November 27, 2013

Reuse, Reduce, Recycle...Test Questions?

by Hana Kim, Pharm.D., PGY-1 Resident, Kaiser Permanente of the Mid-Atlantic States

As an instructor, it is difficult to create quality test questions, let alone make new ones every year.  The question as to whether to recycle questions is an issue any organization administering tests or examinations must address. When a question is reused, it can increase the possibility that it will become more public to test takers and can give an advantage to those who have access to the question.  There is also concerned about repeat examinees, those who fail an examination and are required to retake it.  Does reusing test questions appropriately challenge students to learn the material?  Does it provide an unfair advantage to a select few students who have access to the recycled questions?  And, what can instructors do to alleviate these concerns?

Timothy J. Wood studied the role of reused test questions on repeat examinees who took the Medical Council of Canada (MCC) Evaluation Examination (MCCEE).1 The MCCEE is a basic medical knowledge test for International Medical Graduates that contains 324 multiple choice questions. The MCCEE is offered 3 times a year, 4 months apart. Wood investigated whether prior exposure to test questions enhanced performance among 130 repeat examinees. The examinees were presented 36 repeat questions from the previous examination.  The examinees had no knowledge that these questions would be reused.  The investigators found that the examinees scores on the reused and non-reused questions increased equally, a finding that was consistently with previous studies. He noted that this might be due to increased knowledge of the subject matter, hopefully due to an increased amount of studying in preparation for the re-take exam. Wood concluded that prior exposure to test questions had little impact on the performance. Although there was no difference in examinee performance on repeat questions, the exam was given 4 months apart and the examinees did not have access to the questions in between test administration, so the results may not be representative of what we’d see in most academic settings.

Similarly, Wagner-Menghin and colleagues conducted a study to evaluate the effect of reusing written test questions. The authors specifically utilized the Rasch model, which is a probabilistic psychometric framework measurement model that estimates item difficulty and ability measures. The study noted four conceptual factors that should be taken into consideration:
  • Reuse expectation: passing items along to new test takers can be beneficial, especially when reusing items is expected
  • Cheating attitude: many studies on cheating have not focused on cheating with the reuse of test questions
  • Exam’s consequences: there are consequences if a student fails an examination; therefore, the pressure to pass may promote cheating
  • Item content: reusing questions that require student application of knowledge, not simply recall, may diminish the test validity2
This study was designed to quantify the reuse of test questions based on an item’s level of difficulty. Specifically, the authors introduced a new written multiple-choice course exam to assess clinical skills in 671 medical students. To assist the students, a “representative” set of multiple-choice questions was included in the official study materials. Looking at item content, there was a larger effect on those that tested application of knowledge versus recall questions.  There was a 50% increase in student scores on application test questions that were reused compared to 20% increase when recall-type test questions were re-used.  Although the re-used material did not result in increased overall scores, the authors postulate that the lack of benefit may be due to a ‘deficit in study organization and time management for late test takers.’  A test with 30-45% reused questions (particularly with a large number of recall questions) is, therefore, unlikely to substantially benefit students.2

When questions are pass down from one student to another, it creates a potential unfair advantage as some students have access to the items while others do not.  What can professors do to mitigate the problem of questions being passed down? One possible solution is to make all previous examinations available to students so there is fair opportunity for all students. This is exactly what a law professor at George Mason University has been practicing in his classes. He develops new questions for every exam and makes past exams and answers available to students.3  This strategy certainly improves fairness but increases faculty workload the workload as new questions need to be formulated every year.

While some studies demonstrate a statistically significant difference in scores when questions are reused, one of the biggest concerns is that questions will get passed down from year to year, increasing the possibility of “cheating.”  These situations are inevitable but instructors should consider safeguards to help mitigate this problem. Some options include creating new test questions ever year or allowing a sufficient amount of time (2-3 years) between question re-use. Although there are several suggested solutions, the question as to whether test items should be reused and recycled remains an unanswered one.

