Teaching Pharmacy Students Research Articles

Challenges to Online Pharmacy Classes during COVID 19 Pandemic: cross sectional study in Jordan

Background: Covid 19 pandemic has had a strong influence on all aspects of life . One of these influence is education. The academic authorities in Jordan as in elsewhere across the world have shifted their method of teaching to online class. After four semester of online teaching it’s important for both teaching staff and students of pharmacy faculties to assess the trends and the preference of students to different methods of online teaching. The purpose of this study was to assess the influence of the COVID19 pandemic on online education for pharmacy students in Jordan’s faculties of pharmacy. Methods: We emailed a survey to the majority of students in Jordan’s pharmacy faculties during january and february 2022. Results: We received 230 responses, with 87.2 percent of respondents being female and the majority of the students being pharmacy students. Among the 230 respondents, 75% said they liked combining online and face-to-face training, while 13% said they preferred face-to-face instruction and only 12% said they favored online learning. The major challenges in online teaching during the pandemic are issues with in-person communication (87 percent), student assessment (65 percent) and use of technology tools (35 percent). Conclusion: Due to the fact that the survey was conducted during the fourth semester with the COVID 19 pandemic, and most students have gained confidence in using online technology and the university IT support, one can conclude that pharmacy students have a high level of confidence in the effectiveness of online pharmacy education.

Addressing cultural competence and bias in treating migrant workers in pharmacies: Pharmacy students learning and changing norms.

Little research addressed training pharmacy students on bias towards vulnerable patients such as migrant domestic workers (MDWs). This study evaluates a module addressing bias and cultural competence when working with MDWs in community pharmacies. Two cohorts of Lebanese Bachelor of pharmacy students completed this module as part of a core Public Health class. Guided by a social psychology framework, the module involved watching a lecture, discussing an article, watching a video addressing bias in healthcare, and taking an Implicit Association Test. Second, students interviewed one MDW and one pharmacist before filling a reflection worksheet. Students' reflections were analyzed qualitatively using content analysis. Further, to evaluate the module's impact quantitatively, an aggregate perception of helpfulness scale was created and validated. Items addressed students' own experience with the module as well as its impact on pharmacists interviewed by students. Of 170 students completing the module and providing qualitative data, 131 were asked to fill a survey addressing perceptions of assignment helpfulness. Of those 131 students, 126 filled the survey. On a scale ranging from zero to four, the composite mean score for helpfulness was 3.4, SD=0.5. Students reported a positive impact of the interview in improving awareness of bias for pharmacists they interviewed (mean=3.5, SD=0.6). Qualitative analysis produced insight into students' experience with the module including challenges in communication with MDWs; MDWs' experience with bias and its repercussions; predictability, or lack thereof, of assignment results; plans to address bias after taking the module; evaluation of interviewed pharmacist's service; and perceived pharmacists' impressions of the assignment. A two-part module shows promise in educating pharmacy students about bias and cultural competence. Engaging target audience including pharmacists can make such experiences meaningful for students while providing a learning opportunity for those health professionals.

Using GastroPlus to teach complex biopharmaceutical concepts

Context: In response to the COVID-19 pandemic, many educational adjustments had to be made to move in-person teaching to online classrooms. This report showcases the use of the software GastroPlus in an undergraduate-level pharmacy course. Programme description: This course aimed for the students to learn how to perform a mechanistically based simulation to predict the oral absorption pattern, pharmacokinetics, and biopharmaceutics properties of compounds in humans. The computer simulation offered the opportunity to teach concepts about bioavailability providing all kinds of experience with major biopharmaceutic determinants that affect systemic drug exposure. Evaluation: The advantage of this approach was seen by the enhanced performance on the biopharmaceutics questions on the final exam compared with the previous year where the laboratory was not implemented: An increase from 2019 (where no laboratory was implemented) through 2021 incorrect scores from 52, 76 to 75%, respectively. Conclusion: There is great benefit in using computer programs and simulations as a technique to enhance active learning and to educate pharmacy students in salient aspects of biopharmaceutics.

