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C.M.Long et.

al

Outcome Base Approach For A New


Pharmacoinformatics Course For Bachelor of
Pharmacy Programme
Long Chiau Ming*, Yee Siew Mei, Ahmad Mazli Muhammad, Mumtaz Hussain and
Mohamed Mansor Manan

Abstract. The Pharmacoinformatics course (PHC500) aim to expose Malaysian UiTM

undergraduate pharmacy students to the multi-disciplinary field of pharmacoinformatics. The content of the course comprises of topics such as drug information, pharmacy
information systems with practice relevant skills. This information is expected to be
relevant to these graduates in their future responsibilities in the various fields of
pharmacy. Aim: The current study will present a critical review of PHC500 by assessing the program content and the teaching methods adopted. Its effectiveness is
also measured by considering the feedback of students. Results and discussion: 89 out
of 121 of the respondents thought that the course was well conducted and the course
contents were interesting. Approximately 90% of respondents also believed that the
course content was relevant to their future needs as practicing pharmacists. However
they would prefer a shorter duration and less labour intensive assignment due to the
fact that it is a one credit hour course. The course curriculum was reorganised in order
to better reflect these course outcomes and student learning. The student feedback on
the effectiveness and delivery of this course is very positive. Conclusion: The success
of the program will ensure students receive the technical skills and knowledge to allow them to confidently address pharmacy issues within this era of information. The
current study showed the importance that the clinical curriculum for PHC500 be revised. The adopted approach to practice-based learning could potentially be used as a
blueprint to allow a common focus for successful outcome-based education (OBE).
Keywords: curriculum assessment pharmacoinformatic drug information Malaysia, outcome based education

Dr CM Long, Dr M Hussain and Prof Dr MM Manan


Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam, Malaysia
*Corresponding author; Email:longchiauming@gmail.com
S.M. Yee
School of Pharmacy, Taylors University, Subang Jaya, Malaysia
Email: siewmei.yee@taylors.edu.my

C.M.Long et al

1. Introduction
OBE is not a new theory but has been a major exercise for the medical course. Besides, it is also advocated by other healthcare professional courses such as pharmacy
program and nursing program. The Korean Accreditation Board of Nursing Education
supported the execution of this approach (Kim, 2012). School of Pharmacy at the
Chinese University of Hong Kong has its own guideline of outcome-based teaching
and learning (Kember, 2005)
In this era of science and technology, the application of information technology has
been used widely in various sectors. Health sectors are also one of the sectors which
have integrated the application of information technology into its services. With the
advent of health informatics, the role of pharmacy in health informatics is developing
fast and generally the term pharmacoinformatics is used to describe pharmacy information system and drug information (Ibrahim et al., 2002.).
Despite of advanced technology system provided in the healthcare setting, its usefulness might be low if the pharmacists do not acquire the related knowledge and
skills to use those information technologies. Hence, to avoid this problem, the pharmacy school can play their role in providing a better education to the future pharmacist so that the practice and application of pharmacoinformatics will be optimized
(Ibrahim et al., 2002.).
Meanwhile, the objective of a pharmacy education and learning is to offer the student with the core values and crucial expertise and abilities that she/he will certainly
later apply to her/his method. The objective of competence-based education and
learning is to make specific the hyperlinks between education and practice such that
education and learning is customized to the demands of practice and not the interests
or interests of those which offer the education. As the importance of the task competence is assessed strongly on the end results of job task, we would say that this approach aids to differentiate the demands of understanding and skills, which might be
analyzed via the examination process, and the suitable application of understanding
and skills to generate the required end results, that is the essence of competent method.

Associate Prof Dr Ahmad Mazli Muhammad


Curriculum Affairs Unit, Academic Affairs Division, Universiti Teknologi MARA, Shah Alam,
Malaysia
Email:a.mazli@salam.uitm.edu.my