1. Wood TJ. The effect of reused questions on repeat examinees. Adv Health Sci Theory Pract. 2009; 14(4): 465-73.
2. Wagner-Menghin M, Preusche I, Schmidts M. The Effects of Reusing Written Test Items: A Study Using the Rasch Model. ISRN Education 2013; Article ID 585420.  Accessed 17 November 2013.  
3. Somin I. The Perils of Reusing Questions from Past Exams. The Volokh Conspiracy. Accessed 27 October 2013.

Cognitive-Moral Development in Pharmacy School

by Stephanie M. Callinan, Pharm.D., PGY1 Pharmacy Practice Resident, VA Maryland Health Care System

"I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow:
  • I will consider the welfare of humanity and relief of suffering my primary concerns.
  • I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.
  • I will respect and protect all personal and health information entrusted to me.
  • I will accept the lifelong obligation to improve my professional knowledge and competence.
  • I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct.
  • I will embrace and advocate changes that improve patient care.
  • I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists.

I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.
-       American Pharmacists Association, “Oath of a Pharmacist”

During the commencement ceremony, the pharmacy school class in all their pride and joy recites the “Oath of a Pharmacist” as an affirmation of their dedication to serving others through the profession of pharmacy.  One of the key precepts of this oath is to uphold the highest “moral, ethical, and legal conduct.” Although appropriate ethical and legal principles can be taught in a classroom setting, what can we do as educators to “teach” moral behaviors? How can we insure that every student in that graduating class meets this requirement?

Cognitive-moral development is the process of developing one’s self-awareness regarding ethical and professional behaviors. The process of cognitive-moral development was first described by the great constructivist, Jean Piaget, who observed that children develop and enhance their knowledge through their personal and environmental interactions.1  The moral development process was further described by American psychologist Lawrence Kohlberg as six stages grouped into three levels: pre-conventional, conventional, and post-conventional morality.

Kohlberg’s Stages of Moral Development2
1. Pre-Conventional (Individual)
Person sees only right or wrong and is driven to complete tasks based upon rewards or avoiding punishments.

1. Obedience and punishment
2. Instrumental purpose and exchange
2. Conventional (Group)
Persons conform to social expectations/roles and respect authority as part of a team.

3. Interpersonal relationships
4. Maintenance of Social Order
3. Post-Conventional (Professional/ Institutional)
Persons adhere to institutional rules, however recognize that personal morals may conflict with these regulations.
5. Social contract and individual rights
6. Universal ethical principles

Kohlberg’s stages of moral development can be seen in the educational setting through these examples:
  • Individual: Bob always interrupts class to inject his own opinions. He is frequently seen arguing grades with the professor stating, “You didn’t tell us to study this for the exam!” He often competes with classmates to enhance his self-image.
  • Group: Susie is a listener; she respects the leader(s) in her group project and reflects on their suggestions to create her own recommendation(s). She actively implements changes based on feedback from her teachers.
  • Professional: Joe is a “B” student, involved in several committees, and volunteers his time in the community. He is able to prioritize his responsibilities, while also maintaining his grades.  Joe asks for feedback as he recognizes that he is not “perfect” and sets goals to improve.
As healthcare shifts to a team-based, patient-centered approach, techniques to mold “individual” students into “professional” students are crucial within pharmacy school curricula. A 1999 study that compared the moral reasoning skills of pharmacy students, pharmacy practitioners, and other professions (i.e. medicine, nursing, and law) found that pharmacy students and practitioners had a lower level of moral reasoning when compared to staff nurses, medical students, and law students.4 Although this data is somewhat dated, this is an alarming finding.  Are we, as educators, doing enough in pharmacy schools to promote high-level, post-conventional cognitive-moral reasoning?

A recent review suggests that cognitive-moral development in the classroom can be facilitated by problem-based learning, team (or group)-based learning, in-class discussion, and discussion of topics regarding moral or ethical decisions.5  By using these strategies, the educator adopts the role of a facilitator, instead of a lecturer or “expert.” Students are required to collaborate with peers, defend their recommendation(s) based on their own knowledge, and “experience” difficult ethical scenarios that occur in practice, but are rarely discussed within the pages of a book.  By having students develop and defend their decisions, they can improve individual-level moral reasoning skills by recognizing the “rules,” (group level) and begin to identify and plan for the exceptions to the rules (professional level).

