Teaching Pharmacy Technician Students using the Constructivist Learning Theory

There are many learning theories and not one learning theory encompasses the way students learn in all situations.

The constructivist approach is based on connecting new knowledge with pre-exiting knowledge. Ausbel (as cited in Dennick, 2016) states “The most important factor influencing learning is what the learner already knows.”

Learning involves interacting with the world in order to construct meaning of our reality, as well as “construct a coherent and consistent cognitive model” (Dennick, 2016). Vygotsky pointed out, social interactions also influence the way we construct meaning of our reality.

In the article Constructivism: reflections on twenty five years teaching the constructivist approach in medical education, Dennick discusses that students use hypotheticodeductive reasoning or the scientific method to make sense of their world and experience by connecting new knowledge to pre-existing knowledge “via inductive reasoning and human imagination’ (Dennick, 2016).

Albert Einstein (as cited in Dennick, 2016) states:

“Imagination is more important than knowledge.”

Our knowledge initially starts off as imagination and then is tested against the world by exploration, further experience or manipulation, and processed by deductive reasoning.

Image from Alberta College of Pharmacy (2024), Standards of Practice for Pharmacists and Pharmacy Technicians: What’s Changing?

Constructivism Classroom Activity: Best Possible Medication History

The Best Possible Medication History (BPMH) “is a snapshot of a client’s actual medication use, which is created through a systematic process of interviewing the client and/or designated support person and reviewing at least one other reliable source of information to obtain and verify all medications that the client is using (whether prescribed or non-prescribed). Complete documentation of a BPMH includes the drug name, dosage, route, and frequency of every product” (ISMP Canada, 2000-2024).

Role-playing is a great activity for students to practice the concepts that they learned in their theory courses (pre-existing knowledge involving cultural safety, empathy, communication, professionalism standards, pharmacology, medication safety, etc.) to real-world scenarios (performing a BPMH) in a hands-on lab class that is a safe learning environment. Role-playing is a considered a constructivist classroom activity.

How is this activity performed? Students will work in groups of two. Each group will be given a scenario that is represents what they may experience when performing a BPMH during their practicum or after graduation and working in the field. One student will be the patient, patient’s family member, or care giver and the other student will be the pharmacy technician interviewing the patient. Students have the opportunity to utilize ISMP Canada’s Best Possible Medication History Interview Guide. Depending on the scenario, the student who is role playing the pharmacy technician will have the opportunity to review one other source of information, such as medication vials, blister pack, long-term care MAR, or community pharmacy medication record, to document an accurate list of all medications that the patient is taking and how they are taking the medication. After completing the interview and documenting the medications, the instructor will provide feedback to the role-playing as the pharmacy technician on aspects that were done well and areas of improvement. The student will have an opportunity to reflect on ways that they can make sure they are performing the BPMH in a safe and effective manner. Students will have the opportunity to switch roles and practice different scenarios, as well as work with other classmates. This provides new experiences and opportunities for students to develop their interviewing skills when performing a BPMH.

As the instructor, I facilitate students learning by answering questions students may have, guiding students on where they can find information and resources regarding BPMH, and providing timely feedback to students.

I utilize this approach in the institutional dispensing lab that I teach and students really enjoy the opportunity to practice these skills and learn from each other. I also assess students using a rubric, which allows me to provide students with written feedback. This assessment is done after student’s have had the opportunity to practice different BPMH scenarios and have received feedback prior to completing the assessment.

Constructivism Classroom Activity: Pharmaceutical Calculations

Another method for applying constructivist methods is for teaching pharmacy technicians concentration calculations. I have not thought about this method until reading the article A constructivist method for teaching concentration calculations to pharmacy students by Hannah Batchelor. This article was about a study that was down at Aston University to see if undergraduate pharmacy students preferred learning concentration calculations and improved calculation accuracy within the constructivist environment compared to the traditional lecture-based teaching approach.

Pharmaceutical accuracy is imperative to prevent medication incidents due to dosage and calculation errors.

According the ISMP Canada (2000-2024):

“A medication incident is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer…may be related to professional practice, drug products, procedures, and systems, and include prescribing, order communication, product labelling/packaging/nomenclature, compounding, dispensing, distribution, education, monitoring, and use.”

In 2023 to 2024, the Canadian Institute for Health Information reported that 1 in 17 hospital stays involved one harmful event, and 47% of these harmful events were related to healthcare and medications. Although it is not reported, how many of these incidents involved calculation errors, the statistics show that medications errors significantly impact patient care and that pharmaceutical calculation accuracy is vital for patient safety.

Although the study involved pharmacy students in in-person concentration workshops and concentration calculations, but this method can be applied to pharmacy technician programs both in-person or online and all the different calculations used in pharmacy practice.

Students are traditionally taught pharmaceutical calculations using formulas which students are able to perform these types of calculations if they are consistently presented in the same way. However, many students are unable to explain or deviate from this standards approach, as well it may not work well for student information processing learning style.

Also, students may be able to calculate the correct answer but do not understand the process or concept. “Instead of gaining a deep conceptual understanding, students are likely to merely imitate the procedures to acquire the desired results” (Batchelor, 2007).

Incorporating the constructivist environment into pharmacy calculations, not only depends on the student’s ability to perform mathematical concepts such as addition, subtraction, multiplication, and division, but also be able to understand the problem to determine and describe the steps required to be performed at each step of the problem. It is important for students for students to develop learning strategies that make sense to them and provides the correct answer.

Schwell (as cited in Batchelor, 2007) states:

“What the student does is actually more important in determining what is learn than what the teacher does.”

