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Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
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Currents in Pharmacy Teaching and Learning
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Experiences in Teaching and Learning
Using a course pilot in the development of an online problem-based
learning (PBL) therapeutics course in a post-professional PharmD
Jeff J. Naggea, , Rosemary Killeena, Brad Jenningsb
School of Pharmacy, University of Waterloo, 10 Victoria St. S, Kitchener, ON, Canada N2G 1C5
University of Guelph, Johnston Hall, Room 160, Guelph, ON, Canada N1G 2W1
Problem-based learning
Distance education
Course pilot
Background and purpose: To assess whether the traditional problem-based learning (PBL) process
can be replicated in an online environment, and to identify any barriers and facilitators to
learning using a course pilot.
Educational activity and setting: Eight alumni and one experienced tutor participated in a twoweek simulated PBL course comprised of two three-hour synchronous online tutorials.
Blackboard Collaborate® software was used to permit audio and visual interaction. The PBL tutorials were recorded and observed by the researchers. Participants completed satisfaction surveys after the pilot, and were invited to take part in a focus group to debrief about their experience.
Findings: Once the steep learning curve with the technology was overcome, the quality of the PBL
process was similar in the online course as it was in the face-to-face course. Several key factors for
success were identified through analysis of the videotaped sessions, and interviews with the
participants in the course pilot.
Summary: Conducting a course pilot study demonstrated that an online PBL course is feasible,
and identified some considerations to facilitate success
Background and purpose
The School of Pharmacy at the University of Waterloo created a bridging program to allow their bachelor of pharmacy graduates
to earn a doctor of pharmacy (PharmD) degree via distance learning. Our preference was to utilize a problem-based learning (PBL)
approach in the delivery of the Advanced Topics in Patient Focused Care course (PHARM 495).
PBL is pedagogy that uses a problem to guide student learning.1 When reviewing the literature, it is important to note that the
term PBL lacks a universal definition.1 Several studies that purport to evaluate PBL may in fact be evaluating pedagogies that more
closely resemble a modified case-based approach.2–6 The PBL approach employed in the final therapeutics course delivered in the
undergraduate pharmacy curriculum at the University of Waterloo was developed using Barrow's concept of a closed-loop, problembased approach.6 This concept involves five steps: (1) students are placed in teams of six to eight, 2) meet to develop learning
objectives for the problem under the supervision of a pharmacist tutor, 3) independently research their learning objectives, 4) meet
again with a pharmacist tutor present to discuss the learning objectives and how they apply to the problem, and 5) reflect on their
learning and process to identify areas for improvement. There is some evidence that pharmacy students perform better on
Corresponding author.
E-mail addresses: (J.J. Nagge), (R. Killeen), (B. Jennings).
1877-1297/ © 2017 Elsevier Inc. All rights reserved.
Please cite this article as: Nagge, J.J., Currents in Pharmacy Teaching and Learning (2017),
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
J.J. Nagge et al.
examinations when material is introduced using PBL compared to traditional, lecture-based methods.7 However, the main reason
why we implemented PBL in our final bachelor of pharmacy therapeutics course at the University of Waterloo was to foster skill
development in the areas of literature searching, critical appraisal, evidence-application, and clinical problem-solving. Delivering the
bridging PharmD therapeutics course using any methodology other than PBL would be a regression from the student-centered, activelearning approach that graduates of the University of Waterloo had grown accustomed to.
