Peer Review

Integrating Pharmacy and the Health Sciences with a Liberal Education

The Association of American Colleges and Universities (AAC&U) has developed a twenty-first-century definition of liberal education that empowers students and prepares them to deal with complexity, diversity, and change. It is important to note that with this new definition, liberal education is not synonymous with an education just in the traditional liberal arts fields. A liberal education appropriate for those in arts, science, and professional fields is focused on the acquisition of knowledge, development of intellectual and practice skills, personal and social responsibility, and integrative and applied learning methods.

According to AAC&U’s LEAP initiative, liberal education in the twenty-first century should be focused on intellectual and personal development of all students so that they can be successful in a global economy and be part of an informed citizenry. That liberal education is obtained through studies that emphasize the Essential Learning Outcomes across the entire educational continuum—from school through college—at progressively higher levels of achievement. In the broadest sense this would imply the necessity to have this occur throughout the continuum of college—including in undergraduate, graduate, and professional education.

Some educators, especially in graduate and professional education, may assume that these goals only apply to an undergraduate education. As the dean of a college with a professional Doctor of Pharmacy program—a two-year undergraduate-level pre-pharmacy program followed by a four-year professional program—I would argue, instead that this philosophy of education is relevant at the graduate and undergraduate levels and across a wide currency of fields.The LEAP vision actually aligns almost uniformly with the Accreditation Council for Pharmaceutical Education’s philosophy and emphasis as stated in the Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Guidelines, Version 2.0 (effective February 14, 2011):

The standards and guidelines, taken together, have been refined to ensure the development of students who can contribute to the care of patients and to the profession by practicing with competence and confidence in collaboration with other health care providers. The revision has placed greater emphasis on the desired scientific foundation and practice competencies, the manner in which programs need to assess students’ achievement of the competencies, and the importance of the development of the student as a professional and lifelong learner. The standards focus on the development of students’ professional knowledge, skills, attitudes, and values, as well as sound and reasoned judgment and the highest level of ethical behavior.

New evolutions in health professions education would support the need to incorporate the fundamentals of a liberal education into both undergraduate and professional programs. The Medical College Admission Test® (MCAT) is a standardized, multiple-choice examination required for students interested in pursuing allopathic, osteopathic, podiatric, and veterinary medicine. The MCAT has been revised to give attention to the concepts that tomorrows’ doctors will need. The change most relevant to this discussion is the inclusion of a new critical analysis and reasoning skills section. This section reflects that medical schools want well-rounded applicants from a variety of backgrounds. Another example of this evolution was pioneered by Michael DeGroote Medical School at McMaster University in Canada. The Michael DeGroote Medical School implemented the multiple mini-interview (MMI) format modeled after the objective structured clinical examination (OSCE) used for health professional licensing examinations in Canada and other countries. This approach allows for the testing of multiple domains such as oral communication skills, ethical decision making, problem solving, prioritization, and the ability to work in teams. The MMI has been adopted by many health programs including medicine, physical and occupational therapy, medical radiation sciences, physician assistant, and, most recently, pharmacy. This mission also aligns with our university’s overall mission.

Drake’s mission
Drake’s mission is to provide an exceptional learning environment

that prepares students for meaningful personal lives, professional accomplishments, and responsible global citizenship. The Drake experience is distinguished by collaborative learning among students, faculty, and staff and by the integration of the liberal arts and sciences with professional preparation.

This mission, modified and reinforced during the university’s 2008 self-study process, has become central to the institution and its programs. This statement may seem obvious. The mission should be central to the university. However, having a mission and being mission-driven are two very different things. The alignment of the mission of the College of Pharmacy and Health Sciences and that of the university proper is the beginning of the Drake story. Consider the college’s mission statement:

The College of Pharmacy and Health Sciences provides an intellectually stimulating learning environment with collaborative learning among students, faculty, and staff. Graduates are liberally educated professionals who are dedicated to serving their clients, patients, profession, and community. The college emphasizes excellence and leadership in professional education, service, and scholarship.

This alignment provides the foundation that has driven the college to value both the liberal arts but also to value and integrate the concepts of a liberal education into our Doctor of Pharmacy program. The following sections explore how outcomes are realized by Drake Doctor of Pharmacy Students.

Knowledge of Human Cultures and the Physical and Natural World

All Drake pharmacy students, whether Drake undergraduates or transfer students into the professional program, are required to fulfill “The Drake Curriculum.” This requirement—beyond the standard pre-pharmacy prerequisites—supports the value that Drake places on students who are liberally educated and who have “engaged with big questions, both contemporary and enduring” as outlined by the LEAP Vision.

