Mary T. Roth

The Flipped Classroom: A Course Redesign to Foster Learning and Engagement in a Health Professions School

Recent calls for educational reform highlight ongoing concerns about the ability of current curricula to equip aspiring health care professionals with the skills for success. Whereas a wide range of proposed solutions attempt to address apparent deficiencies in current educational models, a growing body of literature consistently points to the need to rethink the traditional in-class, lecture-based course model. One such proposal is the flipped classroom, in which content is offloaded for students to learn on their own, and class time is dedicated to engaging students in student-centered learning activities, like problem-based learning and inquiry-oriented strategies. In 2012, the authors flipped a required first-year pharmaceutics course at the University of North Carolina Eshelman School of Pharmacy. They offloaded all lectures to self-paced online videos and used class time to engage students in active learning exercises. In this article, the authors describe the philosophy and methodology used to redesign the Basic Pharmaceutics II course and outline the research they conducted to investigate the resulting outcomes. This article is intended to serve as a guide to instructors and educational programs seeking to develop, implement, and evaluate innovative and practical strategies to transform students’ learning experience. As class attendance, students’ learning, and the perceived value of this model all increased following participation in the flipped classroom, the authors conclude that this approach warrants careful consideration as educators aim to enhance learning, improve outcomes, and fully equip students to address 21st-century health care needs.

Health Literacy: A Review

Illiteracy has become an increasingly important problem, especially as it relates to health care. A national survey found that almost half of the adult population has deficiencies in reading or computation skills. Literacy is defined as the basic ability to read and speak English, whereas functional health literacy is the ability to read, understand, and act on health information. Up to 48% of English‐speaking patients do not have adequate functional health literacy. The consequences of inadequate health literacy include poorer health status, lack of knowledge about medical care and medical conditions, decreased comprehension of medical information, lack of understanding and use of preventive services, poorer self‐reported health, poorer compliance rates, increased hospitalizations, and increased health care costs. The medical community must acknowledge this issue and develop strategies to ensure that patients receive assistance in overcoming the barriers that limit their ability to function adequately in the health care environment.

Pharmacy student engagement, performance, and perception in a flipped satellite classroom.

Objective. To determine whether “flipping” a traditional basic pharmaceutics course delivered synchronously to 2 satellite campuses would improve student academic performance, engagement, and perception. Design. In 2012, the basic pharmaceutics course was flipped and delivered to 22 satellite students on 2 different campuses. Twenty-five condensed, recorded course lectures were placed on the course Web site for students to watch prior to class. Scheduled class periods were dedicated to participating in active-learning exercises. Students also completed 2 course projects, 3 midterm examinations, 8 graded quizzes, and a cumulative and comprehensive final examination. Assessment. Results of a survey administered at the beginning and end of the flipped course in 2012 revealed an increase in students’ support for learning content prior to class and using class time for more applied learning (p=0.01) and in the belief that learning key foundational content prior to coming to class greatly enhanced in-class learning (p=0.001). Significantly more students preferred the flipped classroom format after completing the course (89.5%) than before completing the course (34.6%). Course evaluation responses and final examination performance did not differ significantly for 2011 when the course was taught using a traditional format and the 2012 flipped-course format. Qualitative findings suggested that the flipped classroom promoted student empowerment, development, and engagement. Conclusion. The flipped pharmacy classroom can enhance the quality of satellite students’ experiences in a basic pharmaceutics course through thoughtful course design, enriched dialogue, and promotion of learner autonomy.

