Available online at www.sciencedirect.com

http://dx.doi.org1877-1297/r 20

* CorrespondinSchool of PharColorado, 12850

E-mail: conn

Currents in Pharmacy Teaching and Learning 6 (2014) 826–833http://www.pharmacyteaching.com

Facilitating skill development using student-directed activities andpersonalized formative feedback

Connie Valdez, PharmD, MSEda,*, Leticia Shea, PharmDb, Randy Knutsen, RPha,Dorie Hoody, PharmDa

a Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, COb Rueckert-Hartman College for Health Professions, Regis University, Denver, CO

Abstract

Objective: To describe the process and outcome measures of implementing student-directed activities and faculty formativefeedback as methods to develop interviewing, assessment, SOAP note writing, patient presentation, and patient counseling skills.Methods: Student-directed activities and personalized formative feedback from faculty were implemented to facilitate skilldevelopment in first-year pharmacy students. These processes occurred in three steps in which students (1) obtainedfoundational knowledge through the completion of independent student-directed learning activities, (2) applied knowledge anddevelopment of skills through peer teaching activities and peer/self-assessment, and (3) received personalized formativefeedback from faculty during verbal assessments. Outcome measures were determined by students’ performance in courseevaluations and faculty/student survey data.Results: Overall, 70 students and six faculty completed the survey. Based on student survey data, 74% indicated that student-directed activities enhanced learning, 57% indicated that peer feedback facilitated their ability to write SOAP notes, 78% wereconfident in their interviewing skills in a community site, 76% were confident in their patient presentation skills to acommunity preceptor, 97% indicated they had developed adequate foundational skills for writing SOAP notes, and 100%valued receiving personalized faculty feedback. The entire faculty was fairly confident in the students’ interviewing skills.Conclusion: Student-directed activities facilitated the development of skills, which was augmented by peer feedback and self-assessment. Students perceived personalized faculty feedback as beneficial and recommended continuation of such feedback infuture classes.r 2014 Elsevier Inc. All rights reserved.

Keywords: Student-directed learning; Formative feedback; Self-care; Assessment

Background

Students enrolled in professional pharmacy educationprograms have traditionally been instructed using a didacticlecture format. This style of teaching relies on professor/

/10.1016/j.cptl.2014.07.00114 Elsevier Inc. All rights reserved.

g author: Connie Valdez, PharmD, MSEd, Skaggsmacy and Pharmaceutical Sciences, University ofEast Montview Blvd., V20-3128, Aurora, CO 80045.ie.valdez@ucdenver.edu

instructor lecturing to the class. The professor/instructormay use media and/or handouts to assist the student infollowing along with the topic. Although traditional didacticlecturing may be effective for delivering a great deal ofinformation in a concise manner to a large group ofstudents, this method lacks promotion and application ofknowledge, skill development, and higher levels of learn-ing. Furthermore, the testing technique which often accom-panies the didactic style of teaching generally relies onmultiple-choice or short-answer questions. This testing

C. Valdez et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 826–833 827

format is unlikely to prepare the pharmacy studentsappropriately for real-life practice and may not adequatelyfit the testing aptitude of all those enrolled.

The American College of Clinical Pharmacy (ACCP) iskeenly aware of the educational gaps that exist in manyschools of pharmacy. Recently, ACCP released a whitepaper which described its recommendations regardingpharmacy’s future. These recommendations emphasizepatient-centered care. ACCP also acknowledged the dis-crepancy between pharmacy education and pharmacy prac-tice. This report recognizes that pharmacy educators need toplace more emphasis on the preparation of students usingproblem solving, critical thinking, ethics, communication,and self-directed learning.1 Similar to this report, the 2013AACP Center for the Advancement of Pharmacy Education(CAPE) outcomes further emphasize the importance of thisneed and additionally state, “attention should also be paid tointegrated assessments to ensure that students are retaining,integrating, and applying the knowledge, skills, and atti-tudes.”2 Today’s pharmacists must be able to improve thequality of their patients’ lives, which involves the use ofcomplex problem-solving processes, critical thinking skills,clinical reasoning, and reliance on lifelong learning. Theentire profession of pharmacy is moving toward a patient-centered environment, including optimized disease statemanagement. It is imperative our students engage in clinicalreasoning, hypothesis generation, data gathering, and dataanalysis while continuing to use their basic science founda-tion, including pharmacokinetics, physiology, and pharma-cology to generate diagnostic and treatment options for theirpatients.3

