Evidence-based impact of experiential learning Professor Ian Bates Head of Education Development School of Pharmacy University of London

European Directive –3000 hours of directed study at 4-5 years’ duration –Greater part of curriculum and not less than 50% of final year must be core –At least 35% on actions and uses of drugs –At least 35% on experiments and data analysis –Research project of 3 – 6 months duration

The professional imperative –Better health care, –Better patient experience, –Better value for money

–Curricular pressures  Integration of pharmaceutical and clinical sciences –Dislocation of education and practice –Not competency-based  Performance of our graduates? –Not a partnership  With national health systems  With existing health professionals What’s holding us back?

Short term vs Long term –Long term  The science of medicines must be foundation of education  Knowledge half-life –Short-term imperatives  Understand and engage with the health agenda

The learning experience Syllabus – knowledge & content Delivery & quality Outcomes Context – institutional, societal & cultural Access, finance & policy What’s holding us back… …curriculum

Assessment Goals Independence Good Teaching Pharmacy students N = 5,243 p< Standardised mean scores The Learning Experience…

–It varies –Is this acceptable? –How can we improve it? The learning experience

the Knowledge problem …pharmacy syllabus is overcrowded chemistrypharmacologybiotechnology geneticsmedicine analysisformulation physical chemistryethicspharmacognosy phytochemistrydrug designimmunology pharmacokineticstherapeuticspathology epidemiology health economicschemical analysis physiologyproteomicsstatistics lawLicensing&marketingADRs microbiologymedicinal chemistrybiochemistry toxicologydrug metabolismgenomics social & behavioural sciences

And so…? –Methods  PBL  Near to patient cases  Clinical contact  Experiential  Subject Integration –Designs  Scientists as practitioners  Adult learning & self-direction  Pragmatic & meaningful in situ LLL

“Experiential” learning –Experience  We all have ‘experiences’  We often learn from an “experience”  Working or work-like  As children….  Anecdotal…. –No real mysterious or obscure theory

The real issue… …getting the “experience” to UG and PG learners (either students or practitioners) –Design –Environment –Outcomes

Competency → Competence → Performance Fit to practise? …outcomes

Miller’s pyramid Does Shows how Knows how Knows performance assessment in vivo performance assessment in vitro clinical context assessment factual assessment From UG to post-registration development

Experiential learning –Should attempt to bring relevant experience to theory –Should therefore illustrate knowledge (working knowledge?) –Should therefore re-enforce primary learning …it should move learning towards the competency agenda…

10% 20% 30% 40% 50% 60% 70% 1996/971997/981998/992001/02 Pharm Care Competencies (OSCE) 60% 30% Graduation One year later McRobbie et al

Skills Behaviours Knowledge Values attitudes Competency “Competence” is a complex educational construct…...with new currency value

An example.. Drug-drug interactions:- –Theory, knowledge –Examples (from lectures, books, case studies, etc) –Exams and questions

Moving from “knowing” (theory)… towards …“doing” (performance)

Miller’s pyramid Does Shows how Knows how Knows performance assessment in vivo performance assessment in vitro clinical context assessment factual assessment From UG to post-registration development

Barriers –Assessment –Resource –Culture

Miller’s pyramid Does Shows how Knows how Knows performance assessment in vivo performance assessment in vitro clinical context assessment factual assessment From UG to post-registration development

Barriers –Assessment –Resource –Culture …there must be a working relationship with the university and the work environment

Joint Programme Board (JPB) Generalist Training (3 years) –Government funding = committment –PG Diploma in General Pharmacy Practice - Core - MI, Technical, Patient & Clinical Services –Common Validation by HEIs in collaborative –Currently 300 practitioner-students (target 2009 = 750) School Pharmacy Univ Brighton Univ East Anglia Univ Portsmouth Medway School King’s London Univ Reading Kingston Univ NHS

Predominantly FDL and e-modes Predominantly face-to-face modes Cohort learners Lone learner On-site (HEI) learning Off-site (work) learning FDL, e-modes off-site, experiential Independent Career driven Learning modality with time/career pathway UG UG/Pre Post-reg Higher

General and Higher level practice: Growing the next generation The next [urgent] challenge… –Competency frameworks for undergraduate education –Assessment of performance at UG level (medicines-centered)

The pharmaceutical imperative –Bring our pharmaceutical science into healthcare practice

Where is our professional ‘centre of gravity’? Patient-focussed, medicines-centred..can only achieve this through a partnership of universities and health care employers (systems)

Mortality rate Index W W W W W W R-Square = 0.16 R-Square = 0.76

Evidence-based impact of experiential learning Professor Ian Bates Head of Education Development School of Pharmacy University of London