Self-reported medication use in community-residing older adults: A pilot study

BACKGROUND Older adults (ie, those aged > or = 65 years) are at increased risk of developing drug therapy problems, which may lead to poor health outcomes and decreased quality of life. OBJECTIVE The primary goal of this pilot study was to evaluate and report medication use and potential drug therapy problems in older adults who received Eldercare program assistance through the Orange County Department on Aging in North Carolina. METHODS Between May and July 2002, subjects were consecutively sampled from a registry of adults aged > or = 60 years enrolled in the Eldercare program. To be eligible for the study, individuals had to be receiving the services of the Eldercare program, speak English, and reside independently in the community of Orange County. The older adults were contacted by the program director to determine interest in participating in the study. If interested, the individual was contacted by a trained pharmacy doctoral student to verify study eligibility and arrange a home visit. At the home visit, information was collected via self-report on medication use and medical history. Nonadherence, potentially inappropriate prescribing, health literacy, and functional capacity were also assessed. All home visits were conducted between May and July 2002. RESULTS A total of 100 subjects were interviewed. The mean (SD) age of respondents was 77.5 (8.7) years; 85% were women, 66% were white, 34% black, and 70% lived alone. The mean (SD) number of prescription medications used per patient was 9.6 (4.1). Adequate health literacy, defined as a score > or = 23 (range of possible scores, 0-36) on the Short Test of Functional Health Literacy in Adults, was documented in only 35% of individuals. Twenty-five percent of the sample (25/100) had reduced functional capacity when evaluated on the Functional Activities Questionnaire, with total scores > or = 10 (range of possible scores, 10-30) indicative of reduced functional ability. Rates of nonadherence, defined as a score of 0 to 3 on the 4-item Morisky instrument, were 53%. When evaluating inappropriate prescribing based on the Beers criteria, 34% of individuals used > or = 1 potentially inappropriate medication. In bivariate analyses, there was a statistically significant relationship between race and number of medications (P < 0.002), adherence (P < 0.001), health literacy status (P < 0.001), and functional capacity (P < 0.027). No differences were noted when examining the effects of age on the same variables. CONCLUSIONS In this study, older adults residing independently in the community were responsible for managing and taking a considerable number of medications on a daily basis. In addition, inadequate health literacy, poor adherence, and potentially inappropriate medication use were prevalent in this sample. The results also suggest that race may have played an important role in the risk of developing medication-related problems.

Secondary Prevention of Coronary Heart Disease in the Elderly

OBJECTIVE: To review relevant literature supporting the use of aspirin, β-blockers, lipid-lowering agents, and angiotensin-converting enzyme (ACE) inhibitors for the secondary prevention of coronary heart disease (CHD) in an elderly patient population aged ≥65 years. DATA SOURCES: A MEDLINE search (1990–May 2003) was conducted using the key terms coronary heart disease, secondary prevention and elderly. STUDY SELECTION AND DATA EXTRACTION: Primary and tertiary literature relating to the use of aspirin, β-blockers, lipid-lowering agents, and ACE inhibitors in the elderly were reviewed. DATA SYNTHESIS: CHD is the leading cause of morbidity and mortality in persons ≥65 years of age, and the use of pharmacologic agents has created a considerable opportunity for reducing recurrent events in those with established disease. This, combined with the aging of the US population, is creating an increase in the number of older adults eligible for secondary prevention. In 2002, the American Heart Association issued a scientific statement on the benefits of specific secondary prevention risk factor interventions in older adults. This article reviews pertinent findings from this statement, along with additional data supporting the use of pharmacologic agents for the secondary prevention of CHD in the elderly. CONCLUSIONS: Data suggest that use of aspirin, β-blockers, lipid-lowering agents, and ACE inhibitors are effective in secondary prevention of CHD in individuals aged ≥65 years. This benefit is similar to, and often greater than, that observed in younger patients. We believe that these agents should be prescribed for all elderly patients without contraindications. Ongoing studies and future clinical trials will more clearly elucidate the benefits of secondary prevention of CHD, particularly in persons ≥75 years of age, to determine the magnitude of benefits that can be achieved in this population.

