Nursing Articles

 

Maisha Kelly Freeman, PharmD, Robert H. Schrimsher, EdD, and Michael G. Kendrach, PharmD

McWhorter School of Pharmacy, Samford University

Submitted March 21, 2006; accepted May 07, 2006; published December 15, 2006.

Objectives.

drug information course for first-year professional doctor of pharmacy students.To determine student perceptions regarding online lectures and quizzes during an introductory

Design.

a careers in pharmacy exercise, and a final examination were used to deliver the course content

and assess performance. A multiple-choice survey instrument was used to evaluate student perceptions

ofFormal and online lectures, online quizzes, written semester projects, a practice-based examination,WebCT and online lectures.

Assessment.

better, 77% reported that lectures would be used to study for the final examination, and 59% reported

that they would use

online lectures should be used in future courses.More than 47% of students reported that online lectures helped them learn the materialWebCT lectures for future classes. Approximately 40% of students agreed that

Conclusion.

preferred in-class lectures compared to online lectures. A positive correlation was observed for

those students who performed well on the online quizzes and those who performed well on the final

examination.Students reported that WebCT was easy to use; however, the majority of students

Keywords:drug information, Internet, WebCT, active learning

INTRODUCTION

As technology advances, an increasing number of

pharmacists will be required to incorporate information

technology into their daily practices. Online tutorials are

becoming common place in a wide variety of settings that

include academia and the workplace; therefore, colleges

and schools of pharmacy need to embrace the challenges

associated with this teaching style. Furthermore, students

will have to become more familiar with computerized

testing as theNorthAmericanPharmacistLicensureExamination

(NAPLEX) and many state board examinations

are completed via computer only. In addition, many computer

systems in pharmacy are becoming more advanced

while new drugs are consistently being approved for use.

Therefore, technology must be used to allow pharmacists

to keep abreast of the new information that they are

expected to master.

Several pharmacy school instructors have developed

online lectures and/or used the Internet to facilitate student

learning.

was improved and/or no differences with respect to

academic performance was observed between classroom

and online instruction.

evaluated 42 third-year pharmacy students’ knowledge

and ability to assess metered-dose inhaler (MDI) technique

via 3 models: after a traditional lecture, Web-based

MDI technique tutorial, or no intervention.

differences in academic performance were observed

between students who completed the Web-based or lecture

tutorial (

were observed between the control group and the

groups who received additional education related to MDI

technique.

quizzes via

and other teaching methods on learning in a first-year

professional health systems course were examined. The

investigator determined that students who completed

more

compared to other students.1-8 In these assessments, student performance1,3,4,6,8 For example, Erickson et al3 Although nop50.38), differences with respect to knowledge3 Similarly, the effectiveness of Internet-basedWebCT, an electronic course managementsystem,WebCT quizzes performed better on examinations6

Three drug information courses are required at Samford

University, McWhorter School of Pharmacy, in the

first-, third-, and fourth-professional years, respectively,

of the doctor of pharmacy program. The first-professional

year course serves as an introduction to drug information

Corresponding Author:

BCPS. Address: Samford University, McWhorter School of

Pharmacy, 800 Lakeshore Drive, Birmingham, AL 35229.

Tel: 205-726-4175. Fax: 205-726-4012. E-mail:

mkelly@samford.eduMaisha Kelly Freeman, PharmD,

American Journal of Pharmaceutical Education2006; 70 (6) Article 126.

1

and information retrieval skills are emphasized. Students

in the third-professional year course are taught literature

evaluation skills. The course in the fourth-professional

year is a part of the advance practice experience that students

must complete prior to graduation. The instructors

of the fourth-professional year course emphasize both

written and oral communication, literature evaluation,

and information retrieval skills.

Throughout the 3-year sequence of drug information

courses, students are exposed to a variety of strategies to

facilitate the learning process. Students in the first-year

course are expected to complete a series of projects that

primarily focus on efficient methods to retrieve information

within medication references/resources and textbooks, as

well as secondary database searching (eg, International

Pharmaceutical Abstracts and PubMed).

