American Journal of Pharmaceutical Education 2003; 67 (1) Article 19.

INSTRUCTIONAL DESIGN AND ASSESSMENT Virtual Interactive Case Tool for Asynchronous Learning: PBL Students Develop Online Resource for Non-Prescription Drugs

Debra Sibbald, MA, BScPharm Leslie Dan Faculty of Pharmacy, University of Toronto

Objectives. This article describes a class project utilizing an electronic-based format, entitled “VITAL: a virtual interactive case tool for asynchronous learning.” The objective was to encourage self-directed skill development using the Internet as a source to deliver and acquire knowledge. Methods. Student teams developed a web-based, interactive tool to facilitate independent learning in non-prescription drugs courses. The course website server provided an online structure for database submission, publication, and review of therapeutic cases following established objectives and guide-lines. Student perceptions of the learning value of the project in terms of participation and as a poten-tial knowledge resource are explored and reported in a survey. Results. The results were a series of standardized cases using multiple-choice questions which pro-vide feedback and grading. Content is multimedia enhanced and hyperlinked to additional references. Conclusion. This project fostered independent learning and team dynamics in presentation of applied case-based information to health professional peers. Students considered the asynchronous, interactive approach an engaging way to enhance learning. Keywords: learning, problem-based learning, internet, non-prescription drugs

Course Description: Organization and Design INTRODUCTION Two non-prescription medication courses for classes

of 140 students prepare students with the knowledge and skills to practice pharmaceutical care using problem-based, student-directed learning. Previous manuscripts in this Journal have described the first 3 years of course implementation and evolution including development of course-specific websites as a facilitation infrastructure2; the objective structured clinical examination (OSCE) 3; a student-produced consumer website for non-prescription drugs (CareNet)4; and the use of first year students as standardized patients for a third year student OSCE.5 Students work in small teams to prepare cases which they teach to the class using audiovisual en-hancements. These presentations are self- and peer-assessed. The presentations are followed by interactive discussions and development of therapeutic plans with panel members from the class, facilitated by the instruc-tor or guest lecturer. All current and past materials, in-cluding Word or WordPerfect documents, PowerPoint presentations, handouts and overheads are archived on the course websites.

Delivering problem-based learning courses to large classes is fraught with limitations regarding breadth and depth of content and presentation formats for var-ied learning styles. Teaching innovations should con-sider 3 principles. Technology can create new ways to generate, deliver, and present material, selecting in-formation which needs to be accessed many times or displayed many ways. This expands and enhances time and space beyond the classroom. Educational activities which deliver and assess knowledge and skills should augment student scholarship and motiva-tion. Professional practice courses for Pharmacy stu-dents should involve problem solving, decision mak-ing and clinical judgements.1 Considering these con-cepts, an instructional interactive online tool was de-veloped for 2 second- and third-year non-prescription drug courses to enable asynchronous learning and provide accurate information about over-the-counter therapy. The project was entitled “VITAL: A Virtual Interactive Case Tool for Asynchronous Learning.”

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Corresponding Author: Debra Sibbald, MA,BscPharm. Leslie Dan Faculty of Pharmacy, Universityof Toronto, 19 Russell Street, Toronto, Ontario, Can-ada, M5S 2S2. Tel: 416-978-0842. Fax: 416-978-8511.E-mail: debra.sibbald@utoronto.ca

American Journal of Pharmaceutical Education 2003; 67 (1) Article 19. Computer-assisted instruction is increasingly im-

portant as an enabling strategy, particularly enhancing autonomous learning through multi-media compo-nents. For 6 years, computer technology has been de-veloped and refined in these 2 courses, offering com-munication and interactive tools in a balance of 4 learning styles described by Kolb’s inventory.6 The varied formats represent both inductive and deductive approaches in an attempt to appeal to a variety of study preferences. They include reflective observation (perceivers), concrete experience (feelers), active ex-perimentation (changers), and abstraction conceptu-alization (analyzers). The models of instruction used in the VITAL project are a composite of programmed instruction and discovery-based and collaborative learning.

METHODS

A literature search failed to uncover any similar, student-generated case resource, although many ex-amples of case-based approaches can be found online. One such example was reviewed and cited for student reference.7

Learning Goals and Objectives The learning goals for the VITAL project were to

facilitate acquisition of the knowledge and skills re-quired to meet course objectives via a web-based learning tool as an alternative to solving/peer-teaching pre-assigned cases; to augment problem-based, self-directed learning; to provide asynchronous educa-tional opportunities; to enhance proficiency in web-based technology; and to produce a case-based online resource for future use.