C.M.Long et al

After the implementation of OBE in UiTM curriculum, eleven outcomes (POs)


have been outlined. The outcomes content are imperative in churning high quality
students. Since the outcomes are absolute, there is no suggestion to be implemented.
The POs include acquiring knowledge, techniques, multidisciplinary talents, value
and ethics, professionalism, managerial, entrepreneurial and leadership skills. In
agreement with that, the program outcomes (POs) for the Bachelor of Pharmacy
around preparing pharmacist with the ability to provide patient care in cooperation
with patients, prescribers, and other members of an interprofessional health care team
based upon sound therapeutic principles and evidence-based data, taking into account
relevant legal, ethical, social, cultural, economic, and professional issues, emerging
technologies,
and
evolving
biopharmacy,
pharmaceutical,
social/behavioral/administrative, and clinical sciences that may impact therapeutic outcomes. The 2nd PO is student ability to manage and use resources of the health care
system, in cooperation with patients, prescribers, other health care providers, and
administrative and supportive personnel, to promote health; to provide, assess, and
coordinate safe, accurate, and time-sensitive medication distribution; and to improve
therapeutic outcomes of medication use. Lastly, the 3rd PO is student ability to promote health improvement, wellness, and disease prevention in cooperation with patients, communities, at-risk populations, and other members of an interprofessional
team of health care providers.

Method

2.1

Course analysis and improvement

For the past few years, pharmacy instructors and establishments around the world
are checking out the areas and usefulness of OBE. When developing the course eight
key academic abilities are grouped into three extensive areas (Figure 1). The capacities were created from specified keywords, literature searches, and discourse among
panels of professionals. The goals are students will attain CO of their learning.

C.M.Long et al

Personal quality:
Self-directed learning,
reflective healthcare
professional
(Affective domain)

Interpersonal skills:
Effective communication, teamplayer
(Psychomotor domain)

Knowledge & skill application


(Cognitive domain)

Fig. 1. The eight desired graduate capabilities of the UITM program showing the development
of personal attributes and generic capabilities forming the core of the curriculum. Modified
from reference (PC et al., 1994)

Furthermore, the curricular design procedure (Figure 2) was also conducted.

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Curriculum development

Delivery and assessment of student's


learning

Course outcome achievement assessment

Students evaluation on effectiveness and


delivery of the course

Curriculum review and course improvement


Fig. 2. The educational model of curricular design procedure

Faculty of Pharmacy, UiTM reviews the curriculum every four years. The results
serve well for OBE and needs based curriculum to become a competent pharmacist
(Hadi et al., 2011). OBE curriculum design aims to provide an educational and academic program that focus on students outcomes; meaning that students should be
able to demonstrate the stipulated program, course and learning outcomes that the
academic staff/faculty had designed for the program (Spady, 1994).
According to the study plan, PHC580 is offered during semester 8 (4th year) with 1
credit hour (14 contact hours). This course expose student to the multi-disciplinary
area of pharmacoinformatics. The main focus is to improve their skills and role in as
a highly competent hospital clinician and drug information pharmacist. In the attempt
to make this course to be effective, appropriate and suitable topics selections should
be studied so that the future pharmacist can gain a thorough knowledge on pharmacoinformatics. Pharmacy students should equip themselves with a sound knowledge
on this area. This is to ensure, the seven roles of future pharmacist described by
World Health Organization (WHO) could be achieved. The seven roles stated includes, pharmacists roles as a caregiver, managers, decision-makers, communicators,
leaders, teachers and lifelong learners (Abrika et al., 2012).
In congruent with the PO, the course outcomes for this course PHC580 pharmacoinformatics are;

C.M.Long et al

CO 1: Describe current practice of pharmacoinformatics and pharmacy information


system
CO 2: Understand formulary management principles
CO 3: Describe benefits of an effective formulary system
The delivery methods for this subject are lecture, tutorial and small group discussion. The ultimate objectives for the lecturers are to achieve the entire COs. As the
COs involves understanding and implementing the information, students were given
many case study and guidelines on the subjects. Most of the COs will need the student
to understand the concept and memorize the definition of each process and method.
Students are more excellent in question involving understanding rather than definition.
In order to succeed the OBE, student assessment is as important as course planning
and implementation. OBE assessment stresses the importance of criterion-referencing
which intended to judge student achievement. Student is considered to have achieved
certain level of competence if his achievement matches the criteria (Spady, 1993).
The OBE assessment has to conform few principles. Those principles include a
valid, reliable and fair assessment. The assessment should be both comprehensive,
explicit and be able to reflect the knowledge and skills that are important for students.
Furthermore, the assessment should support every students opportunity to learn
things that are important and thus stretch student to the limits of their understanding
and ability to apply the knowledge (Killen, 2000)
2.2

Students evaluation on effectiveness and delivery of the course

Validated and pilot tested questionnaires consisting 7 questions were distributed to


the students after their final test. Apart from basic demographic data, the questionnaire included questions on students evaluation and opinions on the effectiveness and
delivery of the covered based on five-point Likert scale. Furthermore, the students
also were requested to provide suggestions to improve the course based on the
strengths and weaknesses of the course and the additional ways the learning outcomes
could be achieved which the data collected were analysed qualitatively (Long et al.,
2009).