Dueto the repetitiveness of the learning material delivered

through lectures and laboratory sessions between

and within each year and the availability of

a series of online lectures were developed. The goals of

the online lecture series were to help facilitate learning,

decrease the amount of time in class devoted to lectures,

and increase the time available for laboratory activities in

the first-year drug information course. The development

of literature searching, problem-solving, writing, and

technology skills were emphasized via classroom lectures,

laboratory exercises, and online technology. The

activities created for the laboratory sessions were

designed to mimic practice in community, hospital, and

long-term care settings.

The purpose of this study was to determine student

perceptions toward utilizing online lectures andWebCT,WebCT

in an introductory drug information course. The survey

was administered online via

between online quiz grades and final examination scores

were also examined.WebCT. The correlation

DESIGN

Information Systems

course for first-year professional doctor of pharmacy students.

The goal of this course is to prepare students to be

effective providers of drug information. ‘‘An effective

information provider perceives, assesses, and evaluates

drug information requests and efficiently retrieves, evaluates,

communicates and applies data from published literature

and other sources to provide an integral component

of pharmaceutical care.’’is a required, 1-credit hour9

The course structure included the following components:

4 in-class lectures (50 minutes each) with class

lecture notes included in the course packet in sequential

order of lectures that was available on the first day of

class; 5 online lectures, 5 laboratory sessions; and 7 online

quizzes. These quizzes were to be completed 1 week following

the completion of the online or in-class lecture.

Other course assignments included: 2 written semester

projects; a presentation on careers in pharmacy in which

students were assigned 1 of 8 careers and presented a skit

of a pharmacist interaction with a patient and the necessary

educational requirements to complete before entering

the specialty; and a practice-based examination in

which students were expected to answer a tertiary and

secondary literature question within 20 minutes with the

available print and electronic references. A final examination

was administered at the completion of the course.

All written semester projects were submitted electronically

via

Four online lectures were prepared usingWebCT.MacromediaCaptivateEducationVersion

(Macromedia,Lindon,

UT, 2005) that allowed

Internet Web pages to be imported into the software for

interactive simulations of course content. ThePowerPoint presentations andCaptivate

software was used in the following lectures: Tertiary

Literature; Secondary Literature/International Pharmaceutical

Abstracts (IPA); PubMed; Samford University

Drug Information Center Web pages; Davis Library

online catalog system; and Internet sources. Students

were able to access online lecture content anywhere there

was Internet connectivity; however, students were encouraged

to view the lectures at a designated campus site

(eg, Drug Information Center, University library). A

descriptive, oral narration was provided for all lectures

except those on

Center Web pages, and Davis Library online

catalog system. These lectures were supplemented with

written, descriptive captions. Students were able to view

simulations of tertiary literature searches to assist them in

locating information for Internet-based resources includingPubMed, Samford University Drug Information

Lexi-Comp, Drug Facts and Comparisons,and

Clinical Pharmacology

examples regarding the appropriate searching techniques

for

allowed students to observe important characteristics

of medically related web sites.

Online lectures were available on the first day of class

and students had the ability to view these lectures at their

convenience throughout the semester. Students were

informed that lectures could not be viewed without highspeed

Internet connectivity. No in-class lectures were

scheduled during the weeks students were required to

listen to online lectures so the students could have a designated

time to view the lectures. Headphones were available

for check out, free of charge, in the Samford Drug

Information Center or campus library for listening to lectures.

Most lectures were approximately 1 hour in length. Students were also provided withPubMed and IPA. In addition, the Internet-based lectures

American Journal of Pharmaceutical Education2006; 70 (6) Article 126.

2

or less. Only students enrolled in

access to online lectures.Aset of 3 practice questions was

imported into the Captivate lecture. Students had 3

attempts to answer each question correctly. If the question

was answered incorrectly, the lecture was shifted to the

subject matter in which the student was experiencing

difficulty. Multiple-choice questions incorporated in theInformation Systems had

Captivate

questions.

