ACADEMIA

Susan P. Bruce, PharmD, BCPS; Dale E. English II, PharmD, FASHP;
Janis J. MacKichan, PharmD, FAPhA; and Timothy R. Ulbrich, PharmD

CASE

L.R. is a pharmacy student beginning an academic APPE. L.R. is interested in exploring teaching further, although her plans after graduation are still unclear. During the first day of the rotation, the preceptor reviewed all rotation activities and informed L.R. that she would be preparing and presenting a 2-hour large-group lecture in the cardiology module at the end of the rotation. L.R. has limited experience preparing for large-group presentations and feels a bit overwhelmed. In addition, L.R. will be facilitating a small-group cardiology case discussion.

WHY IT’S ESSENTIAL

Teaching is an inherent quality of a successful pharmacist. Experiencing an academic pharmacy APPE is an excellent way for you to develop teaching skills, regardless of the practice setting you choose after graduation. Some students may not be interested in an academic APPE because they perceive it will be helpful only in becoming a faculty member. However, during an academic pharmacy APPE, you will likely be involved in a variety of teaching and learning scenarios, including large-group teaching, small-group teaching, one-on-one teaching, and student assessments. Learning about how people learn and developing your own teaching style are helpful skills for any pharmacist. The experiences obtained can be translated to teaching patients, pharmacy students, and other healthcare providers.

ARRIVING PREPARED

Prior to beginning an academic APPE, you should think about what you would like to gain from the experience. What are the audiences a pharmacist teaches? How can the skills obtained in an academic APPE help you in that role? Are there other scenarios where teaching or presenting information to a group of people will be helpful? While building rotation objectives, you should keep your mind open to what will be learned during the rotation. So much goes on behind the scenes to prepare for teaching activities that you are not likely aware of! If you are thinking about a position after graduation that includes a teaching component, you should make sure to take time during the rotation to talk with faculty about their careers. Doing so will help you learn more about what teaching positions entail and perhaps guide you to a position with ideal teaching components.

Because faculty members’ day-to-day activities differ depending on their positions, you should learn about the different types of faculty positions before starting the rotation. In addition to reading about the different position types,^1-3 you are encouraged to interview faculty during the rotation to learn about what they like and dislike about their positions. There are three general types of faculty positions in colleges/schools of pharmacy: tenure track, non-tenure track, and voluntary. Tenure track positions are typically fully funded by the institution and emphasize scholarly activity (writing grants, conducting research, and publishing in peer-reviewed journals), campus-based teaching, and course administration and possibly involve a percentage of time spent at a practice site precepting students and caring for patients. Non-tenure track positions tend to be located primarily in pharmacy practice departments, and the salary may be “shared” between the institution and a practice site (hence the terms shared or co-funded faculty). The teaching responsibilities of these types of faculty usually focus more on precepting than on didactic teaching, and there tends to be less emphasis on scholarly activity. Non-tenure track positions in PhD-dominated departments or divisions (pharmaceutical sciences, social sciences, and administrative pharmacy) tend also to focus more on teaching than on scholarly activity. Many of the preceptors you have had on IPPE or APPE rotations are voluntary faculty. They are salaried by their practice site but hold faculty appointments at the college. These individuals are especially important given the ever-expanding need for quality rotation experiences.

QUICK TIP

The general descriptions of faculty positions vary from school to school, so it is important that you ask questions about how your school compares to others.

A TYPICAL DAY

There is no typical day in an academic APPE! The rotation schedule will depend on the activities in which you are participating. Faculty members usually work months ahead of the course schedule to determine specific classroom activities and overarching curricular improvements. As a result, many activities in an academic rotation are predetermined and scheduled months in advance. You will be responsible on the first day for reviewing the rotation calendar, understanding your role in each of the activities, and determining how to manage your time to ensure you are adequately prepared for each activity. Like faculty, students completing an academic pharmacy rotation must have excellent organizational and time-management skills.

TEACHING SKILLS

The backbone of an academic pharmacy rotation will help you develop your teaching skills. You may be asked to participate in a number of activities, ranging from development of a teaching philosophy, large-group lectures, small-group activities, to other unique opportunities that will depend on your rotation site.

