Transcript Slide 1
Evidence-based impact of experiential learning Professor Ian Bates Head of Education Development School of Pharmacy University of London European Directive – 3000 hours of directed study at 4-5 years’ duration – Greater part of curriculum and not less than 50% of final year must be core – At least 35% on actions and uses of drugs – At least 35% on experiments and data analysis – Research project of 3 – 6 months duration The professional imperative – Better health care, – Better patient experience, – Better value for money What’s holding us back? – Curricular pressures Integration of pharmaceutical and clinical sciences – Dislocation of education and practice – Not competency-based Performance of our graduates? – Not a partnership With national health systems With existing health professionals Short term vs Long term – Long term The science of medicines must be foundation of education Knowledge half-life – Short-term imperatives Understand and engage with the health agenda What’s holding us back… …curriculum The learning experience Syllabus – knowledge & content Delivery & quality Outcomes Context – institutional, societal & cultural Access, finance & policy The Learning Experience… Pharmacy students N = 5,243 p<0.0001 1.0 Assessment Assessment Goals Goals Independence Independence Good Teaching Good Teaching Standardised mean scores 0.5 0.0 -0.5 Bangladesh Malaysia Australia Portugal Jamaica Romania Spain Croatia Nepal USA Netherlands Ghana Iceland Singapore Taiwan Germany Israel India Canada Finland Slovenia Swiss Serbia UK Czech Republic The learning experience – It varies – Is this acceptable? – How can we improve it? the Knowledge problem …pharmacy syllabus is overcrowded chemistry pharmacology genetics medicine analysis physical chemistry ethics phytochemistry drug design pharmacokinetics therapeutics epidemiology health economics physiology proteomics law Licensing&marketing microbiology medicinal chemistry toxicology drug metabolism social & behavioural sciences biotechnology formulation pharmacognosy immunology pathology chemical analysis statistics ADRs biochemistry genomics And so…? – Methods PBL Near to patient cases Clinical contact Experiential Subject Integration – Designs Scientists as practitioners Adult learning & self-direction Pragmatic & meaningful in situ LLL “Experiential” learning – Experience We all have ‘experiences’ We often learn from an “experience” Working or work-like As children…. Anecdotal…. – No real mysterious or obscure theory The real issue… …getting the “experience” to UG and PG learners (either students or practitioners) – Design – Environment – Outcomes …outcomes Competency → Competence → Performance Fit to practise? Miller’s pyramid From UG to post-registration development Does performance assessment in vivo Shows how performance assessment in vitro Knows how clinical context assessment Knows factual assessment Experiential learning – Should attempt to bring relevant experience to theory – Should therefore illustrate knowledge (working knowledge?) – Should therefore re-enforce primary learning …it should move learning towards the competency agenda… Graduation Pharm Care Competencies (OSCE) One year later 70% 60% 60% 50% 40% 30% 30% 20% 10% 1996/97 1997/98 1998/99 2001/02 McRobbie et al “Competence” is a complex educational construct… ...with new currency value Values attitudes Behaviours Competency Knowledge Skills An example.. Drug-drug interactions:– Theory, knowledge – Examples (from lectures, books, case studies, etc) – Exams and questions Moving from “knowing” (theory)… towards …“doing” (performance) Miller’s pyramid From UG to post-registration development Does performance assessment in vivo Shows how performance assessment in vitro Knows how clinical context assessment Knows factual assessment Barriers – Assessment – Resource – Culture Miller’s pyramid From UG to post-registration development Does performance assessment in vivo Shows how performance assessment in vitro Knows how clinical context assessment Knows factual assessment Barriers – Assessment – Resource – Culture …there must be a working relationship with the university and the work environment Joint Programme Board (JPB) Generalist Training (3 years) www.postgraduatepharmacy.org – Government funding = committment – PG Diploma in General Pharmacy Practice -Core - MI, Technical, Patient & Clinical Services – Common Validation by HEIs in collaborative – Currently 300 practitioner-students (target 2009 = 750) School Pharmacy Univ Brighton Univ East Anglia Univ Portsmouth Medway School King’s London Univ Reading Kingston Univ NHS I tend to describe myself as a student rather than a practitioner There are no boundaries between my roles as student and practitioner - I can be both 40 50 40 Frequency Frequency 30 30 20 20 10 10 0 Strongly disagree 0 Strongly disagree Disagree Agree Strongly agree I tend to describe myself as a student rather than a practitioner Agree Strongly agree If I come across something I do not know, I will always make time to find out more about it I am aware of my knowledge gaps 60 50 50 40 Frequency 40 Frequency Disagree There are no boundaries between my roles as student and practitioner - I can be both 30 30 20 20 10 10 0 Strongly disagree 0 Disagree Agree I am aware of my knowledge gaps Strongly agree Disagree Agree Strongly agree Neither agree not disagree If I come across something I do not know, I will always make time to find out more about it Learning modality with time/career pathway Predominantly FDL and e-modes Higher Post-reg FDL, e-modes off-site, experiential Independent Career driven UG/Pre UG Predominantly face-to-face modes Cohort learners Lone learner On-site (HEI) learning Off-site (work) learning General and Higher level practice: Growing the next generation The next [urgent] challenge… – Competency frameworks for undergraduate education – Assessment of performance at UG level (medicines-centered) The pharmaceutical imperative – Bring our pharmaceutical science into healthcare practice Where is our professional ‘centre of gravity’? Patient-focussed, medicines-centred ..can only achieve this through a partnership of universities and health care employers (systems) Key performance indicators F1(medical) Low Activity High Activity W 200 W 150 W W W W W 100 R-Square = 0.16 W W W W W W W W W W WW W 50 W W W W W W W W W W W W W 0 R-Square = 0.76 70 80 90 100 110 Mortality rate Index 120 Evidence-based impact of experiential learning Professor Ian Bates Head of Education Development School of Pharmacy University of London