Effective Team Members Research Articles

Dental and dental hygiene students' perceptions on intraprofessional education.

Interprofessional education and intraprofessional learning experiences are fundamental to becoming an efficient member of the healthcare team for dental and dental hygiene students. The purpose of this study is to determine the attitudes and perceptions of The Ohio State University's dental and dental hygiene students on intraprofessional education and collaboration. Dental and dental hygiene students at The Ohio State College of Dentistry were surveyed in this cross-sectional study about their readiness for intraprofessional learning. The questionnaire was modeled after a study conducted by Brame etal. which focused on assessing students' readiness for intraprofessional education and determining their perceptions towards the use of intraprofessional education. Two hundred and seventy students completed the questionnaire for a 61.3% response rate. Dental hygiene students agreed more to how incorporating shared learning would help to think more positively about other oral health care professionals (p=0.025) and would help students to become better oral health care team members (p=0.002). Dental students agreed more than dental hygiene students that the function of a dental hygienist is to provide support for dentists (p ≤ 0.001) and that they must acquire more knowledge than other oral health care students (p ≤ 0.001). Most students (93%) agreed that intraprofessional learning would help in becoming a more effective oral health care team member. Dental hygiene students feel more strongly than dental students about including intraprofessional education in their learning. However, all students were receptive to the idea of incorporating intraprofessional practices.

Leadership and Followership Dynamics in Interprofessional Health Care Teams: Attending Physician Perspectives.

Effective interprofessional health care team (IHT) members collaborate to reduce medical errors, use resources effectively, and improve patient outcomes, making interprofessional collaboration imperative. Because physicians are often designated as the positional leaders of IHTs, understanding their perspectives on collaboration within IHTs could help to mitigate the disconnects between what is suggested in theory and what is happening in practice. This study aimed to explore leader-follower dynamics within medical teams that are commonly working in clinical care contexts. Using a constructivist approach, the authors conducted 12 individual, semistructured interviews from November 2022 to September 2023 with attending physicians who have led IHTs in perioperative (i.e., preoperative clinic, operating room, postoperative and recovery unit) or emergency department settings. The transcripts were analyzed from December 2022 to December 2023 using inductive thematic analysis. Three themes explained the physician perceptions of IHT leadership-followership dynamics: (1) physicians are comfortable sharing leadership intra professionally, (2) the clinical culture and environment constrain interprofessional followership and shared leadership, and (3) hierarchical models hold true even while active followers are appreciated, when appropriate. The data in this study suggest that, in perioperative and emergency department settings, shared leadership largely may not occur inter professionally but occurs intra professionally. Participants suggested that the clinical culture and environment (i.e., legal concerns, hierarchical assumption, patient care ownership responsibilities) constrained interprofessional followership and shared leadership. On the basis of the study's findings and how they align with previous research, future research into interprofessional collaboration and followership roles should focus on what factors enable and constrain active followership and shared leadership. Such collaboration can only be achieved when active followership and shared leadership are allowed and promoted. These findings and others suggest that not all contexts are enabling such types of interprofessional collaboration due to legal concerns, hierarchical traditions, and patient ownership considerations.

Call for an interprofessional, experiential, performance-based model for health professions education

Medical errors are cited among the leading causes of death in the United States, resulting in devastating consequences for patients and their families, besides adding substantial costs to healthcare. Communication within and between teams is cited as a major contributing factor to patient deaths due to preventable medical errors. Although Universities and Academic Health Centers aim to graduate competent healthcare professionals who are effective healthcare team members, the importance and degree of emphasis given to interprofessional education (IPE) across health professions accreditation organizations is variable. To ensure a highly skilled, efficient and confident health professions workforce, an interprofessional, experiential, performance-based model for health professions education is proposed. This transformational model must be relevant for this high-risk, data-driven and increasingly technological medical era. Finally, it must revolve around patient safety and well-being as patients traverse through the levels of the healthcare system and upon the safety and well-being of professionals providing them care.

Medical Students' Perception of Interprofessional Education: A Cross-Sectional Study.

