7. Problem Solving in community Practice

7.3 Teaching and Learning Case Studies 7.3.1 Timetabled Class Without Tutor Support - University of Bath The package was time-tabled during the week before the second year students at Bath begin their dispensing course. Therefore most of the material in the package was new to them. Three second year groups were time-tabled for a 90 minute session in the computer laboratory. Students were not given the opportunity to study the package for any further time before the post test was administered. There was no tutor present, although one of the observers was a demonstrator and was able to give limited help but was not familiar with the package itself. Students completed the pre-test immediately before the teaching episode and the post test straight afterwards, followed by a taped discussion with a subset of one group, as carried out previously. No supporting materials were provided but students were allowed to use other sources of information, such as the BNF (British National Formulary) to look up drug strengths, warnings and contra-indications etc. They had not been asked to bring any additional materials and so usage was quite limited, as will be shown when discussing the observation data. In the same way as the previous case studies, student responses showed that they were familiar with both computer and mouse (100% had used previously) and were regular users with 68% declaring that they used a computer "At least once a week". 81% stated that they felt at least "Fairly Comfortable" using a computer. 94% of students worked alone, although this was not prescribed. However, the room was large enough to accommodate the students at separate workstations which were set out individually, so it is not surprising that they chose to work in that way. Students were not given specific advice about how to work through the package but as it is quite short compared to the other two packages that have been evaluated, there was sufficient time for most students to work through all three sections. This is evident from the answers given on the post test questionnaire which showed that 100% completed section 1, 95% completed section 2 and 76% completed section 3. This suggests that students worked through the material sequentially. This was probably appropriate given that the majority of the material was new to them and that the package is quite short. Only 25% of students asked for any help or advice, suggesting that the package was relatively self contained and easy to follow, as these quotations show: "Excellent way of teaching i.e. bringing over information required in an illustrative and understandable form" - Questionnaire response "I found this package easy to work through." - Questionnaire response FIGURE 14: CONFIDENCE LEVELS BEFORE AND AFTER TEACHING EPISODE (n=66) click image to see larger version Figure 14 above shows levels of confidence in the subject recorded by students before and after studying the package. Most students felt either "Fairly Confident" or "Not Very Confident" beforehand but this confidence increased considerably after studying the package with 80% stating that they were either "More Confident " or "Much More Confident" after the teaching episode. This increase in confidence also translates into an increase in scores on the post tests as shown in table 16 below.

TABLE 16: PRE AND POST TEST SCORES AT BATH (N=66) UNIVERSITY PRESCORE Range 0 - 18 POSTSCORE Range 0 - 18 t Value P Value S.E.M Bath 9.4848 11.6212 -6.77 .000 .190

As in the previous case studies a paired t test was carried out on the pre and post test scores and the results are set out here. These results show that there was a significant increase in scores. It is interesting to note however that the mean score for the pre-test is also quite high which suggests that although the students had not yet begun their dispensing course, they did have quite a high level of pre-knowledge in this area. This may also be why 50% of the group described themselves as "Fairly Confident" before beginning the CAL session.

TABLE 17: Bath - Observation Data OBSERVATION NUMBER OF COUNTS Requests for help 20 Discussion with neighbour(s) 125 Use of other aids or support materials: Pharmacy Practice Course Book BNF Medicines, Ethics and Practice     1 4 2 Taking notes 39 Leaving without returning to room 0 Negative statements or behaviour 5 Positive statements or behaviour 0

Table 17 presents the data collected during observations of each of the three groups at Bath. Methods for recording observations followed those of previous studies in this report. There were only a few requests for help recorded, as already shown by questionnaire responses indicating 25% had asked for help. 69% of those help requests were directed towards friends. This almost certainly played some part in the discussions amongst the students recorded here, which appears to indicate quite a high level of interaction between students. As mentioned in some of the previous studies, groups actually varied a great deal, however in this case, the levels of discussion appear to be evenly spread amongst the three groups (A- 47, B - 35, C - 43). Taking notes was a low level activity, bearing out earlier findings from observations which showed that few notes are taken when students are engaged in frequent discussions. As already mentioned, students could use additional sources of information if they wished but few had copies with them, unlike the students at Cardiff who are the subject of the next study. Although the package does not specify the use of the BNF or the Medicines, Ethics and Practice book, for these students it would have been helpful for them to be able to check information on prescriptions and labels, in the same manner that community pharmacists regularly do. Furthermore there was one specific point in the package where several students in each group had problems. In the Labels section, one question asks students to give the correct number for a warning. There is no teaching in the package on this. These numbers are listed in the BNF and unless they are known by heart, the student needs to refer to the book. Students who have already done some dispensing may know these warnings, but at Bath, where they were new to dispensing, they had not come across them before. There were several comments on post test questionnaires which bear out the observers remarks: "Placing 'warnings' on the labels was difficult as we weren't told the corresponding numbers to the warnings" - Questionnaire response "Should have supplied list of cautionary labels on sections of labelling when required" - Questionnaire response In addition there were a number of responses, mentioning drug interactions: "Would have liked a list of contraindications and interactions of medicines as part of menu" - Questionnaire response "The theory was fine but, due to the fact that not much dispensing etc. has been done, it was not easy to know any interactions, dosing regimes, and the numbers for the warnings weren't known" - Questionnaire response This person summed up the problems: "It was just as well I carry the BNF etc. everywhere, as this would have been a difficult exercise without it!" - Questionnaire response Clearly there is a need for further help on this. The package could include sections and lists as appropriate or else the package should contain suggestions to refer to the BNF or any other appropriate sources wherever students new to the subject are likely to encounter difficulties, such as those mentioned in the quotations. Tutors should also make students aware in advance of what they will require for the CAL session. This was brought up during the discussion group, who felt that having some preparation beforehand was important, as the following quotations indicates: "If we could have been given a sheet of A4 - brief description of what's going on - beforehand. Like we could have been told to bring a BNF" - Discussion group "We should be told which bits we're concentrating on" - Discussion group In conclusion, the teaching methods employed in this study have enabled students to increase their learning and confidence in this new area. The package was well received by the students and they were able to work without the need for a great deal of help and support. Some changes to the package, establishing its context more clearly and the support of additional reference books such as the BNF would assist those working through the material as an introduction to the subject as the package sometimes assumes more pre-knowledge than these students actually had. Despite these comments, most students were positive about the package and the learning experience and the package was successful as an introduction to dispensing, as summed up by these quotations: "I found I learnt a lot in a very short period of time" - Questionnaire response "V-useful package so we don't go 'cold' into the Dispensary" - Questionnaire response