Project Description A web-based interactive tool for self-directed,

problem-based learning about non-prescription drugs was developed that consisted of a homepage linking a bank of 28 lessons created by students. The format of each topic includes defined, inclusive learning objec-tives and a list of published and online references. This is followed by a case-based, multi-media-enhanced lesson consisting of sequential, multiple-choice questions, with an introductory abstract. Cases provide 1 or more informative, engaging scenarios which could be clinical case histories or situations of medical importance, with corresponding relevant, in-structive questions. The user is encouraged to greater

understanding by the provision of online access to read-ily available information. User feedback for all re-sponses includes detailed summaries about degree of accuracy; clarifying explanations for incorrect or par-tially incorrect responses; and references and online links for further discovery. Correct response feedback also details the rationale behind the question structure and automatically initiates the subsequent question. The learner who selects an incorrect response cannot proceed until the accurate answer is chosen. A side bar for navi-gating between questions can also be used. Cumulative scoring appears on each page. The target audience is the student or practicing pharmacist, nurse, or physician.

The project began with the second year class of a pharmacy undergraduate baccalaureate program in January 2001. Half the class received the VITAL as-signment, randomly assigned into14 teams of 4 or 5 stu-dents who were to develop a lesson for a self-medication topic (Table 1). Remaining class members were divided into 14 teams and assigned an alternate project on the same topics that consisted of workup and class presenta-tions of cases created by the instructor. The following year, the 2 groups switched assignments. Topics involv-ing more complex content were assigned to the third year class, while less complicated subjects were as-signed to the second year class.

Project Design As the project required computer skills in a non-

computer course, the design considered lack of technical expertise and increased time commitment out of the classroom, as well as minimizing the instructor’s in-volvement in data transfer and storage, in keeping with the tenets of self-directed learning. To simplify student data input and storage and provide uniformity, teams manipulated information online via a database, which generated web pages on demand. Students were able to edit material, topics were published when completed, and finished web pages were standardized to assist user navigation. The students had limited creative options in designing their topic page, and were compelled to manually format some html codes as opposed to using an automated editor such as Netscape Composer or Front Page Editor.

In preparation for implementation, an Access data-base was created, using FrontPage extensions, installed on Microsoft Internet Information Service Four. [Red-mond, Wash.: Microsoft, 2000. www.microsoft.com] Active Server Page (asp) files were written as templates to dynamically generate html pages. Online welcome

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American Journal of Pharmaceutical Education 2003; 67 (1) Article 19. Table 1. Interactive Case Topics Assigned to Pharmacy Students in

Groups Using a Virtual Interactive Case Tool for Asynchronous Learning and Those in Alternate Groups

Second year pharmacy students Third year pharmacy students contact dermatitis lice atopic dermatitis scabies seborrhea eye irritation burns swimmer’s ear insect bites and stings acne smoking cessation hyperacidity athlete’s foot vaginitis warts psoriasis colic cough and cold diaper dermatitis tension headache vitamins constipation motion sickness hemorrhoids garlic pinworms photosensitivity traveler’s diarrhea

and instruction pages for students were developed (Figure 1 and 2).

A submission page was developed with a side bar for database manipulation, allowing the students to point and click to add, delete, edit, or copy a question, print or run a case, send and receive images by file transfer protocol (ftp); or complete the online evalua-tion form (Figure 3). All text would be entered in html code for formatting, or insertion of images or clips.

The home page for the published cases was de-signed with side bar access to topics and supplied with a counter. The site was linked to the instructor’s web server homepage and password protected (http://djs.phm.utoronto.ca).

The web page format for each topic standardized the appearance for each lesson (Figure 4), facilitating editing changes and viewing. The design attempts to attract and engage attention, with a plain white back-ground for easy visualization, and grey or blue head-ings for quick scanning of sections. A side bar con-tains links to all questions. Feedback for each answer appears in a box entitled “correct” or “incorrect” (Figure 5).

At the beginning of the semester, students com-posed a list of questions involving tasks involved, and a tutorial with the instructor was held to provide some suggestions about the best approach. After submission and grading, the team made required changes, after which the lesson was posted online and could be run by learners with a password. In the database, a field,

Figure 1. Welcome screen.

either 0 or 1, determined whether a case was published (Figure 6).

