An Investigation of Teaching and Learning Programs in Pharmacy Education

INTRODUCTION

Standards from the Accreditation Council for Pharmacy Education (ACPE) are holding pharmacy schools accountable to a higher standard of teaching effectiveness than in the past.¹ While previous standards addressed curriculum and assessment, the level of detail was not as explicit. The new standards address curricular quality, content mapping, diverse student learning needs, and outcomes based teaching and learning methods.¹ In addition, they also call for valid, reliable, formative and summative assessments to measure student knowledge and performance.¹ These are all things that require knowledge of learning theory, instructional design, and educational assessment. It was noted at the ACPE Consensus Conference in 2013 that most faculty members in higher education are not trained as teachers.² This will require that educational institutions have professional development programs that assist faculty members in writing clear learning objectives, connecting learning outcomes to course assignments, and developing assessment tools that test higher-order intellectual skills.²

The need for increased levels of teaching expertise is well-defined and not limited to pharmacy education. Numerous teaching and learning workshops and development programs have been created and offered in medical education, spanning over two decades.³ A faculty shortage in dental education prompted Columbia University’s College of Dental Medicine to establish a joint DDS and PhD program in education.⁴ The American Association of Colleges of Nursing stated that the basic doctoral degree in nursing does not prepare the graduate for a faculty role and recommends additional preparation in the science of pedagogy.⁵ Finally, the increasing need for teaching expertise in the health professions is exhibited by the expansion of a unique master’s degree in health professions education (MSHPEd). The MSHPEd has become more popular in the last decade with more than one hundred programs offered internationally, thirty-two of which are in the United States.^6,7 Clearly, health sciences faculty members, including disciplines beyond pharmacy, are experts in their field, but may lack pedagogical knowledge and skills.

Despite the need for faculty development, we could find no recognized standards in academic pharmacy for faculty development in teaching. An American College of Clinical Pharmacy (ACCP) white paper published in 2008 suggested a structure consisting of orientation, mentoring, and ongoing development.⁸ It identified ways to design programs including timelines, types of content and activities to consider, and necessary professional, clinical, and research skills.⁸ More recently, Lancaster et al described the current landscape for faculty development programs in higher education and made recommendations for the implementation of new programs.⁹ They pointed to several existing models to support faculty teaching development and recommended institutions make informed decisions about which plan would be most successful. A model for preparing graduate students for faculty teaching and service roles has also been suggested and emphasizes the importance of experiential learning.¹⁰

Postgraduate pharmacy education has seen a large increase in teaching development programs for residents and fellows in the past decade.^11-13 These programs were created in part to prepare educators prior to an academic appointment. They were also meant to combat the faculty shortage that existed in pharmacy education by creating experienced residents who could quickly transition into a faculty position after completion of their program.¹¹ The American Society of Health-System Pharmacists (ASHP) accreditation standards for postgraduate year one (PGY1) pharmacy residency programs was published in 2012 and identified seven guiding principles to serve as the basis for evaluating residency programs for accreditation, including educational and training outcomes.¹⁴ An ACCP task force published standards in 2013 to guide program development in pharmacy postgraduate programs.¹⁵ These standards were created in response to variability in the purpose, content, and structure of existing teaching and learning programs in pharmacy residencies.^12,16 They emphasized basic pedagogical knowledge, expression of a teaching philosophy, teaching experience in several varied teaching environments, and feedback through coaching and mentoring.¹⁵ Most recently, recommendations to guide teaching and learning curricula for postgraduate pharmacy experiences were published by the American Association of Colleges of Pharmacy (AACP) Pharmacy Practice Section’s Task Force on Student Engagement and Involvement.¹⁷ They addressed items such as program content, teaching modalities, assessment, and program resources.¹⁷

The efficacy of development efforts in the science of teaching and learning in pharmacy is not clear. The purpose of this research was to investigate published, peer-reviewed literature on teaching and learning development programs for faculty members and residents and examine what has been done and how effective these efforts have been. We could find no published reports that summarize the current literature on teaching development initiatives in pharmacy and synthesize current work to identify trends that could benefit the entire academic profession. This paper is the first to comprehensively summarize published efforts and (1) synthesize existing data on the scope and nature of teaching development programs in pharmacy, (2) examine the efficacy of these programs, and (3) identify future areas for research in teaching development in pharmacy. Results of this investigation will help inform teaching development initiatives and proper allocation of resources, and create a platform on which to expand teaching and learning programs for academic pharmacists.

