The first objective of this study was to evaluate the information that students acquired during the first 3 years of the pharmacy curriculum or through pharmacy work experiences outside of the PharmD program. Students often work part-time in pharmacies prior to or after entering the PharmD program, but the quality of the experience and training they receive in these positions varies widely and is difficult to assess. Low scores on the preintervention test suggests that the didactic portion of the pharmacy curriculum and external work experiences alone do not result in a full understanding of the complex techniques surrounding the correct use of inhalers and administration of ear and eye drops. Low scores would also add weight to the argument that on-demand, Web-based vignettes could play a useful role in preparing students to practice pharmacy/pharmaceutical care.
The second objective was to evaluate the effectiveness of using computer-aided learning to augment and extend the teaching by faculty members overseeing these advanced community practice experiences. The vignettes were effective in increasing student knowledge of administration techniques. To determine whether this objective was met, the status quo of learning (without vignettes) was observed. There was not a significant difference in test scores between pretest and posttest in these control groups. However, increases in the students' administration counseling skills secondary to the added resource of computer-aided instruction within an experiential drug store setting were observed. The authors demonstrated improvement between the study and control students' pretest and posttest knowledge in most administration technique questions studied.
The third objective was to gather preliminary evidence on the efficacy of making similar Web-based, multimedia tools a part of the community APPE curriculum. Two faculty coordinators oversee student learning in these multiple APPE settings across the state. These APPE faculty coordinators were interviewed for their perceptions on the ability and promise of Web-based technology/multimedia to provide consistent and accessible training to APPE students. Two of the faculty coordinators who collaborated on this study considered the vignettes an effective way to augment students' experiential training. Specific comments included: “the vignettes allowed us to provide a level of quality and standardization for experiences across the state that had not been possible before,” “student learning was consistent regardless of the site and preceptor variations,” “patients ultimately benefited through the increased knowledge of the students,” and “as a faculty preceptor I believe the vignettes are a extremely valuable to our students,” saying that the vignettes provided a standardized learning experience that would minimize differences in preceptors' training abilities, knowledge base, availability to students, and interest in teaching students. Also, beyond the educational benefits of the vignettes, they enhanced the students' sense of being connected to the college, reducing their sense of isolation and anxiety. These outcomes are especially important to the college, since it is challenging to stay connected and in communication with students during their APPEs. Although not intended to be part of the original study, anecdotal feedback during student debriefing included positive comments: “excellent resource” and “helpful to have an advanced instructor resource that we can use at the actual clerkship site.”
The use of multimedia computer presentations to efficiently serve as a primary or “booster” resource to augment student knowledge is an important area of study. With the efficiency of these vignettes, the authors demonstrated significant opportunities to use Internet-based multimedia resources in a number of scenarios. Although the authors do not advocate the use of these vignettes to replace traditional instruction, vignettes have the potential to extend instruction and require further study. With students missing class, losing concentration in the classroom settings, and simply not understanding the topic the first time around, these vignettes could serve as a resource for specific topics within traditional instruction. Further, these vignettes by nature of being located on the Internet are available to students with Internet access during their practice experiences. Alternatively, the vignettes can be placed on a CD or DVD for the student to carry to their practice sites.
Colleges of pharmacy recognize the importance of teaching computer skills and technological advancements in pharmacy practice. In fact, technology education is an accreditation skill required by the Accreditation Council for Pharmacy Education (ACPE).21
The use of computers to teach general or specialized practice skills varies by college.22
Although ACPE recognizes the importance of technological training of students for practice, colleges of pharmacy have been slow to develop technological advancements in pharmacy instruction. The dearth of various forms of computer-aided learning in pharmacy curriculums leaves considerable room for development, deployment, and study. Perhaps only through collaborative efforts between colleges of pharmacy or via sufficient grants will a compendium of quality computer-based training materials be available for incorporation throughout our curriculums. Whether the perceived academic value of CAL by faculty members is a perception or reality should not delay the study of the effectiveness of CAL in traditional classroom or experiential instruction but rather should spur research into the topic.
The effectiveness of using ultra-short multimedia vignettes can also be studied for use in training other health professionals or for the direct training of patients. The community pharmacist is the most accessible and trusted source of patient/consumer information on medicines, prescriptions, medical devices, and drug administration techniques. The relationship that the medical consumer develops with his or her pharmacist is typically one imbued with great trust, and is one of the most valuable relationships in the health/medical continuum of care. The limits to taking full advantage of this relationship to significantly and positively improve public health, however, is the vast diversity in both the pharmacy settings and individual pharmacists in practice. Too little is known about the knowledge base of practicing pharmacists with respect to administration techniques, and even less about their ability to communicate effectively, and the time and opportunity to counsel patients in the course of routine interaction. With more study on both, appropriate educational resources and tools (and the appropriate methods to deliver them) could be developed. Because of the limits of pharmacist-delivered instructions, on-demand vignettes may have considerable potential for augmenting pharmacist counseling.
Although the average score of students in the control group and the study group was significantly different by 2.3 points (p < 0.001) and therefore generalizable to the larger student population (see graph one), there were some limitations to the study. One large group of students were studied with a specified set of APPE sites. The study design only allowed less than a month between exposure to the Web-based learning vignettes and the postintervention test. A study period longer than 1 month showing the effectiveness of the videos would be ideal but not practical within the constraints of the typical experiential year. Another limitation is that the preintervention and postintervention tests assessed knowledge acquisition and not administration skills. Due to the extensive content covered during the debriefing day, there was only time to administer the knowledge postintervention test covering this material. Ideally, an objectively structured clinical examination (OSCE) of learned skills would have been administered. In addition to skills testing, an OSCE would also evaluate the students' ability to communicate the newly acquired knowledge.