We recognized that significant modifications would be required to transition from the face-to-face interactions in the on-campus,
undergraduate PBL course to an on-line module delivered via distance learning. A search of Medline (OVID 1946 to March 14, 2017)
“internet” < or > “online
systems” < or > “computers”
Pharmacy” < or > “Education, Pharmacy” < or > “Education, Pharmacy Graduate” < and > “Problem-based learning” failed to
find any articles describing a transition from a course that is delivered using the closed-loop PBL to one delivered using a synchronous
online PBL format for post-graduate pharmacy learners. To understand the scope and types of possible modifications required, we
believed a pilot study would help determine how to tailor the traditional PBL process into a fully online learning environment. Our
primary goals were the following: (1) establish whether participants could achieve the required learning outcomes with currently
available resources; (2) identify any barriers or facilitators that could impact usability and participant learning; and (3) establish
what, if any, additional forms of support were required by participants and/or facilitators to ensure successful completion of the
Educational activity and setting
The final therapeutics course of the undergraduate bachelor of pharmacy program at the University of Waterloo is delivered using
principles of PBL. Students are placed into groups of seven or eight by the instructor, and meet once weekly for a three-hour tutorial
under the supervision of a pharmacist tutor. In the first tutorial, students develop learning objectives for a paper case that they are
provided at the start of the tutorial. They are then given five hours of protected time in the curriculum over the next week to
independently research their learning objectives. Each student is required to research every learning objective. The students reconvene in their tutorial groups a week later to discuss their research using the framework of the learning objectives, and to work as a
team to apply concepts and data to the patient described in the paper case. They finish the tutorial by developing learning objectives
for the case that will be discussed the following week, and the process continues for the remainder of the course. The pharmacist tutor
does not teach; rather, their duties are to ensure the students develop appropriate learning objectives, discuss the information at
suitable depth, and use critical appraisal skills when evaluating and applying information. The tutor also performs assessments of
individual student performance at the midterm and final evaluations.
Eight alumni of the bachelor of pharmacy program and one tutor were recruited to participate in a two-week simulated PBL
course comprised of two three-hour synchronous online tutorials. The alumni, who served as the students for the pilot, and the tutor
all had experience with traditional face-to-face problem-based learning. The course pilot was delivered using LEARN® (D2L), the
learning management system employed by the University of Waterloo, and Blackboard Collaborate® software, to permit audio and
visual interaction. During the first tutorial (day 0), the students met online at a mutually agreed upon time to develop learning
objectives for the PBL case under the supervision of the tutor. Two weeks later (day 14), they met online to discuss the learning
objectives they had researched during their independent study. This process mirrors the PBL model used in the undergraduate
PharmD program at the University of Waterloo, with the exception that an extra week was provided in between tutorials to accommodate work schedules of the distance students. The PBL live sessions were recorded for later observation and analysis.
A post-pilot user experience study design was employed to further understand the implications of the initial course design. The
user experience study was based on Nielsen's8 usability engineering methods (commonly used to assist with improving website
design, applications, and other products) and his premise that five users will typically identify the majority of usability issues.
Nielsen9 states that while there may be circumstances that require fewer or more users, in most cases five users will suffice. Four
sources of data were used, all compiled within four weeks of the completion of the pilot: (1) student participants completed satisfaction surveys; (2) student participants were invited to take part in a focus group to debrief about their experience with one of the
researchers (B.J.); (3) the tutor was debriefed independently from the students about his experience by two of the researchers (B.J.
and J.N.); and (4) all researchers reviewed both of the recorded tutorial sessions to describe how students and the facilitator interacted, as well how the software impacted those interactions.
Investigators analyzed the four sets of data using a modified developmental evaluation approach to inform final course production
decisions.9 This technique involves a consideration of what was seen (i.e., what are the indicators of the phenomena? what patterns
are emerging?), the implications of what was seen (i.e., what are the possible impacts on learners, faculty, or the program currently,
what are the possible impacts on learners, faculty or the program in the future?), and what should be done (i.e., what are the options,
what are our resources or what resources do we need?). It is a new and emerging approach “in which those involved discover answers
to their own situationally specific questions.”10 No software was used for data analysis. Approval for this study was obtained from the
Office of Research Ethics, University of Waterloo, Waterloo, Ontario, Canada.
Seven out of eight students completed the satisfaction survey (87.5% response rate) and seven out of eight students participated in
the focus group. The one student who could not attend the focus group provided an email copy of their answers to the questions.
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
J.J. Nagge et al.