The resource was maintained on an ongoing basis by the instructor who responded to technical difficulties.

Instructional Tasks for Students

For assigned topics, students developed learning ob-jectives and designed a case involving one or more pa-tients, with a series of relevant multiple choice questions and answers to assess comprehension of these objec-tives. They were directed to use precise language at the

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American Journal of Pharmaceutical Education 2003; 67 (1) Article 19.

Figure 2. Instruction page.

Figure 3. Input page.

Figure 4. Sample question page.

comprehension level of an expert health care practi-tioner. Each team developed a flowchart outlining how their questions satisfied learning objectives, which was submitted for approval before data input.

They composed an abstract and provided an extensive bibliography, citing extracted information in the text. Students inserted links to online references that they determined were current and accurate. To protect copy-right, the uniform resource locator (URL) for photos, video clips, and multimedia enhancements linked di-rectly to the material’s original source. Copyright per-mission was obtained for material not online. Data were submitted to the database and edited after review via confidential passwords.

Assessment Measures Performance and perception measures were used to

assess the effectiveness of this assignment as a learning tool.

Performance. Student performance was self- and instructor-assessed using the same instrument. Self-assessments were an opportunity for students to apply the marking criteria to their own work and not have those scores factored into the grading. The assignment was worth 25% of the overall grade for the course. Marks were assigned on a scale of 1 to 10, using the following verbal descriptors as guides: inadequate (0-3), marginally adequate (4), adequate (5), competent (6-7), superior (8) and exceptional (10). Assessment criteria reviewed quality of the information, quality of the pres-entation, and content. Information was assessed accord-ing to how well the material was understood and ap-plied. Presentation was assessed according to confor-mance to format, question relevance and appropriate-ness, integration, use of illustrations, conformance to language level, links to other sites, citation of refer-ences, and ability to engage the reader or inspire confi-dence. Content was assessed according to provision and integration of information, with key steps of the system-atic approach used for solving course cases (pharmaceutical care process).

Perception. Student perceptions were determined by a survey which included quantitative and free re-sponse sections. Students in the second year cohort completed a paper copy; the third year cohort completed the survey online via a link in the edit page. All quanti-tative survey questions were graded using a Likert scale with the response “Strongly Agree” designated by 5 and the response “Strongly Disagree” designated by 1. Stu-dents were also asked to record the approximate number of hours spent on the assignment.

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American Journal of Pharmaceutical Education 2003; 67 (1) Article 19.

Figure 5. Sample incorrect response. Figure 6. Status page.

RESULTS

Performance. The performances of both second and third year student teams on the VITAL term pro-ject and the alternate term project (case presentation to peers) are listed in Table 2. The performance of average grades for individual written and oral exams and the final course averages are also listed. Teams were crossed-over for the term projects in third year: in both years, students scored slightly higher on the VITAL project and slightly lower on examinations. The final course averages were similar. Paired t-tests of these means showed no significant differences (p = 0.59).

Perception. After the first cohort had completed the project, a class vote showed all students in the class preferred to do an interactive case, rather than the case presentation assignment in the third year.

The surveys assessed the students’ perceptions of the learning value of creating and then using the fin-ished lessons (Table 3). Students in both years indi-cated support for this project. Results suggested they believed that creating a case enabled knowledge and skill building relating to communicating with health care professionals and understanding content issues and project design, and that the completed lessons were a beneficial learning tool that should be used.

The free responses regarding both the computer assignment and the finished cases were positive, sup-portive, and enthusiastic, describing the project as not only interesting but also educationally beneficial. Stu-dents perceived creating a case as an activity that was innovative, practical, applicable to their profession,

interactive, flexible, and self-directed. It developed team building, complex task handling, research and computer skills, and changed their perspective from learner to teacher. Students commented that finished cases were a good study tool, provided excellent feedback, promoted information retention, and should be continued in future years.

Students reported an average of 18.8 hours required to complete their project. Tracking the number of hits for completed cases on the site recorded over 45,000 hits in 8 months of use by 140 students.

DISCUSSION

Chronicles of higher education report increasing re-liance on computer technology to deliver curricular in-struction, a trend that is driven by a number of factors. Proponents project that informational technologies will cover more content, making instruction more cost effi-cient. Supporters believe that as educators become more proficient with computer-assisted instruction (CAI), tra-ditional classrooms will become obsolete, and students and teachers will have more time for other demands. Concerned opponents question measurable learning gains with CAI, citing the lack of studies reporting sig-nificant effects on cognitive measures. They purport that only students with the highest levels of cognitive ability will benefit and suggest technology-driven curricula may garner a degree of alienation and social dissatisfac-tion among students.

