Academic journal article American Journal of Pharmaceutical Education

Instructional Scaffolding to Improve Students' Skills in Evaluating Clinical Literature

Academic journal article American Journal of Pharmaceutical Education

Instructional Scaffolding to Improve Students' Skills in Evaluating Clinical Literature

Article excerpt

INTRODUCTION

Critical analysis of the medical and scientific literature is one element of evidence-based medical practice (1) and is necessary for today's pharmacists to help physicians and patients use medications safely and effectively. The Accreditation Council for Pharmacy Education recognizes this need forevidence-based pharmaceutical care and includes requirements for training in evidence-based medicine in Standards 2007. (2)

Pharmacy and medical education publications have presented various approaches for training students to read and critically evaluate the medical literature. (3-6) The most common instructional support tools used to teach students to evaluate medical literature are standalone questions and simple checklists. (3,6-12) Although standalone questions and checklists provide some structure for students when learning to evaluate medical literature, there are weaknesses to this approach. Students must possess either extensive background knowledge or depend on faculty members or experts to assist them in answering the questions. Also, standalone questions and checklists may not teach students how to judge the quality of a study or its associated publication. Having faculty members/experts present to support student learning is important and arguably they are irreplaceable; however, use of faculty expertise should be strategic and combined with explicit and targeted instructional support to build solid, transferable skills in students, particularly in complex learning situations.

Reading and evaluating medical literature is a complex process because of the layered knowledge required. Not only is domain-specific knowledge about the content in the article needed (eg, the pharmacokinetics of a specific drug or the anatomy and physiology of a body system), (13) the reader also must have general knowledge of the scientific process and specific knowledge about the particular type of research (eg, clinical trial, cohort, case-control study). When learning complex, domain-specific science skills and knowledge, students need instructional guidance that promotes an integrated conceptual framework. (14-18)

Targeted instructional techniques such as scaffolding can be used to help students develop conceptual frameworks. Scaffolding is "the systematic sequencing of prompted content, materials, tasks, and teacher and peer support to optimize" independent learning, (19) and can include instructional elements such as guided questioning; comparing ideas; identifying connections and distinguishing characteristics between concepts; and identifying valid relationships. When used in such complex, knowledge-based learning situations, scaffolding is more effective than open-ended inquiry-based science instruction and more effective than traditional lecture-based instruction. (14,17-20)

The purpose of this research was to develop and implement an instructional model using targeted scaffolding and an associated activity to teach students to critically evaluate clinical literature. The hypothesis was that the use of targeted instructional scaffolding using highly interactive, student-oriented, and cognition-based approaches would improve student abilities to evaluate clinical literature more critically than traditional lecture-based instruction.

DESIGN

The goal for this research was to develop and test a model and an associated activity to teach students how to read and evaluate clinical literature. This included testing the hypothesis that the use of targeted instructional scaffolding using highly interactive, student-oriented, and cognition-based approaches, would improve student ability to critically evaluate clinical literature compared to more traditional lecture-based didactic instruction. This hypothesis was tested by implementing the clinical literature evaluation activity in the Pharmaceutical Care Laboratory near the end of the semester after students had completed the majority (> 80%) of material and assignments for the Pharmacy Informatics and Research course, including writing a major literature review paper. …

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