7. Problem Solving in community Practice

7.3 Teaching and Learning Case Studies 7.3.2 Time-tabled Class Without Tutor Support - University of Wales, Cardiff The students in this study were working in very similar conditions to those already examined at Bath University. The session was time-tabled for 90 minutes and students worked at individual machines. There was no active tutor support, although one observer was, in fact, the pharmacy practice lecturer . However, he was not always present and when he was, he only responded to direct questions. Observers were sometimes asked for help and in most cases were able to provide some assistance. These students were third years and nearing the end of their degree course. They had already completed dispensing and the aim of the teaching episode was to revise key points on prescriptions and labels. The students were about to take their final year Practice of Pharmacy dispensing examination, which may have increased their motivation. Students had not covered Patient Information Leaflets before, so this area was new. As might be anticipated with third year students, levels of computer awareness were high with 100% declaring previous experience with a computer and mouse and 64% stating that they used a computer "At least once a week". Levels of comfort at using a computer were very similar to those at University of Bath in the previous case study on this package with 75% declaring that they felt at least "Fairly Comfortable". 99% of students worked alone and only 11 people (13%) asked for any help or advice, confirming the impression formed by observers that students worked independently and with little interaction with their peers.

FIGURE 15: CONFIDENCE LEVELS BEFORE AND AFTER TEACHING EPISODE (n=88) click image to see larger version

Figure 15 presents the pre and post package levels of confidence. Beforehand, 62% of students declared that they felt "Fairly confident" with a further 23% claiming that they felt "Confident" or "Very confident". This supports the view that the students already had substantial pre-knowledge in this area. Only 15% described themselves as "Not very confident". It may be surprising therefore that so many students declared an increase in confidence after the teaching episode with only 19% stating that they had "the same amount of confidence" as beforehand. This is all the more surprising as the pre and post test scores shown in table 18 below do not reflect this increased confidence.

TABLE 18: PRE AND POST TEST SCORES AT CARDIFF (N=88) UNIVERSITY PRESCORE Range 0 - 18 POSTSCORE Range 0 - 18 t Value P Value S.E.M Cardiff 11.5682 11.9773 -1.32 .190 .309

Paired t tests were carried out on the scores in the same way as previously. The results show only a very small difference between mean pre-test and post test scores and the P value is not significant. The high pre-test scores bear out the findings on levels of confidence, suggesting a high level of pre-knowledge amongst these students. However, it is surprising that they have not improved still further, given that they have indicated such large increases in confidence. In previous studies the levels of confidence have shown the same general trends as the pre and post tests. Examination of the sections of the package studied gives some further information on this. Of the three sections of the package, students indicated that 100% had worked through Prescriptions, 92% worked through Labels but only 57% worked through the third section on Patient Information Leaflets. This appears to suggest once again that students have worked through the material sequentially and that the area where they are most likely to have shown an increase in learning, namely the third section has not been studied by 43% of the students. However, results of t tests on the scores of just those who worked through all sections show some further improvement but these results are still not significant as shown in Table 19 below:

TABLE 19: PRE AND POST TEST SCORES AT CARDIFF - ALL SECTIONS COMPLETED (N=46) UNIVERSITY PRESCORE Range 0 - 18 POSTSCORE Range 0 - 18 t Value P Value S.E.M Cardiff 11.8261 12.5217 -1.80 .078 .386

The responses on questionnaires only record which sections students worked through, so no information is available on how much time students spent on each section. This might have helped to determine whether the time spent on the new material in section 3 had an effect on increases in scores. Although this might have been useful, another outlook on the performance of these students is illuminated by the observation data shown in Table 20 below.

Table 20: CARDIFF - OBSERVATION DATA OBSERVATION NUMBER OF COUNTS Requests for help 8 Discussion with neighbour(s) 111 Use of other aids or support materials: BNF Medicines, Ethics and Practice Drug Tariff   304 7 4 Taking notes 537 Leaving without returning to room 0 Negative statements or behaviour 2 Positive statements or behaviour 8 Although the discussion levels appear to be quite high, there was a large amount of sharing of the books mentioned in the table which may account for some of this; also observers noted several times that these groups were very quiet. One of the most striking elements of this observation data is the large number of occurrences of students using the BNF (British National Formulary). This was very different in the previous study at Bath where students were not so used to consulting this reference book. Observers reported that the BNF was used by some students almost continuously and that the Drug Tariff and Medicines, Ethics and Practice were passed around. The students appear to have taken a completely different approach to the package from the previous study and have spent time checking and considering each problem fully. The other notable area is the taking of notes. As mentioned previously, the figure in the table represents the number of students making notes, taken at five minute intervals. Whilst this data will always be an approximation it is clear that students at Cardiff were engaged in taking extensive notes, whereas at Bath, where the count was 39, this activity was very infrequent. These two key characteristics of the learning strategies employed by the students at Cardiff may account for the increase in their confidence despite any significant increase in learning. The students' approach to the package has been to concentrate on reviewing and confirming their own knowledge on prescriptions and labels and to consult the relevant reference material in a very methodical way but in the main this appears to have confirmed existing learning rather than providing new insights. It was also time-consuming and prevented many students getting to the third section where the material would have been new to them. The following quotations from the students support these views:

Very useful, especially the practice prescriptions and labels. I will definitely spend more time on the package" - Questionnaire response "I didn't have time to finish it, since I wanted to work through it properly using BNF, D Tariff & MEP and take some notes. It made things easier to learn" - Questionnaire response "I felt a bit rushed today. I didn't get a chance to do everything I wanted to do because I was trying to take notes from it" - Discussion group During the discussion group, several students raised another issue, which might have helped them progress more quickly. They recalled the screen shots that were issued to them when they studied the Guinea Pig Ileum package earlier in their course and would have liked something similar for this package: "It lets you do all the work without having to write it all down" - Discussion group This also led the group to discuss summaries for each section and the fact that this package does not contain any: "A summary at the end is good with key points" -Discussion group "I think a summary is often more useful than an introduction" - Discussion group It seems clear from these comments that the students would have welcomed some mechanism, either within the package or as support material to assist in taking notes. The students generally appear to have taken the task seriously as this comment suggests: "I think things like this, you can't learn often enough until it's second nature. So the more options you have to learn it the better." - Discussion group In conclusion, the use of the package at University of Wales, Cardiff has been successful in increasing student confidence, although it appears that students have made few learning gains. The timing of this package is crucial to its effectiveness and the teaching episode might have been more beneficial to students if it had been presented to them much earlier in their course. Students have gained some benefits but they perhaps needed more guidance on how to use the package for revision. The thorough approach generally adopted has meant almost 50% of the students covering only two out of three sections of the package. Advice, similar to that suggested for those studying the Nomenclature package, on how to approach the material, possibly doing test sections first and not approaching the material sequentially would help to maximise the time available and avoid spending too much of the time on areas of existing knowledge. Also some support material such as selected screen shots would help in summarising the learning points.