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Emergence of Bridging gap between Theory &
Practice in Pharmacology
By
Dr. Debasish Pradhan,
M Pharm, PhD, DSc., MBA, FIC, PDF (USA)
University Dept. of Pharmaceutical Sciences
Utkal University, Vani Vihar, Bhubaneswar, Odisha
Introduction to gap between
pharmacology Theory and Practice
 Pharmacology teaching occurs in a variety of contexts,
including medical schools, nursing schools, schools of
pharmacy, dentistry, physiotherapy, and veterinary
medicine. In addition, pharmacology is taught in research-
oriented biomedical programs in higher education.
Depending on the specific context, the aims and
implementation of pharmacology education differ
substantially.
 The most critical step in professional education is when
students are able to transfer theory learned in the classroom
into practice.
 Integrated reflective practices in pharmacy education offers
a possible solution to bridging theory with practice.2
What does it really mean?
 The difference between idealised practice and common
practice.
 The difference between taught general principles and the
difficulty in interpreting them for application to a specific
situation.
 The gap between taught abstract pharmacology theory and
its use in practice.
 The gap between scientific knowledge and theory used as
common practice.
 The gap between our individual mental representations of
pharmacology theory and the published theories of
pharmacology.
3
Barriers to Implementing Research
 Pharmacologists did not feel they had authority to
implement research findings.
 There was insufficient time on the job to
implement new ideas and/or to read research
articles.
 Management and/or doctors would not allow
and/or cooperate with implementations.
 Statistical analyses were not understandable.
 Facilities were inadequate for implementation.
 Other staff were not supportive of implementation
4
Can the Gap Ever Be Closed?
 The all-important question is, ‘can the theory-practice
gap ever be closed’?
 that it can’t and that while the narrowing of the
theory/practice gap may be a realistic goal, attempts to
close it completely are doomed to failure.
 Parallels can be drawn between the optimal management of
disease and learning environments. For many diseases, an
optimal treatment requires targeting different physiologic
pathway and pathologies in a concerted synergic effort.
5
MEANING AND CORRELATION OF THEORY AND
PRACTICE
 Theories are setup inter- related concept that give the systematic view
of phenomena that is explanatory-predictive in nature.
 Practice is a form of doing action in which practical wisdom and a
morally enlightened disposition are the bases of professional actions.
 The practical syllogism is the specific feature of practical wisdom
which directly links theory and practice in a way which maintains the
unity of the clinical experience.
-Lauder William -2004
6
Reflective Practice
 Integration refers to continuous, Intelligent and interactive
adjusting
Hopkins
 The un-reflected life is not worth living - Plato
 Reflective practice is the cornerstone of uniting theory and
practice in health promotion because the building together of
the past and the present determines future health promotion
actions.
(Naidoo and wills-1998)
7
Correlation of Theory and Practice
8
Why is reflective thinking / practice
important?
 Modern society is becoming more complex information is becoming
available and changing more rapidly prompting users to constantly
rethinking, switch directions, and change problem solving
strategies.
 To promote clinical reasoning and analytical evaluation abilities in
students.
 To apply new knowledge to the complex situations in their day to
day activities.
 To develop higher order thinking skills by prompting learners to
A. relate new knowledge to prior understanding
B. think in both abstract and conceptual terms
C. apply specific strategies in novel tasks
D. Understand their own thinking and Learning strategies.
9
USES OF REFLECTIVE PRACTICE
Reflective practice can facilitate and enhance
 Acceptance of, and increased confidence with, the essential
complexity and uncertainty of professional life.
 Reflexive critical awareness of personal values, ethics, prejudices,
assumptions of professional identity, decision-making processes
 Acceptance of and willingness to explore, the interrelatedness of the
professional and the personal
 Constructive awareness of collegial relationships
 Relief of stress by facing problematic or painful episodes
 Identification of learning needs
 Dissemination of experience and expertise to and from colleagues
 Increased confidence in professional practice
10
Reflective Practice in Pharmacology
 It helps develop critical thinking, problem-solving, and self-
directed and lifelong learning skills through gaining new
understandings, new perspectives, and new alternatives for
future experiences. Incorporating reflective practice into
pharmacy curricula assists students in bridging theory with the
complexities of practice.
