Building upon content with increasing complexity

Participants made reference to the benefits of revisiting material throughout curricula in order to refresh knowledge. HP7 went further in describing the benefits of a “spiral curriculum” in which topics are repeatedly encountered with increasing difficulty. As previously mentioned HP7 has involvement in

the education of medics, hence a potential deeper understanding of such educational concepts.

HP7: “I prefer it with medical students to be honest because you know

like the spiral curriculum, building on something each week, progress and pushing and pushing and pushing and increasing that knowledge stream aren’t you throughout the time frame…”

CP3 and CP4 both referred to the requirement to revisit over-the-counter (OTC) teaching throughout the undergraduate programme. Both interviewees have undertaken further postgraduate studies in education and so their

perceptions may be influenced by their increased awareness of education principles.

BB: “What can schools of pharmacy do to improve their over the

counter knowledge?

CP3: I think partly possibly it’s because it’s visited early in the course.

So perhaps if you could maybe somehow integrate it all the way through. Um, and I know it’s not like not necessarily put in there but they do that responding to symptoms 1st year stroke 2nd year and then it’s like okay we move on to really more important things and actually like actually well that’s still important

BB: ah ok

CP3: so maybe if we could just sort of revisit it a little bit more or

incorporate it into other things so it’s still at the forefront of their mind later in the course?

BB: What about their OTC knowledge? How is that? CP4: [pulls face]

BB: [laughs]

CP4: Not great…most of the OTC stuff was covered in year two

before so I don’t know if it’s still that and if they continue to practice in

community pharmacy they retain those skills and they are on the forefront of any new products that are coming…”

4.4.4.2 A patient centred approach

Employers were keen for students to experience integrated teaching where science and practice are embedded in patient scenarios. Segregating learning into different modules was viewed as problematic where students cannot assimilate learning from different areas.

CP11: “…the problem we’ve got with the way pharmacy is taught from

when I was taught is it’s modular…they don’t think of the patient as a

complete patient they think of them as, well that was module 2 and that was cardiovascular. Respiratory was module 3 of year 2…I’ve looked after pre- reg for quite a few years now and I would say their clinical knowledge is probably worse than it’s ever been and I think the issue is this modular aspect.”

HP2: “I would probably make it, take away some of the science focus

or maybe again trying to integrate some more of the science stuff with some of the clinical stuff”

There were mixed opinions between employers on the value of role-play. Some participants valued its use in contextualising learning for students and providing a safe opportunity to practise, whilst others considered its value to be limited.

HP5: “…well it could be a case of setting up joking consultations

between pharmacist and prescriber because I know they do that… that situation where someone pretends to be a doctor, someone pretends to be a pharmacist or nurse and I think that forces you to think about things more then and have to explain your justification. Because as soon as they have to explain their justification they start realising what they don’t know and what they haven’t looked up.”

CP1: ”…maybe not enough time with real people, real patients. As

opposed to role acting or whatever. Because it’s NOT the same

[laughs]…they know they are acting as opposed to getting a real patient in” CP13 “:…lets do the role play, all this kind of rubbish, but actually role play doesn’t develop you for what really happens”

Having the patient at the centre of learning through case studies at university was viewed as positive in allowing students to make their knowledge more practical. However CP14 held strong negative views about pure Problem Based Learning (PBL) curricula. This may be attributed to her own preferred learning style.

HP7: ”…so things like case based discussions and a little bit maybe

about what they do at diploma level I think that would certainly help for hospital pharmacy…I think it would make them a little more clinical and a little more practical rather than just recalling facts…”

HP10: “I’ve seen students from [University C], they seem to have had

a lot more exposure in terms of clinical and problem solving type teaching, they seem to be a lot more knowledgeable in the clinical setting”

CP14: “…they all do this…what do they call it? Is it problem based? BB: like problem based learning?

CP14: I think so, rather than actually be…and I know there’s room for

both, but I felt that a lot of the knowledge was superficial…maybe I’m an old fashioned girl…I couldn’t have learned like that”

4.4.4.3 Learning with and from others

Having the opportunity to work in groups in undergraduate curricula, to allow discussion between learners, was a notion supported by employers. In particular employers placed emphasis on the benefits of smaller group teaching as opposed to whole cohorts. HP7 highlighted that an element of “peer pressure” in such group learning environments can be a positive contribution.

HP7: “I think because it’s such a big year group they don’t get that

small group teaching and that discussion and that ability to sort of channel that information out…you don’t have discussion or the ability to sort of pull out that information from them…everybody has to chip in…I think it just kicks them a little more to start thinking practically about how to do things. I think also they generate ideas from each other as well and that’s quite useful for teaching because scenarios come up that you wouldn’t necessarily get if you stood up and did it as a classroom presentation, those questions wouldn’t get asked because people would be embarrassed to ask those questions”

CP4: “…on training days they tend to work better if they are in smaller

groups they tend to gel better rather than being in a larger number.”

In particular Inter-Professional Education (IPE) i.e. occasions when two or more professions learn from and about each other (Lakhani and Anderson, 2008) was discussed. Perceived benefits included potential for greater understanding of each other’s roles and increased confidence in inter- professional communications.

CP1: “maybe have some joint sessions with doctors, dentists,

CP3: “So if they’re phoning the doctor it’s like “oooh, I’ve got to phone

the doctor” and put the doctor up on a pedestal rather than talking as an equal.

BB: what do you think leads to that?

C3: [sighs] [pause] I don’t know whether it just goes back to the

public’s perceptions of different roles. Could be even as basic as that. I think actually having IPL should help because you know you’re actually going to be learning alongside each other and respecting each other.”

CP04: “…But exposing them to as many different teams they possibly

can during their undergraduate will then allow them, and I think all the stuff that’s going on with the inter-professional learning, getting them to work with sort of nurses and medics earlier on will give them more confidence then in dealing with those sort of situations when they’re in, well I say you know the real world I guess

A caviat to providing IPE is that provision should be rationalised in order to guarantee its usefulness to both parties.”

One participant discussed the role of multi-professional education, which involves two or more professionals learning the same content side by side where as IPE focuses on practitioners learning together for the benefit of the user (Lakhani and Anderson 2008).

BB: ”what was it about [University D]…

CP11: well it’s funny because I think the first year they’re taught with

medics and medics aren’t taught pharmacy. So why would you want to spend a year with medics? You know, you might be learning anatomy and anything else like that.…”