Background

To assess the benefits of implementation of the longitudinal skills lab course(s) in the PharmD curriculum in schools of pharmacy across the United States.

Methods

This study was an observational analysis of U.S. pharmacy schools’ curricula assessing for current implementation of skills lab courses. This study also consisted of an IRB-approved quantitative analysis of data collection using two anonymous web-based questionnaires administered via SurveyMonkey to evaluate faculty and students’ perception of the skills lab course.

Results

A total number of 126 schools were analyzed, out of which 75 (59%) institutions had a skills lab implemented. The first survey assessed faculty perception of skills labs. Of the 65 respondents, 53 (81%) of the faculty reported that skills lab courses had an impact on their workload, 58 (89%) agreed it improved students’ overall performance and 62 (95%) recommended that skills labs continue to be offered in the curriculum. The second survey assessed students’ perception of skills labs. Of the 93 respondents, 91 (98%) agreed that the course helped them with their long-term learning goals and 90 (96.7%) agreed that it enhanced knowledge retention.

Conclusion

Both faculty and students perceived skills labs to be beneficial and prefer it to be kept in the curriculum. The biggest challenge of the skills lab course was the increased workload for faculty members. The institutions that are considering implementing skills lab courses into their programs should consider student and faculty burnout when structuring the course, while institutions that have already implemented them should consider restructuring to alleviate faculty workload.

A Doctor of Pharmacy (PharmD) program aims to provide extensive drug knowledge for a variety of disease states while also developing professionals who will provide quality patient care. Although each program charts out its own curriculum, the Accreditation Council for Pharmacy Education (ACPE) provides standards of skills and content that students are expected to achieve when completing the program.1  With the vast quantity of information students are required to learn, it is important to not only ensure success in courses but to assure retention and longitudinal learning.

Lectures are the conventional method of teaching that is commonly used in medical and pharmacy education. Schwartz’s study found that pharmacy students rely heavily on faculty PowerPoint lectures as a main modality of studying.2  Aside from lecturing, implementing active learning strategies, such as audience-response tools, games, role-playing, etc. that are routinely employed in the classroom, allow for more interaction and engagement with the subject matter in a manner that encourages discussion, critical thinking and advanced clinical reasoning skills.3,4  In Theobald and colleagues’ study, analyses showed that active learning reduced achievement gaps in examination scores by 33% and improved gaps in passing rates by 45%.5  In higher education settings, including pharmacy schools, skills labs are an example of stepping away from the conventional model of teaching and centering it on integration and application-based learning in order to facilitate student learning and improve outcomes. Skills labs are courses that provide students with an opportunity to practice essential skills and use knowledge learned in didactic courses to build and develop skills in a sequential and integrated manner. Elder and colleagues’ study followed 88 students who were enrolled in patient care lab (PCL) courses. These courses evaluated students’ performance through multiple assessments including drug information quizzes/final exams, patient case presentations and associated critical thinking questions and formal drug information responses. This study assessed the relationship between these PCL assessments and NAPLEX scores and found that the patient case presentations and associated critical thinking questions were linked to pass rates. This study concluded that such courses may help to identify students who struggle with assessments in the clinical skills lab setting who can then be targets for early intervention to help improve the likelihood of NAPLEX success.6  In Poirier and colleagues’ study, which identified ways in which pharmacy schools integrate curriculum, most pharmacy schools reported using a variety of methods to achieve curricular integration. Skills labs were found to be the most common form of curricular integration with about 63% of pharmacy schools having implemented it in their curriculum.7  Other forms of integration included Objective Structured Clinical Examinations (OSCEs), multidisciplinary case studies and team-based learning. Over 70% of participants in Poirier’s study agreed that curriculum integration improved knowledge acquisition, higher-order thinking and enhanced students’ ability to apply knowledge in Advanced Pharmacy Practice Experiences (APPE).7 

Even though importance has been shown in many studies, the challenges are not as clearly defined. In Islam and colleagues’ study, about 80% of respondents reported there being a high demand for faculty workload when integrating the curriculum.8  Faculty and student burnout may be a concern when implementing an all-encompassing course that integrates topics from various departments. While there is a lack of data within pharmacy education, a survey on careers in academic medicine noted that 17% of medical residents described burnout as a reason not to pursue an academic position.9  Shareen and colleagues’ survey which measured the level of burnout among pharmacy practice faculty members found that 41.3% of faculty were emotionally exhausted.9 

This article attempts to see faculty perception of challenges associated with implementation of these labs. That might help address those challenges that make it easier to implement the labs. The objective of this study is to help identify knowledge and application deficit that can be addressed by implementation of skills labs as well as the challenges associated with execution of these.