Although cognitive-moral reasoning can be cultivated in the classroom, there is no substitute for practice and experience. As described by Piaget, moral reasoning is chiefly promoted through interactions with other people and the environment.  As pharmacists in a teaching environment, we must act as role models for pharmacy students — leading by example and holding students accountable, not only for patient care duties but other responsibilities too. Although literature in this area is sparse, some studies suggest the teacher-prompted personal reflection exercises can encourage moral growth.6,7 In my own experience, personal reflection encouraged me to ask for feedback on characteristics/skills which I would like to improve.

We can unknowingly impede our student’s cognitive-moral development by modeling “individual” level behaviors such as self-centeredness and black and white thinking (i.e. refusal to accept the validity of multiple answers). The ideal pharmacy preceptor should reflect on his/her own personal behaviors in order to model high moral character and assess their students’ level of moral reasoning.  Moreover, the ideal preceptor should implement practices that help student become true professionals, aware of the “rules” that should govern our conduct but also able to identify and sort through conflicts between the “rules” and what’s “the right thing to do” for patients and the society in which we live.

Think back on the students you have educated and precepted. What have you done to develop their moral reasoning? Have you inadvertently, at times, sent the wrong messages? What can you do to prevent this in the future? Addressing these questions is essential because you have an important role to play in your students’ cognitive moral development.  When you look at that graduating class each year, do you think we have prepared students to uphold the highest standards of “moral, ethical, and legal conduct?”  I’ll leave that question for you to answer.

1. Piaget, J. The moral judgment of the child. New York: The Free Press; 1965.
2. Moral development and moral education. In: Kohlberg, L. & Turiel, editors. Psychology and education practice. Upper Saddle River, NJ: E. Scott Foresman; 1971.
3. Duncan WC. Strategies for incorporating cognitive & moral development. PowerPoint presented at: 2013 AACP Teacher’s Seminar: Strategies for Effective Teaching and Learning. American Association of Colleges of Pharmacy Annual Meeting; 2013 July 13; Chicago, IL.
4. Latif DA and Berger BA. Cognitive moral development and clinical performance: implications for pharmacy education. Am J Pharm Educ. 1999;63(1):20-27.
5. Schuitema J, Ten Dam G, Veugelers W. Teaching strategies for moral education: a review. J Curric Stud 2007;40(1):69-89.
6. Vertress SM, Shuman AF, Fins JJ. Learning by doing: effectively incorporating ethics education into residency training. J Gen Intern Med 2013;28(4):578-82.
7. Daboval T, Moore GP, Ferretti E. How we teaching ethics and communication during a Canadian neonatal perinatal medicine residency: an interactive experience. Med Teach 2013;35(3):194-200.

November 24, 2013

Preparing Student Pharmacists for Alternate Career Paths

by Kelsey Schultz, Pharm.D., PGY1 Pharmacy Practice Resident, Suburban Hospital Johns Hopkins Medicine

During my years in pharmacy school many friends and family members asked me the dreaded question, “What are your plans after graduation? Which pharmacy chain will you work for?”  Most people who asked about my post-graduation plans assumed I would work for a community pharmacy such as CVS or Walgreens.  They see these places of employment as the “traditional” role of a pharmacist.  While in pharmacy school, I became more aware of the numerous career opportunities a degree in pharmacy affords.  I became more and more aware of the disconnect between what the general public sometimes perceives the role of a pharmacist to be and the many roles pharmacists now play in healthcare today.  Today’s pharmacy graduates have a much wider range of career opportunities such as “IT” (information technology) pharmacist, medication safety officer, public health pharmacist, antibiotic stewardship pharmacist, and many more. Pharmacy graduates’ opportunities can be further widened if pharmacy educators expose students to the numerous available career paths early enough in the curriculum.1  Many colleges and schools of pharmacy have developed formal ways for students to learn about new career opportunities including elective courses in specialized areas of practice, developing dual degree programs, and offering certain “tracks” in the curriculum such as a “research track” for those interested in going into academic or the pharmaceutical industry.