Disaster medical education for pharmacy students using video recordings of practical disaster drills

IntroductionThis study created video-based educational materials for pharmacists' disaster response using video recordings of disaster drills to evaluate the feasibility of online education for teaching evacuation shelter management. MethodsVideo materials were created from an actual disaster drill held at the Hirakata campus of Setsunan University and were provided to second-year pharmacy students as part of their classes. We conducted a questionnaire survey before and after the video intervention to evaluate participants' attitudes toward providing support during disasters, awareness of pharmacists' role in disaster relief, and willingness to participate in disaster drills. ResultsA comparison of the pre- and post-intervention questionnaire results showed that the intervention enhanced participants' understanding of pharmacists' role in disaster medicine. The factor analysis, cluster analysis, and the amount of change showed that the video materials vividly conveyed the confusion of a disaster to the participants and helped them imagine experiencing and responding to a disaster. ConclusionThe findings showed the feasibility of using video-based educational materials to vividly convey the chaos that challenges medical personnel during disaster-response efforts. This method provides a safe way to prepare students who might be called upon to work in emergency conditions and stimulate interest in disaster medicine. Ideally, this and similar interventions will become part of an extensive toolbox of empirically-based disaster preparedness educational materials.

The effect of an augmented reality educational tool on the motivation towards learning in pharmacy students: an evaluative survey

Abstract Introduction Within the context of education, motivation relates to the desire students possess to engage in their learning environment. This quality is vital in determining the effort an individual expresses towards their learning and the desire they have to achieve higher academic performances (1). Educational technologies, particularly digital technologies, have long been used in post-secondary education to increase collaboration, critical thinking and motivation among students (2). The advancements in technology have led to the creation of novel augmented reality (AR) educational tools, however they have not been widely implemented or researched with the education of pharmacy students in the United Kingdom. Aim To identify changes of pharmacy students’ self-reported intrinsic motivation towards learning after using the ‘Pharma Compounds AR’ (PCAR) educational tool. Methods The PCAR tool was an image-based educational AR mobile application – it displayed 3-D models and animations of complex molecules when unique target images were scanned with the mobile’s camera. 118 stage two undergraduate Pharmacy students from a University in England were approached through cohort emails that contained a link to an online consent form and pre-intervention questionnaire. Participants were required to complete the pre-questionnaire before they received the PCAR tool for at least two months. Students were informed that they could use the tool to accommodate their learning in any way they felt appropriate. Once the intervention period ended, participants completed an online post-questionnaire. Changes in self-reported intrinsic motivation were determined with the use of adapted Intrinsic Motivation Inventory (IMI) Likert scale questions. The pre-questionnaire focused on motivation towards learning using conventional methods and their perceived usefulness, whereas the post-questionnaire focused on motivation towards learning with the PCAR tool and its perceived usefulness. Descriptive and inferential statistical analyses were conducted on the IMI adapted Likert scales. Results A total of 68 (57.6% rr) undergraduate Pharmacy students completed the pre-questionnaire. The majority were aged 18-21(82.4%), female (70.6%) and domestic (94.1%). The post-questionnaire was completed by 30 students (44.1% rr), mainly aged 18-21 (83.3%), female (70%), and domestic (86.7%). Participants ranked their agreement to each Likert statement from 1 (not true at all) to 7 (very true). Mean agreement motivation scores were increased after the use of the PCAR tool (pre-3.88 vs post-5.15), as were the mean agreement scores of the learning tools’ perceived usefulness (pre-4.69 vs post-5.29). Dependant T-tests performed on responses of students who completed both questionnaires revealed a significant increase in students’ mean pre- and post-intervention motivation towards learning scores (p=0.000). No significance was calculated between the mean pre-and post-agreement usefulness scores (p>0.05). Conclusion Incorporating the PCAR tool into the education of stage two Pharmacy students significantly increased their reported motivation towards learning when compared to conventional methods, it was also reported as being a more useful learning tool. The drop in post-questionnaire responses has to be acknowledge as a limitation as well as not explicitly knowing how students used the PCAR tool in their studies. Nevertheless, the incorporation of AR into schools of Pharmacy could provide students and tutors more engaging teaching and learning experiences. References (1) Budiman R. Developing Learning Media Based on Augmented Reality (AR) to Improve Learning Motivation. J Educ Teach Learn. 2016 Sep;1(2):89–94. Available from: https://www.learntechlib.org/p/209026 (2) Martin F, Polly D, Coles S, Wang C. Examining higher education faculty use of current digital technologies: Importance, competence, and motivation. Int J Teach Learn High Educ. 2020;32(1):73–86.

