| Summary: | The extended role of today’s pharmacist with the emphasis on patient-focused care has highlighted the need for increased exposure of undergraduate pharmacy students to experiential learning in patient-centred environments, and additional skills development in therapeutics, problem solving and clinical decision making. At the Nelson Mandela Metropolitan University (NMMU), final year pharmacy students complete a university-coordinated, hospital-based, structured experiential learning programme (ELP) for the exit-level module, Pharmacology4. However, the students consistently experience difficulties in the application of pharmacological knowledge during the transition from lecture-based learning to the patient-focused clinical setting. The student population at the NMMU is diverse, with varied cultural, ethnic, language and secondary level education backgrounds, as well as different learning preferences and approaches. The extent to which these factors affect academic achievement in the experiential learning environment is unknown. Central research question The central research question for this study was therefore, “What would be the effect of an intervention aimed at supporting undergraduate pharmacy students during clinical placements, on academic achievement in, and student attitudes towards, experiential learning programmes (ELP)?” In order to explore the research question, several factors which may influence academic achievement in ELPs were investigated, namely: academic achievement (pre-university, in the BPharm programme and, in pharmacology); the admission route into the BPharm programme and the subsequent rate of academic progression; English reading comprehension ability; learning styles; problem solving ability; the extent to which students are prepared for application of knowledge in the ELP, in terms of assessment methods used prior to the final year and previous pharmacy work-based experience. In addition, the students’ lived experience of the ELP was explored, and the need for, and nature of, an intervention was determined. The research was based in a pragmatic paradigm, using an advanced mixed methods approach. An intervention-based, two-phase, quasi-experimental design was employed with an initial exploratory Preliminary Phase (in 2013) preceding the larger experimental framework (Phases One and Two, in 2014 and 2015 respectively). The research design was primarily quantitative, with pre- and post- testing conducted before and after the ELP. The ELP was completed by the comparator cohort in Phase One and the experimental cohort in Phase Two. Supplementary qualitative data was collected before, during and after the ELP. The intervention, in the form of supplementary academic support sessions, was developed from the qualitative data using an iterative approach, and implemented during the ELP in Phase Two. Attitudes and expectations of the students towards the hospital-based ELP were generally positive and realistic. Areas of concern included the difficulties experienced in the application and integration of pharmacological knowledge, both in the clinical setting and the clinical case study-based assessments; students feeling overwhelmed, inadequate and inferior in the clinical environment, compounded by an absence of clinical pharmacists as role models; and feeling unprepared for patient-focused care. The qualitative data strongly supported the need for supplementary academic support sessions. The intervention was developed and implemented in Phase Two, using patient case-based, active learning strategies. The majority of students (91.0%; n = 104) reported improved case analysis skills. A statistically significant (p = .030, Cohen’s d = 0.34) improvement was noted in the summative Pharmacology4 assessment marks obtained by the experimental cohort post-intervention, although of small practical significance. Predictors of academic achievement in the ELP were found to be language, specifically English reading comprehension skills, academic achievement in the BPharm programme and pharmacology, the university admission score, the rate of academic progression, and problem solving ability. Previous pharmacy-based work experience and assessment questions requiring application of knowledge were also found to influence achievement in the ELP. The need for an intervention in the form of supplementary academic support sessions was confirmed. The intervention was subsequently developed and successfully implemented, with student-reported self-perceived improvements in patient case analysis skills. These positive findings were supported by quantitative data which showed a statistically significant improvement in academic achievement in the ELP. Several predictors of academic achievement in the ELP were identified, and invaluable insight was gained into the nature of the difficulties experienced by pharmacy students in the transition from lecture-based learning to experiential learning in patient-focused environments.
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