 Reflective practices have been used to educate doc-tors, nurses,
physiotherapists, occupational therapist, and other allied health
students in higher education, to assist in bridging the gap
between theory and practice.
 Another reason for the lack of reflective practices in pharmacy
education may be because there is no structured framework or
guidelines for implementing reflective practices such as there are
in other health professions education.11
How can I introduce reflective practice in
to my teaching?
Self and peer assessment
Problem based learning
Personal development planning
12
Self And Peer Assessment
 It’s the involvement of student in identifying standards or
criteria to apply to their work and making judgment about the
extent to which they have met this criteria and standards.
 Self assessment involves two clear stages.
1. Learner understands standards of criteria.
2. The making of own judgment against those criteria
 Peer assessment describes about making judgment about the
quality of each other work in relation to agreed criteria.
Uses
 helps the learners to encourage to make qualitative commands
about the work of peers
13
Problem based learning
 Problem based learning starts with problems and
require the students to research, select, analyse
and apply information and theories to solve it.
Uses
Problem based learning helps to students to
think on their feet and draw on previous experience
to transfer in to new settings
14
Personal development planning
 It’s a structured and supported process under taken by an
individual to reflect upon their own learning, performance and
achievement to plan for their personal educational and career
development.
Uses
 Help students become more effective, independent and
confident self directed learners.
 Understand how they are learning and relate their learning to
a wider context.
 Improve their general skills for study and career management.
 Articulate their personal goals and evaluate progress towards
their achievement.
 Encourage a positive attitude to learning throughout life.
 Improving and encouraging dialogue between learners and
teachers15
GIBBS SIX STEPS MODEL
Reflective Practice
16
Reflective teacher model
17
EVOLUTION OF THE CONCEPT OF
REFLECTIVE PRACTICE
Timeline of the key educators in the development of reflective practice
 pharmacists are continually faced with unique and ambiguous
clinical problems that require prompt thought, action, and
problem-solving skills, whereas reflection on action occurs as a
retrospective process after the action has occurred.
18
Transformative Learning
Reflective Concepts framework: acquire, learn, integrate, new perspectives.
19
Implementation of Pharmacology
Practice
 Teaching strategies in pharmacology education :
1. Learner-centered instruction focuses on skills and practices
that enable lifelong learning and independent problem-
solving. The corresponding instructional methods include
problem-based learning, case-based learning, and
outcome-based learning, which are all based on
collaborative and self-directed learning activities.
2. The pharmacology teacher that is well equipped to fulfil
this role must have a thorough under-standing of subject
matter, but at the same time should have pedagogical
expertise.
20
Pedagogical content knowledge in pharmacology :
1. "There is a vast difference between knowing about a topic
(content knowledge), and knowing about the teaching and learning
of that topic (pedagogical content knowledge).
2. In pharmacodynamics, while students study drug binding to re-
ceptors that are expressed on the cell membrane, they often find it
difficult to comprehend what the orders of magnitude are of cells,
receptors, and drug ligands and how chances are that a drug
molecule can interact with a given receptor. By using a balloon, as
an analogy of a cell, students can be challenged to visualize this
problem.
3. Another example deals with drug-binding reaching an
equilibrium. At equilibrium conditions of the following interaction D
+ R ⇌ DR, the concentrations of [D], [R], and [DR] do not change.
Students often have the misconception that at equilibrium nothing
happens.
21
 CREATING MODULES :
It is only a small step from using analogies to better
understand pharmacological concepts, to model-based
learning. A model functions like an analogy, both are
representations of concepts.
1. Autobiography of a drug : Autobiography of a drug refers
to student’s intellect on the knowledge of pharmacokinetic
features of the drug.
