This paper reviews trends in higher education, characterizing both the current learning environments in pharmacy education as well as a vision for future learning environments, and outlines a strategy for successful implementation of innovations in educational delivery. The following 3 areas of focus are addressed: (1) rejecting the use of the majority of classroom time for the simple transmission of factual information to students; (2) challenging students to think critically, communicate lucidly, and synthesize broadly in order to solve problems; and (3) adopting a philosophy of ''evidence-based education'' as a core construct of instructional innovation and reform.Keywords: blended learning, distance education, e-learning, learning environment, online learning INTRODUCTIONAlthough many of our colleagues in the academy might protest vociferously, we contend that higher education has focused for far too long and much too closely on the wrong metric of student performance, and that this misguided focus, however practical and well-intentioned, has influenced virtually all aspects of the educational enterprise. The raison d'être for higher education is simple and straightforward: to prepare students, predominantly young adults, for future success. Success, of course, can be defined in many ways: the ability to pursue and advance in the career of one's choice; the ability to contribute meaningfully to one's community; the ability to pursue an ''intellectual life.'' The challenge to higher education, and where we contend that the academy has failed, is in measuring, in a meaningful way, the success of our students. This failing is particularly problematic for programs that prepare students to pursue a specific profession, such as pharmacy, as compared to those that provide a broader liberal arts experience.Instead of attempting to assess the true impact on students, educational programs at all levels have focused on easier, and arguably more objective, metrics: course grades, aggregate grade point averages, and scores on standardized examinations. These short-term endpoints have resulted predictably in short-term thinking by all parties associated with the educational enterprise. Students, for example, often focus on what is required to achieve a particular grade in a given course. How many times have we listened to our faculty colleagues complain about students asking the question: ''Will this material be on our exam?'' (In contrast, how frequently do we hear our students ask the more intellectually satisfying question, ''How will I be able to use this material once I am in practice?'') Similarly, classroom instructors focus predominantly on content or technical aspects of application. While this is viewed as providing the necessary foundation upon which students can build in a discrete discipline, valuable opportunities to help students learn how to think, rather than simply what to remember, are lost. Moreover, entire educational systems focus on end-of-course, endof-grade, or end-of-program performance measures ...
The typical approach to course delivery in higher education, particularly for those courses that are considered ''foundational'' and are rich with factual content, has remained unchanged for decades. In the usual paradigm, reading or other activities intended to prepare students or provide background information, often in the form of textbooks authored by the lecturer, are provided prior to class. Educators generally believe that students who come to class with the requisite knowledge will be prepared to ask intelligent and informed questions, engage in dialog, or simply be in position to acquire additional information during the class session. This traditional educational strategy has focused largely on communication, retention, and repetition of factual information. While this approach is efficient in achieving a specific endpoint (graduating students who have been exposed to, and hopefully mastered, a well-defined body of knowledge), it does little to bolster perhaps the greatest asset of a bright and motivated student: the ability to critically assess information and utilize that assessment to solve complex problems. Instead, the end result often is students who have a multitude of facts at their fingertips, but are ill-prepared to bring those facts to bear on real-world problems.The authors' experience has been that this classic approach no longer serves students or faculty members well. It is common for students to not complete assigned readings or activities prior to class, in part because they are not held accountable for being prepared. Consequently, we have migrated away from traditional pedagogy, and contact time in the classroom is increasingly devoted to transmitting basic, foundational content from the instructor to the student. Considering the amount of factual material that must be mastered in a professional pharmacy curriculum, the use of class time to communicate such information limits the opportunity to explore concepts in depth, engage students at higher intellectual levels, or reinforce problem-solving and critical thinking skills.Predictably, frustration with the pedagogical status quo is high. Students are frustrated because contemporary technology provides multiple options for efficient acquisition of information; sitting in a classroom with dozens of classmates listening to a traditional, content-rich lecture is viewed as a waste of time. Faculty are frustrated because, in general, they wish to engage students at a higher level of learning than that associated with the simple transmission of factual information. The need to provide students with foundational content in class, coupled with large class sizes and complex in-class dynamics, virtually eliminates meaningful student-faculty dialog within the classroom environment. Administration is frustrated because the academic organization's most valuable intellectual resource, its faculty members, must devote the majority of their student-contact time to the dissemination of information, with limited opportunities to leverage that intellec...
Objective. To assess the characteristics of global experiential and didactic education offerings in the pharmacy curricula. Methods. A 2-stage web-based review of US colleges and schools of pharmacy identified country locations of international advanced pharmacy practice experiences (APPE), globally focused didactic courses, and whether these offerings were interprofessional. Schools were contacted to confirm their offerings and were asked about student participation and demand. Results. Sixty-four percent of responding schools confirmed an international APPE offering in 67 different countries with an average graduating class participation of 6.1%. Forty-seven percent of responding schools confirmed a globally focused course offering with an average graduating class participation of 13.1%. Almost two thirds of international APPEs and a majority of courses were designated as interprofessional. Student demand did not outweigh supply for either. Conclusion. Colleges and schools of pharmacy in the United States are continuing to develop global education opportunities for students in the classroom and throughout the world.
Data from 722 urine collections (627 patients) from 14 medical facilities were used to compare measured creatinine clearance values with clearance estimates calculated using three "urine-free' mathematical formulas. The influence of two patient weight variables (actual weight, lean body weight) and the level of renal function on clearance prediction was assessed. In addition, site parameters (region, facility), time parameters (month, day, day of the week), and patient parameters (age, sex, height, weight, diagnoses) were evaluated for their statistical influence on the relationship between measured clearance and estimates calculated with one of the methods. Strong, statistically significant correlations were observed between clearance values estimated with each prediction method and measured clearances. Although statistical differences were noticed between mean values predicted with each method, these differences were clinically insignificant. Use of lean body weight for calculation of creatinine excretion produced clearance estimates that were significantly lower than those obtained with actual weight and substantially closer to measured clearance values. Among patient variables, age and two specific diagnoses (congestive heart failure and pregnancy), were statistically associated with variability in the relationship between measured and predicted clearance. Interregional and interfacility differences in the measured-predicted clearance relationship, variability associated with the day of the week of collection, and tendency of the urine-free formulas to over-predict clearance support potential inaccuracy of measured clearance determination. The results suggest that inaccuracies in clearance determination, rather than inadequacies of urine-free prediction methods, account for the majority of the observed variability in the relationship.
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