The University of Colorado Skaggs School of Pharmacyand Pharmaceutical Sciences prides itself on developingconfident, competent pharmacy practitioners and thus sharesthe views of ACCP and has modified our curriculum tomeet the 2013 AACP CAPE outcomes. To aid in thiseducational process, course directors are encouraged tointroduce, or increase, current student-directed learningactivities and augment their course with more formativefaculty feedback. Although self-care was historically taughtusing student-directed learning activities (weekly pre-readings and a quiz to ensure preparation) as well as activelearning techniques (case-based discussion and role-play-ing), the course did not utilize peer feedback or formativefaculty feedback to enhance student knowledge and skills.In response to this expectation, the skills developmentcourse maintained the historical student-directed and activelearning activities but augmented the course by designingand incorporating additional student-directed activities andpersonalized faculty formative feedback to facilitate thedevelopment of interviewing, assessment, Subjective,Objective, Assessment, and Plan (SOAP) note writing,patient presentation, and patient counseling skills.

This article describes the process and outcome measuresof implementing student-directed activities and facultyformative feedback as a method to develop interviewing,

assessment, SOAP note writing, patient presentation, andpatient counseling skills in a large class of 160 students.

Methods

The skills development course is a three-credit hourcourse that is conducted for four hours every week for 16weeks. Overall, 80 students are assigned to section onewhich meets for three hours on Mondays (9:00–12:00 PM)and the other 80 students are assigned to section two whichmeets for three hours on Tuesdays (9:00–12:00 PM). Bothsections meet for an additional hour on Wednesdays (2:00–3:00 PM). Attendance is required for the full four hours eachweek. Student learning, knowledge, and skills related to self-care topics are primarily achieved through student-directedactivities as well as formative feedback from faculty.

These processes occur in the following three steps (seeFig. 1):

Step 1: Students obtain foundational knowledge throughthe completion of independent student-directed learningactivities.Step 2: Students apply knowledge and develop skillsthrough peer teaching activities and self-assessment in alarge classroom.Step 3: Students fine-tune their knowledge and skills inpreparation for the formal evaluation through personal-ized formative feedback from faculty which occurs insmall break-out rooms.

Step 1: Independent student-directed learning activities

Students are assigned to read one or two chapters fromthe Handbook of Nonprescription Drugs, 17th Edition priorto each class session.4 This independent learning componentprepares students to come to class with adequate founda-tional knowledge. Based on concepts from the readings, a10-point assessment is administered to ensure the student-directed learning had been completed. The quiz takes placeduring the first 15 minutes of the Wednesday one-hourclass. The remaining 45 minutes of class time is used toreview the answers to the quiz. This review providesstudents with formative feedback related to their under-standing of the content and performance on the quiz.Equally important, when reviewing the quiz, the facultymember utilizes this platform to discuss additional keyconcepts relevant to the topic(s) and highlights clinicalpearls and/or information which were not provided in thereadings. Together, these activities are designed to augmentthe level of student understanding.

Step 2: Peer teaching activities with peerand self-assessment

Four times a semester, during the three-hour Mondayand Tuesday classes, one hour is allocated to student-

Abbreviations:*PCA=patient counseling assessment**VCA: verbal competency assessment^SOAP: subjective, objective, assessment, plan

The incorporation of individual student directed feedback, peer/self assessment and personalized formative faculty feedback

Week 5: Patient counseling evaluation (Mon/Tues)Individual student directed learning-100% of students (Wed)

Week 1: Individual student directed learning 100% of students (n=160)

Week 2: Peer and self assessment (practice patient counseling) 100% of students (n=160)

Week 3: Personalized formative feedback from faculty (*PCA)50% of students (n=80)

Week 4: Personalized formative feedback from faculty (*PCA)Other 50% of students (n=80)

Week 6: Peer and self assessment (interviewing, ^SOAP note writing) 100% of students (n=160)