Elective courses are a great, relatively simple way for pharmacy schools to introduce new, unique specialty areas of practice to student pharmacists. During my time at my alma mater, Butler University College of Pharmacy and Health Sciences, I had the opportunity to take several elective pharmacy courses on topics such as diabetes care, nutritional support, internal medicine, nuclear pharmacy, ambulatory care, and pain management.  The diabetes care elective helped prepared me for an ambulatory care rotation where I spent a week at an American Diabetes Association (ADA) sponsored summer camp for children with type 1 diabetes.  During the rotation I was part of an interdisciplinary team that monitored and adjusted the campers’ insulin regimens. The elective and rotation exposed me to the unique work and responsibilities of ambulatory care pharmacists.

A recent study examined the career preferences of student who completed an elective academic pharmacy course.2 The course was offered to first, second, and third year pharmacy students and included online and face-to-face classroom sessions. The course content included topics such as educational theory, student motivation, lesson and outcome planning, teaching strategies, assessment, instructional technology and design.  Students’ knowledge, skills, and attitudes towards academia were measured by pre- and post-course assessments, quizzes, journal entries, and interviews. The results found that after completing the course, forty percent of the students stated they were considering academic pharmacy as a career.

Another report described the creation of a research elective “track” for pharmacy students and how successfully promoted research-based careers. The research track consisted of 12 credit hours of didactic instruction, independent research, and seminar courses.  Doctor of Pharmacy students and recent graduates provided feedback regarding the research track through face-to-face, email, and telephone interviews. Student feedback was very positive.  Four out of five students were considering graduate education or research-based employment at the end of the course. 3 Although these elective courses seems to positively influence students toward a particular career path, I think students also need to explore on their own to identify potential career areas of interest.

The American Association of Colleges of Pharmacy (AACP) recently published recommendations on the future of pharmaceutical sciences and graduate education in which they recommended the development of dual degree programs.4  Several dual degree programs exist, including the PharmD and JD (Juris Doctor) for those who are interested in healthcare law, government and regulatory agencies, as well as patent law.  The PharmD and MBA (Masters of Business Administration) program trains future pharmacists in leadership, entrepreneurial, and business roles.  Other degrees that student can earn concurrently with the PharmD include a PhD, MPH (Maters in Public Health), MS (Masters in Science), MSHI (Masters in Healthcare Informatics), and MHA (Masters in Healthcare Administration).5

The University of Georgia’s (UGA) College of Pharmacy is an interesting example of a college that initiated a unique Regulatory Affairs Professional Program in response to interest from members of the Georgia Biomedical Partnership, a group looking to bring science companies to Georgia. The Regulatory Affairs Professional Program offers both certificate and master’s studies and normally takes two years to complete. The program trains student pharmacists for jobs at companies that work on the development of new drugs and medical devices. Dr. Svein Oie, Dean of the University of Georgia College of Pharmacy, shared an interesting thought on the change in pharmacy practice settings over time. He said:

We see an increasing trend toward much more clinical, the specialty that can be in the hospital, in ambulatory; it can be in a number of different settings where our graduates are now working. In contrast to where we were 30 years ago, when we educated students to be knowledge-based about various compounds and drugs, we are now training them to be more patient-oriented. 6
It is through new elective courses, curriculum “tracks”, dual degree programs, and post-graduate training that schools and colleges of pharmacy are preparing student pharmacists for new and alternate career paths.  While these approaches are a good start to exposing students to non-traditional employment opportunities, students must actively discover the career path that best matches their personal interest.

1.  DiPiro JT. Preparing Our Students for the Many Opportunities in Pharmacy. Am J Pharm Educ. 2011;75: Article 170.
2.  Baia P and Strang A. An Elective Course to Promote Academic Pharmacy as a Career. Am J Pharm Educ. 2012;76: Article 30.
3.  Surratt CK, Drennen JK, Bricker JD. The “Research Track” Concentration, a New PharmD Elective Option. Am J Pharm Educ. 2005;69: Article 90.
5.  PharmD Dual Degree Programs.
6.  Lightsey E. Pharmacists for the Future. Georgia Trend. 2011:33-37.

