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How can we promote critical thinking to improve students' readiness to practice upon graduation?

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"Journeyman Hospital" is a longitudinal experience that spans the entire second-year pharmacy curriculum in Campbell University's Doctor of Pharmacy program. It combines gamified learning, story-telling, and non-linear sequencing to sustain high-levels of engagement throughout the year-long learning experience. Students are expected to apply what they learned from the classroom and the module to authentic electronic health record (EHR)-based cases that have been purposely designed to promote critical thinking by eliminating typical multiple-choice answers and providing interactive feedback. 

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  • Audience: Second year student pharmacists

  • Responsibilities: Working with SMEs across specialties, gap analysis, task analysis, graphic design, interactivity development

  • Tools Used: Articulate Storyline 360, SCORM, Adobe Photoshop, Pixabay, MS Excel, Adobe Premiere, Suno AI

Across the United States, the North American Pharmacy Licensure Examination first-time passage rate has declined. This project aims to continuously engage student pharmacists at Campbell University with engaging, longitudinal eLearning experiences curated by faculty SMEs to promote critical thinking and knowledge retention of current and previously taught material. It is difficult to assess and promote critical thinking with the typical, multiple-choice exam format, but grading and providing meaningful feedback on papers or during one-on-one interactions is time consuming. This project sought, in part, to develop a process for both promoting critical thinking and providing feedback to develop it.

Solution

"Journeyman Hospital" is designed to provide a robust eLearning experience for students to maintain engagement throughout the year-long experience. The module is comprised of mini-modules, but the cornerstone of the experience are EMR-based cases. These cases incorporate the principles taught within each mini-module and provide an authentic experience that requires students to think about the actions they would take if they were dealing with this patient's EMR in a hospital setting. These EMR experience first requires that students navigate through the patient's records (e.g., History and Physical, Results, Imaging) in order to decide on what actions they wish to take. Individual drugs, doses, and lab recommendations are not provided. Rather, students must consider these changes on their own and select from more ambiguous responses. The ambiguity requires students to think about the specifics of their action as opposed to selecting from four available multiple choice options. Students decisions will add or subtract from their score for the module. If their scores do not reach the threshold needed for the final evaluation experience, they will have to select which of the mini-modules to try again to improve their score.

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Process

The "Journeyman Hospital" experience is a robust learning experience designed around Gagne's Nine Events of Instruction as well as the ARCS model for promoting engagement. The design and development process was  a multi-step process requiring student surveys, SME buy-in, prototyping, and content mapping to NAPLEX standards and professional tool kits.

Prototyping

The early phases of development required rapid prototyping to develop a module that be robust enough to encompass the myriad of pharmacy material that required reiteration, but re-engaged students frequently to prevent attention from waning. Initial designs had more passive learning through video and user-controlled mini-lectures, but users felt that this disengaged them from the module. As development progressed - more engagement focused elements were utilized like story-telling and audio cues to sustain motivation. Ultimately, this lead to a series of mini-modules in various scenes (e.g., health clinic, IV room, break room) which each lasted 4 minutes or less.

Critical Thinking

The EMR-based cases were designed around Gagne's Nine Events of Instruction with an emphasis on eliciting performance (6), providing feedback (7), and assessing performance (8). Clear instruction was provided to students with regard to how they should navigate patient cases within "Journeyman Hospital" to eliminate frustration. They were told that cases, like in real-life, may have more than one appropriate approach, but selecting an appropriate, non-preferred approach would not make a significant impact on the score they needed to progress in the module. 

 

By the time students entered the EMR case, they were in step 6 of Gagne's Nine Events which required them to attempt the case on their own. After submitting their recommendations for the patient they were subsequently provided a step-by-step approach in assessing the patient by the faculty SME via video. Each tab of the EMR provided students with feedback on the SME's approach to determining what is critical to focus on when reviewing this patient's chart. Due to the length of the feedback (six, 90-second videos), interactive question which bolstered the learners' score were incorporated to promote sustained engagement (see below).​

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Takeaway

The "Journeyman Hospital" modules were successful at promoting critical thinking. Each of the five mini-modules were consistently rated > 4.3 out of 5 stars. Among the mini-modules, students consistently provided the highest ratings for the individual case attempts (4.5 stars) and the faculty feedback experience (4.7 stars). Pre and post-assessment data suggest student retention of material was bolstered from this experience. Data for downstream effects on student rotation evaluations will be assessed to help determine Kirkpatrick level III feedback. 

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