Implementation of a Shared Pediatric Pharmacy Elective During the COVID-19 Pandemic

Midway through the spring 2020 semester, COVID-19 forced pharmacy educators to quickly make wide-ranging changes to transition from in-person to online education. This shift in curricular delivery affected all aspects of pharmacy education, including didactic and clinical training. After a rapid pivot to emergency remote teaching (ERT) in March 2020, educators prepared for an uncertain future.^1–3  It was in this environment that pediatric faculty at Purdue University College of Pharmacy and Butler College of Pharmacy and Health Sciences identified a novel opportunity for collaboration on a joint pediatric pharmacotherapy elective that was successfully implemented in spring 2021.

Previously published reports on shared curricula in pharmacy education have largely been related to train-the-trainer programs designed to disseminate content to health professionals.^4–7  These programs typically involve workshops or webinar training sessions for pharmacy educators who, in turn, use these curricula at their home institutions.^4–7  Smoking cessation, pharmacogenomics, and cultural competence programs have previously been described.^4–6  Reports of shared curricula in other areas of pharmacy education, including pediatrics, are limited. Published reports of classes held simultaneously at 2 different pharmacy institutions are rare. However, in the context of the COVID-19 pandemic, faculty at 2 different colleges of pharmacy identified an opportunity to collaborate.

During the ERT of spring 2020, pediatric faculty at Butler and Purdue informally shared course materials relating to their respective institutions' pediatric pharmacy electives. Prior to the pandemic, both electives had been structured as weekly, in-person courses. Each class meeting featured different guest lecturers who were typically local pediatric pharmacy practitioners. After the transition to ERT, lecture content was video recorded with the intent that students asynchronously review materials. While the topics scheduled for the remainder of the spring 2020 semester did not entirely align between the institutions, there were instances where materials could be cross-posted in both courses with permission of the guest speakers. Sharing was especially helpful in reducing the time burden on volunteer lecturers who were balancing the demands of providing clinical services during the initial wave of the pandemic.

Faculty from Purdue and Butler met during late summer 2020 to discuss ideas for the spring 2021 semester. Although guidance for spring 2021 had not yet been formalized by either institution, it became clear that returning to fully in-person instruction for the spring 2021 semester would be challenging owing to social distancing, classroom occupancy, and campus guest policies. By fall 2020, Purdue and Butler Universities decided that the spring 2021 semester would incorporate hybrid instruction to allow students the choice of learning in the classroom or virtually, while also accommodating the transfer of an in-person learner to a remote environment in the event of quarantine, suspected illness, or a COVID-19 diagnosis. Although in-person instruction would be permitted with precautions in place, restrictions on campus visitors would prevent guest speakers from participating in on-site lectures. Because of the inability to bring guest speakers to campus, both faculty members opted to pursue online-only course structures.

Given the success of the initial collaboration, faculty from Purdue and Butler opted to work together more formally in preparation for spring 2021 with a plan to implement a shared pediatric pharmacy elective at both institutions. The Figure includes a timeline of this process. Such collaboration has been recently encouraged by the American Association of Colleges of Pharmacy.⁸  Although the baseline courses were somewhat different, there were significant overlaps in content, structure, and learning outcomes in both electives. In addition to allowing students to learn from various pediatric pharmacy practitioners, the online structure also provided flexibility for just-in-time adjustments should guest lecturers or faculty become unavailable owing to illness or other pandemic-related issue. A considerable benefit of implementing a shared curriculum at both schools was the decreased onus on volunteer guest lecturers who, in a typical year, might lecture at both colleges on different days. Lecturers geographically remote from Indiana were also able to seamlessly participate. The pandemic forced faculty to reset expectations about what the class would look like, allowing for a more radical redesign in format and content than may have otherwise been attempted.

Before the spring 2021 semester began, the faculty developed a joint syllabus, including common learning objectives, schedule, planned assignments, and assessments. Each syllabus included content required or recommended per specific university standards. Activities and schedules were similar between both courses, but not identical. Purdue typically has 12-week-long semesters for third-year pharmacy students; however, during spring 2021 one meeting was eliminated as a university-wide reading day. The Butler elective course ran for 13 weeks. During their initial class meetings, individual faculty provided a synchronous online course introduction and general pediatrics review. This was followed by 10 shared topics, including drug information, newborn care, neonatal intensive care, general pediatrics, oncology, neurology, cardiology, pediatric critical care, infectious diseases, and emergency medicine. Butler students received additional required content focused on pediatric communication and optional content relating to international pharmacy. These materials were optional for Purdue students and no points were associated with any of the activities for those 2 sessions. Table 1 further highlights structural similarities and differences between the classes as implemented in 2021.