Vidcasting: Embracing a New Generation of Learners

by Lauren Lakdawala, PharmD, PGY1 Community Pharmacy Resident, Johns Hopkins Home Care Group

For many students today the thought of not having technology in the classroom would probably make them feel hopeless.  I remember receiving the technology memo prior to the start of college (circa 2000) stating that laptop computers were strongly discouraged due to risk of theft. Nearly a decade later, when I enrolled in pharmacy school, I would not have survived without a laptop computer and smart phone. Indeed, our culture is heavily engaged in a world of Internet-ready computers, tablets, readers, and smart phones. But are educators really using our robust technology to its fullest potential? In 2005, Stanford University embraced podcasting with the launch of “Stanford on iTunes” to provide students downloads of lectures, events, book readings, and even football games.1 But even podcasts are a thing of the past — enter video on demand or vidcast.

Why use vidcasting?
Vidcasting (also known as vodcasting or video podcasting) is the process of simply adding video to a podcast, and linking it to a really simple syndication (RSS). One can subscribe to the RSS feeds which then automatically download new content into software such as Windows Media Player or iTunes.2  Vidcasting serves the instructional needs of the Internet savvy generation-Y and -Z learners. According to Marc Prensky, the majority of students in higher education today are “native speakers of the digital language… [who] think and process information fundamentally differently from their predecessors.”3 As we increasingly rely on the Internet as our main source of information, our pedagogical approach to education needs to complement the digital lifestyle of today.4 Vidcasting allows educators to reach students in an environment in which they are already comfortable.

Unfortunately, many educators have resisted the use of podcasts and vidcasts in their classes due to fears that attendance will decline.5 However, Traphagan et al. found that students typically viewed video lectures for content review before exams, to enhance understanding of a lecture, add more information to notes, reduce anxiety related to the course — not as a replacement for class attendance.5 In addition, vidcasting should not be viewed as a replacement for interaction with the teacher, but a way to blend learning.6

What can pharmacy educators do with vidcasting?
Vidcasting can be used in a number of ways to blend learning within the pharmacy curriculum. One can use a vidcast as a pre-lecture, when something requires review on a topic that cannot be accommodated during classroom time. A pre-lecture vidcast can introduce pathophysiology and this would permit the instructor more time to focus on medications during a class session. Or pre-lecture demonstration video can give students more time to practice how to properly measure blood pressure in skills lab. A vidcast could also be used for an exam review to help “boost their [students’] knowledge…at the time it’s needed most.”2 This type of vidcast may help reduce anxiety by reviewing core concepts for the exam and, as an on-demand instructional tool, would allow every student the opportunity to access the review session materials. Pharmacy educators can record lectures at the beginning of the year and provide review sessions prior to or following exams.7 Vidcasts can also be used a way to break up long lectures so that more time can be dedicated to discussion and hands on work— such as case-based scenarios in the classroom.6 Another use of vidcasting could be student-produced videos, to fulfill the requirements for a group presentation in a class. One professor who replaced conventional in-class presentations with short vidcasts by students found that not only was class time saved, but the presentations were “better structured, more to the point, and more reflected than typical in-class presentations.”6 In the pharmacy classroom, this could be a new drug presentation, patient education, or even a business plan proposal. Moreover, students would develop new technology skills that are needed to succeed in today’s workforce.

To embrace this new era of learning, educators must remember the importance of prudently using technology to compliment traditional methods of learning. When use appropriately, vidcasting forces students to strengthen their independent self-directed learning skills. As pharmacy educators are often burdened with many responsibilities, including research and mentoring, vidcasting can add some flexibility to the instructor’s schedule. One can record vidcasts ahead of time to cut back on the number of face-to-face classroom-based meeting times. As an educator, I probably would not switch everything to blended learning, but rather focus on using vidcasts as an opportunity to enhance learning. If a majority of your class sessions employ lecture-based methods, consider using vidcasts to provide your students with a review session prior to an exam. If your class assignments include a group presentation, allow your students the choice of producing a vidcast instead of giving a podium presentation. Educators need to leverage the skills of students today and engage them with technology — otherwise you may fall short in reaching your learning objectives. The classroom is filled with technology hungry learners and it is the responsibility of educators to harness the power of technology to teach.