Seven, multiple-choice

to facilitate student learning. Quiz material was developed

from examinations administered in previous years.

All students were expected to complete the quizzes within

the time allotted (eg, 15 minutes for a 10-question quiz).

Quizzes for the week were released at the beginning of the

week (ie, Monday) and had to be completed by 11:00lectures were included in the WebCT quizWebCT quizzes were developedPM

Friday of the same week. To ensure that students were

comfortable answering questions via

survey instrument was developed inWebCT, an introductoryWebCT

in which students were expected to communicate pertinent

information about themselves to the instructor.

Students were invited to ask questions about the proper

way to submit quizzes via a session acquainting them with

WebCT

students.

The quizzes consisted of 10 questions for most lectures;

however, 15 questions were administered for, but further explanation was declined by theIPA

and

was 15 and 20 minutes, respectively. When students took

the quiz, only 1 question at a time was visible. In addition,

all answer choices were scrambled with each quiz that

was administered. Quizzes were graded upon completion;

however, quiz grades and feedback were not provided

until all quizzes for the week had been submitted. Along

with their score, students could view questions they

answered correctly or incorrectly. An explanation of

why an answer was correct or incorrect was included.

Students had access to quiz questions and answers after

all quizzes were submitted and graded. A copy of the quiz

completion schedule was included in the syllabus andPubMed lectures. The time restriction for all quizzes

WebCT

Only students enrolled in

to online quizzes.

Course grades were earned from student performance

on quizzes (20%), written project 1 (10%), written project

2 (15%), practice-based examination (15%), careers in

pharmacy presentation (10%), final examination (cumulative,

25%), and professionalism/participation (5%).

Pearson correlation coefficients between quiz and final

examination grades were analyzed via

All students were asked to complete an online survey

instrument to assess the use of online lectures andalerted students when a quiz was to be completed.Information Systems had accessSPSS 12.0.WebCT

over the semester. All statistical analyses were performed

via

Board approved this study.SPSS 12.0. Samford University Institutional Review

RESULTS

During the fall semester of 2005, 124 students were

enrolled in the

asked to voluntarily assess the use of online lectures andInformation Systems course. Students were

WebCT

related to

scale (1-strongly agree to 5-strongly disagree). A total of

109 (87.9%) students completed the survey instrument.

The majority were female (73.4%) and 80.7% were 20-24

years of age. Approximately 45% of students reported

previously completing between 1-2 courses that utilized

online quizzes or lectures. Greater than 97% of students

agreed that they were computer literate. The most frequently

reported locations for viewing online lectures

were off campus (68.8%; eg, home) and the fewest number

of respondents viewed lectures at an on-campus site

other than the School of Pharmacy.

Table 1 lists selected questions from the survey instrument

that were used to assess student perception of online

lectures. Overall, the majority of responders did not have

difficulty comprehending either the combined audio/

video lectures or video-only lectures (66.1% vs. 46.8%;

respectively

the combined audio/video lectures compared to the

video-only lectures with written captions. More than 47%

of students felt that online lectures helped them learn the

material better, 77% reported that they would use the

lectures to study for the final examination, and 59%

reported that they would use

course to reinforce information presented in future pharmacy

classes, if needed. Only 37.6% and 34% of students,

respectively, felt that they could appropriately searchover the semester. Students answered questionsWebCT and online lectures via a 5-point Likertp,0.05). Greater than 70% of students preferredWebCT lectures from theIPA

and

30% preferred online lectures to live lectures and

54% did not.Atotal of 44 (40.4%) students agreed that the

instructor should continue to use online lectures to deliver

course material; however, 34.8% of the students disagreed

with this statement.

Student perceptions regarding overall ease of use ofPubMed after completing online lectures. Approximately

WebCT

majority of respondents agreed that submission confirmations

via

overall process for submission of assigned tasks were user

friendly,

accessibility of viewing

day or night.