The VITAL project was an alternative problem-based instructional instrument that permitted students to create a peer-teaching resource in case-based format for

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American Journal of Pharmaceutical Education 2003; 67 (1) Article 19. Table 2. Mean Grades for Second and Third Year Pharmacy Students Assigned Either to a Group

Using a Virtual Interactive Case Tool for Asynchronous Learning or to an Alternate Group

Group Project Grade Written

Exam 1 Grade Written

Exam 2 Grade Course Grade Second year students alternate group 86.6 84.4 80.6 83.5 VITAL group 90.6 83.2 80.2 83.8 Third year students alternate group 87.0 78.2 78.4 80.4

VITAL group 93.0 75.5 76.6 80.1

various online audiences, which could not be matched by classroom time, and provided them with a publica-tion citation. The finished resource provides an inter-active experience that addresses some specific chal-lenges, such as concept visualization.

Learning Opportunities in Creation of Cases

Students were primarily engaged in the active ex-perimentation mode, described in Kolb’s learning in-ventory as working within cognitive constructivist or discovery-based learning theory. Active-learning edu-cators feel that, whereas didactic presentations tend to support a gradual learning curve or surface learning, a design which requires participation in theorizing, re-flecting, and generalization increases the slope of the learning curve. This project required skills in self-directed research, including planning, organization, and structure; evaluation and integration of knowl-edge to a problem; and scrutiny of audio-visual mate-rial, published literature, and Internet resources. Learning to use online instructions and a database format introduced students to the behaviorist model of learning (programmed instruction), while the team approach provided a forum for socially oriented theo-ries of learning (collaborative learning). Students needed written communication skills in constructing cases, questions, and responses at the appropriate lan-guage level for educated health care professionals. Self-assessment and survey requirements were an op-portunity for evaluating outcomes and satisfaction.

This learning exercise provided an opportunity for students to apply knowledge and skills directly to peer professionals both in pharmacy and in other health care disciplines. Student authors can cite the online published project on their resumes or job applications.

Learning Opportunities in Completed Case Re-sources

The interactive computer case presents an imper-sonal learning opportunity for systematic analysis which relies heavily on logical thinking and rational evalua-tion. Users operate primarily in Kolb’s learning mode of abstract conceptualization.6 The multiple and varied forms of each lesson should engage and appeal to an audience of disparate learning preferences, presenting widely differing “narrative parable” cases, creative mul-timedia enhancements, linked literature references, and requiring skills of integration and problem-solving. Learning is convenient as it may be done independently or in a group situation; the learner controls the interac-tive pacing, the asynchronous nature promotes flexibil-ity; there is immediate feedback and grading, and the ability to repeat lessons may improve learning.

The marks achieved by both cohorts reflect success-ful integration of required elements. The completed les-sons contained appropriate information in an engaging style at the appropriate language level for the target au-dience. The narrative parables established patient histo-ries that were imaginative, humorous, and cleverly con-trived. Applied learning from published lessons was possible, and submissions often refined the technical skill or inventiveness of previous efforts.

Learning Impact

It is difficult to establish a quantifiable beneficial impact on learning outcomes. Comparing course scores to project scores within the crossover groups does not necessarily reflect the impact of the experience since assessment methods are composite and instructors dif-fered for grading other portions of the course. Students who completed the alternate assignment received lower grades on their project and higher grades on examinations.

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American Journal of Pharmaceutical Education 2003; 67 (1) Article 19. Table 3. Pharmacy Students’ Average Responses on a Likert Scale* to Statements on a Survey Assessing a Virtual

Interactive Case Tool for Asynchronous Learning Spring Fall n % n % Creating a Case: Enabling Knowledge Building Helped me to learn one specific non-prescription drug topic in detail. 4.6 92 4 80 Helped me to understand issues important to the patient. 4.2 86 4.1 81 Helped me to learn one specific non-prescription drug topic in detail. 4.6 92 4 80 Helped me to understand issues important to the patient. 4.2 86 4.1 81 Helped me to classify questions of importance to the pharmaceutical

care process 4 80 4.2 83

Helped me to understand principles in explaining incorrect or partially correct responses

4.5 89 4.4 87

Was useful in learning/reviewing the pathophysiology, etiology, and differential diagnosis of a particular self-limiting or minor condi-tion.