2. Module on clinico pharmacotherapeutics : Module on
clinico pharmacotherapeutics with justification for using a
particular drug.
Example: Match the FDA approved therapeutic uses with the
drugs and dose. ZES - Amoxicillin 500mg
Uncomplicated GERD - Tinidazole 1g
H.Pylori infections - Omeprazole 20mg
22
3. Module on pharmacovigilance: Module on Pharmacovigilance
with justification.
Example: a. Mix and match the respective ADRs and Drugs-
Skin rashes - NaHCO3, CaCO3
Gynecomastia -Misoprostol
Uterine Contractions-Pantoprazole
Milk Alkali syndrome-Cimetidine
b. Visual ADR clues- Photo of an adverse drug reaction and
identification of drug groups.
4. Module on pharmacoethics : Module on pharmacoethics could
be justified by the following example.
Example: Photo galleries of THALIDOMIDE DISASTER. Pertinent
questions regarding the case.
23
 OBJECTIVES OF MODULES
 Read pharmacology mindfully not mechanically. (Focus on of dissolving
EARBRAIN BARRIER, Improve on BRAIN BINDING PROTEINS) by
creation of significant learning environment.
 Delete the academic stigma of this subject i.e. pharmacology is a dry
subject.
 Re-shape attitude towards pharmacology reading rather than just
cramming it up.
 Help in memorizing pertinent points i.e. core areas of a topic.
 To inculcate a process of curiosity and a sense of reasoning as the saying
“A moderate degree of curiosity tends to increase a creatures chance of
survival”.
 Promotion of critical reflective thinking and active student teacher
involvement.
 Such modules can be a part of theory as well as practical pharmacology
teachings at the end of particular topic.
24
TOOLS USED IN PHARMACOLOGY
REFLECTIVE PRACTICE
 Educators in medicine, nursing, and allied health professions use
reflective activities such as reflective writing tasks to promote
reflective practice
 These assignments take various formats to suit learning styles
and learning outcomes such as journals, diaries, log books, blogs,
portfolios, e-portfolios, reflective statements, reflective essays,
self-assessments, and peer assessments, all of which are effective
tools for promoting and enhancing reflection.
 It allows the author to present content and hyperlinks, video
recordings, photographs, illustrations, and comments to a site,
which can then stimulate group discussion, interaction, sharing of
ideas and experiences, feedback, and personal thoughts and
commentaries, thus embracing the reflective process
25
Pharmacist e-portfolio & Blog
 Implementation of a pharmacist’s blog with multidisciplinary
team members could improve information exchange and assist
with collaboration of ideas, recommendations of alternative
medicine regimens, and sharing of experiences by other health
professionals.
 Blogs can empower students by giving them a “voice” and
encourages them to consider other issues that they may not
have thought of before. Blogs promote in-dependent student
learning through daily discussions of experiences among a
forum of students on the blog, thus allowing the pharmacy
educator to act as a facilitator rather than as an instructor. This
reflective activity could also enhance communication and
collaboration between the facilitator (educator) and the
student(s).
26
Possible implementation of a framework of
reflective practice in pharmacy.
27
Reflective Practice In Postgraduation
 Incorporating reflective practice into the pharmacy curricula
would have implications for pharmacy students postgraduation
as well
 EXAMPLE : the introduction of reflective electronic instruments
such as blogs in clinical practice has the potential to promote
greater communication among health professionals within a
multidisciplinary team, while enhancing the reflective thinking
process.
 Reflective dialogue may include the fol-lowing: How prepared
were you for the experience? What worked and what did not?
How did you feel about what happened? Did the environment
hinder your clinical decisions? Could things have been done
differently? If so, what have you learned that you will use to
change future practice?28
Conclusions
 Both theory and practice must supplement and
support each other rather than come as two distinct
and separate experiences. Pharmacology in practice
skill requires 3H.
 Head now needs to hold more, Hands must be ever
sever and more skillful and Heart must open ever
widest as the head and hands become busier.