This was a two-part study which consisted of an observational analysis and IRB approved quantitative surveys. U.S. pharmacy schools’ curricula were analyzed for current implementation of skills lab courses, while the two questionnaires assessed for current students’ and faculties’ perception of skills lab courses.10  The two web-based questionnaires were administered anonymously via SurveyMonkey (San Mateo, California) and contained an informed consent for the participants.

The first questionnaire of this study was designed to assess faculty perceptions of implementation of the longitudinal skills lab courses in a PharmD curriculum. Data were collected from October 2019 to February 2020. The survey was posted on the American Association of Colleges of Pharmacy (AACP) web community to help engage pharmacy faculty from across the U.S. Respondents included, PharmD, PhD and “other.” The survey consisted of 13 questions designed to gather information about the respondent’s perspective of challenges and benefits of the longitudinal skills lab in their PharmD curriculum (Supplemental Figure 1). Based on the participants’ response to the questions, the survey branched out to a follow-up question appropriate to that response. Respondents who did not finish the survey were excluded from the assessment and were not considered in the study.

The second questionnaire of this study was designed to gather information regarding students’ perceptions of the longitudinal skills lab in a PharmD curriculum. All responses were collected from November 2019 to February 2020. Due to lack of centralized location to contact all student pharmacists, 25 programs were randomly selected as a sample size. The survey was emailed to academic or student affairs deans with a request to distribute it among the student body. The participants were asked to identify their class level, their institution’s location and whether their school was a three- or four-year program. The survey consisted of 14 questions (Supplemental Figure 2). Similar to the faculty survey, the students’ response to a question determined the follow-up question. The data was analyzed using Microsoft Excel 365 (Microsoft, Redmond, Washington).

In addition to conducting survey questionnaires, an observational analysis was done on U.S. pharmacy schools’ publicly available curricula to determine whether a skills lab type course was offered at each institution. Data were collected in July 2021 and analyzed using Microsoft Excel. Information about each institution was derived from the Pharmacy College Application Service (PHARMCAS) website and the institution’s respective website. Of the 157 pharmacy schools listed on the PHARMCAS pharmacy school directory, 126 were included in this study.11  The institutions that were included were categorized as either East or West Coast schools. Based on the PHARMCAS categorization, both Northeast or Southeast schools were categorized as East, while Northwest and Southwest schools were categorized as West. Institutions that were not fully accredited, had no course description available online, were not the traditional three- or four-year programs or were categorized as international or distance learning were excluded from the study. Institutions that had multiple campuses with the same curriculum had only one of the campuses included while the rest were also excluded. In total, 31 institutions were excluded from the study (Supplemental Table 1).

In this study, an observational analysis was done on pharmacy schools across the U.S. Of the 126 schools included, 64 institutions were located in the West while 62 were in the East. Of the West schools, 63% had skills lab courses implemented, while only 55% had it in the East. When analyzing the curricula, 59% of all institutions had a skills lab listed while about 41% did not. When analyzing the program type, both four- and three-year programs had about 50% of schools with skills lab courses implemented into their curriculum.

The faculty perception survey included a total of 65 participants. Of the participants, 53 were PharmD faculty while seven were PhD faculty. Of the 65 participants, 97% reported having skills lab course(s) included in their institutions’ curriculum, with the majority of the programs offering it during PY1-PY3 (Figure 1). When asked about the content included in the skills lab courses, 84% of respondents selected calculations, 81% selected compounding, 53% selected journal clubs, 90% selected Objective Structured Clinical Examinations (OSCEs), 94% selected patient cases, 73% selected prescription interpretation and 77% selected top medications (Figure 2). The free response portion listed as “other” highlighted alternative subjects/topics included in the skills lab courses that were not already listed above. These included patient counseling and communication along with assessment of skills such as foot exams, blood pressure and blood glucose measurements. Regarding the in-class hours that faculty allocated to the course, about 74% of pharmacy faculty reported that one to three hours a week were allocated for skills labs, 23% reported four to six hours, while 3% indicated that more than six hours per week were allocated for the skills lab (Figure 3). Overall, 81% of faculty reported that the skills lab course has had an impact on their workload (Figure 4). When respondents were asked if they felt that skills lab course(s) improved students’ overall performance in pharmacy school, 89% agreed that it did improve students’ overall performance and 95% recommended that skills labs continue to be offered in the curriculum (Figure 4).

Figure 1.

Placement of skills lab courses in the curricula. The majority of these courses are offered during the first three years of the program.

Figure 1.

Placement of skills lab courses in the curricula. The majority of these courses are offered during the first three years of the program.

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Figure 2.

Content covered in skills lab courses in U.S. pharmacy schools, reported by U.S. pharmacy school faculty. The most common topics include top medications, patient cases, OSCEs and compounding.