4.5 90 4.5 90

Was useful in learning/reviewing the interrelationships between a self-limiting or minor condition, non-drug alternatives, and compara-tive drug therapy,

4.2 83 4.4 87

Was useful in learning/reviewing the situations in which patients should seek advice of a physician or other health care professional, and when they can safely self-medicate

3.9 77 4.5 89

Was useful in understanding parameters for monitoring outcomes for a self-medicating patient

3.5 71 4 80

Was useful in reviewing the published literature about this condition 4.5 89 4.2 84 Was useful in reviewing other Internet sources about this condition 4.6 91 4.7 93 Serves as a useful supplement to the information provided in lecture 4.4 88 4.1 82 Helped in preparation for the written exam in 220 4.6 93 3.8 75 Is a useful learning tool 4.5 89 4.2 84 Creating a Case: Enabling Skills Building Encouraged students to take responsibility for their own learning 4.5 90 4.2 84 Was helpful in building students’ confidence in their ability to learn 3.5 69 4 80 Helped to learn to manage large complex tasks 4.9 98 4.1 82 Encouraged the exercise of creativity 4.9 97 4.6 92 Helped me to formulate questions and responses to enable PBL learn-

ing for my peers and for pharmacists in practice 4.5 89 4.5 89

Enabled acquiring skills useful in my profession 4 80 4 80 Completed Online Cases Should be continued to be used/updated in subsequent years. 4.8 95 4.4 87 Are a useful resource for learning about other self-limiting or minor

conditions 4.7 95 4.3 85

Are a useful resource for preparation for the cumulative oral skills exam

4.4 89 3.6 76

Are a useful resource for preparation for the written exams in 220 and 320

4.4 89 4 80

I have accessed the completed interactive cases as a learning resource. 4.5 89 4.2 83 I intend to access the completed interactive cases as a learning re-

source. 4.8 95 4.3 86

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American Journal of Pharmaceutical Education 2003; 67 (1) Article 19. Table 3 Continued Project Design Was at a level of difficulty I could comprehend. 4.6 92 4.3 86 Instructions were well written and easy to follow. 3.2 64 3.7 74 I was able to enhance my project with images or video clips 4.8 95 4.4 88 The navigational tools (e.g., indexes and navigational buttons) al-

lowed easy access to specific areas 4.6 92 3.8 76

Number of hours necessary to complete the interactive case project 5-25 100 18.8 100 * Likert Scale of 1 to 5 with 5 indicating “strongly agree.”

Differences were not statistically different and overall course marks were similar.

The survey results and free response comments, however, clearly indicated that both creating the pro-ject and the completed resource were perceived by students to be a valued learning experience which promoted active, self-directed learning. Likert scale responses indicated awareness of knowledge and skills building, including communication techniques and technological use of the Internet.

As group work was necessary for successful com-pletion of the project, students attended a half-day seminar on building successful team dynamics, which included activities centred on understanding and accommodating learning styles as described by the Kolb inventory, at the beginning of the second year. Team composition was also academically stratified based on academic averages from the previous year, so that each team had a cross section of academic abilities to facilitate mentoring between stronger and weaker students. Free-response comments reflected the students’ appreciation of this collaborative learning approach. Although time spent was considerable, they considered it reasonable in terms of the efficiency of sharing work among team members. Students felt able to divide the work, discuss options through web conferencing, and meet as needed to coordinate. They noted that work was apportioned based on team members’ expertise with respect to computer skills, efficient writing skills, or content research. The overall perception from students was that the project was not only worthwhile in providing learning benefits, but they felt that working in a state-of-the-art medium put them on the cutting edge in a way that was also appealing, motivating, and applicable to the profession.

Challenges and Modifications in Implementation

Initially, the instructor reviewed all data online to assess the technical functionality of these lessons. After the first few lessons, to optimize time for content re-view, Access was used to print the lessons for portabli-lity. For the second year class, the survey tool was in paper form, which took considerable time to tabulate. A database survey was developed, programmed, and im-plemented for the third year cohort.

