The purpose of this article is to discuss basic concepts related to educating the pharmacy staff. Furthermore, this article does not address training delivery, instructor qualifications or the creative aspect of developing training materials. It simply presents a description of key factors to consider when developing educational materials for the pharmacy staff.

Importance of Educating the Pharmacy Staff

Educating the pharmacy staff is important for two primary reasons:

1. It is key to developing the knowledge, skills and abilities inherent to the practice of pharmacy.
2. Healthcare is a constantly changing environment, and ongoing education, on both clinical and operational topics, is necessary to function effectively and efficiently, as well as to provide excellent patient care.

Adult Learning Theory

It is important to note that adults learn differently than youth. The educational model experienced in the traditional classroom placed the ultimate responsibility for learning on the instructor. The instructor determined what the student should learn, how and when the material was taught, and had the final say on whether learning had occurred. The traditional educational model assumes the teacher is an expert and that students have little to offer to the learning environment.

Conversely, adult learning theory recognizes that adult learners, such as pharmacists and pharmacy technicians, bring a wealth of experience to educational endeavors. In addition, adult learners have a complex set of needs and requirements that must be fulfilled for learning to effectively occur. I would like to highlight a few key points that relate to the pharmacy staff and healthcare providers across the spectrum.

Adults spend a considerable amount of time and energy exploring the advantages and disadvantages of learning a piece of information before they are willing to invest time in learning. It is seldom convincing for an adult to be told by someone, even their supervisor, that it would be beneficial for them to learn something new. Therefore, it is important to tell the pharmacy staff why it is important to acquire the new information.

Additionally, adults have a deep need to be seen by others as being capable of taking responsibility for themselves. Too often, education is designed in a manner that places adults back in their childhood where they are told what, where, when and how to learn. Try to include as much search and discovery into the educational event as possible, because it will help the learner feel more self-directed.

Whenever possible, design educational activities should reflect the actual work the staff performs and provide activities that permit the staff to compare the theoretical aspects of the education with their own experiences. Some of the greatest education and training errors have occurred by forcing people into training activities before they perceived a need for them.

Adults, by virtue of life and work experiences, develop a task-centered or problem-centered orientation to learning. If education is developed around problem solving, then adults will learn the content with the actual intention of using it. It is important that the education is designed so the staff is solving problems or performing tasks as closely as possible to those encountered on the job. It is essential that you avoid an “information dump.” Rather, focus activities on “doing” something with information rather than simply “knowing” the information.

Finally, adult learners respond to extrinsic motivators — promotion, bonuses, etc. — up to the point that they are reasonably well satisfied. However, the more potent motivators are intrinsic in nature, such as the need for self-esteem, broadened responsibilities, power and achievement. Once again, members of the pharmacy staff may not be motivated to learn unless they perceive a need to learn. Learning activities should clearly demonstrate to the staff where he or she would benefit.

Problem-Based Learning

Problem-based learning (PBL) is a curriculum development and delivery system that recognizes the need to develop problem-solving skills, as well as the need to help learners acquire necessary knowledge and skills. The first application of PBL, and perhaps the most strict and purest form of it, was in medical schools, which rigorously test the knowledge base of graduates. As such, it is a natural fit for educating the pharmacy staff. The pharmacy staff need to remain current with the latest information in their field. Many medical and professional schools, as well as undergraduate and graduate programs, use PBL in some form, at varying capacities, internationally.

There are several reasons for using PBL, and many of them have resulted from research. For instance, we know that when adults are taught in a traditional lecture format, they retain little of what they learn and often do not appropriately use the knowledge they have acquired.^1,2 Given these findings, educational activities should create conditions that optimize retrieval and appropriate use of the knowledge in future professional practice.

PBL creates the three conditions that information theory links to subsequent retrieval and appropriate use of new information²:

1. Activation of prior knowledge – Learners apply previous knowledge to understand new information.
2. Similarity of contexts in which information is learned and later applied – Research indicates that knowledge is more likely to be remembered or recalled in the context in which it was originally learned.³ PBL provides problems within context that closely resemble future professional problems.
3. Opportunity to elaborate on information that is learned during the problem-solving process – Elaboration provides redundancy in memory structure, reduces forgetting and facilitates retrieval of information. Elaboration occurs in discussion with peers, peer-teaching, exchanging views, completing case studies and preparing essays about what learners have learned during the problem-solving process.