 Integration of Pharmacology education with
Pharmacy service is important to give a quality to
Healthcare System, Clinical Trials, Research And
Development etc.
29
Thank you…
30

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Bridging gap between theory & practice in pharmacology

  • 1. 1 Emergence of Bridging gap between Theory & Practice in Pharmacology By Dr. Debasish Pradhan, M Pharm, PhD, DSc., MBA, FIC, PDF (USA) University Dept. of Pharmaceutical Sciences Utkal University, Vani Vihar, Bhubaneswar, Odisha
  • 2. Introduction to gap between pharmacology Theory and Practice  Pharmacology teaching occurs in a variety of contexts, including medical schools, nursing schools, schools of pharmacy, dentistry, physiotherapy, and veterinary medicine. In addition, pharmacology is taught in research- oriented biomedical programs in higher education. Depending on the specific context, the aims and implementation of pharmacology education differ substantially.  The most critical step in professional education is when students are able to transfer theory learned in the classroom into practice.  Integrated reflective practices in pharmacy education offers a possible solution to bridging theory with practice.2
  • 3. What does it really mean?  The difference between idealised practice and common practice.  The difference between taught general principles and the difficulty in interpreting them for application to a specific situation.  The gap between taught abstract pharmacology theory and its use in practice.  The gap between scientific knowledge and theory used as common practice.  The gap between our individual mental representations of pharmacology theory and the published theories of pharmacology. 3
  • 4. Barriers to Implementing Research  Pharmacologists did not feel they had authority to implement research findings.  There was insufficient time on the job to implement new ideas and/or to read research articles.  Management and/or doctors would not allow and/or cooperate with implementations.  Statistical analyses were not understandable.  Facilities were inadequate for implementation.  Other staff were not supportive of implementation 4
  • 5. Can the Gap Ever Be Closed?  The all-important question is, ‘can the theory-practice gap ever be closed’?  that it can’t and that while the narrowing of the theory/practice gap may be a realistic goal, attempts to close it completely are doomed to failure.  Parallels can be drawn between the optimal management of disease and learning environments. For many diseases, an optimal treatment requires targeting different physiologic pathway and pathologies in a concerted synergic effort. 5
  • 6. MEANING AND CORRELATION OF THEORY AND PRACTICE  Theories are setup inter- related concept that give the systematic view of phenomena that is explanatory-predictive in nature.  Practice is a form of doing action in which practical wisdom and a morally enlightened disposition are the bases of professional actions.  The practical syllogism is the specific feature of practical wisdom which directly links theory and practice in a way which maintains the unity of the clinical experience. -Lauder William -2004 6
  • 7. Reflective Practice  Integration refers to continuous, Intelligent and interactive adjusting Hopkins  The un-reflected life is not worth living - Plato  Reflective practice is the cornerstone of uniting theory and practice in health promotion because the building together of the past and the present determines future health promotion actions. (Naidoo and wills-1998) 7
  • 8. Correlation of Theory and Practice 8
  • 9. Why is reflective thinking / practice important?  Modern society is becoming more complex information is becoming available and changing more rapidly prompting users to constantly rethinking, switch directions, and change problem solving strategies.  To promote clinical reasoning and analytical evaluation abilities in students.  To apply new knowledge to the complex situations in their day to day activities.  To develop higher order thinking skills by prompting learners to A. relate new knowledge to prior understanding B. think in both abstract and conceptual terms C. apply specific strategies in novel tasks D. Understand their own thinking and Learning strategies. 9
  • 10. USES OF REFLECTIVE PRACTICE Reflective practice can facilitate and enhance  Acceptance of, and increased confidence with, the essential complexity and uncertainty of professional life.  Reflexive critical awareness of personal values, ethics, prejudices, assumptions of professional identity, decision-making processes  Acceptance of and willingness to explore, the interrelatedness of the professional and the personal  Constructive awareness of collegial relationships  Relief of stress by facing problematic or painful episodes  Identification of learning needs  Dissemination of experience and expertise to and from colleagues  Increased confidence in professional practice 10