After week 1, each class followed a similar blended asynchronous-synchronous instructional format.⁹  All materials were posted to a learning management system (LMS), ideally at least 1 week in advance. The speaker provided pertinent readings, recorded a short introductory video and a 30- to 40-minute lecture for students to review prior to the synchronous session. Each instructor developed in-class cases to be completed in small breakout sessions during the synchronous session, as well as a facilitator guide for the faculty instructor. Synchronous sessions were designed to last approximately 1 hour and were conducted via Zoom because of ability to create breakout rooms. Instructors also recorded a 20- to 30-minute debriefing video covering key points from the in-class cases for students to view after completing the synchronous activity. Although the class could be conducted without any synchronous participation from non-faculty speakers, resident lecturers were encouraged to attend the live sessions to provide a more “typical” teaching experience. Table 2 includes representative examples of various assignments.

To encourage students to prepare for the synchronous sessions, open-book, multiple-choice quizzes related to each week's material were required and were intended to be completed individually. The quizzes were low-stakes, and students were permitted to retake the quiz once if they were not satisfied with their initial performance. Owing to the formative nature of the quizzes, the open-book format was selected to encourage students to complete the pre-work while reducing the need to “police” academic dishonesty. This strategy was previously used at Butler, although closed-book assessments were historically used in the Purdue elective. Given the success of the format in encouraging students to prepare and the reduced stress around assessments, this strategy will likely be continued after a return to in-class instruction at Purdue. Additional individual assignments included drug information questions (weekly at Butler, 5 throughout the semester at Purdue) and a reflection about a book or movie relating to pediatric illness (Purdue only).

Both faculty members required a semester-long group presentation about a pediatric clinical controversy. This assignment had previously been part of the Purdue elective but was new to Butler. Students summarized the available literature relating to a clinical controversy and presented their final recommendations as though they were making a recommendation to an institutional pharmacy and therapeutics committee. Students self-selected groups of 4 to 5 and chose their topics, although a list of suggestions was provided. Students video recorded their presentations, which were approximately 20 minutes in length, and submitted the recordings though the LMS for faculty and peer review. Students were required to peer review their colleagues' work as part of their total grade for the presentation assignment. Faculty provided written feedback via a rubric.

Although this initiative was ultimately successful, faculty encountered challenges during course development and implementation. For example, the courses had slightly different schedules, including number of class meetings. To address this, some content was not covered in the Purdue course, which met fewer times. There had also been plans for students to attend final presentations jointly via a shared synchronous class meeting; however, this was ultimately scuttled owing to time constraints. Because not all lecturers had access to the same audiovisual applications, a variety of methods were used for lecture content recording. Some duplicative work was necessary because both courses utilized different LMS platforms, requiring creation of two separate, parallel sites. Although some presenters attended the synchronous online sessions, students did not consistently interact with guest speakers which was an additional limitation of the hybrid design.

Despite the challenges, developing a combined pediatric pharmacy elective allowed faculty at 2 neighboring institutions to share ideas and implement effective new teaching strategies and assignments. An added benefit was reducing the workload on the pediatric pharmacy practitioners serving as guest lecturers. The rapidly changing instructional environment allowed for a revision of both courses that would have previously taken significantly more time. Although faculty anticipate the return to in-person teaching and learning, key elements of the collaboration will be continued in the future.

Beyond the success of the initial joint offering, there are opportunities for future development of collaborative pediatric pharmacy electives. For example, this innovation could serve as a framework for colleges of pharmacy that may lack institutional resources for pediatric-specific faculty or do not currently offer a pediatric pharmacy elective. A 2020 Joint Statement on Pediatric Pharmacy Education recommends all colleges of pharmacy offer a pediatric elective; however, this may be challenging for schools that lack a dedicated pediatric faculty member.¹⁰  Improving access to pediatric pharmacy education through collaborative efforts may benefit both students and institutions while better preparing students to care for a vulnerable patient population.