Didactic Coursework Research Articles

A Workshop Series Using Peer-grading to Build Drug Information, Writing, Critical-thinking, and Constructive Feedback Skills

To utilize a skills-based workshop series to develop pharmacy students' drug information, writing, critical-thinking, and evaluation skills during the final didactic year of training. A workshop series was implemented to focus on written (researched) responses to drug information questions. These workshops used blinded peer-grading to facilitate timely feedback and strengthen assessment skills. Each workshop was aligned to the didactic coursework content to complement and extend learning, while bridging and advancing research, writing, and critical thinking skills. Attainment of knowledge and skills was assessed by rubric-facilitated peer grades, faculty member grading, peer critique, and faculty member-guided discussion of drug information responses. Annual instructor and course evaluations consistently revealed favorable student feedback regarding workshop value. A drug information workshop series using peer-grading as the primary assessment tool was successfully implemented and was well received by pharmacy students.

Student perspectives on prescriptive authority

PurposeTo gauge student perceptions regarding collaborative drug therapy management (CDTM), including prescriptive authority activities, and to determine student perceptions of level of preparedness and desire to provide these services. MethodsA 15-item survey was administered to all currently enrolled students in the University of Missouri—Kansas City (UMKC) School of Pharmacy. The study population included students in years one through three of didactic coursework as well as students in their experiential year. ResultsOverall, 44.3% (n = 90) of students felt adequately prepared for CDTM and the prescriptive authority activities that fall under that scope. Of the respondents, 74% (n = 29) of students in their last experiential year reported feeling prepared. The majority of students also believe pharmacists can accurately choose, initiate, and modify drug therapy. Moreover, 77% (n = 61) of fourth-year students expressed interest in participating in some form of CDTM upon graduation. ConclusionsThe majority of pharmacy students feel adequately prepared for the prescribing responsibilities that fall within a collaborative drug therapy management agreement, and most intend to be an active participant.

Epistemic and ontological cognition of entering and postdidactic occupational therapy students.

Beliefs about knowledge and knowing, also called epistemic and ontological cognition (EOC), are associated with many aspects of learning and achievement; no published studies have described the EOC of occupational therapy students. This study compares and contrasts occupational therapy students' EOC at entry and on completion of didactic coursework. Twenty-one incoming and 33 postdidactic students completed the Epistemic Beliefs Inventory and the modified Four-Quadrant Scale and provided explanations for their self-ratings. Results indicate that the postdidactic students held more sophisticated stances toward occupational therapy-specific knowledge. The entering students demonstrated dogmatist and skeptic perspectives, with minimal evidence of a rationalist view of knowledge, whereas the postdidactic students showed evidence of primarily skeptic stances, with the emergence of rationalist views. Implications for occupational therapy theory, education, and research are discussed.

Using a Critical Appraisal Assignment to Infuse Evidence-Based Practice into a Therapeutic Modality Course

Context It is the responsibility of athletic training educators, through curriculum and clinical experiences, to engage students towards adopting evidence-based practice (EBP) into their practice. The initial task of implementing EBP into a curriculum or course can seem like a large task for educators and students. As a way to start scaffolding EBP concepts across the curriculum, a modified critical appraisal assignment was developed to teach therapeutic modality concepts. Objective The purpose of this action research project was to demonstrate how a modified critical appraisal assignment can be used to introduce the process and aspects of critical appraisal and begin scaffolding the development of critical appraisal skills over time. The objectives of this study were to evaluate the students' ability to (1) successfully locate relevant research needed to answer clinical questions and (2) successfully appraise the literature according to basic EBP strategy. From a program perspective, the modified critical appraisal assignment was a starting point from which to include EBP principles into didactic coursework. Design Seventeen athletic training students completed 3 modified critical appraisal assignments pertaining to the use of therapeutic modalities. Each paper included 5 sections: (1) clinical question, (2) key clinical findings, (3) clinical applicability based on information from the appraisal and significance of results, (4) article comparison table, and (5) implications for clinical practice, patient education, and future research. The instructor evaluated the assignments blind. Conclusions Students were generally able to complete the critical appraisal assignment; however, students had difficulty locating research that answered the clinical question. Students struggled to relate the key clinical findings of the research articles and implications for clinical practice to the given clinical question. Findings from this study have informed faculty teaching, including introducing EBP skills earlier in the curriculum and inserting assignments that stress various aspects of the critical appraisal process.