Results and discussion

3.1

Suggestion for Course Outcome

CO 1: Able to describe current practice of pharmacoinformatics and pharmacy


information system
Suggestion: Able to analyze the conceptual terms of pharmacoinformatics and
pharmacy information system

C.M.Long et al

CO 2: Able to understand formulary management principles


Suggestion: Able to apply the principles of formulary management
CO 3: Able to describe benefits of an effective formulary system
Suggestion: Able to compare the implementation of effective formulary system
Suggestion: All of the suggestions being proposed due to the terms used do not reflect Blooms Taxonomy and the level of psychomotor domain for degree students
covers from P1 to P3.

3.2

Course Syllabus

Programmed, systematic and structured curriculum review is essential to ensure


quality professional education. Curriculum evaluation is a part of OBE exercise that
enables the institution to validate the compliance of didactic and experiential strategies with the current needs and future demand of the profession. The four conceptions
of curriculum as highlighted by Ewell namely designed curriculum, expectational
curriculum, delivered curriculum and the experienced curriculum must be evaluated
for an effective curriculum review (Ewell & Jones, 1996, p.^pp.).
It is important to note that research done by Ibrahim et al. back in 2002 (Ibrahim et
al., 2002, p.^pp.) on the design and evaluation of the pharmacoinformatics course at a
pharmacy school in Malaysia had suggested that this subject was divided into five
segments that includes the introduction of drug information services, web based information and internet, telemedicine, approaches in handling drug inquiries and also
the application of pharmacy information system (Ibrahim et al., 2002, p.^pp.).
Meanwhile, we have expanded the curriculum scope so as to keep abreast with the
latest IT and informatics development as well as the expanded roles of pharmacist.
One of the pharmacoinformatics sub-areas is on drug information services where
pharmacist is responsible in handling the drug information request. In this area, pharmacist are required to acquire a sound knowledge on effective searching, interpreting
and evaluating of drug information, as well as analyzing adverse drug reaction reports
and composing bulletins (Hadi et al., 2013, p.^pp, Hadi & Long, 2011, p.^pp.). Secondly, under information technology and internet scope, where pharmacy information
systems such as electronic prescription, clinical decision support and computerized
prescriber order entry are practiced in healthcare setting whereby computers and information is used in an innovative ways to provide better healthcare services. The
third area is on drug formulary management whereby pharmacist imparts their role in
Pharmacy and Therapeutics (committee in managing the drug formulary. Pharmacists
routinely play an integral role in conducting periodic drug utilization review in purpose of ensuring appropriate and cost effective therapy. Defined daily dose, ABC and
Vital, Essential and Non-Essential analysis are the tools used to manage formulary
medicine list and identify medication use problems. In supply chain management,
pharmacoinformatics involves the use of information systems to provide better pharmacy decision making in planning and monitoring the availability, affordability, usage of drugs as well as in managing human resources (Zamaludin et al., 2014, p.^pp.).
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C.M.Long et al

In health policy, pharmacists are perceived to have well understanding on national


health financing and familiar with tele-health and tele-medicine. There are many
emerging new area of pharmacoinformatics that would potential change the current
health practices. It is crucial to ensure a well-trained pharmacy graduate in these areas
to optimize the collaborative health care services.
3.3

Students evaluation on effectiveness and delivery of the course

121 students participated in the survey which gave a response rate of 75% (total
161 students in the 4th year cohort). Female respondents consist of 70% of the sample
which mainly attributed to the fact that almost 75% of the pharmacy students in the
faculty are female. Generally, the students thought that the course was well conducted
and the course contents were not dull. Students feedback also shown that up to 91%
agreed that they had enhanced their knowledge of pharmacoinformatics after the
course. Approximately 90% of them also thought that the course contents were relevant their future practice as pharmacist. This is important information considering all
the students had been trained in the tertiary care hospital, community pharmacy and
manufacturing facility for a total duration of more than seven months in their previous
training. However, majority of the students felt that the assignment given was more
advanced than their learning level. Many of the students gave their opinions from the
open ended questions about the strengths and weaknesses of the course. Many of
them mentioned that assignment on performing a comprehensive drug review on unlabelled indication was too time consuming and required much critical appraisal of
clinical data and literature (Hadi et al., 2011a, p.^pp.). Some of them also felt that the
course contents could be streamlined so that there are no overlapping and repetition of
several topics such as drug utilization, drug formulary management as well as pharmacy and drug therapeutic committee. Owing to the fact that this is a one credit hour
course, they are not comfortable with the written final examination and wide range of
topics covered. They stated that pharmacy automation and robotic dispensing could
be conducted as a site visit rather than a class in lecture hall. The details of the findings are presented in Table 1.