The mean score (

quizzes was 90.8during the course were positive (see Table 2). TheWebCT were received in a timely manner, theWebCT was easy to use, and they preferred theWebCT lectures any time of the6SD) that students earned on online6 10.3 and the mean score earned on

American Journal of Pharmaceutical Education2006; 70 (6) Article 126.

3

the final examination was 79.86 8.9. The Pearson

r

quizzes and overall examination scores was significant:correlation between the scores students earned on online

r

between the scores earned for completing online quizzes

and examination scores. Students who performed better

on the quizzes also performedwell on the final examination.

A total of 36 comments were submitted regarding50.321 (p,0.01). This indicates a positive correlation

WebCT

who commented stated that live lectures were more beneficial

than online lectures (11 students); however, 6 students

said they ‘‘liked’’ online lectures and 5 students

commented that they ‘‘liked’’

included

lectures consumed too much time (1 student); the online

lecture files were too large (1 student); quizzes were

difficult (1 student); online lectures were boring (1 student);

and video-only lectures were not helpful (2 students).

Three students expressed displeasure with online

lectures because they felt they could not ask questions.

Two students wanted to be able to view the online lectures

sooner.and online lectures. The majority of the studentsWebCT. Other commentsWebCT was easy to use (2 students); the online

DISCUSSION

Online lectures were integrated in an introductory

drug information course to allow more active learning

via laboratory activities within the course. The results of

the survey indicated that students enjoyed usingWebCT

Table 1. Perceptions of First-Year Pharmacy Students Regarding the Use of Online Lectures in an Introductory Drug Information

Course (N5 109)

Question

Strongly

Agree,

No. (%)

Somewhat

Agree,

No. (%)

Neither Agree nor

Disagree, No.

No. (%)

Somewhat

Disagree,

No. (%)

Strongly

Disagree,

No. (%)

I did not have difficulty following

the combined audio/video lectures

23 (21.1) 49 (45) 11 (10.1) 17 (15.6) 8 (7.3)

I did not have a difficult time

following the video-only lectures

with written captions

16 (14.7) 35 (32.1) 16 (14.7) 31 (28.4) 11 (10.1)

I prefer the audio/video

presentations more than the videoonly

presentations

56 (51.4) 21 (19.3) 18 (16.5) 10 (9.2) 4 (3.7)

Online lectures helped me learn the

subject matter

7 (6.4) 45 (41.3) 13 (11.9) 22 (20.2) 22 (20.2)

I feel that I can appropriately search

IPA after completing the online

lectures

5 (4.6) 36 (33) 15 (13.8) 35 (32.1) 18 (16.5)

I feel that I can appropriately search

PubMed after completing the

online lectures

4 (3.7) 33 (30.3) 25 (22.9) 28 (25.7) 19 (17.4)

I prefer online lectures to live

lectures

16 (14.7) 16 (14.7) 18 (16.5) 24 (22) 35 (32.1)

I will view the online lectures

again to help me prepare for

the final exam

40 (36.7) 44 (40.4) 11 (10.1) 6 (5.5) 8 (7.3)

I recommend that more instructors

use WebCT to deliver online

lectures

6 (5.5) 16 (14.7) 23 (21.1) 31 (28.4) 33 (30.3)

I will use WebCT lectures from

PHRD 303* to refresh my memory

of the material for other classes, if

needed, while in pharmacy school

16 (14.7) 48 (44.0) 27 (24.8) 11 (10.1) 7 (6.4)

The instructor should continue to use

online lectures to deliver material

in future classes

18 (16.5) 26 (23.9) 27 (24.8) 19 (17.4) 19 (17.4)

*PHRD 303 is the course number forInformation Systems

American Journal of Pharmaceutical Education2006; 70 (6) Article 126.

4

(62.4%) and preferred having the ability to viewWebCT

lectures any time of the day or night (87.1%). Students

agreed that they did not have difficulty following content

present in the audio/video lectures, but they were less

accepting of video-only lectures with written captions.