Physical Therapist Student Experiences With Ethical and Legal Violations During Clinical Rotations: Reporting and Barriers to Reporting

BACKGROUND AND PURPOSEAs the physical therapy profession moves toward increased professional autonomy, it is in the best interest of the public and the profession for physical therapists to continually develop the skills required to uphold legal and ethical standards in the workplace.1 With increased clinical autonomy, physical therapists (PTs) will need to navigate more complex ethical dilemmas. The foundation for developing clinical skills related to ethical decision making should occur in didactic coursework of physical therapist education programs. Physical therapist education must teach students to make ethical and legal clinical judgments in order to meet the challenges of clinical practice.2The specific aims of this research were to: (1) gain insight on students' ability to identify, address, and report legal issues, ethical issues, and dilemmas; (2) gather insight into barriers that prevent students from reporting these violations encountered in the clinic; and (3) collect student suggestions for the curriculum and clinical supervision that might assist students in identifying and reporting ethical and legal violations.Previous research has shown that many ethical conflicts arise from inappropriate use of resources,3'5 improper supervision,6 sexual harassment,7,8 lack of truth telling,4,5,9 respect,3'5,10 and blatant wrongdoing.6,9 In a fast-paced practice environment, it can be challenging to recognize ethical dilemmas and determine the appropriate course of action. Students in many health care professions are encountering an increased number of ethical dilemmas and conflicts when practicing in the clinical setting.10'12 The Code of Ethics for the Physical Therapist13 serves as a resource for physical therapists and physical therapist students to aid in recognition and resolution of ethical and legal dilemmas. Recent literature has provided some explanation and insight into the health care practitioner's ability to identify and resolve certain ethical and legal issues.4,6,12,14 For the purposes of this study, legal issues are defined as those explicit behaviors which violate the state practice act, state laws, or any of the federal laws governing the health care workforce, including but not limited to the Health Insurance Portability and Accountability Act (HIPAA) and Occupational Saftey and Health Administration (OSHA) or Medicare and Medicaid rules and regulations. Ethical issues are those areas such as respect for autonomy or beneficence that are essential to professional conduct but may not be required by law. Ethical dilemmas are defined as situations in which moral reasons come into conflict, and it is not immediately obvious what should be done.8(p3) In most cases we are concerned with both ethical issues and dilemmas. The following are domains of concern that appeared repeatedly in the literature relevant to clinical behaviors witnessed or performed by health care students in various health professions.Inappropriate Use of ResourcesThe Ethics and Judicial Committee of the American Physical Therapy Association (APTA) has identified the following as examples of improper use of resources: overutilization of services, billing fraud, improper use of personnel, false advertising, endorsement of products, and inappropriate fees.6 The literature supports that these issues are among the most common current ethical issues facing physical therapists.10,13,15,16Improper SupervisionState practice acts, as well as payers such as the Centers for Medicare and Medicaid Services, establish specific requirements for PTs regarding supervision of students, physical therapist assistants (PTAs), and physical therapy aides involved in patient care. Supervision also includes proper use of clinical time. In spite of these laws and regulations, improper supervision is a frequent theme experienced by students in many health professions, including medicine, nursing, occupational therapy, and physical therapy. …

Professional development: Students' perceptions of an immersion elective in substance abuse