Problem-based learning has several distinct characteristics that may be utilized in designing curriculum. These are:

• Use of real-world problems that are relevant and contextual. It is in the process of struggling with actual problems that learners learn content and critical thinking skills.
• Reliance on problems to drive the curriculum. The problems do not test skills; they assist in development of the skills themselves.
• The problems are truly ill-structured. There is not meant to be one solution, and as new information is gathered in a reiterative process, perception of the problem, and thus the solution, changes.
• PBL is learner-centered. Learners are progressively given more responsibility for their education and become increasingly independent of the teacher for their education.
• PBL produces independent, lifelong learners who continue to learn on their own in life and in their careers.

PBL is inherently social and collaborative in methodology and teaches essential “soft skills,” as well as domain specific content and skills, such as the following:

• Problem-solving skills
• Self-directed learning skills
• Ability to find and use appropriate resources (e.g., drug information references, medical literature, professional practice standards, laws and regulations, etc.)
• Critical thinking
• Performance ability
• Social and ethical skills
• Self-sufficiency
• Self-motivation
• Leadership skills
• Ability to work on a team
• Communication skills
• Proactive thinking
• Congruence with workplace skills

Critical Thinking and the Pharmacy

Critical thinking is the process of examining, analyzing, questioning and challenging situations, issues, and information of all types.³ Successful critical thinkers are able to separate what is false, partially true, incomplete, biased, based on false premises, or assumed to be true because “everyone says so” or “that is the way we have always done it” from the actual true and correct information. They can consider the context and history of a situation and understand assumptions being made, while focusing on the true problem, issue or situation being addressed. Finally, successful critical thinkers can create alternative ways of approaching problems, issues and situations that address the real, rather than assumed or imagined, factors that underlie the situation.

Critical thinking is a commonly used skill in the pharmacy and examples include the following:

• Evaluating lab results
• Reviewing medical records
• Reading medical and scientific research
• Conducting interventions with physicians and nurses
• Making dosing adjustments to obtain a specific therapeutic effect
• Balancing risk versus benefit for use of a specific medication in a specific patient
• Evaluating the selection of agents included on the formulary based on efficacy, safety and cost
• Synthesizing drug information to be presented at a level appropriate to the listener (physician, nurse, patient)
• Identifying drug-related problems and their possible resolution through use of therapeutic alternatives
• Developing a revised disease treatment protocol based on new data

Because critical thinking is such an important skill in the pharmacy, care needs to be taken to ensure that educational activities include opportunities for the pharmacy staff to practice those skills.

Selecting an Instructional Strategy

Finally, when selecting an instructional strategy, it is important to consider the nature of the content. For example, content that is clinical in nature and that contains a large amount of reference information cannot be adequately delivered via a simple PowerPoint presentation. Rather, access to the documentation and narrative surrounding the concepts should be provided. Conversely, information that is fairly simple can easily be displayed via a PowerPoint presentation, a memorandum or a job aid (e.g., checklist).

Another important consideration when selecting an instructional strategy is the amount of time required for the pharmacy staff to complete the education. It is usually not practical to pull the entire pharmacy staff from work duties to attend a workshop. Therefore, multiple sessions may be needed, or an alternative method of delivery needs to be developed. Additionally, sometimes it is best to use a blended approach and combine different methods of instruction to adequately address the topic. For example, the pharmacy staff may attend a workshop but also receive reference materials to assist them when conducting interventions, or they may be paired with a mentor to assist them with applying the new information.

Summary

Adults are most interested in learning material that has immediate relevance to their job or personal life and have a deep need to be self-directing. They enter a learning experience with a task-centered orientation and are motivated to learn by both extrinsic and intrinsic motivators. When developing educational materials for the pharmacy staff, it is important to consider the needs of adult learners, and identify an instructional strategy that will effectively and efficiently help the staff acquire the knowledge, skills or new attitudes needed.

References

1. Bok D. Needed: A new way to train doctors. In: Schmidt HG, et al., eds. New Directions for Medical Education. New York: Springer-Verlag; 1989.
2. Schmidt HG. Problem-based learning: Rationale and description. Med Educ. 1983;17(1):11-6.
3. Diestler S. Becoming a Critical Thinker. New Jersey: Prentiss Hall; 1998.