  • 11. Reflective Practice in Pharmacology  It helps develop critical thinking, problem-solving, and self- directed and lifelong learning skills through gaining new understandings, new perspectives, and new alternatives for future experiences. Incorporating reflective practice into pharmacy curricula assists students in bridging theory with the complexities of practice.  Reflective practices have been used to educate doc-tors, nurses, physiotherapists, occupational therapist, and other allied health students in higher education, to assist in bridging the gap between theory and practice.  Another reason for the lack of reflective practices in pharmacy education may be because there is no structured framework or guidelines for implementing reflective practices such as there are in other health professions education.11
  • 12. How can I introduce reflective practice in to my teaching? Self and peer assessment Problem based learning Personal development planning 12
  • 13. Self And Peer Assessment  It’s the involvement of student in identifying standards or criteria to apply to their work and making judgment about the extent to which they have met this criteria and standards.  Self assessment involves two clear stages. 1. Learner understands standards of criteria. 2. The making of own judgment against those criteria  Peer assessment describes about making judgment about the quality of each other work in relation to agreed criteria. Uses  helps the learners to encourage to make qualitative commands about the work of peers 13
  • 14. Problem based learning  Problem based learning starts with problems and require the students to research, select, analyse and apply information and theories to solve it. Uses Problem based learning helps to students to think on their feet and draw on previous experience to transfer in to new settings 14
  • 15. Personal development planning  It’s a structured and supported process under taken by an individual to reflect upon their own learning, performance and achievement to plan for their personal educational and career development. Uses  Help students become more effective, independent and confident self directed learners.  Understand how they are learning and relate their learning to a wider context.  Improve their general skills for study and career management.  Articulate their personal goals and evaluate progress towards their achievement.  Encourage a positive attitude to learning throughout life.  Improving and encouraging dialogue between learners and teachers15
  • 16. GIBBS SIX STEPS MODEL Reflective Practice 16
  • 18. EVOLUTION OF THE CONCEPT OF REFLECTIVE PRACTICE Timeline of the key educators in the development of reflective practice  pharmacists are continually faced with unique and ambiguous clinical problems that require prompt thought, action, and problem-solving skills, whereas reflection on action occurs as a retrospective process after the action has occurred. 18
  • 19. Transformative Learning Reflective Concepts framework: acquire, learn, integrate, new perspectives. 19
  • 20. Implementation of Pharmacology Practice  Teaching strategies in pharmacology education : 1. Learner-centered instruction focuses on skills and practices that enable lifelong learning and independent problem- solving. The corresponding instructional methods include problem-based learning, case-based learning, and outcome-based learning, which are all based on collaborative and self-directed learning activities. 2. The pharmacology teacher that is well equipped to fulfil this role must have a thorough under-standing of subject matter, but at the same time should have pedagogical expertise. 20
  • 21. Pedagogical content knowledge in pharmacology : 1. "There is a vast difference between knowing about a topic (content knowledge), and knowing about the teaching and learning of that topic (pedagogical content knowledge). 2. In pharmacodynamics, while students study drug binding to re- ceptors that are expressed on the cell membrane, they often find it difficult to comprehend what the orders of magnitude are of cells, receptors, and drug ligands and how chances are that a drug molecule can interact with a given receptor. By using a balloon, as an analogy of a cell, students can be challenged to visualize this problem. 3. Another example deals with drug-binding reaching an equilibrium. At equilibrium conditions of the following interaction D + R ⇌ DR, the concentrations of [D], [R], and [DR] do not change. Students often have the misconception that at equilibrium nothing happens. 21