ObjectivesPersons facing substance abuse and addiction are ubiquitous in all areas of pharmacy practice. Some colleges of pharmacy (COP) do not report didactic coursework in substance abuse. An off-site elective was developed to offer students an experience in immersion learning on this topic. The elective objectives were (1) to facilitate professional pharmacy student development by challenging student perceptions of people regarding addiction and substance abuse concerns and (2) to elicit input on the course structure and activities to improve entry-level pharmacist preparation. Participation in the second goal was optional. MethodsEleven pharmacy students participated. Surveys and on-site student reports were evaluated for common themes of student learning and substance abuse knowledge. This project maintained participant anonymity and was approved by the University's institutional review board. ResultsThe most common self-reported experience was recognizing addiction as a disease. Secondly, students reported increased knowledge in the following areas: healthcare provider risk, disease prevention, and treatment options for impaired healthcare professionals. Students included personal reflections on the entire experience, assigned personal goals for service delivery, considered this education essential for adequate pharmacist preparation, self-reported changes in knowledge and understanding of substance abuse and addiction following completion of the elective, reported the experience would influence their practice as pharmacists, and opined more students should have access to this educational experience. ConclusionPilot study data supported substance abuse education inclusion in core curricula. COPs are encouraged to use published curriculum guidelines as a road map for development.

109 Bedside Ultrasonography Training and Barriers to Utilization in Chiapas, Mexico

109 Bedside Ultrasonography Training and Barriers to Utilization in Chiapas, Mexico

University of Miami Leonard M. Miller School of Medicine

University of Miami Leonard M. Miller School of Medicine

An Evidence-Based Practice Model Across the Academic and Clinical Settings

This tutorial is designed to provide academic communication sciences and disorders (CSD) programs, at both the undergraduate and graduate levels, with a comprehensive instructional model on evidence-based practice (EBP). The model was designed to help students view EBP as an ongoing process needed in all clinical decision making. The three facets of EBP (research, client/contextual factors, and clinical expertise) are addressed through explicit teaching practices and assignments in didactic coursework and considered in parallel with a concurrent clinical practicum. At the graduate level, the reciprocal nature between theory, research, and practice is emphasized using components such as structured EBP protocols in coursework and clinic, application of clinical case studies that emphasize EBP procedures, and the integration of authentic research assignments. Examples are provided, and ways in which academic faculty and clinical educators can actively engage in creating a shared language and culture at all levels in a CSD program are presented.

Postbaccalaureate Nurse Residency: EBP in Action

It is no secret that health care in the United States is in need of reform. Great attention has been paid over time to the problems of errors in medical and nursing practice, cost vs quality, and evidence needed to improve patient outcomes. We like to think that health care in the United States is well advanced, but we have yet to tackle significant problems that have plagued our country for so many years. Transformation is certainly the theme of the day! We have a long way to go to heed the call made by Florence Nightingale in 1863 when she stated, while admitting to the full extent the great value of hospital improvements of recent years, a vast deal of suffering, and some at least of the mortality, in these establishments is avoidable (p. 7). Evidence-based practice (EBP) is critical to changing our evolving health care delivery and reimbursement systems. Examining how nursing faculty are incorporating EBP in the curriculum for student nurses and how clinically based nursing professionals are using EBP are essential to understanding how nursing will contribute to improved patient outcomes. The Health Professions Report (2003) describes the shortcomings of today's health professions, citing much-needed competencies related to the provision of patientcentered care and the employment of EBP. How is EBP used in nursing education and service? How are nursing faculty transforming curricula? Is nursing service taking the important steps in the clinical setting so that professional nurses and other members of the health care team formulate and apply evidence in their practice? The Postbaccalaureate Nurse Residency program at Westchester Medical Center (WMC) serves as an example of how academic and practice partners are approaching these kinds of questions. The Postbaccalaureate Nurse Residency Program grew out of an interest in improving patient care by providing additional training and support to new baccalaureate graduates. The goal of the program is to develop competent professionals to provide patient care leadership at the bedside ( Commission on Collegiate Education [CCNE], 2008 , p. 6). The curriculum developed through a partnership of the University HealthSystem Consortium (UHC) and the American Association of Colleges of Nursing (CCNE, 2009 ). The program is based on partnerships between accredited acute care hospitals and at least one accredited academic nursing program. The residency builds on the The Essentials of Baccalaureate Education for Professional Practice (American Association of Colleges of [AACN], 2008). During the program, nurse residents develop skills in decision-making, EBP, clinical leadership, and lifelong career planning as they advance their commitment to professional nursing The Lienhard School of (LSN) has worked for several years to ensure that baccalaureate nursing graduates have a strong foundation in EBP. While curriculum reform was initiated in the graduate Family Nurse Practitioner Program, this was soon followed by the undergraduate program. Baccalaureate didactic coursework is framed within an EBP context, and numerous clinical opportunities throughout the program extend that focus. The 2008 AACN Essentials for Baccalaureate Education for Professional Practice lists as its third essential Scholarship for Evidence- Based Practice. The LSN undergraduate curriculum has been revised to be consistent with the revised Essentials , and has as one of its expected student learning outcomes, Apply nursing theory and research in an evidence-based approach to nursing practice. Likewise, in the Nurse Residency program at WMC, EBP is an important basis for advancing safe, quality patient care. Introduced to nurse residents during their orientation period, the concept of EBP is a thread discussed throughout their year-long program. The EBP curriculum at the University and Medical Center reinforces and guides the nurse residents through developing and presenting a final EBP project. …

