A radical new approcah to teaching pharmacy has been adopted by two institutions in Southern Africa. They took the opportunity presented by the reopening of a pharmacy school to redesign the course to produce pharmacists better suited to modern pharmacy practice
The schools of pharmacy at MEDUNSA (the Medical University of Southern Africa) and Technikon Pretoria have a solid track record in pharmaceutical education. The School of Pharmacy at MEDUNSA was inaugurated in 1983 and concentrated on continuing education, postgraduate studies, research and outreach programmes for the first 15 years of its life.
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The professional reasons for changeThere are four professional reasons for changing the nature of the pharmacy course. They are:
The educational reasons for changeChanges to the course have also been made necessary by four professional considerations.
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Because of South Africa's multicultural character, a selection process that includes a range of components is followed. It incorporates the student's academic record, an assessment questionnaire, tests of potential and interviews.
In order to ensure that only highly motivated students are admitted, pharmacy must be the student's first course choice on the application form. A low cut-off level for entry is deliberately used because of the historical disadvantage suffered by the majority of the South African population. If students have passed the school matriculation examination in the key subjects of mathematics, science and biology, they go forward to the next step of the selection process. This is a battery of computerised tests which do not require computer skills and which take into account the multicultural and multilingual population of South Africa. The tests evaluate mental alertness, calculation ability, spatial reasoning and perception. There is also a biographical questionnaire in which key questions assess the student's real interest in pharmacy as a career and likely degree of motivation. Interviews assess potential students' interpersonal skills and help clarify points arising from the biographical questionnaire. Final selection is racially based on the demographic profile of South Africa so that a microcosm of South African society is created within the schools.
A thematic, integrated, problem-based, experiential approach is followed. It promotes the activation and elaboration of prior learning. The modules build one on another, beginning with an attempt to bring all students to a common starting point in module 1.1 "Orientation and induction". This module covers: computer and language skills; communication and life skills; problem-solving skills; the role of the pharmacist (as an individual, as a part of the health care team and from a sectoral viewpoint); and working site visits (to community pharmacies, clinics, hospitals and industry). The second module "Tasks and challenges in health care" introduces the students to the pharmaceuticals management cycle (research and development, registration, production, selection, procure- ment, distribution, storage, issue, use and monitoring). Thus, the students are brought to an understanding of the total pharmaceutical concept within which future learning is to be applied.
The course is designed to meet the requirements of the South Africa Pharmacy Council's unit standards.
Learning methods used include small group work, scenarios/problems, workshops, individual assignments, laboratory sessions and site visits. The first site visits take place within the first month of the programme. In subsequent thematic modules, relevant traditional pharmacy subjects are addressed together in an integrated way. The key to the whole curriculum is the use of the "problem based learning" (PBL) approach.
Pharmacists must understand the context within which they function. Two beliefs are central to the philosophy of learning at the schools of pharmacy.
The first is reflected in the emphasis on the knowledge, skills and values required of future pharmacists. Knowledge alone is not enough. Graduates must also have the skills necessary to apply their knowledge, as well as the attitude to be responsible, compassionate health professionals.
The second is that the content of the curriculum and the method of education employed are equally important. Skills such as those required for effective learning, problem-solving, critical thinking and communication, and a caring attitude, cannot be learned or developed in the traditional lecture situation. They are learned through small group discussion, and other methods, in which students actively participate in the learning process. Small groups of six students, facilitated by subject specialists, derive their own learning goals by discussing set problems or scenarios. Based on this analysis, students collect additional information and report their findings to the group. This method is often referred to as the "7-jump" approach to problem-based or problem-orientated learning. |
Seven-jump learningThe Maastricht "7-Jump" approach to scenarios is:
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In addition to the activation and elaboration of prior knowledge, the method promotes the processing of new information. This step is also facilitated by discussion of the scenario/problem among the members of the group. Thus, self-directed learning is enhanced and the intrinsic motivation of students is developed and encouraged.
Various other learning activities, such as individual or group projects, journal writing, and seminars and workshops are employed to develop problem-solving and critical thinking skills. Other skills required are learned in skills laboratories. Throughout the learning process, orientation to the health care setting is emphasised, practical and professional skills are stressed and the integration of basic sciences and clinical subjects is promoted. Students are exposed to real life situations. Education and training are, therefore, aimed at the acquisition of relevant, new skills and knowledge in the context in which they are applied.
This approach to education demands students with a degree of maturity who are motivated and committed to learning. They must desire an active role in their education and understand the value of learning as a life-long goal.
Students learn how to learn and acquire the ability to analyse and solve problems. In addition, they must be clear about their own career and educational objectives and have insight into their role in the future of their profession. Early and on-going exposure to practice is aimed at enhancing acquisition of this insight. The four-and-a-half-year course includes 24 weeks of experiential learning.
Staff training is an integral part of the new approach. Training courses are held on an on-going basis in PBL methods, module construction, scenario-writing, facilitation, and assessment.
A new educational approach requires a new assessment approach. This is eight-fold, only two elements of which follow the traditional approach:
The new course is being monitored on an annual basis by the South Africa Pharmacy Council. Two monitoring visits have been conducted to date and the response to the course has been very favourable. Council members were particularly impressed by the level of knowledge and communication ability of our students.
An on-going process of two-weekly "reflection" periods is used to obtain student feedback on their perceptions of all aspects of the course.
The two schools must now develop and apply an evaluation process which will inform management and staff of the success, or otherwise, of the BPharm programme. It has been suggested that a comprehensive research project would be the best way of achieving this objective.
The new course has been running for only eight months and the enthusiasm of staff and students is evident.
So far, various questions have been posed, such as:
Perhaps the last words on the course should be left to the students. Some of their comments follow.
The realisation of true potential is a deeply moving experience. It is one of the fundamental gifts on the road to fulfilment. It may not be appropriate to combine emotion with science but the presentation of the new degree has been just such a rewarding experience for both students and staff. It is difficult to convey in words the spirit of those involved. Suffice to say that in the backdrop of the pain, division and suppression of the old South Africa, it has been a great privilege to be part of this unifying and galvanising project.
Defining the problem is an early stage in the "7-jump" learning process |
First year students from the first year of the new course with some of their teachers |
We would like to thank Dr Mano Chetty, the newly-appointed head of the school of pharmacy at Technikon Pretoria, the staff of the MEDUNSA and Technikon Pretoria schools, the staff of the service departments at Technikon Pretoria and MEDUNSA, the B Pharm I students and the management of the two institutions for supporting a new approach to pharmacy education.
Robert Summers is head of the School of Pharmacy, Medical University of Southern Africa (MEDUNSA), where Beverley Summers is a senior lecturer. Mariette Lowes is dean of health sciences at Technikon Pretoria. Gill Enslin is a senior lecturer at the Technikon Pretoria school of pharmacy