  • 22.  CREATING MODULES : It is only a small step from using analogies to better understand pharmacological concepts, to model-based learning. A model functions like an analogy, both are representations of concepts. 1. Autobiography of a drug : Autobiography of a drug refers to student’s intellect on the knowledge of pharmacokinetic features of the drug. 2. Module on clinico pharmacotherapeutics : Module on clinico pharmacotherapeutics with justification for using a particular drug. Example: Match the FDA approved therapeutic uses with the drugs and dose. ZES - Amoxicillin 500mg Uncomplicated GERD - Tinidazole 1g H.Pylori infections - Omeprazole 20mg 22
  • 23. 3. Module on pharmacovigilance: Module on Pharmacovigilance with justification. Example: a. Mix and match the respective ADRs and Drugs- Skin rashes - NaHCO3, CaCO3 Gynecomastia -Misoprostol Uterine Contractions-Pantoprazole Milk Alkali syndrome-Cimetidine b. Visual ADR clues- Photo of an adverse drug reaction and identification of drug groups. 4. Module on pharmacoethics : Module on pharmacoethics could be justified by the following example. Example: Photo galleries of THALIDOMIDE DISASTER. Pertinent questions regarding the case. 23
  • 24.  OBJECTIVES OF MODULES  Read pharmacology mindfully not mechanically. (Focus on of dissolving EARBRAIN BARRIER, Improve on BRAIN BINDING PROTEINS) by creation of significant learning environment.  Delete the academic stigma of this subject i.e. pharmacology is a dry subject.  Re-shape attitude towards pharmacology reading rather than just cramming it up.  Help in memorizing pertinent points i.e. core areas of a topic.  To inculcate a process of curiosity and a sense of reasoning as the saying “A moderate degree of curiosity tends to increase a creatures chance of survival”.  Promotion of critical reflective thinking and active student teacher involvement.  Such modules can be a part of theory as well as practical pharmacology teachings at the end of particular topic. 24
  • 25. TOOLS USED IN PHARMACOLOGY REFLECTIVE PRACTICE  Educators in medicine, nursing, and allied health professions use reflective activities such as reflective writing tasks to promote reflective practice  These assignments take various formats to suit learning styles and learning outcomes such as journals, diaries, log books, blogs, portfolios, e-portfolios, reflective statements, reflective essays, self-assessments, and peer assessments, all of which are effective tools for promoting and enhancing reflection.  It allows the author to present content and hyperlinks, video recordings, photographs, illustrations, and comments to a site, which can then stimulate group discussion, interaction, sharing of ideas and experiences, feedback, and personal thoughts and commentaries, thus embracing the reflective process 25
  • 26. Pharmacist e-portfolio & Blog  Implementation of a pharmacist’s blog with multidisciplinary team members could improve information exchange and assist with collaboration of ideas, recommendations of alternative medicine regimens, and sharing of experiences by other health professionals.  Blogs can empower students by giving them a “voice” and encourages them to consider other issues that they may not have thought of before. Blogs promote in-dependent student learning through daily discussions of experiences among a forum of students on the blog, thus allowing the pharmacy educator to act as a facilitator rather than as an instructor. This reflective activity could also enhance communication and collaboration between the facilitator (educator) and the student(s). 26
  • 27. Possible implementation of a framework of reflective practice in pharmacy. 27
  • 28. Reflective Practice In Postgraduation  Incorporating reflective practice into the pharmacy curricula would have implications for pharmacy students postgraduation as well  EXAMPLE : the introduction of reflective electronic instruments such as blogs in clinical practice has the potential to promote greater communication among health professionals within a multidisciplinary team, while enhancing the reflective thinking process.  Reflective dialogue may include the fol-lowing: How prepared were you for the experience? What worked and what did not? How did you feel about what happened? Did the environment hinder your clinical decisions? Could things have been done differently? If so, what have you learned that you will use to change future practice?28
  • 29. Conclusions  Both theory and practice must supplement and support each other rather than come as two distinct and separate experiences. Pharmacology in practice skill requires 3H.  Head now needs to hold more, Hands must be ever sever and more skillful and Heart must open ever widest as the head and hands become busier.  Integration of Pharmacology education with Pharmacy service is important to give a quality to Healthcare System, Clinical Trials, Research And Development etc. 29