Week 7: Personalized formative feedback from faculty (**VCA)50% of students (n=80)

Week 8: Personalized formative feedback from faculty (**VCA)Other 50% of students (n=80)

Week 9: Individual student directed learning-100% of students (Wed)

Week 10: Peer and self assessment (practice patient counseling) 100% of students (n=160)

Week 11: Personalized formative feedback from faculty (*PCA)50% of students (n=80)

Week 12: Personalized formative feedback from faculty (*PCA)Other 50% of students (n=80)

Week 13: Patient counseling evaluation (Mon/Tues)Individual student directed learning-100% of students (Wed)

Week 14: Peer and self assessment (interviewing, ^SOAP note writing) 100% of students (n=160)

Week 15: Personalized formative feedback from faculty (**VCA)50% of students (n=80)

Week 16: Personalized formative feedback from faculty (**VCA)Other 50% of students (n=80)

Fig. 1. The incorporation of individual student-directed feedback, peer assessment/self-assessment, and personalized formative facultyfeedback.

C. Valdez et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 826–833828

C. Valdez et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 826–833 829

directed activities which facilitate the development ofinterviewing, assessment, SOAP note writing, and patientcounseling skills. Students are paired to work in groups oftwo and are provided a patient scenario (case A or case B).Each case is related to self-care topics covered during theprevious Wednesday class session. The student whoreceives the patient case plays the role of a “patient” and“evaluator.” For the interviewing, assessment, and SOAPnote writing skills, the “patient/evaluator” is provided with ascript, a discussion guide, and a SOAP note key/gradingrubric. For the patient counseling evaluation, the “patient/evaluator” is provided with a script and grading rubric. Priorto the activity, the “patient” attends a ten-minute simulated“patient” training session with a faculty member to preparefor the simulation activity.

Patient interviewing skills

The students assigned to be the “pharmacist” are notprovided with any information related to the patient caseand need to interview the “patient” to obtain pertinentinformation. The “patient/evaluator” responds to the inter-view questions from the “pharmacist” as instructed in thepatient script and is provided with an assessment tool totrack the thoroughness of the “pharmacist’s” interview(Appendix A). The “patient/evaluator” is also provided adiscussion guide to facilitate constructive feedback and peerteaching related to interview skills in a consistent manner.Once the “pharmacist” has completed the patient interviewprocess, the “patient” switches to the role of an “evaluator”and identifies key interview questions that are needed, butwere not asked by the “pharmacist,” to make a thoroughassessment and plan. In addition, the “evaluator” drives thediscussion as to why these questions are important for thecase and provides feedback related to the “pharmacist’s”communication skills. During this question and discussionprocess, the design allows the “pharmacist” to activelyreflect on his/her strengths and weaknesses related to his/herpatient interviewing skills. After all pertinent information isobtained from the interview and discussion process, the“pharmacist” writes a complete SOAP note. The aboveprocess is repeated to allow each student to engage inboth roles.

SOAP note writing skillsOnce each student has written a SOAP note, these

notes are exchanged and graded by the peer who servedas the “evaluator.” The “evaluator” is provided with theSOAP note key/grading rubric and grades the note foraccuracy and thoroughness, as well as provides feedbackrelated to strengths and areas of improvement for theirpeer’s SOAP note (Appendix B). After the SOAP notecases have been graded and returned to their owner,students are provided with some time to review the peerassessment. At this point, students discuss these findings

with each other as a method to further develop SOAPnote writing skills.

Patient counseling skills

Like the patient interviewing skills development activity,the patient counseling skills development activity isdesigned in a similar manner. The students who areassigned to be the “pharmacist” are provided only with aprescription and patient profile and no other informationrelated to the case. The “patient/evaluator” responds to thequestions from the “pharmacist” as instructed in the patientscript. The “patient/evaluator” is provided with a rubric totrack thoroughness of the pharmacist’s counseling and tofacilitate constructive feedback related to communicationskills in a consistent manner (Appendix C). Once the“pharmacist” has completed the patient counseling process,the “patient” switches to the role of an “evaluator” andidentifies key counseling points that were not provided tothe patient. In addition, the evaluator drives the discussionas to why these counseling points are important for thepatient and provides feedback related to the “pharmacist’s”communication skills. It is designed that during thisquestion and discussion process the “pharmacist” is activelyreflecting on his/her strengths and weaknesses in his/herpatient counseling skills. The above process is repeated toallow each student to engage in both roles.