Fostering Cultural Competency, Clinical Reasoning, and Leadership Through International Outreach

ABSTRACTThe Centennial Vision of the American Occupational Therapy Association (AOTA) has called for occupational therapy to be globally connected. Students can gain cultural competency, clinical reasoning, and leadership from attending didactic coursework and participating in discussions and clinical simulations. Immersing oneself in international settings, however, tends to have a greater impact on learning. The authors describe the outcomes of two international outreach programs: China Honors Immersion Program (CHIP) and Institute for Latin American Concern (ILAC). The outcomes of these programs indicate that students believe that such international experiences greatly affect their development, both professionally and personally. Implications of the program outcomes to current professional education are discussed. Future research directions are also proposed.

Grade Inflation at a North American College of Veterinary Medicine: 1985–2006

Grade inflation, an upward shift in student grade-point averages without a similar rise in achievement, is considered pervasive by most experts in post-secondary education in the United States. Grade-point averages (GPAs) at US universities have increased by roughly 0.15 points per decade since the 1960s, with a 0.6-point increase since 1967. In medical education, grade inflation has been documented and is particularly evident in the clinical setting. The purpose of this study was to evaluate grade inflation over a 22-year period in a college of veterinary medicine. Academic records from 2,060 students who graduated from the College of Veterinary Medicine at Kansas State University between 1985 and 2006 were evaluated, including cumulative GPAs earned during pre-clinical professional coursework, during clinical rotations, and at graduation. Grade inflation was documented at a rate of approximately 0.2 points per decade at this college of veterinary medicine. The difference in mean final GPA between the minimum (1986) and maximum (2003) years of graduation was 0.47 points. Grade inflation was similar for didactic coursework (years 1-3) and clinical rotations (final year). Demographic shifts, student qualifications, and tuition do not appear to have contributed to grade inflation over time. A change in academic standards and student evaluation of teaching may have contributed to relaxed grading standards, and technology in the classroom may have led to higher (earned) grades as a result of improved student learning.

Guidelines for Pharmacoeconomic and Outcomes Research Fellowship Training Programs