A Call to Action for Cultural Humility in Pharmacy Education Student Assessments

An important topic in the conversation on the education of pharmacy students evolves around methods of pedagogy and assessment and attention to diversity and inclusion. Well-intentioned educators may introduce bias into their teachings and assessment tools by focusing on diseases with a higher rate of presentation in minorities without engaging in conversations about why these health disparities exist. When considering the content and structure of a curriculum, it is also important to review its assessment tools, with attention to cultural humility in multiple-choice examinations, case-based presentations, and even observed structured clinical examinations. Disregarding this component of the conversation may lead students to have an unconscious impression that social constructs are biological markers for a disease. Students may recall not only what they learned in a classroom setting, but often the content included in their assessments as well. By writing test items that are culturally responsible, unconscious bias can be reduced and test items can better measure the knowledge that educators intend to assess. As pharmacy educators perform programmatic reviews, attention should be directed toward unconscious bias, not only in the curricula but also in evaluation and assessment tools.

Remote learning during Covid-19 lockdown: A study on anatomy and histology education for pharmacy students in Jordan.

The Covid‐19 pandemic has changed almost all aspects of education. The anatomy and histology courses for pharmacy students focus heavily on the face‐to‐face communication of theory and practical knowledge, and due to the pandemic, only theory content was delivered in an online format. This brought up many concerns about pharmacy student preparedness. This work explores the effectiveness and student perspective of remote teaching of the theoretical anatomy and histology course in Jordanian universities from the perspective of pharmacy students. The objectives are to determine the strengths, challenges, and the effectiveness of remote delivery on student learning. An online‐based validated questionnaire was distributed to students majoring in Pharmacy and enrolled in the course during the second semester of 2019–2020 at 11 universities in Jordan. A total of 442 students participated in the study. Results showed that there were significant differences in perceptions of the social media platforms used in distance learning and remote delivery of the course. Most participants had positive perceptions of the educational process and studying via distance learning. There were many strengths noted including time flexibility and several challenges such as the lack of face‐to‐face interaction with instructors, inadequate internet connectivity, and technical issues. In conclusion, online‐taught anatomy and histology course during the Covid‐19 lockdown in Jordan was a success as perceived by students, but the course still possessed challenges need to be overcome in the future.

A Pilot Program to Teach Pharmacy Students Practical Skills to Navigate Drug Insurance Benefits.

Pharmacists must be able to navigate prescription drug coverages to help providers and patients reduce out-of-pocket costs. Traditionally, curricula on drug insurance benefits rely on lectures and lack a practicum that offers students hands-on experience with determining formulary and cost-sharing information. An activity for pharmacy students to update a free public website that summarizes formularies and copayment requirements across major insurers was piloted. Pharmacy students were trained to locate online formularies and identify a drug’s coverage tier, step therapy, prior authorization, and cost-sharing during a 6-week experiential rotation. Students checked formularies from six insurance plans for 250-plus drugs across 15 health conditions. Graduates were surveyed (74% response rate) about the activities’ impact on their learning and ability to navigate drug benefits. Respondents rated the training as helpful in learning whether a drug was covered (100%), or required step therapy or prior authorization (100%). The majority of graduates reported being able to look up formulary coverage (90%), step therapy or prior authorization (90%), and copayment requirements (65%). Our innovative skills-based pilot activity was effective in teaching pharmacy students to navigate insurance formularies, which is essential for helping patients access medications.

A practical study to optimize remedial and supplementary education for pharmacy students

A practical study to optimize remedial and supplementary education for pharmacy students

Learner attitudes towards a virtual microbiology simulation for pharmacy student education

IntroductionSimulation for education has become popular, but much literature on this modality fails to critically examine the learner's experience, focusing instead on learning outcomes. Learner attitudes should be scrutinised and monitored to appraise a technology-enhanced learning experience as student perceived educational benefits of technology-enhanced learning is reported to be more important than the intrinsic characteristics of any particular medium or tool. This study sought to evaluate pharmacy students' attitudes toward a virtual microbiology simulation. MethodsThe virtual microbiology simulation (VUMIE) was compared with a traditional wet laboratory (lab) in a second-year integrated pharmacotherapeutics course for bachelor of pharmacy students. Data were collected using surveys deployed at baseline (pre-intervention), post-intervention (VUMIE or wet lab), and endpoint (post-interventions). Statistical and qualitative thematic analyses were performed. ResultsLearners found the simulation valuable, and outcomes suggest that it is possible for technology-enhanced learning activities to replace face-to-face instruction to some extent, which may be useful given the current challenges with in-person education resulting from COVID-19. More students reported a specific preference for the wet lab rather than VUMIE. ConclusionsAlthough technology-enhanced simulation can produce a similar learning experience to a traditional wet lab, this evidence is not sufficient to completely replace the traditional lab experience for clinical courses of study. Technology-enhanced simulation could be considered for just-in-time training before exposure to traditional lab activities, for specific skill acquisition using deliberate practice, and perhaps for standardised assessment for clinical microbiology education.