  1. The Drake Curriculum contributes to specific objectives drawn from Drake’s commitment to build an exceptional learning environment, including to
  2. Enhance the integration of liberal and professional education, with a strong focus on reflective practice, ethics, and leadership
  3. Focus the Drake Curriculum on the achievement of mission learning outcomes, with a strong focus on interdisciplinarity and engaged citizenship competencies
  4. Create and enhance global and interdisciplinary learning opportunities, including learning opportunities which bridge professional divides, for both undergraduate and graduate students
  5. Expand collaborative, experiential, and international learning for students, faculty, and staff
  6. Strengthen the integration of academic and cocurricular experiences

Pharmacy students at Drake have the advantage of continuing to build on this foundational educational experience through the ability to major or minor in another discipline area, focus additional study in an area of a concentration, and/or complete dual degree programs. The college’s strategic plan has emphasized the need to support and enhance such programs such as dual degree programs (PharmD/MBA, PharmD/MPA, PharmD/JD), the university’s leadership and global and comparative public health concentration, and an entrepreneurship minor. The extent to which the 460 Doctor of Pharmacy students at Drake take advantage of these enhanced educational opportunities is as follows:

  • sixty students enrolled in the PharmD/MBA
  • sixteen students enrolled in the PharmD/MPA
  • eighty-five students enrolled in a Diabetes Concentration
  • fifteen students enrolled in the Global and Comparative Public Health Concentration (this is the second year of this program)
  • one student in the leadership concentration (second year of this program)
  • nine students in the entrepreneurship minor (second year of this program)
  • four in other university concentrations
  • seventy-six completing minors in other disciplines (business, biology, music, psychology, etc.)

Intellectual and Practical Skills

The pharmacy curriculum at Drake University has developed many innovations that address several of the skills outlined in the LEAP Essential Learning Outcomes. Pharmacy Skills and Applications is a six-semester course series intended to assist students in the professional program in developing their abilities and hands-on skills in eight basic competency areas: professionalism, communications, calculations, clinical reasoning, cultural competence, drug information, distribution systems and processes, and systems management. These skills are then tested in a “real world environment” in the students’ introductory pharmacy practice experiences. Students are expected to progress through the series (basic to intermediate to advanced) and develop proficiency in each competency area. In all six courses students are evaluated by various means including written examinations at mid-term and a final practical examination utilizing rubrics in any of the eight competency areas covered in that course. Students must earn at least 70 percent or more in each of the core competencies to pass the final examination. Students are allowed an opportunity to retake the portion in which they received less than 70 percent once.

Pharmacotherapeutics is another course in which the learning pedagogy employed requires the development and utilization of intellectual and practical skills. Team–based learning (TBL) is employed as a method to develop and assess the programmatic outcome of problem solving and decision making. TBL is an active learning-teaching strategy that assists students in learning primarily how to apply course concepts. Students are given module readings and other background materials to be completed outside of class. Students are expected to come to class prepared and are accountable for that preparation via the Readiness Assurance Test (RAT) and peer evaluations. The RAT includes an individual test and a retaking of the same test as a student team. Student teams are formed at the beginning and maintained through the entire three-semester course sequence. Following completion of the RAT, the majority of class time involves the use of application exercises (e.g., reviewing patient cases). These application exercises stress the use and application of course concepts. Peer evaluations are conducted periodically during the semester.

Reading assignments, study questions, drug lists, and objectives are provided the week before the RAT for each topic. This study and reading time pre-class has several purposes: review of knowledge learned in other classes but not practiced lately (e.g., pharmacology, pathophysiology, pharmaceutics), introduction to the treatment of a disease or condition, and learning the application of basic principles of drug therapy for a particular disease or condition. Reading assignments and supplemental resources provide information, and the objectives have associated study questions to help students identify what is important to know. Drug lists are provided so students will have a means to test their knowledge of drugs that are used to treat a particular disease or condition.

RATs are the assessment of students’ knowledge of background material and basic application skills. The material covered in the RAT is the knowledge that you need to know to be able to go on and practice advanced application in the application exercises. IRAT is the assessment of an individual students’ knowledge. GRAT is the assessment of the team’s knowledge. To encourage learning from one another, teams are advised to discuss WHY the answer is correct and WHY the other options are not the best answer. Students often find that they know the correct answer but have difficulty explaining why it is correct. The team is a valuable resource for practicing the explanation of why.