Background and objective Interprofessional education (IPE) involves learners from multiple health professions learning collaboratively to improve patient care. This study assessed medical students' perceptions of IPE at Taibah University in Saudi Arabia. Methods In this cross-sectional study, 319 medical students in years two to six of graduate medical school and internships completed the Readiness for Interprofessional Learning Scale (RIPLS) questionnaire between April 2022 and July 2022. RIPLS consists of 19 items measuring teamwork/collaboration, negative/positive professional identity, and roles/responsibilities. Comparisons were made based on gender and academic level by using the Mann-Whitney U and Kruskal-Wallis tests. Results Students generally expressed positive attitudes towards IPE. The majority agreed that IPE improves teamwork, communication, and patient care. In our cohort, 148 students (46.4%)strongly agreed and 140(43.9%) agreed that shared learning enhances understanding of clinical problems. However, 186 students (60%) disagreed that clinical problem-solving is profession-specific. On the teamwork/collaboration subscale, 279 students (87.7%) strongly agreed that learning with others makes them more effective team members. Regarding negative identity, 186 students (58.3%) disagreed that learning with other students wastes time. By gender, males had lower ranks for negative identity (p=0.03) and positive identity (p=0.03) versus females. As for academic level, clinical students and interns had higher and lower ranks, respectively, for negative identity (p<0.01). Conclusion Based on our findings, medical students generally hold favorable views toward IPE and recognize its benefits for collaboration, communication, and patient care. Incorporating IPE throughout medical training may further improve attitudes and interprofessional skills.

Management of COPD and Comorbidities in COPD patients by Dispensing Pharmaceutical Care following Global Initiative for chronic Obstructive Lung Disease-Guidelines (GOLD guidelines 2020): A study protocol for a Prospective Randomized Clinical Trial

COPD (chronic obstructive pulmonary disease) is a medical condition that encompasses several chronic, progressive, and severe respiratory illnesses, such as emphysema and chronic bronchitis. COPD is the 4th most deadly disease in the world and its prevalence is expected to increase. Despite the abundance of information on the disease's etiology, pathophysiology, and treatment possibilities, it has long been underdiagnosed and underreported for a long time, particularly in developing countries. The symptoms of COPD result in significant impairments and significant impact on quality of life. COPD is the third leading cause of death in Pakistan. According to the published literature, COPD has been found to be associated with a serious economic burden, either the direct cost to healthcare systems in the form of frequent hospital admissions or indirect costs to patients suffering from COPD. Despite the availability of excellent medication, COPD treatment goals are frequently not achieved resulting in poor management of COPD. The recent studies revealed that due to the missing role of Pharmacists in most of the public sector hospitals of Pakistan, the COPD disease management protocols are not being properly followed. Pharmacists can help the healthcare system by implementing these management protocols that focus on patient education about the disease, prescribed medications, and proper inhalation techniques. Furthermore, the pharmacists as an effective healthcare's team member properly educate the patients about the ongoing assessments and their willingness to follow treatment recommendations and quit smoking, while referring them to smoking cessation programs as needed, following the GOLD guidelines. This aim of this clinical trial is to evaluate the impact of implementing standard treatment guidelines and the role of pharmacists in implementing GOLD guidelines for COPD management.

Evaluation of an interprofessional education intervention in partnership with patient educators.

Patient involvement in interprofessional education is a novel approach to building collaborative and empathic skills in students. However, this area of teaching is lacking in rigorous studies. The project aimed to evaluate whether an interprofessional education intervention in partnership with patient educators (IPE-PE) would increase readiness for interprofessional learning and empathy in health sciences students. This is the report of a didactic innovation project. Participants included 310 undergraduate health sciences students who took part in an IPE-PE intervention. Data were collected before and after the training, using the Readiness for Interprofessional Learning Scale (RIPLS) and the Jefferson Scale of Empathy-Health Professions Student version (JSE-HPS). Only at the end of the intervention, a data collection form was administered to explore the value of the patient educator in the training and to investigate the socio-demographic variables. The mean age of participants was 21±3.2 SD years and 76% were female. A paired t-test showed significant changes from before to after the IPE-PE in the mean total RIPLS score (42.7±5.8 SD vs 44.62±5.9 SD, P<0.001) and the mean total JSE-HPS score (112.7±12.5 SD vs 116.03±12.8 SD, P<0.001). Conclusions: Our students reported that IPE-PE had helped them to become more effective healthcare team members, to think positively about other professionals, and to gain empathic understanding of the perspective of the person being cared for. The results of the project confirm that the intervention promoted the development of empathy, fostering a better understanding of the patient-centred perspective.