Table 1. Student evaluation of the course with five-point Likert scale (Likert scale: 1 = strongly
disagree to 5 = strongly agree)

Statement

Course is well conducted and interesting


(N=121)
Knowledge about pharmacoinformatics
increased after the course (N=119)
Course was relevant to pharmacy practice

N (%)
Strongly
agree to
agree (5 &
4)

Neutral
(3)

Disagree to
strongly
disagree (2 &
1)

89 (74)

23 (19)

9 (7)

108 (91)

9 (8)

2 (2)

107 (89)

9 (8)

4 (3)

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(N=120)
Assignment
(N=118)

3.4

given

was

appropriate

19 (16)

21 (18)

78 (66)

A de-emphasis of time-based training

Calls to change clinical curricula through the implementation of OBE have additionally evaluated considerably of contemporary clinical education and learning to be
oriented toward the amount of time invested in a component of training (e.g., a turning) as opposed to the abilities in fact acquired. Elements of pharmacy student training, such as eligibility for specialisation credibility, additionally often concentrate on
time spent on particular experiences. Contemporary education, they suggest, must
shift its emphasis in favour of creating the student's capabilities. Learners might proceed much faster or slower than their peers in a provided curricular part. Theoretically, by accommodating these different rates of discovering and abilities accomplishment, a curriculum with flexible time periods might be a lot more reliable and appealing than a strictly time-based educational program (Table 2) (Frank et al., 2010 ).

Table 2. Course contents of Pharmacoinformatics

Existing

Revision

Introduction to health informatives: Telehealth and Telemedicine project


National Health Financing/
Healthcare restructuring
Economic Pharmaceutical Management
E-prescribing/ Electronic Medication Orders and its management
Drug Formulary Management
and National Essential Drug
List
Drug Utilization Review/Drug
Audit

Introduction to pharmacoinformatics

National Health Financing in Malaysia


Economic Pharmaceutical Management
E-prescribing and its management

Drug Formulary Management and National Essential Drug List


Drug Utilization Review

Defined daily dose/ ABC analysis/ VEN Analysis

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Pharmacy automation: Automated medication dosage, filling and packaging, Coding of


information and bar-codes,
medication distribution, management and inventory control

Pharmacy automation

Online Applications
(Apps)/social media and internet technologies to pharmacy and medicine
Pharmacy and Therapeutics
Committee; the role and function (case study)

Pharmacy and Therapeutics Committee its role


and function

Suggestion: The course syllabus was compiled into fewer chapters (10 to 8). This
is because some of the subjects in this course were omitted due to the irrelevancy to
the current situation.
Assessment
The existing assessment:
Continuous Assessment (60%)
Test 1
=10%
Test 2
=10%
Assignment 1 , assignment 2 and assignment 3=40%
Final Exam=40%
To optimise the learning, the assignment given to the students also involves the CO
of the subject. Students will be assessed using the following revised assessment:
Test =10%
Presentation=10%
Problem based education=10%
Assignment =20%
Final Exam=50%
For this course, objective tests measure the learners ability to remember facts and
figures as well as their comprehension of course materials. Exams are used primarily
for grading or selection purpose. While in case study assessment students are given a
factual description of a problem or situation. They are asked to analyze some information, diagnose the problem and prescribe a solution using keyword as presented in
Table 3. Final grades will depend on the student will demonstrate successful comple-

C.M.Long et al

tion of the following outcomes as evidenced by successfully passing written test and
examinations, or case studies.