Writing a Teaching Philosophy

During an academic rotation, you may be asked to begin developing and collecting materials that showcase your teaching experiences, such as a teaching philosophy or a teaching portfolio. A teaching philosophy is an evolving document that serves two purposes. First, the philosophy is a means of providing evidence to learners, peers, and employers of your understanding of the purpose and value of the teaching process. Second, a philosophy serves as means of self-reflection, allowing you to put deep thought into the learning process and how you can improve as a teacher. The teaching philosophy is generally written in a first-person narrative form and is one to two pages in length. When completing an academic rotation, you should consider drafting a philosophy before teaching for the first time and then revisiting and revising the document on a regular basis.

Students and new teachers often find the process of constructing a philosophy to be daunting. A teaching philosophy that focuses heavily on self-reflection can be difficult and uncomfortable to write.

Asking yourself the following questions when drafting a philosophy may be a helpful way to get started:

• What happens to the learner during the learning process?
  
• What is the ultimate aim of teaching?
  
• What characteristics are present in “great” teachers?
  
• What strategies or techniques do “great” teachers use?
  
• When students are engaged during class, what is happening during that time?
  
• What factors go into making a learning environment ideal?
  
• What is the teacher’s responsibility and what is the student’s responsibility?
  
• How will the teacher measure effectiveness? How will the teacher know that he or she has been successful?⁴

QUICK TIP

It takes time and significant reflection to articulate your personal approach to teaching. The process of self-reflection is just as important as the product, which will likely be revised many times along the way!

Large-Group Teaching

When starting an academic rotation, you will likely be given a large-group teaching assignment in addition to other small-group opportunities. Similar to L.R.’s reaction to the cardiology topic assignment, this can be overwhelming. The apprehension often comes from the aspect of speaking in front of a large group. Planning and delivering this lecture can require a significant amount of time that consists of writing objectives, developing the presentation, and writing test questions. It is integral to meet with the appropriate course director or other faculty members early to identify the overarching goals for the assigned session and where it fits in with the other content students are learning. Understanding what the students have (or have not) already learned in class will allow you to develop the lecture at the appropriate level and may provide opportunities for building on previous material. Before jumping in, you should also be aware of any course standards with regard to learning objectives (e.g., how many objectives should be written), style of presentation (e.g., PowerPoint^® versus discussion or cases), and the number and format of test questions that will be expected from the session. First, identify the session’s objectives because they will drive the important content areas that you will cover as well as the test questions that you will write. Well-written objectives will be beneficial to both the teacher and learners.

In pharmacy education, the traditional presentation style for a didactic session is often centered on the content expert delivering a large amount of information via PowerPoint^® slides. Use of this technology has potential benefits, such as ease of conveying information, student comfort, and decreased anxiety by the lecturer. However, using presentation software has potential limitations, such as conveying overwhelming amounts of information, asking the learner to simultaneously focus on both the slides and the presenter’s narrative, and putting the learner in a passive role. The books Beyond Bullet Points, Presentation Secrets of Steve Jobs, and Presentation Zen highlight key concepts to develop when delivering a presentation.^5-7 These concepts are designed to transform a traditional slide presentation that is overwhelmed by text and bullets to a presentation that minimizes the amount of text and uses more images, allowing the learner to focus on the presenter.

Some of the concepts that can apply to all teachers include:

• Planning in analog. Rather than jumping right into filling the slides in on your computer, take a step back to map out and plan the presentation. This will help you avoid putting excessive information on slides and allow for a consistent message throughout.
  
• Make it personal. Rather than just talking about a disease state or treatment regimen, talk about how this will directly apply to the students or the patients they may be treating via use of a patient case.
  
• Use the rule of three. Long-term memory is lost when the brain is inundated with large amounts of information. Breaking the topic into three clearly defined categories or main points may allow for better retention.
  
• Create visual slides. The focus on creating slides should be to supplement the speaker, not replace the speaker. Therefore, slides should be free of clutter (bullets and text) and replaced with relevant images and taglines that are easy to remember. Images used must be relevant to avoid distraction. Unrelated clipart or other images should be avoided unless they directly relate to the text or point being made.
  
• Make numbers meaningful. Large numbers are often lost in long-term memory because they are hard to grasp or relate to. For example, you may supplement “46 million Americans are smokers” by saying “on average, one out of every six students in this room uses tobacco.”
  