DISCUSSION

This research provides a detailed account of the scope and nature of teaching and learning programs published in the pharmacy literature, and the effectiveness of these programs in improving teaching. The conclusions of this article are based on the premise that the published literature is an accurate representation of all available programs. The lack of published literature on teaching and learning programs for faculty members does not necessarily represent the true availability of these programs.

In addition to the paucity of literature on faculty development programs, the number of published papers from residency programs represents a small number of the actual teaching and learning programs available for residents.¹⁶ Another important consideration is that the quantitative data we compiled reflects whether our measurement criteria were mentioned in each of the manuscripts. Less robust descriptions or program details not described in the manuscripts could have an impact on some of our data and conclusions.

Multiple papers have been published describing teacher development programs for postgraduate pharmacy residents with the intent to create future academicians. This reflects a strong desire to prepare graduates to begin faculty positions with teaching experience. Surprisingly, we could only find one paper that described a program specifically for pharmacy faculty development that articulated gains in knowledge and teaching behaviors as an outcome of the program. This may reflect either a lack of faculty development efforts in relation to resident development, or it may simply reflect a lack of scholarship in this area. It is our hope that this important finding will encourage pharmacy leaders to emphasize the academy’s focus on the scholarship of teacher training. Findings from this research can also identify how well we are integrating, developing, and monitoring core teaching and learning knowledge in our professional development programs.

Program format referred to the total length of the program as well as the organization of the didactic and experiential teaching opportunities. The most common program format was longitudinal, spanning an entire year. Although the commonality of this format suggests time and repetition are valuable components, this was not measured, nor did it reveal any differences in participant satisfaction within their programs. Stein et al managed to demonstrate positive outcomes in knowledge and teaching behaviors in just one day.³¹ The commonality of the longitudinal format was most likely an effect of the current program design in postgraduate residencies. However, other considerations probably impacted this such as placement of didactic material prior to the experiential portion to better sequence and scaffold residents’ learning experience.

Participants were usually required to attend multiple seminars that provided didactic instruction on teaching. These occurred at different periods of time—some programs frontloaded in the first weeks of the residency, but most occurred monthly for the duration of the program. Other variations of this format had participants complete all of the instructional seminars and didactic components in the first half of the residency year, prior to engaging in supervised teaching experiences during the second half of the residency year.

The variability in program format was likely a result of factors such as faculty availability, resident schedule, timing and availability of teaching experiences, and ease of program administration. Purposeful timing of the didactic experiences in relation to the experiential component to allow time for preparation could have also impacted program design. Many programs offered more than one teaching experience to residents. There may have been purposeful integration or scaffolding of these experiences to enhance the residents’ learning. Finally, some programs had their residents complete research projects or teaching portfolios. Programs may have been formatted to facilitate completion of these projects. The efficacy of these formats has not been evaluated to see if one design is better at instilling knowledge and skills than the other.

Programs designed as 4-6 week education rotations tried to immerse residents in a full-time teaching experience.^25,27,33,36 This format fits with the typical rotational resident schedule and provides dedicated time for teacher development that doesn’t compete with usual patient care responsibilities of the resident. However, this program format is not proven in the literature to be superior to other formats.

As Lancaster et al identified in their research, more examination is needed to explore the outcomes of faculty development programs.⁹ Future research should investigate whether program format influences outcomes such as participant preference and satisfaction, increases teaching skills or knowledge retention, and whether there is a significant resource difference that would make one program preferential to another. In addition, faculty members can make informed decisions about which teaching development format would be most appropriate and successful for them and their institution.

Program content refers to the topics and types of didactic and experiential methods of the program. Since we did not have access to actual program seminar material, assumptions about the content had to be made based on the listed titles given in the publications. This may not be a true representation of the breadth and depth of topic coverage in these programs and more emphasis on teaching theory, instructional design, and learning assessment may have occurred.