Table 3. Keyword for assessment based in taxonomy matrix

C1
Knowledge
Identify
Label
Locate
Select
Name
State
Write

C2
Comprehension
Explain
Relate
Describe
Match
Discuss
Estimate
Confirm

C3
Application
Apply
Modify
Build
Construct
Solve
Sketch
Produce

C4
Analysis
Analyze
Sort
Categorize
Investigate
Compare
Differentiate
Examine

C5
Synthesis
Combine
Compose
Design
Generate
Plan
Formulate
Revise

C6
Evaluation
Solve
Critique
Criticize
Assess
Conclude
Justify
Judge

Suggestion: The relevance of changing this assessment is to actively encouraging


the students to discuss and involve in teamwork. Also, we want them to become more
active learners who will be able to present their opinions and knowledge in class.
Taxonomy Matrix
The revision of taxonomy matrix is presented in Table 4.
Suggestion: The level of cognitive domain should covers from C1-C4. For psychomotor domain, we should covers from P1-P5. Affective domain should remain.

Table 4. Pharmacoinformatics taxonomy matrix

Existing Format
20 questions (20 marks)
-covers knowledge (C1) and comprehension
(C2)
15 questions (15 marks)
-covers knowledge (C1) and comprehension
(C2)
7 questions (35 marks)
-covers knowledge (C1) and comprehension
(C2)
2 out of 4 questions (30 marks)
-covers application (C3)

Suggestion Format
Remain

10 questions (15 marks)


-covers knowledge (C1) and comprehension
(C2)
5 questions (25 marks)
-covers knowledge (C1), comprehension (C2),
and application (C3)
2 out of 4 questions (40 marks)
-covers application (C3) and analysis (C4)

Suggestion: The proposed format is presented in order to make it compatible and to


ensure it is aligned with the course. Amendment made are in the aspect of mark
allocation, number of questions, examination format and content of the syllabus.

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The changes suggested above are mainly to ensure a strategic way to enhance the
quality of teaching and learning. All the suggestions are based on the three-cycle
model defined by Harden and colleagues (Harden et al, 1999). The model classified
the Dundee twelve outcome model into three dimensions which provides a framework
for medical program development. This model has been recommended by few
preliminary studies (Kim 2012 and Kember 2005) to be used in other healthcare
professional program. The three dimensions of this model depict what the graduate is
able to do, how do the graduate approach a given task and the development of the
graduates personal attributes.

3.5

Advantage of new curriculum

The University of Dundee medical school, one of the leading UK Medical schools
who was ranked 5th in the Guardian 2013 University Guide applied the OBE in 1997.
This approach showed a promising result where their students showed the highest
level of confidence of all UK medical students. The students mentioned that their
school education equipped them well for their first postgraduate year (Davis, 2003).
Aga Khan University Medical College in Pakistan is another university who adopted
OBE and showed an encouraging result (Davis et al, 2007)
The taking into consideration of a competency-based method to teaching and learning of this subject using an OBE curriculum is critical. Some of the benefits are:
A new standard of skills: This is indicated by graduated pharmacist capabilityand
improvement of their abilities.
A renewed dedication to outcomes: OBE curricula, with their emphasis on graduate capacities, could meet universitys mission to prepare pharmacy professionals to
serve their people and communities.
A system to advertise a true continuum of pharmacy education: By determining
expertises and turning points for each stage of pharmacy education and learning and
technique, OBE could promote vertical and straight combination of training applications, from undergraduate pharmacy education to continuous professional development.
An approach to advertise learner-centred curricula: By giving encounters within a
much more pliable period and focusing on the student's advancement, OBE could aid
pharmacy student to be involved in a process that advances at their very own pace.
A method to de-emphasize time-based training in healthcare: Transitions from undergraduate education and learning to post-graduate education and learning to continuing expert development or upkeep of capability would certainly be based mainly on
evidence of abilities rather than on currently widely used time frames. Time then
becomes a source for education and learning, not the standard yardstick for
knowledge learned.
Potential for mobility of training: The adoption of a competency-based strategy
could facilitate the activity of pharmacy student.

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Conclusion

A revised clinical curriculum of which educational outcomes act as a blueprint for


program focus and achievement of common abilities needs to be established. It is
important so as to ensure the students receive the best education possible and be well
prepared to enter the profession upon graduation. It is also aimed to develop a more
competent and well-rounded pharmacist.

Acknowledgments

AP Dr Sariwati Mohd Sharif, AP Dr Hadzli Hashim, Dr. Hajah Zainab Mohd


Noor, lecturers of Certificate in Education (Cied), iLQAM, UiTM and Prof Aishah
Adam (Dean), Dr Mizaton Hazizul Hasan (Deputy dean) as well as staffs of Faculty
Pharmacy UiTM Puncak Alam.

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