Pharmacy schools nationwide are currently experiencing a decline in admission applications and an increase in the number of academically struggling students in their programs. Thus, schools of pharmacy are not only searching for effective ways to increase enrollment of qualified candidates but are also focusing on the development of programs to improve academic performance and retention of enrolled students.

 

Our students struggle academically for a number of reasons:

1. personal issues such as those involving jobs or family,
2. mental disorders or conditions such as attention deficit disorder, anxiety, or depression,
3. lack of academic skills,
4. deficiencies in prerequisite knowledge, and/or
5. lack of motivation and discipline to meet the requirements necessary to succeed in a rigorous professional degree program.

Some students may be helped by resolving the underlying personal or medical issues.  For the others, we have developed an academic performance enrichment program (APEP) aimed to improve academic skills (e.g. study skills, time management skills), comprehension of course material, metacognition, discipline and accountability with the overall goal to decrease course failures and to improve retention.

During the first year of our Pharm.D. curriculum, students complete a two-semester (10-unit) integrated biological sciences course sequence (BSI I & II) which integrates biochemistry, cell biology, physiology, and pathophysiology.  The summative assessments include 4 exams and a comprehensive final in each semester. Formative assessments include worksheets and assignments, which are not submitted to the instructor, and various in-class active learning activities. BSI is the course in which the first year pharmacy students struggle the most. BSI is a prerequisite for most other advanced courses, so it is required to pass in order to complete the program in 4 years. Furthermore, a failure in BSI I is highly predictive of a student struggling throughout the program. Thus, developing a means to improve academic performance is imperative to facilitate success. Historically, we have found that traditional one-on-one or small-group peer-tutoring did not lead to significant improvements in academic performance or course failure rates. Feedback from the peer-tutors revealed that tutees did not adequately prepare for the tutoring sessions and were passive participants in the tutoring process.  We have also observed that most of the students struggle in BSI and the first year pharmacy curriculum due to lack of academic skills and/or lack of motivation and discipline to implement the skills rather than difficulty in understanding course content. Therefore, the APEP includes academic skills training and student accountability to be active participants in the tutoring process.

The APEP is comprised of structured group tutoring sessions which are 1.0-1.5 hours twice per week, led by graduate assistants (2^nd year pharmacy students).  At the beginning of each week, the students are emailed instructions as to what to prepare and expect for the sessions that week.  They are asked to develop a 15-question multiple choice quiz from the specified BSI material and to complete worksheets or assignments that coincide with each BSI course lecture note set. At each session, the students exchange and complete the quizzes followed by discussion of wrong answers among each other.  The students then complete various activities which may include drawing specific diagrams, flowcharts, or pathways that were assigned to learn for the session. The students are expected to complete the drawings from memory and then work together to fill in any missing information. The graduate assistants discuss active study methods most effective for learning the particular course content, along with the importance of continuous self-testing. We have observed that linking the discussion of study methods to specific material is more effective than giving general study skills advice, which low performing students often ignore and/or do not know when or how to apply.  Each session also includes a question and answer period where the students can ask questions for clarification and the graduate assistants ask higher order questions to probe their level of understanding. The students submit their quiz grades, completed worksheets, and drawings to the graduate assistants in order to track attendance and preparedness for the sessions.  Procrastination and the underutilization of active studying techniques are common among our low performing students; the completion of the assignments in preparation for and during each session is aimed to prevent these unfavorable habits.  To improve metacognition we have incorporated two activities. Before each BSI exam, the APEP students predict the grade they will receive based on their self-perceived preparedness and understanding of the material.  After each exam, they are required to meet with the course instructor to review the questions that they missed and then to write a paragraph with their insights as to why they earned the grade and what they plan to do differently to improve on the next exam. In the BSI course, all students are encouraged to meet with the professor to review their exam; however, the lower performing students often do not follow through. Thus, we have made it a required piece of the APEP.

Students with an average BSI course grade below 73% at any point during the semester are required to attend the APEP sessions until their course grade exceeds 73% (<69.5% is a failing grade). Most of the students attend the sessions and complete the required tasks without being pressed. However, a small percentage require further enforcement which includes a meeting with the Director of the APEP and the Assistant Dean of Academic Affairs. Typically, such a meeting leads to improved engagement in the APEP. So far, only 1 student out of 35 who have participated in the APEP has continued to skip required sessions.

The APEP was implemented in the fall semester of 2017. Preliminary data indicate that the program is effective for improving academic skills and performance. The failure rate in BSI I decreased by 36% compared to the previous two years. For those who entered the program after performing poorly on an exam, the APEP was deemed effective to improve performance on the following exam.  For example, 80% of the students who were required to join the APEP after Exam 1 improved on Exam 2, while only 29% of the students who scored between 74-79% on Exam 1 (and not required to attend the APEP) improved on Exam 2.  86% of the students in the APEP after Exam 2 improved on Exam 3, compared to 54% of the comparative group who did not attend the APEP. 65% of the students in the APEP after Exam 3 improved on Exam 4, compared to 38% in the comparative group. 78% of the students in the APEP after Exam 4 improved on Exam 5 (comprehensive final exam), compared to 36% in the comparative group.  We do not know yet if the APEP was effective at reducing the failure rate in BSI II, since the semester is still in progress.

According to a survey, the majority of APEP attendees believed that the program helped:

1. to improve study skills by incorporating more active studying techniques,
2. to prevent procrastination of studying,
3. to study with more intent by having quizzes and assignments to complete for each APEP session,
4. to improve understanding of the course material and
5. to identify course content that they did not fully understand.

A program such as this requires active engagement to be effective; what you put into it, you get out of it. 68% of the APEP students believed that they came to each session as prepared as they should have been.  The biggest struggle has been to find an effective means to increase this number to closer to 100%.  The APEP will continue to evolve as we strive to meet the 100% mark and to reduce the failure rate even further.

Amie Dirks-Naylor is Professor and a member of the founding faculty at Wingate University School of Pharmacy in North Carolina where she teaches the basic sciences to the first-year pharmacy students. She earned her Ph.D. in Exercise Physiology (minor in Biochemistry and Molecular Biology) from the University of Florida, her M.S. from San Diego State University, and B.S. from the University of California, Davis.  She completed her post-doctoral research at Stanford University School of Medicine in the department of Radiation Oncology.  Her current research interests include mechanisms of adverse drug effects involving oxidative stress and apoptosis, physiological effects of lifestyle modifications, and the scholarship of teaching and learning.