Evidence for the Cardioprotective Effects of Omega-3 Fatty Acids

OBJECTIVE: To review available literature regarding the cardiovascular effects of marine-derived ω-3 fatty acids and evaluate the benefit of these fatty acids in the prevention of coronary heart disease. DATA SOURCES: Biomedical literature accessed through a MEDLINE search (1966–April 2002). Search terms included fish oil, omega-3 fatty acid, sudden death, hypertriglyceridemia, myocardial infarction, and mortality. DATA SYNTHESIS: Following an early 1970s observational investigation that ω-3 fatty acids may reduce the occurrence of myocardial infarction—related deaths in Greenland Eskimos, additional trials have been conducted that support this finding. Epidemiologic and clinical trial data suggest that ω-3 fatty acids may reduce the risk of cardiovascular-related death by 29–52%. In addition, the risk of sudden cardiac death was found to be reduced by 45–81%. Possible mechanisms for these beneficial effects include antiarrhythmic properties, improved endothelial function, antiinflammatory action, and reductions in serum triglyceride concentrations. ω-3 Fatty acids are fairly well tolerated; potential adverse effects include bloating and gastrointestinal distress, “fishy taste” in the mouth, hyperglycemia, increased risk of bleeding, and a slight increase in low-density-lipoprotein cholesterol. CONCLUSIONS: ω-3 Fatty acids may be beneficial and should be considered in patients with documented coronary heart disease. They may be particularly beneficial for patients with risk factors for sudden cardiac death.

Completeness of prescription information in US commercial claims databases

Pharmacy commercial claims databases are widely used for pharmacoepidemiologic research. However, concerns have been raised that these databases may not fully capture claims for generic medications as a result of patients filling outside the context of their insurance. This has implications for many research activities and quality improvement programs. We sought to estimate the percentage of missing prescriptions in US commercial claims data using a novel design.

Measuring the Quality of Medication Use in Older Adults

The quality of health care in the United States continues to fall short of expectations. A contributing factor is the suboptimal use of medications, a problem that is causing significant morbidity and mortality and costing the healthcare industry billions of dollars each year. Older adults are especially vulnerable to suboptimal quality medication use because of their concurrent medical conditions, multiple medications, and the physiological effects of aging on the use of drug therapy. In addition, older adults and their caregivers are often responsible for managing complex medication regimens. Efforts to measure the quality of medication use in older adults have traditionally focused on inappropriate medications and doses, select indicators of medication appropriateness, or diseases rather than the unique medication needs of individual patients. The goal is to move toward a measure that can account for the complexities of an individuals medication regimen and that is responsive to individual patient values and needs. The purpose of this article is to discuss the benefits and limitations of current strategies to measure the quality of medication use in older adults and, using a case study, illustrate the variations in quality measurement using existing measures. The article concludes with recommendations for moving toward a more‐comprehensive approach to measuring the quality of medication use in older adults.

Student experiences across multiple flipped courses in a single curriculum

The flipped classroom approach has garnered significant attention in health professions education, which has resulted in calls for curriculum‐wide implementations of the model. However, research to support the development of evidence‐based guidelines for large‐scale flipped classroom implementations is lacking.

Development of student professionalism.

In late 2007, the American College of Clinical Pharmacy (ACCP) charged their National StuNet Advisory Committee to formulate tenets of professionalism, with the primary goal of introducing students to essential attitudes and behaviors of professionalism. The committees list of tenets served as a working document for the development of this White Paper. This collaborative effort of the ACCP Board of Regents and the National StuNet Advisory Committee sought to complement other published documents addressing student professionalism. The purpose of this White Paper is to enhance student understanding of professionalism, emphasizing the importance of the covenantal or “fiducial” relationship between the patient and the pharmacist. This fiducial relationship is the essence of professionalism and is a relationship between the patient and the pharmacist built on trust. This White Paper also outlines the traits of professionalism, which were developed after an extensive review of the literature on professionalism in medicine and pharmacy. The traits of professionalism identified here are responsibility, commitment to excellence, respect for others, honesty and integrity, and care and compassion. It is from these traits that student actions and behaviors should emanate. Students, pharmacy practitioners, and faculty have a responsibility to each other, to society as a whole, and to individual patients whom they serve to ensure that their words and actions uphold the highest standards of professional behavior.