Figure 2.

Content covered in skills lab courses in U.S. pharmacy schools, reported by U.S. pharmacy school faculty. The most common topics include top medications, patient cases, OSCEs and compounding.

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Figure 3.

Number of class hours dedicated to skills lab courses.

Figure 3.

Number of class hours dedicated to skills lab courses.

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Figure 4.

Faculty response to skills labs’ impact on workload and student learning.

Figure 4.

Faculty response to skills labs’ impact on workload and student learning.

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The students’ perception survey had a total of 93 participants. Of the total participants, 98.9% reported that skills lab course(s) are offered at their institution. A significant majority of students (93.5%) agreed that the course has increased their level of comfort in performing pharmaceutical and therapeutic calculations. About 88.0% agreed it has increased their level of comfort in applying therapeutic concepts, while 98.9% also agreed that the course has given them the opportunity to practice and reinforce counseling skills. Despite the amount of work and time invested, 97.8% agreed that the course helped them with their long-term learning goals, 96.7% agreed that it enhanced knowledge retention and 89.1% agreed that it improved their APPE readiness (Figure 5).

Figure 5.

Students were questioned on the benefits of the skills lab course. About 90% and above reported that skills lab courses dramatically helped with knowledge retention, APPE preparation and fulfillment of long-term learning goals.

Figure 5.

Students were questioned on the benefits of the skills lab course. About 90% and above reported that skills lab courses dramatically helped with knowledge retention, APPE preparation and fulfillment of long-term learning goals.

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Based on the data collected, skills lab courses are a common form of longitudinal learning that have been implemented by almost 60% of accredited pharmacy schools in the U.S. The topics most commonly included were calculations, compounding, OSCEs and patient cases. It is important to differentiate skills labs from active learning. Active learning is designed to stimulate enhance student engagement with the material and is often used to complement lecture-based passive learning. On the other hand, skills labs are designed to help students apply their knowledge, use critical-thinking skills and integrate various topics that are important for gaining clinical reasoning skills.

From the data collected, both students and faculty perceived the courses to have improved students’ performance in pharmacy school and have enhanced knowledge retention.

While over 80% of faculty considered the skills lab courses to have had a significant impact on their workload, the majority of students and faculty in this study agreed that skills lab courses should continue to be offered in the curriculum regardless of the workload and time invested. Designating a faculty member as lab coordinator to solely focus on all skills labs offered throughout the curriculum may help mitigate this workload concern while also providing structure and a better sense of continuity for longitudinal learning. Multiple coordinators throughout the years could lead to confusion while a designated leader would allow for a more cohesive longitudinal integration and consistent expectations. A future area of study would be assessing the design and execution of established skills labs to compare with students’ performance and satisfaction of the course. This would help uncover whether there is a preferred structure that contributes to student outcomes and would allow other institutions to modify their courses accordingly to support students’ success. Another potential area of study is assessing whether skills lab courses have an impact on North American Pharmacist Licensure Examination (NAPLEX) pass rates. The Elder and colleagues study provided some significant results, linking patient case presentations and critical-thinking questions from skills lab courses to NAPLEX scores.6  The drug information responses, however, were not predictive of total NAPLEX scores. Only 88 student participants from one institution were enrolled in the study. A stronger study with a larger sample size linking to pass rates could potentially influence the remaining 53 (41%) pharmacy schools to implement a skills lab course to facilitate knowledge retention and longitudinal learning.

Some limitations of this study were the small sample sizes of 93 students and 65 faculty. Due to privacy protection of the student information, there is not a direct way to contact pharmacy students and collect heterogeneous responses. The student survey was emailed to the student or academic deans of 25 randomly selected PharmD programs and there were asked to be distributed to the students. Based on which programs forwarded the opportunity to participate in this study, more responders may have been from one institution, rather than multiple, which could have skewed the data. Similarly, in the faculty surveys, demographic information was not collected to protect the identity, which could have resulted in homogeneous responses.

The goal of a skills lab course is to reinforce the knowledge learned from previous semesters, practice communication skills and to develop clinical competency through application, patient cases, competency assessments and other forms of hands-on learning experiences. The results of this study showed that the longitudinal skills lab courses help enhance a wide range of topics and are already offered in many PharmD programs across the U.S. and provide more hands-on application. Despite the increased workload, both faculty and students perceive skills labs to be beneficial and prefer it to be kept in the curriculum. The biggest challenge of the skills lab course was the increased workload for faculty members. With these results, the remaining institutions that are considering implementing skills lab courses into their programs should consider student and faculty burnout when structuring the course, while institutions that have already implemented them should consider expanding and potentially restructuring it to alleviate faculty workload.

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