1. Reducing the Cost of a Laboratory Course While Maintaining Quality Educational Experiences Andrea Porter, PharmD Susanne Barnett, PharmD, BCPS Casey Gallimore, PharmD Karen Kopacek, RPh

2. Objectives Discuss the importance and rationale of reducing the cost of course activities while maintaining quality experiences Identify changes that have been implemented in the Pharmacotherapy Lab at the School of Pharmacy Describe the process for course mapping and implementing course changes Identify one aspect of the participant’s course that could be changed to reduce cost and develop ideas on how to accomplish this

3. http://chronicle.com/article/Interactive-Map-Many-States/63567/http://chronicle.com/article/Interactive-Map-Many-States/63567/. Accessed 5/13/11.

4. Background National Center for Academic Transformation – Supports colleges and universities across the country in redesigning courses – Incorporates technology to decrease expenditures and enhance learning – Main cost reduction strategies Use of online tutorials Online assessment that is automated Online course management system Eliminating duplication of faculty efforts Substituting less expensive instructional staff when appropriate Twigg CA. Improving learning and reducing costs: new models for online learning. EDUCAUSEreview. 2003;Sept/Oct:28-38. Twigg CA. Course Redesign Improves Learning and Reduces Cost. San Jose, CA: The National Center for Public Policy and Higher Education; June 2005.

5. Description of Pharmacotherapy Lab

6. Pharmacotherapy Course Four credit hour, four semester team-taught course – Second year: Pharmacotherapy I and II (728-555, 556) – Third year: Pharmacotherapy III and IV (728-655, 656) – Description: Clinical application of medications in the management of various disease states Assessment and therapeutic monitoring of drug therapy with emphasis on the concepts of pharmacokinetics/dynamics, drug interactions, pharmacy practice, and patient counseling. Lab held in conjunction with each course

7. Pharmacotherapy Lab One 3-hour lab per week, one 50-minute weekly discussion – Total number of labs: 12-14 per semester – AM lab: DPH-3 students – PM lab: DPH-2 students – Each lab session has 21-28 students Staff – 4 Lab faculty coordinate labs – 18-24 Madison-area Pharmacy Practice Residents assist in teaching lab modules – Lecturing faculty attend lab sessions to assist in teaching and reinforce lecture materials – Academic Clerkship (DPH-4) and independent (DPH-1 and DPH-3) students assist in teaching lab modules and participate as “standardized patients”

8. Laboratory Activities Patient case discussion – Individual cases, individual longitudinal cases, or multiple mini-cases; discussion questions; documentation of recommendations (SOAP) and interventions – Preparation: Drug therapy assessment questionnaire, patient case assessment form Hands-on training – Medication delivery systems, physical assessment, and disease monitoring tools Patient education issues – Disease monitoring, drug and non-drug therapies, risk factor reduction strategies Simulated patient consultations – Preparation: Consult prep form, peer evaluation, self evaluation Drug-disease discussions

10. Examples of Hands-On Training

12. Student Assessment Mixture of individual and team assignments Weekly graded laboratory worksheets, case discussion questions, patient case SOAP notes Objective Structured Clinical Examination (OSCE): – Participation required each semester of DPH-2 and DPH-3 years – Worth a portion of overall Pharmacotherapy course grade – Requires trained assessors (faculty and residents) and standardized patients – Multi-station exam includes: Dispense new prescription to SP Dispense refill prescription to SP BP/HR assessment and tobacco cessation Patient chart review SOAP note

13. Course Mapping

14. Educational Outcomes Expectations CAPE Educational Outcomes (2004): – Provide pharmaceutical care in cooperation with patients, prescribers, and other members of an interprofessional health care team – Manage and use resources of the health care system – Maintain professional competency by committing oneself to being an independent, self-initiated life- long learner

15. ACPE Accreditation Requirements Standard 11: Curriculum: – The college or school, throughout the curriculum and in all program pathways, must use and integrate teaching and learning methods that have been shown through curricular assessments to produce graduates who become competent pharmacists by ensuring the achievement of the stated outcomes, fostering the development and maturation of critical thinking and problem-solving skills, meeting the diverse learning needs of students, and enabling students to transition from dependent to active, self- directed, lifelong learners.