Can a virtual microbiology simulation be as effective as the traditional Wetlab for pharmacy student education?

BackgroundPharmacy practice education requires the development of proficiencies and an understanding of clinical microbiology. Learning in this area could be delivered using practical laboratory exercises, or potentially, simulation-based education. Simulation has previously successfully enhanced learning in health professional education. The current global climate due to COVID-19 has further highlighted the important role of technology-enhanced learning in delivering outcomes that meet the requisite learning objectives of a course. The aim of the present study was to compare the impact of a commercially available virtual microbiology simulation (VUMIE™) with a traditional wet laboratory (wetlab) on learner knowledge, skills and confidence in a second-year integrated pharmacotherapeutics course for Bachelor of Pharmacy students.MethodsA randomised, crossover study was employed to determine whether the simulation intervention (VUMIE™) improves learning outcomes (knowledge, skills and confidence) of pharmacy students, when compared to a traditional wetlab intervention. Each student completed three 1–2 h length sessions, for both the wetlab and VUMIE™ interventions (6 sessions total). Data was collected using surveys deployed at baseline (pre-interventions), post-intervention 1 or 2 (VUMIE™ or wetlab) and endpoint (post-interventions 1 and 2). Statistical analysis was conducted using SPSS Statistics 25 and Instat™ software.ResultsResponse rates were approximately 50% at initial survey and approximately 25% at endpoint survey. VUMIE™ produced higher post-intervention knowledge scores for the multiple-choice questions compared to the wetlab, however, the highest score was achieved at endpoint. Both interventions produced statistically significant differences for mean scores compared to baseline (pre-VUMIE™ and wetlab) across the domains of knowledge, skills and confidence. VUMIE™ produced higher post-intervention mean scores for knowledge, skills and confidence compared to post-intervention mean scores for the wetlab, however there was no statistical significance between the mean score for the two interventions, thus the VUMIE™ activity produced learning outcomes comparable to the wetlab activity.ConclusionThese findings suggest VUMIE™ provides similar effects on students’ knowledge, skills, and confidence as a wetlab. The simulation’s implementation was not cost-prohibitive, provided students with a physically and psychologically safe learning environment, and the benefit of being able to repeat activities, supporting deliberate practice.

Teaching Pharmacy Students and Residents Patient-Centered Care Through Interviewing Veterans

Objective. To incorporate the My Life, My Story program into pharmacy learners' training and assess its impact on the learners' self-reported patient-centered care competencies.Methods. Fourth professional year (P4) pharmacy students and first and second year (PGY-1 and PGY-2) pharmacy residents at a veterans health care facility were instructed to identify a patient to interview during their rotation. Following a guide provided to them, the learners conducted an interview and wrote their patient's story. Learners also completed anonymous, voluntary, pre- and post-activity surveys online intended to assess their patient-centered care competencies and report the impact of and overall perceptions about the experience. The total number of learners and stories were tracked by reviewing patients' medical records.Results. Between July 2016 and February 2019, 34 pharmacy learners completed 40 veterans' life stories. The participants included 28 P4 pharmacy students and four PGY-1 and two PGY-2 pharmacy residents. Of the 34 learners, 9 (26%) completed the optional, anonymous pre-activity survey and 16 (47%) completed the post-activity survey. On a Likert scale (1=poor to 5=excellent), learners reported a significant improvement in their ability to let the patient tell their story, view the patient as a whole person, and show care and compassion. Overall, participants reported that the learning experience was a good use of their time to a great (56%) or large (28%) extent and helped them to foster a positive relationship with their patients.Conclusion. Integrating the My Life, My Story program into pharmacy learning experiences may assist in developing patient-centered care skills in the clinical setting.