Prior to students receiving personalized formative feedbackfrom faculty, they would have practiced the skills previouslyduring class using the same rubrics used by the faculty.

Step 3: Faculty assessment

Verbal competency assessments and patient counselingassessments

Students are assessed periodically throughout the semes-ter with Verbal Competency Assessments (VCAs) andPatient Counseling Assessments (PCAs). These assessmentshave been incorporated during class to assess the develop-ment of skills and to provide personalized formative feed-back from “faculty” evaluators who are full-time facultymembers, community pharmacists, and/or education rota-tion residents/students. The personalized formative feed-back is designed to target strengths and weaknesses in theindividual student’s skill set.

For each VCA, students are assessed on their ability to(i) effectively approach a patient, (ii) interview a patient,(iii) take an appropriate medical history, (iv) use pertinentpatient information to make an assessment, (v) formulate atreatment plan, (vi) document information using requiredformat, and (vii) correctly respond to verbal questions.For each PCA, students are assessed on their ability to (i)effectively communicate and (ii) accurately deliver clinicalcontent. Students who do not demonstrate competency inthese abilities during their VCA or PCA are required torepeat the activity the following week.

C. Valdez et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 826–833830

Personalized formative feedback from faculty related tointerviewing, assessment, SOAP note writing, andpresentation skills

The semester is 16 weeks, eight of which have an hourallocated each week to provide students with personalizedformative feedback from faculty in the form of VCA andPCA. A group of 40 students from each section willcomplete a verbal assessment with one of the facultyevaluators—this will allow 50% of the students to completea VCA or PCA per week. Every student will receivepersonalized formative feedback related to two VCAs andtwo PCAs during the semester. Although the formativefeedback does not contribute to the student grade, it ishypothesized that personalized formative feedback aug-ments the development of skills. Faculty members, com-munity pharmacists, and education rotation residents/students are trained to be simulated patients (SP) and serveas “faculty” evaluators for each VCA and PCA. “Faculty”evaluators are trained by the course director on each aspectof the grading rubric and are provided instructions withspecific examples on how to score various student responsesprior to each class. This was performed to enhance gradingconsistency among the evaluators.

Patient interviewing skillsStudents present to the “pharmacy” where the SP asks

for a recommendation to treat a specific set of symptoms.The student has three minutes to interview the SP followingthe QuEST SCHOLAR format.4 After three minutes, theSP, who also serves as an evaluator, provides feedback anddrives discussion related to the interview questions andidentifies pertinent information not extracted during theinterview (Appendix A). The evaluator then providespersonalized formative feedback to the student.

SOAP note writing and patient presentation skills

Based on the interview, students are provided 20minutes to write a SOAP note. Once the SOAP note iscompleted, the student has five minutes to present the caseto the evaluator. The evaluator grades the SOAP note foraccuracy and thoroughness based on a grading rubric(Appendix B). Following the case presentation, the eval-uator asks the student questions related to the case (e.g.,information that was missing or was presented but not insufficient detail or lacking in clarity) to promote self-assessment and reflection.

Patient counseling skillsStudents present to the “pharmacy” where they introduce

themselves as an intern pharmacist. The SP asks to pick uphis/her medication the doctor called in. The student has fiveminutes to ask any pertinent questions and counsel the SPon their new medication. After five minutes, the SP whoalso serves as an evaluator provides feedback and drivesdiscussion related to the counseling session and identifies

pertinent information that was not provided to the patientduring the counseling session (Appendix C). The facultyevaluator also provides additional personalized formativefeedback regarding communication skills.

Following each of the personalized formative feedbacksessions, the evaluator will either conclude the encounter ornotify the student his/her interviewing, SOAP note writing/patient presentation, or patient counseling skills is deficientand that he/she will be required to complete another VCA orPCA the following week.