• Practice. A good lecture should emulate a sales pitch in terms of intentional planning and practice. The practiced presenter will be more enthusiastic, engaging, and adept at facilitating group discussion.

Keeping students engaged can be a challenge with today’s learners. Teachers are often competing for students’ attention with technology-related distractions such as e-mail, instant messaging, texting, and social media. Therefore, consideration should be given to using an active presentation style (e.g., use of handouts, multimedia, etc.) to grab the learners’ attention. If adequately constructed and delivered, active learning provides a change of pace in the classroom and allows the students to actively participate in their own learning rather than passively sitting and listening. A few examples of active learning techniques are outlined in Table 12-1.

Although the benefits of engaging students via active learning may be apparent, these techniques may not always be well received if done without much thought and planning. In addition, several challenges exist in changing the dynamic of the traditional lecture-oriented classroom, such as student comfort with traditional didactic lecture, student expectation of the teacher telling them what they need to know, and the expectation for the student to actively participate.

As you get ready to enter into the large classroom, the following items should be considered:

TABLE 12-1. EXAMPLES OF ACTIVE LEARNING TECHNIQUES

• There is no “right” way to lecture. An effective style should be one that is measured by student learning and may vary from one teacher to another, depending on the style of the presenter, the unique characteristics of the learner, and the topic being presented.
  
• Consider varying your methods during the class (e.g., lecture, cases, clicker questions, small-group work, etc.). This will help to engage students with different learning styles and will keep students attentive by changing the pace.
  
• When it comes to content, less is more. In a 1- or 2-hour lecture, it is easy to try to transfer as much knowledge as possible. However, the retention of that material by an overwhelmed learner will be minimal. Therefore, consider supplementing the lecture with readings or cases to free up some of the lecture time.
  
• Consider using active learning techniques (e.g., clicker questions, mini-cases, etc.) strategically to break up the lecture and keep students attentive. For example, the presenter may consider doing an active learning technique every 15 to 20 minutes rather than presenting all the material at the beginning and then doing cases or some other active learning technique at the end.
  
• Use the time at the beginning of class wisely. Student retention of material covered at the beginning of class is high compared to the end of class. Rather than spend a great deal of time reviewing objectives or logistics related to the course, consider jumping right in to set the tone of the session.
  
• Like it or not, teaching has a performance side to it. Be cognizant of your voice, mannerisms, gestures, movements in the classroom, pace, and other factors. Consider recording your presentation to identify gestures that you may not be aware of. A common mistake is to focus so heavily on the content that the delivery is overlooked.
  
• When asking questions, communicate a true interest in receiving input from the class. Avoid asking a question, glancing at the room, and then providing a response. This approach will not encourage future participation among the learners.

CASE QUESTION

L.R. is getting ready to work on her 2-hour class session. What questions should she ask about her audience?

Small-Group Teaching

You will likely be asked to participate in some small-group teaching experiences, including journal club discussions, physical assessment workshops, or breakout sessions. Although you may be more comfortable with small-group teaching, the amount of planning should not be underestimated for a successful group encounter. The large-group or lecture-type setting may be beneficial to introduce a topic, whereas a small-group or breakout session may be valuable to apply the information learned.

Besides providing an opportunity for application, several other benefits to small-group teaching exist:

• Compared to a lecture environment, students working in groups to solve problems and other tasks tend to learn and retain more information.
  
• Small-group sessions allow students to understand and experience the importance of working in teams to share ideas and provide feedback. This is essential to mirror what will happen during pharmacy practice experiences and residencies.
  
• These sessions allow students to express ideas verbally rather than on a multiple-choice exam. For example, a student may have to verbalize how he or she would prioritize, assess, and plan for a series of problems a patient is having rather than answer a multiple-choice question that does not require any rationale or feedback from peers.
  
• Having a high-functioning group allows the members to ask questions of each other and provide feedback in a welcoming environment that encourages further learning. This environment allows the student the opportunity to receive immediate feedback.
  
• A small-group setting encourages more self-directed and independent learning that will be experienced on rotation and in practice.
  
• A small-group setting allows for an intimate discussion where students may be more willing to participate than in a large-group discussion.

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