Approximately 48% of students felt that online lectures

helped them learn the subject matter; however, fewer students,

37.6%and 34%, respectively, felt they could appropriately

search

amount (77.1%) of students reported that they would view

the online lectures again to help them prepare for the final

examination, which is more than those who felt that listening

to the online lectures contributed to their learning.

One possible explanation is that the students did not listen

to the online lectures as assigned and felt they needed to

view the lectures prior to the examination to perform

better. For the most part, students did not feel that more

instructors should use

Students were less clear about whether the online lectures

should be continued in this course. Approximately40% of

students felt that online lectures should be used in future

classes; however, 35% felt that online lectures should not

be used. Students may not have appreciated online lectures

for

43.1%, respectively, of students disagreeing that they

learned the material from the online lectures well enough

to search databases in the future; however, this value may

be more of a reflection of students (54%) not preferring

online lectures. Furthermore, if students did not prefer

online lectures, they may have responded in the same

manner about any material presented via this technology.

Although the majority of responders were female students

(73.4%) and 66% of the class is female, it is unclear

whether the results would have been different if more

male students had responded to the survey.

Overall, there were no significant correlations

between the number of courses in which students had been

enrolled that utilized online quizzes or lectures and the

students’ agreement that online lectures should be used to

deliver material in future classes (

92% of students completed all of the quizzes for

the

correlation between academic performance on online

quizzes and final examination scores. One possible explanation

is that students may have had access to previously

administered examinations, as most students performed

better on quizzes delivered early in the semester than on

those given later. The content on the latter quizzes wasIPA or PubMed. An overwhelmingWebCT to deliver online lectures.IPA and PubMed as indicated by 48.6% andp 5 0.905). ApproximatelyInformation Systems course and there was a positive

Table 2. Pharmacy Students’ Perceptions Regarding the Use ofWebCT in an Introductory Drug Information Course (N 5 109)

Question

Strongly

Agree,

No. (%)

Somewhat

Agree,

No. (%)

Neither

Agree nor Disagree,

No. (%)

Somewhat

Disagree,

No. (%)

Strongly

Disagree,

No. (%)

WebCT assignment

confirmations are received

in a timely manner after

uploading projects

66 (60.6) 24 (22) 17 (15.6) 2 (1.8) 0

The due dates and deadlines

for WebCT projects are

clear to me

79 (72.5) 24 (22) 1 (0.9) 4 (3.7) 1 (0.9)

Overall, the process used for

submitting assigned tasks

(eg, projects, quizzes) is

easy (eg, user friendly)

36 (33) 57 (52.3) 11 (10.1) 3 (2.8) 1 (0.9)

WebCT is easy to use 49 (45) 48 (44) 9 (8.3) 3 (2.8) 0

The university/school computers

consistently allows me to access

course components in WebCT

56 (51.4) 41 (37.6) 11 (10.1) 1 (0.9) 0

My home computer consistently

allows me to access course

components in WebCT

61 (56) 36 (33) 4 (3.7) 2 (1.8) 5 (4.6)

I like the accessibility of viewing

WebCT lectures any time of the

day or night

64 (58.7) 31 (28.4) 9 (8.3) 2 (1.8) 3 (2.8)

I enjoyed using WebCT 24 (22) 44 (40.4) 26 (23.9) 9 (8.3) 6 (5.5)

American Journal of Pharmaceutical Education2006; 70 (6) Article 126.

5

derived from the final examination from the previous

year, which students did not have access to before completing

the online quizzes. The students may have gained

access to the information on the quizzes administered in

previous examinations from former students. Although

questions and answer choices were randomized to discourage

cheating, students may have shared answers and

that could havemade a positive impact on their online quiz

score. In addition, some students may have used lecture

notes to assist them in answering online quiz questions.

Some discontent with online lectures was identified.

Revisions to the methods of delivery and selected other

items need to be incorporated for future use. Possible

actions for future classes include the following: all lectures

will have narrated voiceovers to convey pertinent

information; more exercises will be available to allow the

students to simulate the material they have learned

throughout the online lectures; students will be responsible

for completing the simulations before they are

allowed to view the remainder of the lectures; students

will be encouraged to work individually on online lectures

as it will be easier to record their time spent completing

online lectures for use in developing course content; and

additional time will be given to complete online quizzes.