Course evaluations to formally assess knowledge and skilldevelopment

The evaluations include a midterm, an end-of-termperformance-based evaluation, and two patient counselingevaluations. As part of the performance-based evaluation,students write a SOAP note as a method to demonstratetheir ability to apply knowledge and accurately write aSOAP note. As part of the patient counseling evaluation,students should demonstrate they are able to effectively andaccurately counsel a patient on a new medication.

To measure the development of skills, student perform-ance on patient counseling evaluations and performance-based exams were evaluated. To determine student andfaculty perception of skill development and activity effec-tiveness, faculty and student survey data were evaluated.Students who completed the course were e-mailed a link toan online survey and were asked to complete the optional9-question survey (Likert scale and yes/no format) within atwo-week time frame. Faculty who served as evaluators weregiven a five-question written survey (Likert scale) tocomplete within the same week they served in this role.Student evaluation performance was evaluated using theFischer’s exact test, and survey data was evaluated usingdescriptive data analysis. The study was approved by theUniversity’s Institutional Review Board.

Results

Overall, 156 students completed the course and 70students completed the survey (45% return rate). Of thosestudents, 31% were male and 69% were female and 94%were between 20 and 33 years of age. All six facultyevaluators were surveyed.

Overall, 74% students indicated the student-directedactivities enhanced their learning, 26% were neutral, and nostudent felt these activities hindered his/her learning; 57%students indicated peer feedback facilitated their ability towrite SOAP notes, with only 1% feeling it hindered his/herability. The remaining 42% had a neutral opinion (Fig. 2).

At the end of the course, 78% of students were confidentin their interviewing skills in a community site (12% werevery confident and 66% were fairly confident), whereas22% lacked confidence (18% were not very confident and4% were not confident). However, 100% of the faculty was

C. Valdez et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 826–833 831

fairly confident in the students’ interviewing skills. Overall,76% students were confident in their patient presentationskills to a preceptor in a community site (12% were veryconfident and 64% were fairly confident), whereas 24%lacked confidence (18% were not very confident and 6%were not confident). Again, 100% of faculty was fairlyconfident in the students’ patient presentation skills (Fig. 2).

Only 12% and 13% of the students were required tocomplete another VCA to enhance patient interviewing skillsor to enhance patient presentation skills, respectively. How-ever, 21% of students who were not required to completeanother VCA indicated they would have liked to repeat theVCA as an optional activity to increase their interviewingskills and 14% would have liked to repeat the VCA as amethod to increase their patient presentation skills (Fig. 2).

Of the students surveyed, 97% perceived they haddeveloped adequate foundational skills for writing SOAPnotes. Over the course of the semester, objective data alsosupported the majority of students had developed adequateSOAP note writing skills. There was a 71% pass rate for themidterm SOAP note compared to a 96% pass rate for theend-of-term SOAP note (p value o 0.0001). The classperformed well on both of the patient counseling

Abbreviations:SOAP: subjective, objective, assessment, plan*VCA: verbal competency assessment

Student survey results related to impact of learning from student directed activities

Enhanc

Role-playing to facilitate the development of interviewing skills

74%

Receiving peer feedback to facilitate the development of *SOAP note writing skills

57%

Student and faculty confidence of student interviewingskills at a community site

Very confiden

Student 12% Faculty 0%

Student and faculty confidence of students patient presentation skills to a community preceptor

Very confiden

Student 12% Faculty 0%

Percentage of students required to complete an additional **VCA to enhance:

Yes

Interviewing skills 12% Patient presentation skills 13%

“Have you developed adequate foundational *SOAP note writing skills?”

“How would you rate the value of receiving personalized faculty feedback?”

Extremely beneficial

54%

“Should personalized faculty feedback be continued in the Professional Skills Development II course?”

Yes but increa

43%

Fig. 2. Student and facu

evaluations (PCE) and demonstrated adequate patient coun-seling skills throughout the semester. When comparingstudent performance of PCE #1 with PCE #2, there wasonly a difference of six failures (96% pass rate for PCE #1vs 100% for PCE #2). Although this number was small andmay not seem academically significant, it did demonstratestatistical significance (p ¼ 0.0298).