Teamwork Traits Associated with Positive Perceptions of the Dependability and Utility of Autonomous Advisors

Near future human-autonomy teams (HATs) will feature artificial agents with increasingly advanced social capabilities. The social atmosphere of a team is known to be important for successful teaming; however, it is not clear that factors influencing human-to-human exchanges will transfer directly to human-autonomy exchanges. Here, using data from the DARPA ASIST program, we employed four measures tapping individuals’ personality, social preferences, and social intelligence to explore differences in perceptions of human as compared to autonomous teammates’ dependability as well as perceived impacts regarding team coordination and performance. We found that psychological collectivism, sociable dominance, and extraversion were associated with positive perceptions of autonomous teammates serving as advisors, but not human teammates in the same role, and a reversed relationship for conscientiousness and openness. Awareness and examination of these factors in increasingly social HATs will be important for developing successful agents and selecting effective team members.

Undergraduate Medical Education Leader Performance Predicts Postgraduate Military Leader Performance.

Developing physicians as leaders has gained attention across the United States. Undergraduate medical education (UME) and graduate medical education (GME) leader development programs have increased. During postgraduate years (PGY), graduates bring their leadership education to the bedside; however, associations between leader performance in medical school and GME is largely unknown. It is important to find experiences that can assess leader performance that may be useful to predict future performance. The purpose of this study was to determine if (1) there is a correlation between leader performance during the fourth year of medical school versus leader performance in PGY1 and 3, and (2) leader performance during the fourth year of medical school is associated with military leadership performance in PGY1 and 3s while taking previous academic performance markers into account. This study examined overall leader performance of learners (classes of 2016-2018) during the fourth year of medical school and their graduate leader performance post-medical school. Leader performance was assessed by faculty during a medical field practicum (UME leader performance) and graduate leader performance was assessed by program directors at the end of PGY1 (N = 297; 58.3%) and 3 (N = 142; 28.1%). Pearson correlation analysis examined relationships among UME leader performance and between the PGY leader performance items. In addition, stepwise multiple linear regression analyses were conducted to examine the relationship between leader performance at the end of medical school with military leadership performance in PGY1 and 3, while taking into account the academic performance markers. Pearson correlation analyses revealed that the UME leader performance was correlated with 3 of 10 variables at PGY1, and was correlated at PGY3 with 10 out of 10 variables. Results of the stepwise multiple linear regression analysis indicated that leader performance during the fourth year of medical school explained an additional 3.5% of the variance of PGY1 leader performance after controlling for the previous academic performance markers (MCAT total score, USMLE Step 1 score and Step 2 CK score). In contrast, leader performance during the fourth year of medical school alone accounted for an additional 10.9% of the variance of PGY3 leader performance above and beyond the set of academic performance markers. Overall, UME leader performance has more predictive power in PGY leader performance than the MCAT or USMLE Step exams. The findings of this study indicate that a positive relationship exists between leader performance at the end of medical school and leader performance in PGY1 and 3 years of residency. These correlations were stronger in PGY3 compared to PGY1. During PGY1, learners may be more focused on being a physician and an effective team member compared to PGY3 where they have a deeper understanding of their roles and responsibilities and can take on more leadership roles. Additionally, this study also found that MCAT and USMLE Step exams performance was not predictive of PGY1 or PGY3 leader performance. These findings provide evidence of the power of continued leader development in UME and beyond.

Evaluation of Product Development Success: A Student Perspective

The time pressure on new product development under unpredictable conditions requires the renewal of the project management approach that suggests the prominent role of project managerial competencies in achieving project success. Project management education must be adjusted to understand students’ opinions in the field. The study uses a survey among Hungarian engineering, business, and IT higher education students. The analysis aims to explore opinions about the main barriers to successful product development projects, and the expected ways of regulating the project by ANOVA and principal component analysis. The responses of 126 students confirm the appreciation of management competencies. Gaps in team composition, inadequate communication, common changes in the plans, and the lack of experience in similar development tasks are considered to be the main contributors to product development project failures. Collaboration and competition with external partners were found to be less essential factors. Students believe that regulation of the work is necessary, but the project team should be trusted to establish it. Beyond developing the curricula, the experience of this study can promote the successful execution of collaborative projects between companies and higher education institutions. It can establish expected student competencies to quickly become effective project team members.

