Clinical Pharmacology I

Submitted by felver on 16 April 2008 - 4:13am.

This course introduces the theoretical background that enables students to provide safe and effective care related to drugs and natural products to persons throughout the lifespan. Students will learn to make selected clinical decisions regarding using current, reliable sources of information, monitoring and evaluating the effectiveness of drug therapy, teaching persons from diverse populations regarding safe and effective use of drugs and natural products, intervening to increase therapeutic benefits and reduce potential negative effects, and communicating appropriately with other health professionals regarding drug therapy. Drugs are studied by therapeutic or pharmacological class using an organized framework.

Course Information

Course Number/ID:

NRS 230

Course Length (number of weeks):

Course Delivery Mode:

In-Class

Average Number of Enrolled Students:

Between 30 and 60 students

Course Level:

College

Course Development & Delivery

Course Contributors:

This course was designed and taught by Dr. Linda Felver. The words for the application beyond this point are hers. Assistance with interface design for web content links opening into new windows for access to the electronic materials I created: Maggie Lynch, Ed.D. and Thomas Boudrot, Ed.D. Assistance with loading my test questions into more than 25 self-tests in Sakai: Laurie Youker and Patricia Cornman, M.S.

Course Development:

I wrote the course outcomes for Clinical Pharmacology I to state what students are expected to do with their pharmacology knowledge by the end of the course. These outcomes involve clinical judgment, described by Tanner (2006) as “case-based, contextually bound, interpretive reasoning” and decision-making in clinical contexts. Keeping my focus on the course outcomes, I created a menu of many different ungraded learning activities to assist students to attain those outcomes and the graded assessments to evaluate how well they do attain them.
My role as a teacher focuses on what and how the students are learning, which Weimer calls “learner-centered teaching”. Principles that guided me in course development include viewing students as self-directed adult learners; providing organizing frameworks to fit pieces of knowledge; moving students to deep learning by explaining principles that underlie the facts; focusing on application of pharmacology information in clinical situations rather than merely memorizing factoids; incorporating active rather than passive learning; providing rapid feedback; using metacognitive strategies to help students think about their own learning; and individualizing student learning by providing choices of learning activities for students with varying learning styles and background preparation.
In order to provide choices of learning activities for students to use independently to support their in-class learning, I envisioned an easily navigable online environment that would engage students actively in their own learning, would provide opportunities for them to engage with each other and learn together if desired, and would address multiple ways of learning, so that students could select the ones that fit their own learning styles and own level of prior preparation. I learned basic HTML and created sets of interconnected HTML pages to provide a menu of learning activities for each course topic; built online crossword puzzles to help students learn technical terms; mounted online graphics; and learned and incorporated basic principles of web content accessibility. I developed multiple online self-tests with immediate feedback for student self-assessment and learning.
In order to provide an overall organizer that always would be visible and facilitate rapid access by students, I insisted on having a visible link to each course topic from the left column of the Home screen rather than have all course materials accessed from one link.
I view a course as a work in progress and continue to revise, polish, and create new activities to support student learning, including materials created by students themselves, as discussed later in this application.

Course Delivery:

I use class sessions to engage students, establish the scope of the material and my expectations for the outcome of their study; help them construct an understanding of pharmacology principles beginning with familiar concepts; teach them how to approach learning about classes of drugs; show them how to reason and explain material rather than memorize it; clarify difficult points; lead them from understanding facts and principles to immediate application of them in clinical situations; and challenge and coach them as they practice actively in class to attain the course outcomes. I work on building student self-efficacy for learning and applying pharmacology knowledge in situations requiring clinical judgment.
I choose pedagogical strategies to fit my students. Data provided anonymously by my students indicate that 37% of them benefit from tactile learning and 21% identify kinesthetic learning as useful. On the first day of class, students discover empty medication packages and vitamin containers at every seat, which immediately captures their attention and prompts curiosity. By the end of the first session, they have had those containers in their hands several times, investigating the labeling while they learn the difference between generic and trade names and searching for USP symbols when learning about regulations. I bring hand props to every class, for my own demonstrations and for student use. On the Sakai site, I built learning activities for tactile and kinesthetic learners, including crossword puzzles to work online, photographs of three-dimensional objects in online Art Galleries, online self-tests, suggestions regarding role-playing of situations, and Field Activities that require activity or hands-on investigation. In class and Sakai, I include learning activities for visual word, visual picture, and auditory learners as well, based on student self-report data.
I use the Sakai Web Content tool, one for each course topic, to mount these extensive learning activities, connecting them not to the Internet at large, but rather to linked files within my Workspace Resources in Sakai. With the Tests & Quizzes tool I provide self-tests with immediate feedback at different cognitive levels for each course topic, leading students from knowledge to application. Tests and Quizzes tool also allows me to provide timed open-book self-tests for students to practice finding information rapidly in their Drug Guide books, supporting in-class work and building student skill and confidence. The Dropbox tool enables students to submit extra credit course content they create for Clinical Stories and Art Galleries. The Resources tool provides students with study documents, including previous exams with answers. Finally, in addition to using the Announcements tool to manage course logistics, I use Announcements to provide resources beyond course requirements, such as citations for research articles I mention in class.

