BACKGROUNDColleges and schools of pharmacy have undergone major curricular changes to better prepare first-professional degree doctor of pharmacy students for practice and to enhance problem-solving skills. The use of techniques that foster active learning and critical thinking are necessary to accomplish this task. Despite increased efforts to enhance active learning, many pharmacy educators have difficulty engaging and maintaining the interest of all students in large classrooms. 1 Engaging students throughout a lecture is believed to make them more active participants rather then passive listeners. 2 Lecturing alone often provides only factual information to students, without enabling them to apply the knowledge. Relying on hand-raising or volunteered responses to questions posed by instructors in class usually only secures responses from a small number of more outspoken students. Other techniques have been used to determine student understanding of concepts and areas of confusion during class (eg, short quizzes, asking students to write down questions they have, etc). However, it takes time to review the students' responses. Thus, it is difficult for instructors to fully assess the degree of student comprehension of the material as it is being presented.Reports from as early as the 1970s on the use of electronic response systems in educational programs showed that such systems could serve as useful tools in large classrooms. 3 Audience response systems (ARS) are electronic tools that provide instantaneous feedback to facilitators and audience members about participants' responses (anonymously) to multiple-choice questions. ARS technology has largely been used by the corporate sector at training meetings and conferences, or as interactive trivia gaming system in taverns. Studies of ARS in corporate training have reported enhanced trainee interest, attentiveness, and retention. 4 The term interactive student response (ISR) system was coined for referring to these systems in the classroom setting. The typical ISR system includes a computer and specific software, a projector and screen, a radio signal receiver unit or a directly wired receiver unit, and personal hand-held units Objective. The purpose of this study was to evaluate the impact of an interactive student response (ISR) system on student learning, interest, and satisfaction. Methods. Students enrolled in 3 courses, Clinical Pharmacokinetics, Medical Literature Evaluation, and Pathophysiology and Therapeutics, were taught using either a traditional lecture format (study year 1) or an ISR system format (study year 2). Primary outcomes of interest were performance on examinations and student attitudes. Results. Students using the ISR system had better scores on the Clinical Pharmacokinetics examination questions (mean scores, 82.6% ± 9.6% vs 63.8% ± 8.3%, p <0.001), on the cumulative final examination for Medical Literature Evaluation (82.9% ±11.5% vs 78.0% ± 12.2%, p = 0.016), and on the evaluable "analysis type" examination questions in the Pathophysio...