To apply this constructivist method, students work in small groups. Students are given the opportunity to pick their group members. In the online environment it may be easier for the instructor to assign group members, especially if students are learning pharmaceutical calculations early on in the pharmacy technician program and have not had the opportunity to develop relationships with their peers.

In the study and this could be applied to the classroom, students and groups are able to use calculators and any resources, such as the textbook, to help them answer the questions.

The first step would be to assign students individually a certain number of pharmaceutical calculations and timeframe for the student to complete them (in the study student’s were assigned 32 questions and given one week to complete these questions).

The second step, is after students have completed the questions on their own, students discuss the questions from step with their group and complete an answer sheet for these questions. In the online setting, this can be down in discussion boards. During this step, the instructors could guide students if the request assistance.

For the third step, give each group a different set up similar questions (in the study they gave each group eight similar questions). Each group has to answer these questions and show their calculations. In the study, students were given 45 minutes to complete this step, but in the classroom environment, this may be down over a couple days depending on how instructors want to set this up.

For step two and three, students are given immediate feedback after all the questions have been solved and submitted.

For step four, have students complete a short weekly quiz individually utilizing similar questions that you have used throughout these activity. In the study, students were given four questions to answer individually in 40 minutes. In the online setting, students would receive feedback immediately after completing the quiz because most online learning platforms allow you to have this option. In the classroom, this could be done right after the quiz was submitted and marked. Some in-person classrooms utilize online learning platforms for quizzes as well.

The assessment of this concentration workshop in the study was broken down as follows:

• 25% of the marks were awarded for the team sheet that was created during step 2.
• 25% if the marks were from the team worksheet from step 3.
• 25% of the marks were for the individual task in step 4.
• 25% was the mean score of each individual in each team for the four questions that were answered individually.

As an instructor, you could apply similar assessment marks to your classroom. For me, I would probably not give a mean score for step 4, but would apply the quiz mark as part of their quiz grade counting towards their final mark.

According to the article, Batchelor explains that constructivism is broken down into five E’s: engage, explore, explain, elaborate, and evaluate. Students in the study had to answer the following statements using a rating scale of strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, and strongly disagree.

• Engage: I see the relevance of this work for my future career.
• Explore: I found it useful to discuss these problems with my colleagues.
• Explain: I enjoyed collaborating with others in this work.
• Elaborate: Sometimes other students can explain ideas better than a lecturer.
• Evaluate: I learnt some useful tips within this session (Batchelor, 2007).

For myself, I think I would try to incorporate the concepts of this study into the pharmacy calculations course that I teach for pharmacy technician students. I would try to incorporate this activity each because students are learning new concepts each week. I really like how students had to answer the five statements and it would be beneficial if the constructivism method outline in the study would benefit my students and their learning process. Students would answer these statements weekly as part of the exit ticket. This way I would be able to provide additional feedback to students each week and get a true sense of if this style of teaching is beneficial for students in the pharmacy calculations course.

In the study, students were administered a questionnaire at the end of the term to evaluate the constructivist method to the lecture-based method. Students had to answer the following questions and circle the response that applied to their learning:

• I learnt more in the: concentrations workshop/lecture
• I enjoyed learning in the concentration workshop/lecture (Batchelor, 2007).

I would ask similar questions for my students to answer but this would be part of the final feedback for this course. This would provide me with insight on whether I wanted to continue to use the constructivist method for teaching pharmacy calculations or revert back to my previous way of teaching the course which includes lecture.

The study did determine that students were able to find simpler ways to perform these calculations that made sense to them based on their prior knowledge.

• 54.7% of students in the study felt that they learned more during the concentration workshops.
• 45.3% felt they learnt more from traditional lectures.
• 73.4% of students preferred to learn in the workshops.
• 26.6% of students preferred lectures.

Although, I have not applied the constructivist method for teaching pharmacy calculations at this time, it is something that I am going to explore the next time I teach the course. I look forward to providing readers with update on my progress with incorporating the constructivist method into my teaching practice.

After reading about two constructivist classroom activities, I would love to know your thoughts. Please leave me a comment on whether you are interested in applying these constructivist methods to your teaching practice or if you have utilized other constructivist methods in your teaching practice.

Teaching Pharmacy Technician Students using the Constructivist Learning Theory © 2024 by Kathleen Young is licensed under CC BY 4.0 

References:

Alberta College of Pharmacy (2024). Standards of Practice for Pharmacists and Pharmacy Technicians: What’s Changing? Retrieved, November 20, 2024 from, https://abpharmacy.ca/news/standards-of-practice-for-pharmacists-and-pharmacy-technicians-whats-changing/

Batchelor, H. (2007). A constructivist method for teaching concentration calculations to pharmacy students. Pharmacy Education, 7(1), 69-76. https://pharmacyeducation.fip.org/pharmacyeducation/article/view/137/114

 Canadian Institute for Health Information (2024) Healthcare Excellence Canada. Patient harm in Canadian hospitals? It does happen. Retrieved November 20, 2024, from https://www.cihi.ca/en/patient-harm-in-canadian-hospitals-it-does-happen

Dennick, R. (2016). Constructivism: reflections on twenty five years teaching the constructivist approach in medical education. International Journal of Medical Education, 2016(7), 200-205. https://www.researchgate.net/publication/304455213_Constructivism_reflections_on_twenty_five_years_teaching_the_constructivist_approach_in_medical_education

Institute for Safe Medication Practices Canada. (2000-2024). Best Possible Medication History Interview Guide. ISMP Canada. https://ismpcanada.ca/wp-content/uploads/BPMH-Interview-Guide.pdf

Institute for Safe Medication Practices Canada. (2000-2024). Definitions of Terms. ISMP Canada .https://ismpcanada.ca/resource/definitions-of-terms/