"Managing Up": Cultivating Relationships With Practice Leaders.

"Managing up" for the radiologist means developing and cultivating work relationships to benefit high-level stakeholders and the institution at large, and to maximize one's own effectiveness. Today's breast radiologists are responsible for more than image interpretation and image-guided interventions. Radiologists' roles and responsibilities have evolved to include clinical initiatives, staff development, quality improvement, and administrative tasks where management skills are needed. To be successful in these roles, developing skills to manage up will allow radiologists to be more effective team members. In this article, we discuss tactics to start developing strategies for managing up, including how to understand practice leaders and create meaningful relationships; explain various work style personalities and how to navigate them; describe how to understand oneself, including strengths and weaknesses; and, finally, provide tips on how to begin to cultivate managing up skills.

Interprofessional identity: an ethnography of clinical simulation learning in New Zealand

BackgroundThis article explores the experiences of clinical healthcare students on an interprofessional simulation course in Auckland, New Zealand. The four-day course aims to provide a formative learning experience for final year medical, pharmacy, nursing, and paramedicine students. It focuses on building skills in professionalism, communication, leadership and interprofessional safe teamwork through structured learning activities and clinical simulation scenarios.MethodsIn 2018, we commenced focused ethnographic research involving participant observation, field notes, interviews, photography and ethnographic film.ResultsA total of 112 students participated in this research from the disciplines of medicine (n = 53), nursing (n = 27), pharmacy (n = 17), and paramedicine (n = 15). In a revisit to Van Gennep’s (1972) seminal work on liminality, we suggest that the course represents a liminal space where students’ ideas about what it means to be a healthcare ‘professional’ are challenged, disrupted and reconstructed. We observed students emerging from the course with transformed professional and interprofessional identities.ConclusionsWe posit that the ritualised and liminal nature of the course plays a role in the development of interprofessional identities by interrupting the reproduction of siloed biomedical culture. Students are challenged to become effective team members alongside other students and experts from other professions. We discuss these findings as they relate to medical and health sciences education.

Measurements of Intercultural Teamwork Competence and Its Impact on Design Students’ Competitive Advantages

Main issue: This article aims to measure intercultural teamwork competence and assess its impact on career competitive advantages for design students in order to determine how effective and competitive team members are in culturally diverse settings. Sampling: there were 51 participants (48 effective) in pretesting and 405 (338 effective) in formal testing. Participants were students from three colleges of design in Zhejiang Province of China. Statistical tool: this study used the on-line platform of wenjuanxing (wjx.cn) for data collection and SPSS software for data analysis. Methods: data were collected through on-line questionnaires, and then processed through factor analysis, t-test, and stepwise regression. Results: (1) TWC-CQ scale was formed to measure intercultural teamwork competence; (2) there were no statistically significant differences among participating design students (junior and senior) in intercultural teamwork competencies; (3) key competitive advantage = 0.347 × T-behavioral CQ + 0.232 × T-metacognitive CQ + 0.172 × T-motivational CQ + 0.124 × T-cognitive CQ. Conclusions: intercultural teamwork competence and its positive impact on design students’ competitive advantages could be measured. Implications: theoretical and practical implications were summed up for future studies.

Preparing Effective InterProfessional Teams to Meet the Needs of Older Adults in Integrated Healthcare Settings

Background: Gerontology education has evolved from focusing primarily on the individual practitioner outcomes to promoting integrated, inter-professional team approaches to integrated care. Practicum training and service learning are effective pedagogy for paraprofessionals in integrated care settings to support clinicians and advance their effectiveness in meeting the needs of older adults. Interprofessional education (IPE) aims to enhance the capacity of practitioners to work collaboratively as integrated team members. Yet, little is known about the implementation of IPE in colleges and universities that are not affiliated with a medical center or medical school. This presentation will describe the implementation of IPE in a School of Social Work without a medical school system. We will explore students’ experiences with the implementation, facilitation, and evaluation of this workforce development model, and will discuss both challenges and successes. Methods: Narrative data collected over the past two-year period with social work student participants in IPE reflect their perspectives on the selection process for the specialized training, placement in an interprofessional integrated care setting, and the learning experience. Participants represented cohorts of more than 200 trainees. Results: Challenges of effective interprofessional health care teams include the approach taken to integrating the teams, level of knowledge and skills required to be an effective team member, and the need for supervision within integrated care experiences. Successes include increased professional self-efficacy. Participants reported post-completion of IPE, (1) desirable outcomes achieved for their patients, such as care satisfaction and role satisfaction for themselves as practitioners.