To learning more about how vidcast, check out these resources:

Mac and windows users can learn how to create vidcasts at:

Mac users can view this how-to create vidcasts at:

1.  Leach J. University to podcast course content. 2005. Accessed 2013 November 14.
2.  Educational Technology Network. Classroom podcasting/vodcasting. 2009. Accessed October 19, 2013.
3. Hart J. Understanding today’s learner. 2008 September 22.  Accessed November 11, 2013.
4. Educause. 7 things you should know about flipped classrooms. 2012 Feb 28. Accessed 2013 October 19.
5.  Flynn R, Newbutt N, Ackroyd T, Dastbaz M. Podcasting and Vidcasting–Delivering Engaging Learning to A New Generation. 2009.  Accessed 2013 October 19.
6.  Storgaard CS, Heilesen SB. Facilitating blended learning by means of vidcasting. 2010. Accessed November 11, 2013.
7.  Pew internet and American life project. Health information online. 2005 May 17. Accessed 2013 October 19.

November 16, 2013

Help Students Develop Good Study Habits

by Katherine Logan, Pharm.D. PGY1 Pharmacy Practice Resident, Suburban Hospital

Developing good study habits as a student is of upmost importance, not only in formal learning environments but also in life. Being organized and having good time management skills can aid in this process.  Teachers need to encourage and develop these skills in students, residents, and other trainees.

As a fourth-grader, I attended a class that discussed study and test taking habits. I still use techniques that were discussed that day!  I believe these skills should be developed early.1 The earlier students are empowered with this knowledge, the more practice they will have using these skills and the greater likelihood they will be successful in and outside the classroom. What are some methods teachers can employ to help students develop good study habits?  Let’s examine a few strategies.

Maintain a Planner1
Once students are able to read, teachers can have them try different planners.1 This allows them to see assignments ahead of time. Having students try out different types will allow them to see which works best for them. Teachers can encourage this behavior by having the entire class discuss it. Ask students to discuss the benefits of planners compared to calendars. As a resident, I keep a detailed planner.  One my peers prefers to keep a printout on her calendar on a bulletin board at work and home.

Test Knowledge Between Tests
Many students are afraid of tests, and as such, need more experience taking them to build their level of comfort. Giving quizzes can help learners adjust to the types of questions asked by specific teachers. Quizzes also force students stay on top of studying, and help to break up the overall class grade into smaller percentages.2 This break-up of the grade could help alleviate some of the stress associated with major tests.2 A study of pharmacy students found that half quizzed themselves while studying to see how well they understood the material and many found quizzes more effective than re-reading material.2

Practice makes Perfect1
Homework can also help students.1 Homework deadlines encourage students to keep a schedule. Subtract points from the assignment for every day it is late. Rewards can be given to the student(s) with the most assignments that were turned in on time.1

Give Practice Problems1
Make practice problems required.1 My first chemistry teacher gave the class a list of problems from the book and each problem had to be completed and handed in prior to the test. Sometimes it was stressful to get the problems done on time, but it meant that I was constantly studying and reinforcing my knowledge.  A study by Sansgiry and colleagues demonstrated “that students who have difficulty in coping and managing the study material for tests will have a lower GPA.”2

Create a Healthy Study Environment1
Another important aspect of studying is the surrounding environment.4 Some people can only study in the library; others prefer listening to music. Talk to your students about options such as sitting at the coffee table or staying after school to work in the library.1 Many distractions confront students today; social media in particular is very distracting. It is important to teach students to separate themselves from these potential distractions.  Another important consideration is the time of day spent studying. Some learners prefer staying up late and studying. Personally, I have always felt that my brain shuts down after 11 pm.  So, I always made sure that my studying took place earlier in the day. Students should remain realistic and plan their study habits around the way their minds and bodies function best as each person is different.