Pharmacoeconomics and outcomes research (PEOR) demonstrates the added value of health services and treatments and is used by a variety of individuals in numerous settings to optimize patient care. Currently, 51 PEOR fellowship programs are publicized on Web sites from organizations such as the American College of Clinical Pharmacy (ACCP), the International Society of Pharmacoeconomics and Outcomes Research (ISPOR), and the Academy of Managed Care Pharmacy. These programs demonstrate the diversity of PEOR fellowships, as they are offered by sponsors in a variety of environments (e.g., academia, industry, consulting services, United States managed care, and government). Although the program sponsors vary, all fellowships should have the common goal of providing directed, highly individualized postgraduate training designed to prepare participants to become independent PEOR researchers. Like any health discipline, advancements in knowledge and technology along with changes in health care systems require refinement of existing training programs, including PEOR fellowships. Members of ACCP and ISPOR developed a survey instrument to assess structure, educational objectives, and outcome measures of PEOR fellowship programs. The survey objectives were to determine PEOR researchers' beliefs regarding qualifications of the training site, program, and preceptors(s) as well as fellowship applicant requirements, research commitment, didactic coursework and evaluation of fellows' research skills; and to develop PEOR fellowship guidelines based on data obtained from the survey. Pharmacoeconomics and outcomes research fellowship guidelines were originally published in 1999; this document outlines the revised PEOR fellowship guidelines based on recent literature and results of the ACCP‐ISPOR survey described above. These guidelines are intended to assist PEOR researchers design, refine, and self‐assess their fellowship program and to serve as a tool for prospective PEOR fellowship candidates to evaluate programs.

A Longitudinal Medical Spanish Program at One US Medical School

Policymakers have recommended recruiting or training (or both) more US physicians who can provide care in Spanish. Few longitudinal medical Spanish programs have been described and evaluated. This study aims to describe development and evaluation of the preclinical phase of a 4-y program designed to graduate physicians who can provide language-concordant care in Spanish. Study was done in one public medical school in southeastern USA. The program targeted intermediate/advanced Spanish speakers. Standardized fluency assessments were used to determine eligibility and evaluate participants' progress. Curriculum included didactic coursework, simulated patients, socio-cultural seminars, clinical skills rotations at sites serving Latinos, service-learning, and international immersion. For the first two cohorts (n = 45) qualitative evaluation identified program improvement opportunities and found participants believed the program helped them maintain their Spanish skills. Mean interim (2-y) speaking proficiency scores were unchanged from baseline: 9.0 versus 8.7 at baseline on 12-point scale (p = 0.15). Mean interim listening comprehension scores (second cohort only, n = 25) increased from a baseline of 77 to 86% (p = 0.003). Proportions "passing" the listening comprehension test increased from 72 to 92% (p = 0.06). We describe development of a longitudinal Spanish program within a medical school. Participation was associated with improved Spanish listening comprehension and no change in speaking proficiency.

Resident and Graduate Training in Veterinary Nutrition

Training programs for veterinarians seeking board certification by the American College of Veterinary Nutrition (ACVN) are structured in one of two ways: (1) as programs similar to specialty training in other clinical disciplines or (2) as graduate programs leading to advanced degrees combined with clinical training. Residency training occurs through a variety of approaches, including didactic coursework, case-based and applied learning, clinical training, teaching, research, and self-study. Challenges to successful residency and graduate training include low numbers of diplomates, particularly at veterinary schools; low numbers of applicants; small numbers of funded programs; and faculty promotion systems that do not reward residency or graduate training and program development. The mentoring of individuals seeking both board certification and a graduate degree presents additional considerations, including recruitment of individuals motivated in research and structuring a combined program that facilitates completion of both tasks in a timely fashion.

One Medicine, One University: The DVM/MPH Program at the University of Illinois

The University of Illinois at Urbana-Champaign College of Veterinary Medicine (UIUC-CVM) and the University of Illinois-Chicago School of Public Health (UIC-SPH) are in the fourth year of a collaborative Doctor of Veterinary Medicine and Master of Public Health dual-degree program. The two campuses, one urban and one rural, are 150 miles apart but are sister schools within the University of Illinois system. This article describes the origin of the program, how the program functions across two campuses, its academic focus, required coursework, and research projects designed to fulfill the program's capstone requirements. The article shows how two campuses can be linked through a combination of online and on-site didactic coursework, briefly describes innovative proposals for projects within the United States and abroad, and highlights faculty committed to educating cross-trained public-health professionals while addressing the national need for veterinarians trained in public health. The authors also discuss how the dual-degree program has led to the formation of the Illinois Center for One Medicine, One Health (ICOMOH), an intra-university collaboration focusing on the interface of human, animal, and ecosystem health.