All the students valued receiving personalized formativefeedback from faculty, with 54% of these individualsindicating it was “extremely beneficial,” 40% indicating itwas “beneficial,” 6% found this “somewhat beneficial,” andthere were no students who determined personalized feed-back to not be beneficial. All students who were surveyedthought the personalized formative feedback from facultyshould be continued and not eliminated or decreased.Overall, 57% felt it should remain the same and 43% feltit should be increased.

Discussion

Although the mainstay of information exchange in thepharmacy curriculum is performed using a didactic formatin a large classroom, the profession of pharmacy education

ed Neutral Hindered

26% 0%

42% 1%

t Fairly confident Not very confident Not confident

66% 18% 4% 100% 0% 0%

t Fairly confident Not very confident Not confident

64% 18% 6% 100% 0% 0%

No Not required, but would have liked to have completed and additional **VCA

67% 21% 73% 14%

Yes No 97% 3%

Beneficial Somewhat beneficial

Not beneficial

40% 6% 0%

se Yes and remain the same

Yes but decrease No and eliminate

57% 0% 0%

lty survey results.

C. Valdez et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 826–833832

is moving toward a self-directed learning process. TheUniversity of Colorado Skaggs School of Pharmacy andPharmaceutical Sciences has incorporated not only student-directed activities but also personalized formative feedbackfrom faculty into the course as a method to augment thedevelopment of interviewing, assessing, SOAP note writing,patient presentation, and patient counseling skills in a largeclass of 160 students. It is thought this teaching method-ology may also be beneficial for students with differentlearning styles.

There are undoubtedly many different learning styles ina class of 160 students. Pungente et al. described four basiclearning types and how they complement and differ fromone another. This tends to hold true for all populationsregardless of setting. The goal of this learning format is toensure learning is promoted for all individuals, regardless oflearning styles.5

Learning styles have also been defined as, “an individu-al’s unique approach to learning based on strengths, weak-nesses, and preferences.”6 The use of didactic lectures maynot touch on everyone’s learning style. Students who learnvia logic tend to do well with propositions, questions, ormathematics, whereas those who learn verbally are able tosimply listen and process the information being presented. Alarge group of graduate students tend to learn with anintrapersonal style. These students are typically independentand do well with self-interaction and thus are excellentcandidates for didactic lectures. However, there remains asubset of students who use a visual–spatial learning style andrequire images, pictures, or abstract representations tofacilitate their knowledge retention. Finally, there is a subsetof students who learn through interpersonal or socialinteraction. It is this last group of students who do not farewell with didactic lecture formats because it is difficult forthem to transform lecture material into something meaningfulto help them retain the knowledge.7 It has been suggestedthat over time, individuals will demonstrate a reliance on oneor more of these learning styles.8 Based on the results of ourstudy, our teaching methodologies seemed to have met theneeds for most of our students enrolled in the class and havethus been deemed successful.

Although the majority of students agreed the self-directedactivities augmented their learning and no students felt likethis hindered their learning, 26% remained neutral to theactivity. We were not surprised by the magnitude of thisresponse, as a large fraction of students have learned throughthe traditional didactic format and have verbalized they preferto be told what they need to know rather than learning ontheir own. Therefore, we were pleasantly surprised to find74% of students stated that the student-directed activitiesenhanced their learning. Interestingly, only 57% of studentsthought the peer feedback positively enhanced their learning.Although over half of the students thought this positivelyenhanced their learning, it was perceived to be less beneficialthan other educational activities. This was unexpected as theliterature supports how peer discussion enhances student

understanding of difficult concepts, as well as increasesstudent confidence and the ability to answer questionscorrectly.9–13 Similar to our study, Storjohann et al. usedpeer grading to teach SOAP note writing which resulted in astrong majority of respondents agreeing that peer feedbackenhanced their learning, and furthermore, it was requested tobe used more frequently. In contrast to our study, their resultswere obtained in a blinded manner which may have resultedin an enhanced appreciation for peer feedback becausestudents were more likely to provide honest objective andcritical feedback.14 This has been documented by O’Brienet al. as a reason why peer feedback may not be highlyeffective. This is largely ascribed to the tendency towardleniency with peers and the likelihood that peers are assessedmore on their effort rather than their actual performance.15

One of the goals of this course is to develop studentconfidence, knowledge, and skills. Although confidence doesnot necessarily correlate with knowledge or ability, it is animportant area for students to develop during their educa-tion.16 There is concern among faculty members that studentshave a sense of confidence is higher than their actual ability.Although 78% of the students were confident in their abilityto interview patients in a community site and 76% wereconfident in their patient presentation skills, the students’ trueability is unknown until the student engages in an interviewwith a patient or presents a patient to a pharmacist in theactual community practice site. When combining the studentconfidence with the faculty confidence, a better assessment oftrue student ability can be made.