All of the programs offered some type of didactic instruction to the participants. There were no data to suggest any topic was more important to teacher development than the others. None of the papers indicated how these topics were approached from a theoretical standpoint and the depth of topic coverage was not included in the research (ie, sample lesson plans). The lack of content depth presented in the publications made it unclear to what degree participants learned educational theory (ie, adult learning theory or constructivism), or if they were simply introduced to common teaching practices (ie, teaching in a large lecture environment). Areas of study in K-12 professional development include instructional methods, social and psychological foundations, field experience, and pedagogical strategies.⁴⁰ There are commonalities between these content areas and the programs we evaluated, which is reassuring. However, higher education professional development programs could focus more on social and psychological foundations of teaching. Examples of this could include stages of development, adult learning theory, or motivation.

All of the programs (except for Sylvia²⁶) had an experiential portion where participants practiced what they learned through planned teaching sessions. Some programs determined the type and number of essential experiences, such as large classroom teaching, small group facilitation or oversight of pharmacy students in introductory or advanced practice experiences. Other programs varied depending on available resources and teaching opportunities. Teaching at clinical sites (ie, continuing education programs or clinical presentations) were not usually mentioned in the descriptions of the teaching and learning programs. However it is likely that residents were also doing these as part of their training. Programs with many residents are challenged to place all participants in multiple varied experiences. Affiliated schools of pharmacy may have limited room in their curriculum to give teaching opportunities away to nonfaculty members. Future studies should look at program efficacy data in relation to the experiential teaching components of these programs.

The effectiveness of the programs was measured using Kirkpatrick’s learning evaluation model. Specifically, we were looking for changes in attitudes, knowledge or teaching behaviors as a result of the teaching and learning programs. A little more than half the papers collected data on participant opinions about their respective programs. It is fair to say that generally, participants in the teaching and learning programs enjoyed their experiences and felt the programs were valuable. However, there is little data to substantiate that programs made them better teachers. Some of the programs tried to measure changes in attitudes or knowledge, but they were done through self-evaluation and represented participants’ opinions. The validity of these measures in light of the high rate of participant satisfaction with their programs could be questioned. None of the resident teaching programs measured level 4a or 4b changes in organizational practices and student learning outcomes.

Stein et al measured changes in teaching behaviors, reaching level 3 on Kirkpatrick’s pyramid.³¹ Participants were evaluated by trained panelists who assessed their pre/postworkshop lecture skills.³¹ Their program’s evaluation tool measured three domains: (1) planning and preparation, such as content knowledge, coherent instruction, and assessment; (2) classroom environment such as respect and rapport; and (3) instruction, such as communicating with students, questioning and discussion techniques, and responsiveness. After a 6-hour workshop, faculty participants demonstrated significant improvements in the three domains. Self-perceived effectiveness also increased as did their perception of the efficacy of certain teaching methods. The authors demonstrated improvements in teaching using minimal resources such as faculty time. Questions that still remain include whether these increases in teaching skills ultimately improve student learning. Another question is whether other teacher development topics, such as assessment or learning theory, would lend themselves to this 6-hour format and replicate the same positive results. Finally, this approach was effective with experienced teachers, but may not yield the same results with new teachers or residents.

The papers that described teaching certificate programs for residents cited the pharmacy faculty shortage as one of the reasons for program development. Nappi et al commented that their program had limited success recruiting their residents into academic positions (13% of residents subsequently accepted faculty positions).²¹ Gettig et al also had a low percentage of their graduates end up in faculty positions (7.5% were in a faculty job one year after program completion).²³ Timing of data collection may have had an impact on these results since many of their program graduates were involved in postgraduate year 2 (PGY2) residencies one year later, and measurement two years after program completion may have resulted in higher numbers of faculty positions.²³ Alternatively, some programs had much higher rates of success (Sylvia et al 52%, Slazak et al 71%).^26,27

From our data collection and evaluation, we calculated the mean percent of graduates who subsequently went on to get a faculty position at 34%. Interestingly, Ratka et al surveyed 122 graduates of pharmacy teaching skills development programs and found 36% had academic appointments.⁴¹ Pharmacy residents who pursue faculty positions are more likely to have experienced typical teaching activities during their residency (ie, precepting pharmacy students or giving a lecture) than their nonfaculty peers.⁴² However, it is not clear if the program itself or residents’ original disposition toward teaching was responsible for this. Because there is not much published on career or skills progression of residents after completion of their program, little is known about the efficacy of their training programs in producing better teachers, or how the variability of programs impacts teacher development.