16. Course Mapping Identified overall objective of course/lab – Based on educational outcomes and accreditation standards Mapped out objectives of four-semester course – Based on lab objectives, identified activities which would remain in-lab activities – Identified key activities to consequentially build upon – Identified redundancies throughout curriculum

17. Change Process Identified high cost items associated with laboratory course – Pharmacy practice residents (teaching assistants) Laboratory sessions run 3-hours, 5-days per week – Objective structured clinical examinations (OSCEs) Once per semester per course Standardized patients – Supplies Hands on learning of disease state management

18. Cost Item: Resident Time Activity – Involvement in all labs, grading, and OSCEs Objective – Aid student learning through direct supervision, feedback, and assessment – Assist lab coordinators with development and teaching of lab activities

19. Cost Item: Resident Time Identified areas of involvement: – Various involvement required to maintain course Teaching support critical for small group work, grading written assignments, and observing/providing feedback to students – Less critical activities could be moved out of lab Used online course management systems to include these activities as pre- and post-lab assignments IT support required to implement change

20. Cost Item: Resident Time – Changes Implemented Majority of labs reduced from 3- to 2-hours Less critical activities which did not require direct student feedback were moved out of lab Examples – Some patient case discussions moved to virtual patient cases and/or quizzes (point-based versus pass/fail) – Additional student preparation required for in-class activities – Transition of worksheets from written to electronic format – Tutorials versus in-lab drug-disease discussions – Overlapping of lab activities to increase efficiency

21. Cost Item: Resident Time – Changes Implemented

24. Cost Item: Resident Time – Assessment Methods Student Performance – Moodle quizzes – Final lab grade – Exam scores – Final course grade Student Feedback – Lab evaluations

25. Assessment

26. Cost Analysis CourseCost Reduction** Fall Semester 728-55562% 728-65567% Spring Semester 728-55663% 728-65648% **Comparison between ’07-08 and ’09-10 years

27. 728-655 Course Performance * P value <0.01 for comparison

28. 728-656 Course Performance * P value <0.01 for comparison

29. 728-655 Course Evaluations ’07-08’09-10p-value I can apply the information/skills I learned in the course.4.134.25NS The teaching methods used in the course enable me to learn.3.813.90NS Instructional technology is well coordinated with course material.3.854.11<0.05 Course activities/assignments helps me learn the material.3.824.14<0.05 Lab experiences assists me in learning concepts.3.554.25<0.001 The lab sessions are well organized.3.444.13<0.001 What letter grade to you expect to earn in this course?5.475.44NS If I had to assign a letter grade to this course what would it be?5.475.83NS 1=Not at all 2=Slightly 3=Moderately 4=Very 5=Extremely Grade Scale: 1=F, 2=D, 3=C, 4=BC, 5=B, 6=AB, 7=A

30. 728-656 Course Evaluations ’07-08’09-10p-value I can apply the information/skills I learned in the course.4.224.12NS The teaching methods used in the course enable me to learn.3.743.73NS Instructional technology is well coordinated with course material.3.904.05NS Course activities/assignments helps me learn the material.3.84 NS Lab experiences assists me in learning concepts.3.633.85NS The lab sessions are well organized.3.503.88<0.05 What letter grade to you expect to earn in this course?5.195.17NS If I had to assign a letter grade to this course what would it be?5.395.69NS 1=Not at all 2=Slightly 3=Moderately 4=Very 5=Extremely Grade Scale: 1=F, 2=D, 3=C, 4=BC, 5=B, 6=AB, 7=A

31. Summary of Course Evaluations Student Feedback – Coordination of instructional technology, ability of course assignments/activities and lab experiences to facilitate learning, and organization of lab sessions were improved – Ability to apply course information and skills, teaching methods employed, expected performance in the course, and course rating remained consistent

32. Barriers Faculty time – Redesigning or developing course activities – Organizing meetings with lecturing faculty – Transitioning material to online course management system – Creating online tutorials IT time (and patience) to train and support lab coordinators Learning curve in utilizing new management system – Students and faculty Planning far in advance

33. Activity

34. Individually fill out worksheet (5-10min) Discuss in groups of 2-3 (15 min) – Share information on worksheet – Provide suggestions to others on their idea for revision Large group discussion of sharing ideas (10 min)

35. Thank you for attending this learning circle! Feel free to contact us with any questions: – Andrea Porter (aporter@pharmacy.wisc.edu)aporter@pharmacy.wisc.edu – Susanne Barnett (sbarnett@pharmacy.wisc.edu)sbarnett@pharmacy.wisc.edu – Casey Gallimore (cgallimore@pharmacy.wisc.edu)cgallimore@pharmacy.wisc.edu – Karen Kopacek (kjkopacek@pharmacy.wisc.edu)kjkopacek@pharmacy.wisc.edu