The entire surveyed faculty was fairly confident instudent interviewing skills and patient presentation skills.The findings from the faculty survey were not expected, asmost faculty do not believe students have developedadequate skills or knowledge to effectively interact withpatients in their first year of pharmacy school. As such, itwas actually anticipated that faculty would have little to noconfidence in these students at this educational level. Thus,to have 100% of the faculty fairly confident in the students’ability and the vast number of students confident supportsthat the majority of students have developed adequate toabove adequate skills as first-year pharmacy students. Thefaculty confidence was additionally supported with the lownumber of students required to complete another VCAsecondary to deficient skills and/or knowledge, 12% and13%, respectively.

Not surprisingly, 100% of the students valued receivingpersonalized formative feedback from faculty. The facultywas expecting students would find personalized feedbackbeneficial, but did not appreciate how challenging it wouldbe to implement this teaching method. The evaluatorresource requirements were substantial, as four to fiveevaluators were needed for each one-hour session on eightseparate days. Although this teaching method was resourceintensive, it did seem to develop student skills more rapidlythan other active learning methods, as demonstrated instudent performance on assessments and evaluations.

C. Valdez et al. / Currents in Pharmacy Teaching and Learning 6 (2014) 826–833 833

When the personalized formative feedback from facultywas incorporated into the course, it was determined eachstudent would receive at least two PCA and two VCApersonalized feedback sessions with faculty. Based on theresults, students thought personalized feedback from facultyshould be continued and not eliminated or decreased.Although 43% would like personalized formative feedbackfrom faculty increased, it is not feasible based on timeconstraints of the course.

Limitations

We did not perform baseline assessments or solicitopinions of student confidence and skills. We assumedstudents had little to no exposure or experience in inter-viewing, SOAP note writing, presenting patient cases, orcounseling patients prior to this class. However, it ispossible a small fraction of students may have hadexperience performing some or all of these activities.

The small number of faculty involved in the VCAs isanother limitation on several levels. First, faculty may havefelt pressure to answer survey questions in a positive waysince it is difficult to remain anonymous with such a smallsample size. Second, those surveyed were already involvedin the active learning courses, contributing to a homogenousstyle of teaching and thus similar survey responses. Third,asking students to repeat a VCA involves subjectiveevaluation of student ability. Engaging faculty with differ-ent perceptions of communication standards may haveresulted in additional requirements for repeat. Along thosesame lines, evaluation forms work well for evaluatingclinical skills, but are not as effective for evaluatingcommunication skills. It is more difficult to evaluate theseonce a student reaches a minimum competency. Forexample, lack of empathy or appropriate interview ques-tions are easily identified as an area of weakness. Yet otherless tangible skills such as body language, level of studentengagement, and choice of wording are often based onevaluator opinion. Lastly, we had a 45% return rate on thesurvey, which leads to speculation as to how the 55% ofnon-responders felt toward the educational methodologies.

Conclusion

The incorporation of student-directed activities andfaculty formative feedback was determined to be an efficientand effective method for the development of interviewing,assessing, SOAP note writing, patient presentation, andpatient counseling skills in a large class and will becontinued in future classes. The student-directed activitiesfacilitated the development of skills and these skills wereaugmented by peer feedback and self-assessment. Studentsperceived personalized faculty feedback as beneficial andrecommended continuation of such feedback in futureclasses. Giving students the opportunity to participate ina simulated experiential activity created confidence in

interviewing, assessing, SOAP note writing, patient presen-tation, and patient counseling skills. Such confidence isexpected to facilitate a smoother transition to the actualexperiential site visits which will occur in the future.

Appendix A. Supplementary Information

Supplementary data associated with this article can befound in the online version at doi:10.1016/j.cptl.2014.07.001.

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