The Need to Educate Pharmacy Students in Telepharmacy and Telehealth

The global pandemic has dramatically impacted how pharmacists connect with patients. Telepharmacy and telehealth technologies are being used by pharmacists in a multitude of settings to positively influence the health and wellbeing of patients. Having pharmacists that are prepared to deliver services using telepharmacy and telehealth necessitates that Doctor of Pharmacy (PharmD) students receive tele-education. Tele-education topics may include telepharmacy and telehealth, audio and visual technologies, etiquette, law, reimbursement, and privacy and confidentiality. In many cases, the pandemic has required pharmacy programs to incorporate tele-education into curriculums quickly, resulting in limited and underdeveloped experiences for students. Tele-education should be purposefully incorporated into curriculums through a combination of didactic, simulation, and experiential training. Programs should evaluate how tele-education is taught within their curriculum and share those experiences with the Academy as pharmacy graduates will likely be providing patient care services using telepharmacy and telehealth.

Educating pharmacy students through a pandemic: Reflecting on our COVID-19 experience.

The impact of the COVID-19 pandemic on pharmacy education worldwide has been immense, affecting students, educators and regulatory agencies. Pharmacy programmes have had to rapidly adapt in their delivery of education, maintaining standards while also ensuring the safety of all stakeholders. In this commentary, we describe the challenges, compromises and solutions adopted by our institution throughout the pandemic, the lessons learnt, adaptive measures taken, and strategies to develop and future-proof our curricula.

Educating Pharmacy Students About Underserved Populations Using Patient Speakers and Simulation Activities

Objective. To assess the impact of the Patient Voices series on Doctor of Pharmacy (PharmD) students.Methods. A series of patient speakers and integrated simulation activities focused on underserved populations, otherwise known as the Patient Voices series, was embedded into a pharmacy skills laboratory curriculum. First-year PharmD students' self-ratings of confidence were compared on pre- and post-course surveys. Using evaluations from first-year introductory pharmacy practice experiences (IPPEs), student self-evaluation data were compared to preceptor evaluations of student performance. Open-ended responses to course evaluations from first- and second-year PharmD students and student reflections from third-year PharmD students were assessed using conventional content analysis to identify and characterize student perceptions.Results. Significant increases were observed in first-year students' confidence to show empathy (mean, 4.2 to 4.7) and to interact with patients from underserved communities (mean, 2.2 to 4.2). Preceptor ratings of students' empathy were consistent with the students' self-rated abilities, while students' self-ratings on cultural sensitivity were higher than the preceptors' ratings. Qualitative analysis of course evaluation surveys and reflections revealed common themes identified by students, such as understanding different perspectives, increased empathy for patients, and the value of including this content in the curriculum.Conclusion. Student confidence to interact with patients from a variety of underserved populations increased following introduction of the Patient Voices series into the PharmD curriculum. Students perceived the series to be a valuable learning experience.

AACP Awards Recipient Presented at the 122nd Virtual Annual Meeting of the American Association of Colleges of Pharmacy, July 19-22, 2021

### A Remote Health Equity Curriculum: Teaching Pharmacy Students to be Advocates for Social Justice Stephanie L. Hsia, University of California, San Francisco , Rupa L. Tuan, University of California, San Francisco . Objective : To describe the implementation and evaluation of a Health Equity

Transgender health education for pharmacy students and its effect on student knowledge and attitudes

Background and purposeIncreased student pharmacist education on health issues and concerns of the underserved Lesbian, gay, bisexual, transgender, and queer (LGBTQ) population is needed. We incorporated pharmacy-specific, transgender-focused education into the curriculum and sought to identify whether pharmacy students' knowledge and attitudes towards LGBTQ individuals were affected by: (1) required online module or in-class lecture and (2) student demographics.Educational activity and setting: Pharmacy student attitudes and perceptions towards transgender individuals and the LGBTQ population were assessed before and after online (video) and in-person education using a modification of the Attitudes towards Lesbian Gay Bisexual Transgender Patients Scale. Wilcoxon test for non-parametric paired data was used to test for statistically significant changes between the pre- and post-education surveys, while two-way analysis of variance was used to analyze correlations between student demographics and responses. FindingsChanges in students' knowledge and attitudes were observed after exposure to either online or in-person education. Increases in students' perceived competence to provide care to patients identifying as LGBTQ were associated with both teaching methods. Significant demographic associations were seen with specific attitudes; female students and students who knew a transgender person were more likely to strongly disagree that discussing sexual behavior with LGBTQ patients is challenging. SummaryDelivery of transgender-focused education produced observable changes in student pharmacist perceptions and attitudes towards working with the LGBTQ patient population. Demographic characteristics, such as being female or knowing a transgender individual, positively correlated with student pharmacists' feeling more comfortable discussing sexual behavior with LGBTQ persons.