Student and tutor feedback from course survey and focus groups
No students felt that they were unable to active the learning objectives set for the case discussed in the course pilot. However, a
steep learning curve with the communication technology was identified. The consensus of students and the tutor was a requirement
up to an hour to install video cameras and/or microphones, and some extra time to experiment with the Blackboard Collaborate®
software. Both the students and the tutor highlighted various nuances of carrying out PBL across distance. Not being in the same room
as each other made it difficult to read non-verbal communication cues (e.g., student 2 “…I found it difficult, the actual physical
discussion difficult. Everyone was a little bit more hesitant to get in on it because you don’t want to talk over each other…”), and
some delays in the audio and video feed led to choppier discussions at times (e.g., student #6 “…(with respect to technology) I guess
things were kind of slow or sometimes things were fading in and out…”). It was noted by three participants that the conversational
flow improved significantly in the second tutorial (e.g., student 2 “…I think that our second session went reasonably better than our
first session”). The tutor suggested that the course instructor provide detailed training for all subsequent tutors on the communication
software, and to offer a mock-tutorial for practice. He felt this was important because even as an experienced PBL tutor, he was
surprised at how different the online version was from a tutor perspective. One specific example he provided: in the face-to-face
format, the uncomfortable silence that occurs when students in the same room are stuck on a concept can serve as a stimulus for more
discussion. However, in the online experience, silences were sometimes prolonged, and the tutor felt this might be because everyone
was at home and comfortable in their own environment. Another example was how he believed that one of his major roles in the
online course would be to help with students with the etiquette of participating in an online discussion. This is something that is not a
role of the tutor in the face-to-face PBL sessions in our undergraduate curriculum. He thought that making new tutors aware of some
of these nuances would be important prior to their first live session.
Researcher observations of taped tutorial sessions
The students required more time to develop their learning objectives during the first tutorial than they typically do in the face-toface PBL course. However, the depth of content discussion during the second online tutorial was like that expected of students in faceto-face PBL courses. The time allotted to complete the discussion of the learning objectives was appropriate (three hours, as in the
face-to-face PBL tutorials).
Barriers to, and facilitators of success
One student did not have access to high-speed internet, and this caused a slow-down in the connection speed for all users. Two
students were in an environment with background activity that caused distractions for other group members.
There were several useful findings from our pilot study. First, once the students and tutor were comfortable with the technology,
they found the method of delivery acceptable and the students could attain the learning outcomes that were specified for the case.
This achievement is important from both educational and practical perspectives, as students enrolling in the actual version of the
course reside across North America, which makes a face-to-face PBL interaction impossible. Second, we identified barriers to and
facilitators of success. To help students and tutors adapt to the differences between the online and face-to-face PBL sessions, the first
tutorial in the actual course is assessed formatively. This means that the first tutorial session is not included in the midterm tutorial
assessment grade; rather, tutors simply provide verbal feedback at the end of the first tutorial session about what went well, and what
should be improved upon for the next session. By providing this feedback without an associated grade, the first tutorial can be
considered a practice session, allowing participants to be comfortable making mistakes with technology as they develop experience
using it. Since all students who enroll in the actual course are familiar with PBL from their undergraduate degree, they will not need
additional time to adapt to this learning style. Also, the minimum technology requirements are made clear to students prior to course
enrollment. Students who fail to adhere to these requirements in the actual course risk losing professionalism marks, because it was
found that this is detrimental to the experience of all learners.
Finally, we learned that enhanced tutor training and supports would be required to recruit and retain good facilitators. Because of
the feedback from this pilot, we offer all new tutors a 1.5‐hour training session for the communication software, access to a 24‐hour IT
support line, and have created a detailed frequently asked questions (FAQ) document that includes tips for dealing with the nuances
between the online and face-to-face versions of the PBL course.
Our pilot study is limited by a relatively small sample size of eight students and one tutor. This number of participants was chosen
as it is the exact size of a tutorial group in the face-to-face version of the PBL course on campus. Despite the small numbers of
participants, we generated some very useful considerations that aided us in the development of the actual course.
Conducting a course pilot study demonstrated that an online PBL course is feasible in a distance education pharmacy program,
and identified some considerations to facilitate success.
Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx
J.J. Nagge et al.
We would like to Eric Schneider, PharmD, Assistant Dean and Professor, School of Pharmacy, Wingate University for his assistance with this project. We also want to acknowledge the test students who volunteered to participate in the pilot study: Artyom
Korenevsky, Amanda Tavone, Patricia Stefanscisc, Jenny Reid, Allam Hallan, Kim Adamczyk, Denise Kreutzwiser, Kayleigh Sinasac
and our volunteer test tutor, Stephan Sadikian.
Financial disclosures
Conflicts of interest
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