Informing collaborative relationships between community pharmacists and health care professionals in primary care practices

BackgroundCollaborative relationships between community pharmacists and health care professionals in primary care practices can assist with the provision of medication and disease management services in community pharmacy settings. ObjectivesThe objective was to describe the attitudes of providers working in primary care practices with on-site pharmacist collaborators to understand how to facilitate similar collaborations with pharmacists in community pharmacy settings. MethodsThis qualitative study was conducted among physicians, nurse practitioners, and nurses of 3 primary care practice sites in the Commonwealth of Pennsylvania. A demographic survey and a semistructured interview were conducted to elicit feedback on participant perceptions about building relationships with community pharmacists. Interviews were audio-recorded and transcribed. A qualitative analysis was performed to identify emerging themes using an inductive approach. Demographic data were summarized using descriptive statistics. This study was approved by the University’s Institutional Review Board. ResultsNineteen interviews were conducted. Fifty-eight percent of participants were physicians and 68% were female with a mean age of approximately 46 years. Five themes were identified: (1) Pharmacists were highly valued and were effective team members to promote coordination of medication-related care; (2) Direct access to pharmacists facilitates efficient communication and effective patient care; (3) Trust is the foundation of an effective collaboration between pharmacists and providers; (4) Pharmacists demonstrating responsibility for patients enables collaboration with providers who view themselves as stewards of patient care; and (5) Providers believe that community pharmacists’ dispensing requirements may limit their ability to participate in patient care. ConclusionsThe following strategies to establish relationships with primary care practices are suggested: pharmacists should initiate face-to-face relationships with providers in practices; communication and patient interventions should be conveyed directly to providers and be conducted by the same person; and pharmacists need to demonstrate their commitment to patient care by following up promptly on patient interventions.

Building a Coaching Culture-The Roles of Coaches, Mentors, and Sponsors.

Building a Coaching Culture-The Roles of Coaches, Mentors, and Sponsors.

Early career midwives’ perception of their teamwork skills following a specifically designed, whole-of-degree educational strategy utilising groupwork assessments

ObjectiveThe aim of this study was to investigate whether a specifically designed whole-ofdegree strategy utilising groupwork assessments was effective in facilitating the development of early career midwives’ teamwork skills. Design and MethodsA qualitative study using in-depth, semi-structured interviews was undertaken with early career midwives who had graduated within the previous two years. This study is the final cycle of a larger participatory action research project. Qualitative data was analysed using thematic analysis. ParticipantsNineteen early career midwives from one Australian university participated. Their preregistration education was via a Bachelor of Midwifery. Their education included a whole-of-degree educational strategy to facilitate the development of teamwork skills. FindingsOne overarching theme “Becoming an Effective Team Member’ and three sub-themes: ‘Learning and developing Teamwork Skills’; ‘More secure and confident’ and ‘Self-Assurance in interprofessional interactions’ were identified in the interview data. Despite their junior status, the midwives demonstrated the knowledge, skills, and attitudes of an effective team member. Their social and emotional skills appeared well developed and they felt confident interacting with other health care workers in a professional manner. Key conclusionsEarly career midwives who were taught and practiced teamwork skills throughout their degree, appear to have developed the social and emotional competencies required for effective teamwork. Implications for Practice: The capacity for effective teamwork of this small group of early career midwives has the potential to improve the quality and safety of their care for childbearing women. Learning teamwork skills in the educational setting appears to have generated skills focused on conflict resolution, emotional self-regulation and social and emotional competency in these new midwives. These are favourable skills in the emotionallycharged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing. Health care employers want new graduate health professionals to be work ready and to have the skills necessary to be effective team members. The program undertaken by these new graduates may be of assistance in developing these capabilities in other health students. The knownTeamwork skills are an intrinsic part of the day-to-day activities of maternity services, influencing the workplace culture, retention of midwives and the quality and safety of care. Poor teamwork is associated with clinical errors, bullying and high turnover of staff. The newEarly career midwives who were taught teamwork skills and practice these skills using their groupwork assignments throughout their undergraduate degree appear to demonstrate the social and emotional competencies required for effective teamwork. The implicationsImplementing a whole-of-degree program to develop teamwork skills in undergraduate midwifery students may improve early career midwives’ social and emotional competencies and interactions with other health professionals. Learning teamwork skills in the educational setting may generate skills in the new midwife that focus on conflict resolution, emotional self-regulation, and social and emotional competency. These are favourable skills in the emotionally charged environment of maternity care, where inter-collegial bullying is present and where new midwives can experience poor psychological wellbeing.