Student feedback identified the following issues: they were sometimes unable to edit and had to retype all the information and resubmit when changes were neces-sary. They often did not correctly access their original file and created several copies of the lesson, which the instructor would have to delete. They sometimes had difficulties in obtaining permission for images or in up-loading the images. From time to time, images would disappear from the published lesson, and the instructor would have to ask the teams to replace the images. Some students wished to be more creative and asked for a number of other html codes or additional options. In general, accessibility to computers was not a problem, but some students with older hardware or remote con-nections via modems experienced long waiting times when downloading from the Internet. Problems and technical difficulties were addressed as the project pro-ceeded during both the second and third year phases.

Subsequent Use of Completed Resource

Students were encouraged to use the lessons as a testing method prior to examinations, either independ-ently or in study groups. Many employed the latter strat-egy, reporting benefits from the discussions generated and also time efficiency, especially if their remote loca-tions were slow to download material. In response to their enthusiasm and to encourage use of the resource as a study tool, as an added incentive, a few selected mul-tiple-choice questions from these cases were included on

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American Journal of Pharmaceutical Education 2003; 67 (1) Article 19. the examination. Thus, students could achieve a few 'secured' marks when completing the exam (lessons had indicated the correct responses), in addition to having the benefits of studying material in an enter-taining way and the opportunity for self-assessment. The response of students was understandably positive. Interestingly, not all students achieved perfect marks on these questions, either because they did not under-take the effort or they lacked the recall and under-standing necessary. This motivational strategy was employed with the participating classes during their second and third year and with 2 subsequent classes.

To explore the value of this interactive e-based tool compared to other problem-based formats in these courses, an exercise to measure relative benefit was undertaken in the fall of 2002 with the succeed-ing third year class. The results of this exercise will be monitored and assessed. Subsequently, the online site may be modified.

Implication for Faculty Workload and Finances

A 2-year University of Toronto grant from the in-formation technology courseware development fund supported the programming technician but not the instructor’s time for the project, which were addi-tional hours to previous iterations of the course. This included time for design and programming of the home page and instructions and submission pages; modifications; weekly review of submissions and re-visions online; response to student questions or tech-nological problems; completion of assessments; tabu-lation of survey results, and maintenance of the site as an online student resource. The project may entail revisions with future classes. However, students were exposed to double the number of case-based applica-tions of course content, expanding the breadth and depth of content beyond instructor-facilitated class-room time.

The interactive technology revolution creates a challenge to faculty in developing new ways to pre-sent content, creating new assignments, implementing appropriate evaluation, and measuring outcome as-sessment. It is increasingly difficult to have the time and resources to effect these changes.

CONCLUSIONS

This project was intended to reinforce concepts presented in lectures and to afford individual students with an opportunity to apply knowledge and skills in an asynchronous, interactive way that fostered both independent learning and team dynamics. It allowed

students to gain practical experience in presentation of applied case-based information to health professional peers. In transforming the learner into the teacher, it augments the educational experience: “when one teaches, two learn.” Additionally, it presents not onlythe creator, but also the user, with the opportunity to direct their own learning. Delivery of course objectives in an attractive format and project that cannot be duplicated by texts or lectures resulted in an experience student considered a constructive and engaging way to enhance learning.

ACKNOWLEDGEMENTS

The author wishes to thank the students of the class of 0T3 for their efforts and feedback, and for granting permission to post their work on the Internet.

REFERENCES 1. Perrier DG, Winslade N, Pugsley J, Lavack L. Designing a phar-maceutical care curriculum. Am J Pharm Educ. 1995;59:113-25. 2. Sibbald DJ. Innovative, problem-based, pharmaceutical care courses for self- medication. Am J Pharm Educ. 1998;62:109-18. 3. Sibbald DJ. Oral Clinical Skills Examination: An innovative Rein-forcing Strategy for Nonprescription Medication Courses. Am J Pharm Educ. 1998;62:458-63. 4. Sibbald DJ. Bridging the Gap to Practice - Pharmacy PBL Stu-dents Establish Consumer Website for Non-prescription Drugs. Am J Pharm Educ. 2000;64:339-48. 5. Sibbald DJ. Using First Year Students as Standardized Patients for an Objective Structured Clinical Exam (OSCE) for Third Year Pharmacy Students. Am J Pharm Educ. 2001;65:404-12. 6. Kolb DA. Experiential Learning. Englewood Cliffs, NJ: Prentice-Hall, 1984. 7. Cliff WH, Wright AW. Directed case study method for teaching human anatomy and physiology. Am J Physiol. 1996;270: S19-S28.

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