Course Self-Assessment

Communication & Collaboration Self-Assessment:

Excellent

Communication & Collaboration Evidence:

I encourage student-faculty contacts in multiple ways: I always arrive 30 minutes early in the classroom and stay 30 minutes afterward; weekly in-person office hours; weekly evening telephone office hours; students have a special code for email subject lines so that I can give them high priority; course policies include “There are no stupid questions; there are only questions to which we do not yet have answers.”
The OHSU system itself facilitates student-to-student communication in that all students are issued email accounts in the OHSU email system and everyone has access to their classmates by email. From the first day of class, I set the tone of working together for learning. The course develops reciprocity and cooperation among students by grading against a set standard rather than on a curve; through frequent use of in-class scenarios discussed in small groups; through in-class exercises requiring pair or group cooperation; through encouragement in online learning activities for students to discuss together or practice in role-play. I often help students connect with other students who have similar interests or backgrounds and make sure that students who sit alone in the room are paired with several different students during various in-class activities. Most terms, the class becomes a supportive community: students assist others who are struggling, celebrate important life events, and provide support in cases of illness or injury.

Learning Material Self-Assessment:

Excellent

Learning Material Evidence:

The visual design of the online Home screen provides topic links showing scope and sequence of the course and a welcome message provides an overview of the learning activities. A Course Norms page linked from Course Introduction delineates faculty and student roles.
An online menu of learning activities for each of the eleven course topics addresses multiple instructional preference learning styles: Notes and Clinical Stories (visual word learners); Art Galleries (visual picture learners); a video, audio files, stories to discuss out loud (auditory learners); Field Activities, crossword puzzles to work online (tactile and kinesthetic learners). Activities fit both solitary and interpersonal preference learners. Class sessions address multiple learning styles as well, incorporating multiple manual props, drawing by students, auditory story-telling, some kinesthetic activities, written words, flow-charts, pictures, some short videos, and occasional sound effects (e.g., heart sounds).
Online Review if Needed lists assist students who need review of prerequisite course topics; research findings and articles beyond the scope of the course are mentioned in class and made available for students who want more challenge. Numerous online self-tests provide students with instant feedback as they learn at both knowledge and application levels.

Learning Outcomes & Assessment Self-Assessment:

Excellent

Learning Outcomes & Assessment Evidence:

Syllabus and each topic page list the course outcomes. A chart in the Syllabus delineates, for each outcome, the ungraded learning activities available to assist students to attain the outcome and the graded assessments to evaluate outcome attainment.
Active learning includes hands-on materials for student exploration during class; student use of Drug Guide in class; in-class scenarios; online field activities; Clinical Stories or Art Gallery submissions; Drug Resource Comparison Assignment.
Online practice self-tests provide immediate feedback, as do in-class exercises. Graded midterm exams are returned to students for study. Feedback on Drug Resource Comparison Assignment provides encouragement and highlights strengths. Course outcomes are application level, requiring students to learn about certain classes of drugs and develop clinical judgment to apply facts and principles appropriately in specific clinical situations.
Class sessions move from facts to application requiring explicit clinical judgment. Application Self-Tests for each topic enable students to practice. Graded examinations are application-level questions in clinical scenarios. Self-reflection is encouraged through metacognitive questions in class and required in Drug Resource Comparison Assignment, receiving written feedback. Students generate course content during class sessions by telling true clinical stories and through submissions to online Art Galleries or Clinical Stories.