Discuss Proper Study Materials1
Good study habits mean having good study materials.1 Producing organized and detailed notes are another way to reinforce good study habits. Teachers can create notes with fill-in-the-blank entries, which keeps students’ attention. 1 Another option is to create general notes and leave spaces to add more details later. These notes should be kept in a binder with numbered pages so students can keep them in order. Study materials also include the supplies necessary to study.1 Some students make flashcards and others may need to rewrite notes.4 Students that rely on such aids should keep a good supply of notecards, legal pads, and pens.1

Suggest Study Breaks
The brain needs rest. Metcalfe and Kornell argue that the length of time spent studying is based on the “judgment rate of learning” or the rate that learning occurs.4 Once the rate of learning drops, retention stops for a time.4 Since many people are unaware of their learning rate, I the recommendation from the RxPREP Course Book is a good one: “do not study for more than 45-50 minutes” at a time, and “do some type of physical activity during short breaks.”

The suggestions above are just a few of the ways to teach good study habits. These skills will aid students throughout their lives.  They will be able to complete tasks in a timely fashion as well as learn the conditions they best operate. Teachers should make these skills a priority in all academic settings beginning in elementary school and reinforced all way through graduate school.

2.  Sansgiry SS, Bhosle M, Sail K. Factors that affect academic performance among pharmacy students. Am J Pharm Educ. 2006; 70: Article 104.
3.  Donohoe L, Mawyer M, Stevens T, Morgan A, Harpe E. Student pharmacists’ perceptions of testing and study strategies. Am J Pharm Educ. 2011; 75:  Article 35
4.  Kornell N, Bjork R. The promise and perils of self-regulated study. Psychonomic Bulletin and Review. 2007; 14:219-224.
5.  Shapiro D, Brown SA. RxPREP Course Book: A Comprehensive Course for the NAPLEX & CPJE. 2013 Ed. RxPrep, Inc; 2013

November 15, 2013

Service + Learning: Not Merely Two Words Combined

By Christine Darby, Pharm.D., PGY1 Pharmacy Practice Resident, VA Maryland Healthcare System

Community service has always played an integral role in my life.  I have found meaning, fulfillment, and even my husband by donating my time and resources to helping those in need.  My belief in voluntary work is so great that, when relevant and appropriate, I think that every educator should consider integrating it into his or her course.

So, how do you create a great service-learning experience?  Whether service-learning is intended to supplement a course or its the entire goal of course, there are a series of steps that you can take to make it most successful.  A great service-learning experience can lead to positive outcomes, leaving students feeling that they positively and directly influenced people.

What is service-learning?

Service-learning is a “form of experiential education in which students engage in activities that address human and community needs together with structured opportunities intentionally designed to promote student learning and development.”1 The hyphen between “service” and “learning” indicates the importance of reflection and assures that learning is integrated with the service activities.2  Service-learning is not equivalent to volunteering, in which the recipient of the service is the primary beneficiary.  Service-learning benefits both the server and the served.3

In pharmacy education, the Accreditation Council for Pharmacy Education (ACPE) defines specific criteria that service-learning must meet.  Many criteria are listed, including the opportunities for inter-professional interaction and the extension of student learning into the community.4

Steps to designing a service-learning course

Keeping in mind the definition of service-learning, you first need to decide whether service-learning is right for your course.  There are a series of steps that Barbara Jacoby, Ph.D. recommends you do: 

1. Consider how it will help your students achieve your learning outcomes.
After having determined the learning objectives for your course, what instructional methods (such as service-learning, lectures, and class discussions) align with your objectives?5 Look for resources such as the Michigan Journal of Community Service Learning.  This workbook includes worksheets not only for determining your learning outcomes, but also for outlining teaching strategies (such as service-learning) that can help you achieve your outcomes.6

2.  If service-learning is a good fit, determine what service and educational content will enable your students to achieve your outcomes.
Decide upon what type of service is appropriate, how frequently the students should be engaged in the service, and for how long.  Establish prerequisite readings or other materials, as well as activities to complete after the course, such as reflection.5 Reflection is a critical element for the “learning” component of service-learning.6 It involves metacognition, or thinking about one’s own thinking.7  Examples of reflective activities include structured journals, portfolios, simulations, discussion groups, and oral presentations.6