Communicating definitive uncertainty: Teaching pharmacy students to say “I don't know”

Background and purposeCommunicating uncertainty is an art requiring practice. The purpose of this study was to compare pedagogies for the instruction of pharmacy students in communicating definitive uncertainty. Educational activity and settingA case scenario featuring a busy physician asking a question without a definitive answer was directed to the pharmacy student using two pedagogies: (1) in-person standardized client and (2) virtual written case. Students provided self-assessments of their confidence in communicating uncertainty after completing the case utilizing a survey containing both rating scale questions and open-ended questions. Self-confidence within-group differences were compared using Wilcoxon signed-rank tests and between-group differences were compared using Mann-Whitney U tests. Responses to open-ended questions were descriptively analyzed for themes using qualitative assessment methods. FindingsBoth the in-person standardized client (70 to 81, P ≤ .001) and the virtual written case (74 to 85, P ≤ .001) significantly increased students' self-rated confidence to verbalize “I don't know” to a healthcare provider. No significant differences were observed between the pedagogies. However, students who participated in the virtual written case mentioned a desire for “additional practice opportunities” more frequently than students who participated in the in-person standardized client. SummaryIn-person standardized client and virtual written case are effective methods for increasing pharmacy student comfort with communicating definitive uncertainty. Further research is needed to instruct pharmacists in uncertainty communication.

Blended Learning on Blood Pressure Measurement: Investigating Two In-Class Strategies in a Flipped Classroom-Like Setting to Teach Pharmacy Students Blood Pressure Measurement Skills.

For reliable blood pressure measurement, various potential sources of inaccuracies need to be considered to avoid incorrect decision-making. Pharmacy students should be sensitized and taught the skill accordingly. One strategy to teach students’ blood pressure measurement skills might be through a blended learning approach in a flipped classroom-like setting. With a randomized two-arm study among pharmacy students in their eighth semester, the required extent of in-class session in the scope of a blended learning approach in a flipped classroom-like setting was evaluated. Participants’ self-confidence and self-perceived proficiency were evaluated through a survey, and participants’ blood pressure measurement performance was assessed by objective structured clinical examination (OSCE). Participants’ satisfaction with, and perception of, the flipped classroom were also surveyed. The extended in-class activities did not result in a significantly higher increase of participants’ OSCE score and self-assessment score when compared to the brief in-class session. Both in-class sessions yielded a significant increase in the OSCE scores as well as in the self-assessment scores. Moreover, the teaching approaches were predominantly well-received by the students. The use of both flipped classroom-like approaches improved pharmacy students’ blood pressure measurement performance, though the brief in-class session was sufficient. Students’ self-confidence/self-perceived proficiency in blood pressure measurement skills increased similarly in both settings.

Enhancing Student Knowledge of Diabetes through Virtual Choose Your Own Adventure Patient Case Format.

Educational strategies to teach pharmacy students about diabetes are necessary to prepare future pharmacists to manage complex patients. The Choose Your Own Adventure (CYOA) patient case format is an innovative activity that presents a patient case in an engaging way. The objectives of this study were (1) to describe the development of the innovative teaching activity and (2) to assess its effect on student knowledge and confidence in outpatient management of diabetes. The CYOA patient case activity was designed by transforming a traditional paper patient case involving outpatient diabetes management into an interactive format utilizing an online platform. The activity was conducted with 186 second-year pharmacy students in a skills-based course. This activity was administered virtually through a combination of small group work and large group discussion. After completion of the activity, students completed an online self-assessment questionnaire. Of 178 completed questionnaires, there was a statistically significant difference in students’ self-ratings after versus before the activity for all survey items (p < 0.001). The CYOA activity improved self-reported knowledge of outpatient diabetes management and increased self-reported confidence in clinical decision-making skills. This format shows promise as an educational tool that may be adapted for other disease states to enhance clinical decision-making skills.