a unique set of attributes to inspire someone.  I was lucky to find a teacher who had so many of them. He inspired me to take the path to nuclear pharmacy. When we become teachers, we must try to inspire our students … and change the path they take in their lives.
Sources:
1. van der Zee T, de Jong A. Teachers as a source of inspiration in catholic schools. Journal of Empirical Theology 2009 06;22(1):7-29. 
2. Gross Davis Barbara. Tools for Teaching. Hoboken: Joey-Bass, An Imprint of Wiley. c1999. Motivating Students.
3. Meetu. Teachers as Role Models. [Internet] BrightHub. 2010 Apr 5. [cited 2010 Oct 29] Available from: http://www.brighthub.com/education/special/articles/17266.aspx

Application of the Socratic Method in Health Professionals Education

by Stacy Elder, Pharm.D., PGY1 Pharmacy Practice Resident, Johns Hopkins Hospital

The Socratic Method is a widely used term for teaching via question and answer dialogue between a teacher and a student. However, the Socratic Method has undergone many changes since its first documentation by Plato, a student of Socrates.  Health professional instructors frequently employ various forms of this style of teaching in order to explore the critical thinking of their students and trainees. Analysis of the Socratic Method in the healthcare setting is a prime example of the evolution and contemporary utility of this mode of teaching.
The classic Socratic Method involves dismantling prior ideas in order to free the mind to think about a topic without the constraints of preconceived notions. By definition, this method deconstructs all prior thoughts on a topic and leaves the learner without a satisfactory answer to the primary question. Socrates taught that the only person who cannot learn, is the person who thinks he already knows the answer, so it is logical to remove prior beliefs in order to make way for the creation of new ideas. An example of the classic Socratic Method is observed in Meno, where Socrates asks Meno to define virtue. They discovered that they could not define virtue and, furthermore, virtue could not be taught. Meno learned that even this common term, when broken down to its fundamental parts, was actually not definable. As you might imagine, it was an Earth-shattering revelation for Meno to realize that it was impossible to trust even the most basic beliefs. The abolishment of prior beliefs on a subject is the deconstructive phase of the Socratic Method.
Once the student’s mind is freed from the constraints of prior beliefs, the teacher is free to bring forth new ideas during the constructive phase.  Notably, the teacher’s role in this scenario is to help the student clear away previous ideas in the deconstructive phase so that he may build new ideas in the constructive phase. Socrates stressed the importance of humility on the part of the teacher, due to the need to create a safe environment for the student to have these revelations. He believed that the teacher served to help the student do his own learning and asking questions was his method to facilitate that goal.
The classic definition of the Socratic Method is not always practical for teaching health professionals.  After the abolishment of the definition of virtue during Meno’s lesson with Socrates, Meno suggested a paradox that no one could ever question anything if definitions are impossible. Science, in general, does not accept the impossibility of defined answers, making the classic Socratic Method incompatible with the field of science. Also, healthcare does not generally involve discussion of abstract ideas. Established definitions of terms used to describe conditions and disease states are a critical part of healthcare learning. Standard, well-accepted “truths” in medicine make it possible to advance patient care by using the outcomes from research in a specific subset of patients in order to apply the highest level of decision making to patient care. However, the Socratic Method is still utilized in healthcare teaching, in a modified form.
The modern Socratic Method differs from the classic method by establishing that knowledge is recollection. Another of Socrates’ theories was that a student can only learn that which he already knows. Therefore, the teacher’s role is to facilitate the production of a constant progression of defined knowledge from the students pre-existing stores. In general, the teacher asks direct questions that have a predefined range of answers, allowing the student to answer correctly before moving on to the next step in the construction of an idea. If the student is unable to answer the question at hand, the teacher is responsible for guiding the student to a point where he/she can conquer the question.  This is accomplished by helping in the student/trainee recollection prior knowledge required to answer the question.  The modern Socratic Method is compatible with the training of health professionals, and it remains within the scope of Socrates’ belief that a student can only learn things that he already knows.
Using the Socratic Method is more than asking a lot of questions. In contrast to “pimping,” the Socratic Method requires the teacher to create a nurturing environment and ask helpful questions to achieve the desired lessons for the student.  Teachers must recognize that these probing questions can expose ignorance … and this can invoke fear in the student.  But Socrates described the role of the teacher as similar to a midwife, in that they facilitate by clearing the way for the student to bring forth new knowledge without intimidation. In any setting, finding the balance between using progressive questions to provoke deep thought while maintaining a comfortable environment for learning is the key to using the Socratic Method of teaching.
References
1    Maxwell, M. Introduction to the Socratic Method and its Effect on Critical Thinking. [Accessed on 9/30/10].
2    Fritts, HW. Are We Socratic Teachers? Trans Am Clin Climatol Assoc 1979;90:109–115.
3    Gordon, LA. Is the Socratic Method Illegal? Am Surg 2003;69:181-182.
4    Oh, RC. The Socratic Method in Medicine-The Labor of Delivering Medical Truths. Fam Med 2005;37:537-539.
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