3.  Form community partnerships.

Establish who will be responsible for the initiation and development of partnerships.  Decide how many students are needed, the skills and knowledge considered necessary (and prerequisite) for students to participate in the service, and the tasks that the organization needs completed.5 Create timelines and decide upon the level of supervision needed.  Plan a student orientation to introduce students to the community.6

4.  Establish standards to assess and evaluate students.

Clarify how students will show what they have learned and how often you will assess them.  Figure out what role community partners will have in student assessment on-site.5 The Michigan Journal of Community Service Learning also contains worksheets for aligning assessment methods with learning outcomes.6

5.  Create the syllabus.
Provide details about the rationale behind service-learning in the course, roles and responsibilities of students, prerequisites and training, course materials, assessment methods, and reflection activities.5  Communicate what service activities and service sites are available.  Explain how service-learning is different from volunteerism.6 You may want to share the syllabus with community partners to obtain their input and make revisions as necessary.7 

6.  Prepare to manage the course.
Address any logistical issues that arise, including transportation and safety.  Determine what resources are available to assist you during the course.5 Get feedback from those who have experience with service-learning and ask for copies of syllabi they may have created.

Outcomes of service-learning

By thoughtfully and systematically planning your service-learning experience you will greatly enhance the likelihood that students will have a positive learning outcomes.  There are many examples in the literature of positive outcomes from service-learning.  In a study assessing first-year pharmacy student, service-learning was shown to positively impact knowledge.  Knowledge regarding cultural differences and their impact on health improved was significant higher among student who participated in a service-learning course when compared to a control group of students who did not participate in service learning activities.8

In another study, a majority of students who participated in a service-learning course felt a high level of personal responsibility toward their community and a greater interest in participating in local community organizations after course completion.  The service-learning activities helped students to see the connections between class discussions and real world, which enhanced learning in both settings.9 

Service-learning helps students develop caring attitudes toward people, rather than relying strictly on clinical skills during their interactions with patients.10 John W. Gardner describes the development of values and citizenship skills that are fostered through service-learning as follows:

Young people do not assimilate the values of their group by learning the words (truth, justice, etc.) and their definitions...they learn these through intensely personal interactions with their immediate family or associates...they do not learn ethical principles; they emulate ethical (or unethical) people. They do not analyze or list the attributes they wish to develop; they identify with people who seem to have these attributes. That is why young people need models, both in their imaginative life and in their environment, models of what—at their best—they can be.11

In this way, by being true champions of patients and active members of the community, not only do students thrive, but so too society.  Service-learning goes beyond “merely” service and beyond “just” learning.


1.  Jacoby B and Associates. Service-learning in today’s higher education. 1st ed. San Francisco: Jossey-Bass Publishers; 1996. 416 p.
2.  Eyler J and Giles DE. Where’s the learning in service-learning?. San Francisco: Jossey-Bass Publishers; 1999. 352 p.
3.  Stanton TK, Giles DE and Cruz NI. Service-Learning: a movement’s pioneers reflect on its origins, practice, and future. San Francisco: Jossey-Bass Publishers; 1999. 304 p.
4.  Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the Doctor of Pharmacy degree [Internet]. Chicago: Accreditation Council for Pharmacy Education; 2011 Jan 23 [cited 2013 Nov 3].
5.  Bart M. Six steps to designing effective service-learning courses [Internet]. Madison (WI): Magna Publications, Inc.; 21 April 2010 [cited 2013 Nov 2].
6.  Howard J, editor. Michigan journal of community service learning. Ann Arbor (MI): OSCL PRESS; 2001. 82 p.
7.  Kelly R. Service-learning course development [Internet]. Madison (WI): Magna Publications, Inc.; 12 June 2012 [cited 2013 Nov 3].
9.  Nickman N. (Re-)learning to care: use of service-learning as an early professionalization experience. Am J Pharm Educ. 1998;62:380-387.
10. AACP Commission to Implement Change in Pharmaceutical Education. Maintaining our commitment to change [Internet]. Alexandria (VA): American Association of Colleges of Pharmacy; 1996 [cited 2013 Nov 3].
11. Gardner JW. Self-renewal: the individual and the innovative society. New York: Norton & Company; 1981. 176 pp.