Application exercises (AE) are intended to build on the knowledge reviewed and learned before and during the RAT. AEs are intended to help students learn advanced application of course material to give them the fundamentals of drug therapy management prior to starting clinical rotations in the fourth year. Class discussion starts within a team as they select the best answer to a question. Class discussion then moves to between teams and the instructor to arrive at the learning point of the exercise. Notice that the end result of the exercise is the “learning point” not the “answer,” because often the best drug therapy answer is “it depends.”

Peer evaluations are intended to reinforce individual accountability and prevent uncomfortable scenarios for students where group work is done by one or two members instead of being shared equally among all team members. Peer evaluations also have the potential to provide valuable feedback to team members so that they may improve and allow for practice evaluating others as many professionals do in practice.

Both of these pedagogical approaches allow for the development of intellectual and practical skills essential to obtaining a liberal education.

Personal and Social Responsibility and Integrative and Applied Learning

The experiential education program and cocurricular innovations of the pharmacy program provides significant opportunity for students to be actively involved with diverse communities and encounter real-world challenges. The experiential nature allows students to apply their knowledge, skills, and responsibilities to new settings and complex problems.

Pharmacy students are required to complete 300 hours of introductory pharmacy practice experiences and 1,440 hours of advanced pharmacy practice experiences. These experiences occur in local, regional, national and international locations, provide exposure to diverse individuals, cultures and communities, and span the health care system, including individual and group home visits, free clinics, health service organizations, ambulatory care clinics, community pharmacies, hospitals, long-term care facilities, and a wide variety of administrative support agencies.

Drake’s College of Pharmacy and Health Sciences has provided the opportunity for international experiences for pharmacy students since the early 1990s. The available opportunities have expanded and the number of students completing international experiences has increased to the point that approximately 30 percent of each class completes a global health care experience.

The learning objectives of these experiences are assessed utilizing a set of fifty-one competencies that define skills, abilities, and values that the student must demonstrate in order to progress in the curriculum. An example of such a competency is: “Uses appropriate communication strategies along with cultural sensitivity when counseling patients whose culture and language is different than the student.” Students are evaluated over the course of the four years with progressive expectations for performance. These competencies are grouped into four major areas:

  • Drug Therapy Problem-Solving: The student is able to demonstrate problem-solving and decision-making skills necessary to evaluate drug use and monitor individual patients’ drug therapy.
  • Communication: The student can communicate ideas, information, and analysis in order to educate, at an appropriate level, colleagues, other health professionals, students, and patients.
  • Product and Service Management: The student is able to utilize management theory in planning, organizing, directing, and controlling patient-centered care systems and pharmacy business practice.
  • Professionalism: The student possesses a desire and motivation for lifelong learning and a personal and professional value system consistent with pharmacy ethical and legal standards.

Each core area in the LEAP personal and social responsibility outcomes is developed through the experiential education program. Students must be personally responsible to develop and demonstrate competencies. These competencies include the demonstration of cultural competence, values, and ethics, and require that students demonstrate current skills, also but continue to develop knowledge, skills, and attitudes through the application of critical thinking, information literacy, evaluation, and judgment—all life-long learning skills—and, finally, that students are engaged in the community in which they practice.

Conclusion

The distinctive nature of a Drake Doctor of Pharmacy graduate is directly linked to the value placed on our graduates receiving a liberal education. Curricular content and pedagogy are developed and directed to develop both individual and group learning skills. Education value can be obtained through combining the Doctor of Pharmacy program with complementary and sometimes disparate educational offerings, such as a public health concentration or music minor. Cocurricular opportunities to continue to develop a meaningful personal life allow a Drake Doctor of Pharmacy graduate to lead through athletics, the fine arts, university- or college-level governance, or engagement in our local, regional, national, and international communities. A reflective, engaged practitioner is a hallmark of a professionally trained graduate who has been liberally educated—which describes Drake University pharmacy graduates.

References

Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. Guidelines Version 2.0 Effective February 14, 2011. Accreditation Council for Pharmacy Education. Chicago, Illinois 2011. https://www.acpe-accredit.org/pdf/FinalS2007Guidelines2.0.pdf. Accessed April 21, 2012.

Association of American Colleges and Universities. College Learning for the New Global Century. 2007. Washington, DC: Association of American Colleges and Universities.

Competencies and Outcomes Objectives. Experiential Education Manual. Doctor of Pharmacy Program. Drake University College of Pharmacy and Health Sciences. http://www.drake.edu/cphs/experiential/pharmacy/manual/manual.pdf, accessed April 23, 2012.


Raylene M. Rospond is the dean of the College of Pharmacy and Health Sciences at Drake University.

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