Course Look & Feel, Web Usability Self-Assessment:

Excellent

Course Look & Feel, Web Usability Evidence:

On the Course Home screen, a welcome message with a colored banner attracts student attention and provides a quick overview of what is available and how to access it. Course topic links in the left frame of the Course Home screen demonstrate the topic sequence and provide easy access to learning activities for each topic. Each set of linked topic pages begins with a clinical story to engage students immediately and links to the main topic page in a new window without frames for maximum visibility. Each main topic page uses a standard template with some visual graphic cues to provide a consistent structure and ease of navigation to all of the linked learning activities for that topic. Colored header bars at the top of each file indicate the topic and the type of learning activity. Long files have on-page bookmarks at top and bottom. Colored link bars at the end of each file assist navigation.
In addition to numerous media used in class sessions, the online site provides crossword puzzles that work online, multiple graphics, a video, and student-created audio music files. As far as possible, web content accessibility issues are addressed, as in providing explanatory for tables, link text that contains the content name rather than a generic Click Here, and equivalent alternatives to visual and auditory content such as text for graphics and a transcript for the video.

Learner Support Self-Assessment:

Excellent

Learner Support Evidence:

The Sakai Help Desk is available 24 hours daily, 7 days per week via Internet trouble ticket submission and by email, with telephone support available weekdays during business hours. Response time for trouble tickets is rapid. Links for submitting trouble tickets are available from the gateway page and after logging into Sakai. In addition, Sakai online help is available from the gateway, the Workspace, and from within each course. The gateway page has an Assistance column that provides links to FAQs, tutorials, and contact mechanisms for the Help Desk. Over 30 tutorials, many of which are video demonstrations are available to students. New support information, such as “Avoid the top two technical issues”, appears intermittently as needed in announcements on the gateway and within the Workspace. A link for people who forget their password appears in a clearly visible location near the password submission box on the gateway.
OHSU School of Nursing coordinates extensive in-person orientation to the campus environment for each incoming cohort of students, including practical details such as transportation and parking, financial aid procedures, assignment of email accounts and library barcodes to all students, and orientation to accessing library resources in person and electronically. The OHSU website provides additional information and support, with extensive electronic resources available through OHSU library.

Teaching Innovation

Teaching Innovation:

My use of Sakai is innovative in two ways: First, I provide multiple online learning activities for each topic, allowing students to choose the ones that fit their particular learning styles. Following an instructional preference model that focuses on the senses through which students most effectively perceive information, my Sakai site provides learning activities for visual word, visual picture, auditory, tactile, and kinesthetic learners. In addition, my online materials support solitary learners and interpersonal preference learners, the latter by suggesting discussion or scenario role-play with classmates, joint work on online self-tests, and the opportunity to interview people for clinical stories to submit for extra credit, thus creating online course content. Students say: “When I called my relatives to get their stories, I thought of it as merely something I was doing for extra credit. Actually hearing their stories and putting everything together really helped me understand beta blockers and the statins. I wasn’t trying to abstractly remember things anymore. I just thought of them, the drugs they took, and the conditions for which they were taking the drugs and it made those two classes of drugs stick in my mind very well.” “I really LEARNED a lot, not just memorized, and now have tools to continue learning.”
A second innovation is my strategies to assist students to learn facts and principles and immediately begin applying them. Each topic main page has a Knowledge List that specifies “Here is the knowledge you will gain” followed immediately by a list of Outcomes that specifies “Here is how you will apply that knowledge.” I direct students to keep the Knowledge List and Outcomes in mind while they engage the Learning Activities. My knowledge-to-application approach continues through online self-tests that provide two levels of self-assessment and learning. Each topic has a Knowledge Self-Test followed by an Application Self-Test. Knowledge Self-Tests enable students to test and build their knowledge base. Application Self-Tests then enable students to practice applying their knowledge and see the style of exam questions they will encounter. All my exam questions are application level. On anonymous course evaluations, 96% of students indicated that they used self-tests and found them beneficial, while only 4% did not use them. “[Self-tests] helped me to think about what I was learning and apply it.” “Your teaching has transformed the way in which I learn. I love how you reach so many learning styles. I have gained a solid foundation on which to build my nursing practice. Your style of teaching has helped me to grow my confidence in both learning and application.”

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Clinical Pharmacology I