Archive \ Volume.14 2023 Issue 4

Improving Pharmaceutical Compounding Skills Using Gagne’s Instructional Design Model

Hanan Mohammed Alharbi¹*

¹Department of Pharmaceutics, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia.

Abstract

Compounding is a fundamental skill that pharmacists perform professionally. However, inappropriate learning and superficial training can lead to medication errors. Thus, this study proposed a lesson plan based on Gagne’s instructional design to teach basic compounding skills, such as weighing, measuring, and trituration. The study utilized Gagne’s model to compose extemporaneous preparations for dermal use. A standardized questionnaire was devised to analyze learners’ opinions and feedback regarding the lesson. Fifty students (third-year Doctor of Pharmacy) with 1.3 ± 0.2 years of compounding experience participated in the lesson. The analysis revealed that 83.5% of the respondents correctly identified the role of ingredients and 85.6% identified the correct tools and instruments. The overall view was 4.9 ± 0.2 on lesson concept and realization; 4.8 ± 0.1 for motivation, participation, and climate; and 2.7 ± 0.3 for workload and difficulty. Gagne’s instructional design model effectively guided the development of an active and comprehensive lesson plan to teach compounding skills to pharmacy students.

Keywords: Gagne´s instructional design, Pharmaceutical compounding, Pharmacy education, Teaching strategy

Prerequisite Knowledge and Skills

Learners had previously received didactic instructions based on semi-solid dosage forms (during lectures) and had attended practical sessions to prepare formulations (prior pharmaceutical courses). For the proposed session, the learners were organized into groups of three to facilitate active learning, collaboration, and knowledge exchange. Before the session, the assigned materials (handouts, activities sheet, and report sheet) were distributed among the learners at least one week in advance. The materials included introductory information, such as guidelines for preparing formulations and mathematical principles used in pharmaceutical preparations. In addition, to curate a learning experience, the instructors were made aware of the strategies that impart active learning and the importance of learning outcomes.

The Nine Sequenced Steps of GIE

Gaining Attention

When students arrive in class, they must be interested in initiating communication. Learners’ attention is gained by beginning the session with a multimedia video showcasing a scenario involving a pharmacist who receives a medication order that is not available in the hospital pharmacy. The instructor can ask students to suggest solutions to the problem. Consequently, brainstorming induces sufficient curiosity that motivates students to learn.

Informing Learners of the Objectives

Objectives are tasks aimed at achieving the primary goal of a learning session [9]. The objectives must be built around the goal, according to Bloom’s taxonomy (2002 revision). Clear, measurable objectives define the instruction and performance assessment [9, 20]. Further, learning objectives should focus on inducing performance, which is the goal of a lesson. Here, the primary goal was to teach pharmacy students the skills required to prepare extemporaneous formulations. Early in the lesson, students should encounter an easy-to-read list of learning objectives to inform them of what to expect and motivate them to succeed.

Stimulate Recall of Prior Learning

Connecting new information with previous knowledge and personal experiences can facilitate learning. Foundational knowledge helps integrate new learning into existing cognitive structures (i.e. schemas) [8]. In addition, recalling previously learned concepts, such as the differences between creams and ointments, makes new learning sessions more meaningful and relatable. The instructor can engage the students in interactive discussions to reflect on previous experiences acquired during summer training or laboratory sessions.

Presenting Stimulus

In this event, new content is presented in an organized and attractive manner to capture learners’ attention. A PowerPoint presentation containing texts, images, and a video demonstrating procedural steps are shown to the students. The use of different instructional strategies supports learning at different levels through observation and collaboration.

Provide Learning Guidance

This event demonstrates the appropriate actions required to correct the performance by using examples, graphical representations, and live performances. This would help students learn meaningful information using skills stored in their long-term memory [19, 20]. Students first watch a video and observe the steps and techniques involved in preparing zinc oxide cream, before preparing it themselves. The instructor may perform the task and give students some tips, answer questions, and ask some questions to guide students’ attention toward the task.

Eliciting Performance

This step is implemented after a short break and constitutes a major part of the session. Eliciting performance is important for applying what has been learned to reinforce new skills and knowledge and confirm the understanding of the lesson concepts [9, 20]. In this lesson, preparing zinc oxide cream is used as an example of an extemporaneous formulation. Students are divided into groups of three to collaborate and plan the performance of the procedure. They are also provided with the time and equipment to practice preparing zinc oxide cream according to the procedure.

Providing Feedback

Providing meaningful and timely feedback ensures reinforcement and assessment of correct performance, identifies gaps in understanding, and ensures the attainment of proficiency [19]. After the learners practice the newly learned skills, the instructor supervises them while they work on their assigned laboratory [21] benches. Feedback during the session should be constructive and actionable to provide learners with opportunities to improve in specific areas.

Assessing Performance

 At this step, learners should demonstrate knowledge retrieval and the achievement of learning outcomes. Literature suggests several methods for assessing learner performance, such as administering pre-and post-tests, formative assessment throughout the session, and collaborative projects or presentations [9]. This study assessed the progression of competencies and skills. In this lesson, the instructor assesses the performance using two different approaches. First, the instructor uses an activity sheet containing questions linking previous laboratory sessions to the new lesson. The second method involves group collaboration in preparing the cream, wherein students submit a summary report. Then, the instructor examines product quality according to a rubric.

Enhancing Retention and Transfer

The instructor concludes the session by summarising the outcomes and main points of the lesson. This step supports students in retaining more information by providing opportunities to internalize new knowledge. At the end of the lesson, after the students present the product and receive immediate feedback, each group completes and submits a summary report.