After thorough evaluation of the published literature on pharmacy teaching programs, and considering white papers and guidelines for faculty and resident development in teaching, we recommend six areas for future research. (1) better evaluation of teaching and learning programs; (2) investigation into longevity of development efforts; (3) evaluation of program format and resources; (4) better measures of program quality; (5) impact of resident teaching programs on academic career choices; and (6) faculty development program research.

Program efficacy must be associated with better teaching ability. It should also be associated with positive student outcomes such as motivation and engagement (indirect measures) and grades (direct measures). Outcomes data is necessary to justify how resources should be used to develop residents and faculty members into better teachers. Several programs mentioned that data such as faculty and student evaluations of the resident’s teaching were collected.^{19,23,27,32,34-36} These measures of teaching must become part of the discussion and used as evidence of program efficacy. Future research should concentrate less on program design and more on program outcomes.

More needs to be known about the effects of teacher development programs over time. This kind of information can help create standards for continuing education and development. Johnson et al found that although graduates of their teaching certificate program felt they had learned a lot, they were much less confident in their teaching practice several years out.³⁴ Almost all the studies measured immediate results of their programs. Even delayed posttests asked participants about their immediate impressions. Since confidence is influenced by external factors, such as environment, it makes sense that residents initially felt confident at the conclusion of their teaching experience. However, if teaching was not part of their postresidency career environment, one would expect a decrease in confidence in knowledge and skills. Ideally, the increase in confidence that participants felt would be a sustained effect, not just a byproduct of their direct experiences. If confidence is part of program development efforts, environment and challenges need to be considered.

Evaluations of the traditional program models are necessary to determine the best uses of resources. Gonzalvo et al changed the didactic portion of their program from a monthly seminar series to a 2-day conference.²⁴ Garrison et al changed their live, synchronous seminars to an online, asynchronous format.³⁷ Taylor et al made use of videotaped lectures when logistics of face-to-face seminars became a challenge.²⁹ Cost-benefit analysis of these models will help institutions make resource decisions. In addition, teaching preparation programs require significant resources such as multiple, varied teaching experiences for participants, and faculty mentors who can provide feedback. Gonzalvo et al commented that as their program grew, there were fewer resources available to support the number of participants involved.²⁴ This need was also addressed by a 2002 AACP task force that recommended residency teaching programs partner with schools of pharmacy in order to strengthen their programs and offer appropriate teaching experiences for residents.⁴³ Future research should focus on cost effective methods that provide maximal benefit of available resources and format.

The 2013 Residency Teaching Guidelines and the recommendations by Wright et al will likely impact minimum standards for quality teaching experiences for residents.^15,17 They defined standards for both essential content and assessment of resident growth and development.¹² We also suggest looking to the education profession as a leader in this regard. To ensure pharmacy teaching certificate programs are not simply job preparation programs, but true teaching and learning development programs, education curricula should be consulted as the gold standard in teaching and used to help programs develop and grow over time.

More robust investigations are necessary to determine whether these programs create academicians and help to fill the faculty shortage. Almost all the papers on resident teaching programs cited the pharmacy shortage as a reason to prepare residents for academic positions. However, the result of these claims are highly variable. Better measurements of efficacy in this regard as well as prospective study design should be used to examine the impact of the programs on career choice. If the programs are not fulfilling this need, there may be alternative ways to encourage residents to pursue faculty positions.

Finally, there is a need for more research on teacher development programs for faculty members. Little published literature exists on programs to develop pharmacy faculty members in existing positions. If the lack of published literature on teaching programs for faculty members represents the availability of these programs, more development efforts are needed. However, we believe there is evidence of the existence of these programs, despite the lack of published data. Education, as a discipline, is promoted by some national pharmacy organizations. The mission statement of AACP centers on advancing pharmacy education.⁴⁴ Faculty development is an important part of the role and is supported in many ways, including faculty special interest groups and through programming at annual meetings. The association also supports faculty development in teaching. They offer an annual teaching and learning certificate program and support networking through their education practice research and network group.⁴⁵ Some schools have developed teaching and learning centers to facilitate faculty development in teaching.⁴⁶ The academy would benefit greatly from knowledge of how these programs are addressing new and existing faculty needs.