Social Distancing Lessons: Short-Term Transitions with Long-Term Value

By: S. Eric Nybo, PhD; Kali M. VanLangen, PharmD, BCPS; David R. Bright, PharmD, MBA, BCACP, FAPhA

The social distancing measures during the spring 2020 COVID-19 pandemic significantly disrupted in-person delivery of our integrated pharmacotherapy course. This situation prompted a rapid conversion from synchronous to asynchronous instruction and presented three challenges to overcome: communication with students, transition of synchronous to asynchronous delivery of course content, and implementation of remote assessments. In this article, we briefly outline our process guided by scholarly practices and ask a series of questions that attempt to encapsulate lessons that the pharmacy academy may learn from this pandemic. 

First: Establish Communication

We quickly recognized the need for clear and effective communication about coursework given the rapidly changing climate of COVID-19. We developed a series of communication policies based on an amalgamation of “best practices” from the literature (Table 1). 

Table 1 “Best practices” for virtual communication and application to a virtual integrated pharmacotherapy course

Literature “Best Practice”	Application to course
Establish clear expectations for student work 1	First week delivered asynchronouslyAttendance not required during this transitionOnline course policies decided in advance and communicated ahead of time via email
Ensure consistent, effective communication with students 2	A “daily email blast” was sent by a single point person with all major course updates aligned with University updates about COVID-19
Establish a personal relationship with students via communication 3	Instructors hosted virtual office hours via Calendly and Zoom conference appointments that students could schedule directly.

Second: “Get your Sea Legs”

The first week of remote instruction would take place entirely asynchronously to ease students into the transition to online coursework (Table 1). We applied “best practices” to guide the transition of face-to-face coursework to an online environment with a one-week turnaround time (Table 2).⁴ As the course series continued, selected blended active learning (roughly 40%) returned to synchronous instruction to make it easier for students to ask questions and interact with instructors.⁴

Table 2 Application of “best practices” for transitioning to online course delivery

Literature “Best practice”4	Application to Course
Setting the stage	Students informed about Examsoft settings ahead of timeTime limits enforcedOpen-note examsNon-secure examInternet turned offBackwards navigation turned off
Consistency of teaching	Faculty used web conferencing to conduct blended active learning and SOAP (subjective, objective, assessment, and plan) note assessments.
Timeliness	Faculty uploaded content 24-48 hours ahead of time to help students adjust to online environment
Accountability	Students reminded of upcoming course deadlines in daily email blastTime management strategies for remote educationExam composition communicated in advanceExamID enforced to ensure student identity during exam
Structured active learning	Pre-recorded patient cases during the first week for students to work in a self-paced mannerInteractive Q&A with a faculty member about the COVID-19 pandemicWeb conferencing for synchronous blended active learning.
Faculty feedback on student learning	Faculty conduct exam review via web conference directly after exam conclusion
Technology	Use web conferencing for one-on-one meetings and group SOAP note assessmentsCanvas LMS for asynchronous delivery of course content

Third: “Show what YOU know”

Formative and summative assessments were identified as a major challenge for remote education due to concerns about cheating and group exams in a remote, non-proctored exam setting. Remote proctoring was cost-prohibitive, and instructors envisioned a series of policies that could assess students’ application of knowledge using an open-note examination that prevented group work thus encouraging individual student accountability (Table 2). Interestingly, students reported very few technology glitches, roughly equivalent to invigilated exams. Within the same cohort, exam performance was virtually identical on an in-person exam and an exam administered remotely (the open-note exam had a slightly higher exam mean score) (Table 3).

Table 3 Comparison of exam statistics between an exam given after in-person instruction and an exam given after remote instruction. 

Metric	Exam (In-Person Instruction)	Exam (Remote Instruction)
Number of students	n = 137	n = 136
Number of items	74	72
Mean Score	82%	86%
Median Score	84%	88%
Standard Deviation	10%	7.7%
KR-20 Formula	0.82	0.80

Questions for the Academy

The broader discussion of transitioning synchronous pharmacy coursework to remote education poses unique opportunities for the future. The following topics are worthy of further discussion:

1. What balance of synchronous/asynchronous instruction is ideal? 
2. How do we make the best use of face-to-face time after the pandemic is over?
3. How do we take advantage of lessons learned during the pandemic to improve face-to-face instruction going forward? Do we simply return to the status quo?
4. What is the viability of a student cohort participating in an offsite didactic curriculum for an entire academic year (e.g., P3) to spend more time at an IPPE site? 
5. Could hands-on skills instruction and assessment be “batched” earlier in the program, with simple opportunities for reassessment at later stages to identify any “skill atrophy” that might take place?

References

1. Holdford D, Lovelace-Elmore B. Applying the principles of human motivation to pharmaceutical education. J Pharm Teach. 2001;8(4):1-18. 
2. Betts, K. Lost in translation: Importance of effective communication in online education. Online J Distance Learn Admin. 2009;12(2).
3. Venable, M. (July 22, 2015)  “Make a personal connection in your online classroom.” http://www.onlinecollege.org/2013/07/22/make-a-personal-connection-in-your-online-classroom/
4. Margolis AR, Porter AL, Pitterle ME. Best practices for use of blended learning. Am J Pharm Educ. 2017;81(3):49.

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Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning