Educational Approach in Integrated Pharmacotherapy Cardiology Course: Emphasizing Pharmacology in Clinical Cases

Abstract

Curricular models that merge biomedical and/or pharmaceutical sciences with clinical sciences are being increasingly employed across schools of pharmacy and other health professions with the goal to promote integrative learning among students. Integrated Pharmacotherapy (IP): Cardiology is one of 12 courses in the IP series taught in the Doctor of Pharmacy program at St. Louis College of Pharmacy designed to prepare student pharmacists to care for patients by integrating pathophysiology, pharmacology, medicinal chemistry and therapeutics. About 25% of the didactic course content is taught by pharmacology faculty with main emphasis on basic pharmacology of drugs in clinical use for cardiovascular disorders.To incorporate pharmacology content and develop knowledge and skills that can be applied in therapeutic decision making, we included pharmacology concepts in patient cases prepared by clinical faculty. To aid in creating and grading these integrated cases, a faculty‐developed patient case rubric was used. This rubric included a descriptor titled “scientific‐guided appropriateness” where a student was expected to evaluate appropriateness of given drug regimens and justify them based on drug’s mechanism of action. This rubric was introduced during the first course offering in Fall 2017.Prior to completing integrated patient cases, students had opportunities to solidify their understanding during group learning sessions focused on pharmacology content. However, despite good performance on these sessions with class averages above 80%, class average for scientific‐guided appropriateness section on 10 integrated case vignettes included in four IP: Cardiology course exams was only 68.4±14.5%. Many student answers pointed to the lack of clear understanding of the information expected in this segment and, after clarification, performance appeared to improve towards the end of the course.To increase student understanding of the expectations regarding the case‐related pharmacology content, we introduced targeted questions within the patient case in the following course offering (Fall 2018). For example, we asked students to describe the mechanism of antihypertensive effect of drug X or describe pharmacogenetic factors affecting response to drug Y. Class performance on pharmacology content‐related targeted questions improved to 78.7±10.7% in Fall 2018. We observed about 10% increase in average grade, but due to larger standard deviation in Fall 2017 cohort resulting from higher scores in the latter part of the semester, the difference was not statistically significant. Nevertheless, student answers to targeted questions showed significant qualitative improvement in Fall 2018, and appeared to be a better indicator of their knowledge and understanding.We plan to continue using targeted questions for science content in integrated cases in IP: Cardiology class. In addition to providing direction to students, these questions enable us to expand the range of topics that relate back to pharmacology content relevant for clinical case management. Similar approaches are used in some IP courses and we plan to expand it to patient cases given in other IP courses which should help us achieve meaningful integration across the entire series.