Evaluation

At the end of the session, participants were asked to complete a questionnaire (answered on a five-point Likert scale) to evaluate their opinions on readiness to transfer and apply the gained knowledge to their daily practice (Kirkpatrick’s evaluation level I and II). The questionnaire was adopted and modified from [19]. It was divided into the following three sections: lecture concept and realization; motivation, participation, and climate; and workload and difficulty level. Students could select one out of five options (1=strongly disagree, 2=disagree, 3=undecided, 4=agree, and 5=strongly agree) for sections 1 and 2. Options for section 3 (workload and difficulty level) were: 1=very low, 2=low, 3=undecided, 4=high, and 5=very high. The questionnaire was assessed for face validity by two instructors from the Department of Pharmaceutics, College of Pharmacy, Umm Al-Qura University.

After explaining the purpose of the study, assuring participants of confidentiality, and obtaining informed consent, the questionnaire was electronically distributed among students to collect information regarding their experience of the proposed lesson. This study was reviewed and waived from obtaining ethics approval by the ethics committee of Umm Al-Qura University (DJGS140623).

RESULTS AND DISCUSSION

Fifty respondents (30 women and 20 men) participated in the lesson. The average age was 20 ± 2.1 years with 1.3 ± 0.2 years of compounding experience. Previous exposure to some practical techniques improved the retention of prior and new information, which added to advanced experience. The questionnaire presented to the participants after the lesson focused on three main categories. The first category was understanding the lecture concept through attractive, sequential, and relevant content. In other words, this category was mainly concerned with the actual learning process. The participants highly rated items within the category, with the highest rating for the clarity of learning outcomes at the beginning of the lesson (5 ± 0.0), and the lowest rating for sufficiency of time to perform each activity (4.3 ± 0.3). The overall rating for lecture conceptualization was 4.8 ± 0.3.

The second category covered motivation and participation because motivation fuels learners’ behavior and participation is the link between the learner and activity [22]. The participants found the lesson motivating (4.5 ± 0.5) because of the appropriate use of media and sufficient assistance from the instructor. The overall rating for all items in this section was 4.4 ± 0.5. The third category examined workload and difficulty levels to assess how students cope with and handle stress. The average rating of each item in this category was mostly low (2.7 ± 0.3), which indicates that students easily acquired new knowledge and prepared the cream. Descriptive analyses of each item in the three sections are presented in Table 2.

This study used a systematic approach to develop unique learning experiences that connect prior knowledge with new structured teaching strategies to support learners’ internal cognitive processes. It recommended a sequenced stepped teaching approach for the dissemination of psychomotor skills among pharmacy students [16, 20]. Preparing a formulation involves different skill sets, such as understanding the interaction between medicinal ingredients, performing mathematical calculations, and executing the preparation. This multi-step task should be taught in a structured, logical manner (for example, GIE) to ensure the learner’s ability to recall, retain, and execute these skills for an extended period after the conclusion of the learning session.

During the development of this lesson, GIE was slightly altered to improve students’ experiences. For example, before the session, assigned materials (handouts, activities sheets, and report sheets) were distributed among learners one week in advance. Providing such materials facilitated the retrieval of information from long-term memory [8, 9]. In addition, using a real-world example such as that used in this lesson can be effective in managing orders and making decisions [14, 16]. Finally, providing timely feedback after the completion of a task enhances retention and learning [14-17]. The findings of this study demonstrated the lesson plan’s effectiveness for teaching compounding in the pharmacy curriculum.

Therefore, it can be concluded that GIE provides a framework for delivering content while considering the learning conditions. However, it cannot be standardized for every session and topic because of certain limitations, such as the necessity of instructors’ training before the implementation of GIE. Training should include various aspects of active learning, outcome-based learning, and the design of effective GIE. In addition, GIE assumes that all students have the same level of knowledge, which could be challenging for both the instructor and learners because GIE is structured and detailed to deliver specific content within a predesigned context. Consequently, it is difficult to apply GIE to teach large groups. Moreover, GIE is more suited for teaching psychomotor skills than approaches that depend on knowledge or memory such as lectures and seminars.

Some examples of specific limitations include problems that might occur during step six of GIE (eliciting performance), in which the laboratory may become noisy owing to constant movement and student discussions. This could hinder the learning environment and cause distraction and anxiety, which could interfere with students’ performance and motivation to accomplish the task within the allocated time. Furthermore, step seven of GIE (providing feedback) should be immediate and individualized, which is difficult to carry out promptly because some individuals require more time than others. To avoid these limitations, it may be necessary to split the cohort, using an additional laboratory and soliciting help from other facilitators. However, the cost and availability of such resources may be infeasible. Step eight of GIE (assessing performance) may also be challenging because it may not accurately assess each student’s performance; some skills may require repetition or further knowledge to develop fully. Overall, however, the nine steps of GIE can be modified to suit the content, learners’ level of knowledge, availability of instructors, and availability of facilities.

CONCLUSION

This research reports how GIE can be applied to teach psychomotor skills and cognitive knowledge. The lesson proposed in this study was effective and comprehensive in teaching the theoretical concepts and practical skills required for compounding. The results indicated the effectiveness of the lesson. Thus, this instructional design model, which enhances learning outcomes and ensures the retention and mastery of compounding skills over time, could close the gap between classroom and workplace practice. Future research should focus on contextualizing compounding lessons with other related topics such as dispensing medication and the pharmaceutical industry.

ACKNOWLEDGMENTS: None

CONFLICT OF INTEREST: None

FINANCIAL SUPPORT: None

ETHICS STATEMENT: This study was reviewed and waived from obtaining ethics approval by the ethics committee of Umm Al-Qura University (DJGS140623).