Academic journal article American Journal of Pharmaceutical Education

A Case-Based Toxicology Module on Agricultural- and Mining-Related Occupational Exposures

Academic journal article American Journal of Pharmaceutical Education

A Case-Based Toxicology Module on Agricultural- and Mining-Related Occupational Exposures

Article excerpt

INTRODUCTION

Case-based teaching fits well with the increased emphasis on evidence-based classroom management encouraged by the Accreditation Council for Pharmacy Education (ACPE) and other accrediting boards. The emphasis that the ACPE has placed on active learning and critical thinking in pharmacy curricula increased with the release of Guidelines 2.0. (1) Thus, pharmacy educators are obliged to investigate active-learning techniques for the classroom, not only in response to the accreditation guidelines, but also because they help students with process skills such as communication, team-building, and problem solving. (2,3) Case studies are a natural way for pharmacy educators to incorporate active learning into a course curriculum as there are myriad patient cases to draw from in the literature. Additionally, case-based teaching effectively increases student engagement, particularly in the health sciences. (4-6) This is advantageous as there are multiple studies linking student engagement to learning, as the students feel more personally invested in learning outcomes if they are effectively engaged. (7-9) Case-based teaching has found much success in the fields of pharmacy, including in pharmacokinetics, (10) pharmaceutics, (11) medicinal chemistry, (12,13) pharmacology, (14) and toxicology. (15) Outside of pharmacy, faculty members have successfully used case-based teaching in nursing and professional ethics. (16,17) Overall, case-based teaching is prevalent in medical education because it increases professional and clinical competence and fosters critical thinking. (3,16,18)

Hiott and colleagues note the lack of appreciation within medication education for occupational exposures to chemicals and dust as such incidents relate to the diagnosis of illnesses. (19) These authors emphasize that healthcare professionals often fail to recognize the symptoms of pesticide poisonings and that knowledge regarding such exposures is especially important for clinicians serving rural and migrant populations. (19) Hiott and colleagues identify resources that clinicians can use, the most relevant of which is the Environmental Protection Agency's (EPA's) manual. (20) Unfortunately, the extent to which chemicals are encountered in various US occupations has outpaced their inclusion in medical curricula. (19) Colleges and schools of pharmacy are equally if not more deficient than medical schools in teaching students about occupational exposures; in fact, findings from an earlier study of the curricula of US colleges and schools suggested that approximately 30% offer a formal toxicology course in which occupational exposures are most likely to be covered. (15) The module described here emphasizes exposures associated with the occupations of farming and mining. Epidemiologists have linked these exposures to increased risk of cardiovascular disease, (21) respiratory illnesses, (22) and cancers. (23) Because of these additional risks, the implications for pharmacists' intervention in occupational exposure go far beyond the job itself.

A unique aspect of the Bill Gatton College of Pharmacy at East Tennessee State University is a component of its mission statement that emphasizes rural health care. This paper describes a case-based module created for second-(P2) and third-year (P3) doctor of pharmacy (PharmD) students at the college to help prepare them to assess patients who have suffered occupational exposure related to mining and agricultural jobs, with specific emphasis on the farming community's exposure to pesticides. Through a pre- and post-module case study and 5 additional case studies, as well as summative-evaluation examination questions, the effectiveness of the module for addressing these ends was assessed. The summative evaluation questions were constructed to correspond to the first 2 levels of Bloom's Taxonomy: Level 1, which includes knowledge, comprehension, and application, and Level 2, which includes application, analysis, synthesis, and evaluation. …

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