Growing Our Own: A Regional Approach to Encourage Psychiatric Residents to Enter Research

This article describes a regional program developed by the Department of Veterans Affairs South Central Mental Illness Research, Education and Clinical Center for training psychiatry residents in research and attracting them to academic careers. The authors describe a low-cost, innovative program developed to increase the number of psychiatry residents entering postresidency research training fellowships by providing them with mentorship and exposure to seasoned researchers, didactic coursework, and a stipend to cover academic expenses. Over the first 4 years, the program has generated enthusiastic participation among postgraduate year 3 (PGY-3) residents, with a high percentage of underrepresented ethnic minorities and women. Products include publication of four first-authored and two coauthored manuscripts, one first-authored abstract, submission of six additional papers, 28 academic presentations and development of research projects. Half of graduating awardees have gone on to pursue research careers. Our regional approach provides sufficient academic expertise to make residency training feasible in a cost-effective manner.

Pharmacoeconomic Fellowships: Preceptors' Views Regarding Adherence to the American College of Clinical Pharmacy Guidelines

Objectives. The purpose of this study was to describe the extent to which pharmacoeconomic/outcomes research (PE/OR) fellowships adhere to the American College of Clinical Pharmacy (ACCP) guidelines developed in 1999. Methods. Fellowship preceptors' opinions regarding the components that identify the structure and process of current PE/OR programs were solicited using a web-based survey method. Results. Of the 49 preceptors who completed the web-based survey, 38 met the inclusion criteria. Concerning the structure of PE/OR fellowships, preceptors reported that their programs provided fellows with appropriate resources and facilities in accordance to ACCP guidelines. Preceptors indicated that their programs offered fellows appropriate didactic coursework as well as skills taught in adherence to ACCP guidelines. Few preceptors indicated that their programs provided trainees with hands-on research activities at the level suggested by the guidelines. Preceptors' responses showed that current PE/OR fellowship ...

Reflections on Clinical Practice by First‐Year Dental Students: A Qualitative Study

During the first and second year of the dental curriculum, students have little time to process and learn the didactic material in a meaningful way because of the large number of required courses in the curriculum. If an outcome of dental education is to promote critical thinking, however, methods need to be explored to encourage this process in dental students throughout the curriculum. Reflecting on experience is the way learners "make meaning" out of the information they acquire, and "making meaning" is an integral component in the development of critical thinking. The purpose of this pilot study was to explore how reflection on clinical experiences may facilitate the development of critical thinking in first-year dental students as well as assist them in integrating their didactic coursework with clinical care. I used Luborsky's thematic analysis to analyze semi-structured interviews, clinical observations, and written reflection papers from dental students. The major themes identified from the data were: 1) connections between didactic material and the clinical experience, 2) the students' vision of their future role as dentists, and 3) the nature of the dentist-patient interaction. The data further suggest a process of reflective thinking that begins with students' questioning assumptions about their prior experience and knowledge that leads them to look at things in a new way and ultimately to recognize the need to take some action to provide care to the patient. The findings suggest that encouraging students to keep a clinic journal or write reflection papers about their experience may be a way to enhance student learning and is an area that deserves further research.

Future roles and training of internal medicine subspecialists. American Board of Internal Medicine Task Force on Subspecialty Internal Medicine.

While fellowship training programs are being reduced in size to better conform to societal needs, the training of subspecialist basic scientists and clinical investigators must be protected to ensure continued discovery and the scholarly application of knowledge to patient care. Fewer subspecialist clinicians must be appropriately trained to serve as consultants, as principal care providers, and as scholarly leaders and educators in their subspecialties. This article describes the recommendations of the American Board of Internal Medicine for subspecialty training. To encourage physicians to choose careers as investigators, overlapping but different training paths are delineated for subspecialist clinicians and investigators. More didactic coursework is recommended for both paths. To maximize the contribution of fewer subspecialists, it is essential to provide rigorous training that is appropriately relevant and realistically matched with career opportunities.