Hopefully as technology becomes more common in the

workplace for learning new daily operational procedures

and for post-graduation requirements (eg, continuing education),

students will be more accepting to this online

instructional teaching method.

Distance education is becoming increasingly popular

in pharmacy asmore colleges and schools of pharmacy are

founded andmore pharmacists are completing the requirements

for a doctor of pharmacy degree. Online lectures

serve as a unique way of uniformly delivering information

to all students, reducing inconsistencies with learning

experiences, delivering material to larger groups of students,

offering learning flexibility to students with parttime

jobs or other needs, actively engaging the learner,

decreasing the need for printed handouts,monitoring learningmore

effectively, and increasing students’ accountability

by having an electronic trail of accessed lectures.5,10

Potential disadvantages to this type of learning include the

amount of time required to prepare lectures, students’ sense

of isolation fromthe instructor, ‘‘screen fatigue,’’ computer

malfunctions (eg, crashes, long load times, etc),

to have immediate answers to questions that may arise

when students are viewing lectures.

Investigators of several studies have examined the

benefits of using Web-based education in medicine and

nursing.

Web-based education is present in graduate nursing education

literature. In these studies, graduate student nurses

reported that the benefits of online courses with respect to

flexibility outweighed the disadvantages of online

courses.

of undergraduate and graduate nursing students regarding

Web-based courses.

(328 undergraduate students; 230 graduate students) from

6 schools of nursing were eligible for the survey. No

differences between the groups were observed for the

use of technology (eg, the availability and reliability of

technology). Several differences were observed regarding

educational practice among graduate and undergraduate

students. Undergraduate students perceived a greater

need for student-faculty interaction compared to the graduate

students (

anticipated a greater time commitment for studying Webbased

courses than undergraduate students. Overall, students

did not feel they were at a disadvantage because of

inadequate computer skills.

The student perceptions of

drug information course were positive; however, perceptions

about online lectures were less favorable. Possible

explanations related to unfavorable thoughts about online

lectures include: students may not have anticipated the

amount of time required outside of the classroom to prepare

for class; students transitioning from undergraduate

training may have required more contact with a faculty

member; and students may have been more accustomed to

passive learning instead of being an active participant in

the learning process.

Interactive lectures are becoming increasingly popular

as training tools for new pharmacists. Several community

pharmacies have advertised state-of-the-art

prescription systems that require completion of an extensive

CD-ROM based training program.

become familiar with this type of learning system before

starting practice. As more students are exposed to this

technology, overall perceptions of online lectures may

improve. In addition, students may become more accustomed

to using this technology as the pharmacist shortage

increases and new techniques to attract students to pharmacy

schools from remote locations are developed.5 and inability10-16 The majority of experience with interactive,11,15,16 Another study evaluated the perceptions12 Five hundred fifty-eight studentsp 5 0.01). In addition, graduate studentsWebCT in the introductory7 Students need to

Limitations

Although academic dishonesty was discouraged

through random assigning of answer choices and the ability

to view only 1 question at a time, students may have

shared answers or conferred with other students after

completing the online quizzes and that could have falsely

elevated grades for online quizzes. However, since a positive

correlation between higher online quiz scores and

higher final examination scores were observed, academic

dishonesty may be unlikely.

American Journal of Pharmaceutical Education2006; 70 (6) Article 126.

6

CONCLUSIONS

Examination scores and final course grades indicate

that first-professional year pharmacy students are capable

of comprehending and retaining the content of lectures

administered online. In addition, students have a positive

perception of

materials using both on- and off-campus computer terminals,

flexibility in accessing the materials, and clarity in

the feedback addressing performance. Students preferred

an audio/video lecture format over a video-only format

with written captions that had to be read.WebCT in regards to accessing the learning

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