Reflection on the Importance of Interprofessional Training

Historically, physicians have worked in isolation. More recently, there has been an emphasis to create interprofessional patient care teams to provide better patient care and reduce patient risk. This shift in focus has filtered down to the undergraduate medical education level where the American Association of Medical Colleges has created accreditation standards focused on interprofessional team training. This paper gives a first-hand narrative on how interdprofessional training can shift perspectives and create effective team members centered around patient care.

Assessment of Affective Domain by Open Ended Laboratory Approach in Structural and Material Laboratory Course

The objective of this study is to improve the development of affective domain among students with the introduction of the Open-Ended Laboratory (OEL). This enables students to design and conduct experiments, as well as to analyze and interpret data in a groups. By conducting the laboratory exercises in a group, students shall develop the ability to function effectively as a leader, as well as an effective team member. The present paper describes the assessment of the affective domain in OEL of Structural and Material Laboratory course for Diploma Program. This study involved a group of second-year students of Diploma of Civil Engineering for March-July 2019 semester who enrolled in the Structural and Material Laboratory course. There were ten groups involvesd in this study with the total number of 233 students; 98 male and 135 female.The attainment of affective domains among students in the evaluation rubrics was investigated in discovering the effectiveness of the course assessment. Not many differences in affective domain attainment between genders are reported; females shows better performance in punctuality and discipline attributes as compared to males. The outcome of this study is to observe that the OEL approach creates positive impacts in developing student generic skills such as leadership, communication, and teamwork. This attribute is expected by the industry, thus this also contributes to the overall students’ learning experience.

Student satisfaction with use of an online peer feedback system

We contribute to the growing evidence of the positive effect of use of online peer feedback tools on students’ teamwork skills development. We do so by exploring individual and contextual factors underlying satisfaction with using a peer feedback system alongside team projects. Employing path analytical framework and bootstrap methods, we analysed data from an international sample of 100 project teams in management studies. Drawing on procedural justice theory, we theorised and found support that students’ uncertainty avoidance orientation and virtuality in collaboration were positively related to their satisfaction with use of a peer feedback system. Such satisfaction in turn allowed them to be more effective team members. Our findings provide evidence for higher education institutions and instructors considering the adoption of online peer feedback systems alongside teamwork in their curricula. Specifically, peer feedback appears to be effective in the development of teamwork skills and students appreciate the opportunity to provide feedback to their peers in a structured and dedicated environment. Our findings are timely and of important practical significance as educational institutions increasingly rely on the use of computer-mediated technology during the COVID-19 pandemic.

Teaching process design in a multidisciplinary capstone design course

AbstractTo increase the percentage of our graduates trained in a multidisciplinary setting, we have pooled resources from several departmental capstone design courses to create a common multidisciplinary course with a novel structure. The new course consists of multiple sections, one for each of the project types previously offered in the departmental courses. The new teaching platform has increased the choice of capstone design projects available to students and provides the flexibility to form multidisciplinary as well as mono‐disciplinary teams of students depending on the needs of the projects. In the process design section of the course, teams of four or five students work on design projects sponsored by industry and are co‐mentored by a practicing engineer and a faculty member. Seven evenly spaced milestones are used to pace students, guide mentors, and facilitate the progressive assembly of a high‐quality final report. Peer evaluations are also used to improve team dynamics and are combined with mentor ratings to derive individual grades from the assessment of team deliverables. The normalized peer ratings of effective team members follow a normal distribution with a mean of unity and a SD of 0.04, whereas the ratings of ineffective members fall below the distribution. Our collaborative approach for teaching process design provides a motivating educational experience to students and each of the course learning outcomes was achieved by over 95% of the students during the first two offerings of the course.