Abstract

Objectives. To develop, implement, and assess a learner-centered approach to teaching a third-year pharmacotherapy course in a doctor of pharmacy (PharmD) program. Methods. The pharmacotherapy course was restructured according to the learner-centered approach. The Motivated Strategies for Learning Questionnaire (MSLQ) was administered to students before and after taking the course, and changes in MSLQ subscales from baseline were evaluated. Students' response to the learner-centered approach and characteristics associated with MSLQ scores were also evaluated. Results. Compared to baseline, students' intrinsic goal orientation control of learning beliefs, selfefficacy, critical thinking, and metacognitive self-regulation improved after taking the course. Students responded positively to the learner-centered approach. Additionally, students with a clinical practice career orientation or who prepared frequently for classes scored higher on several MSLQ domains. Conclusions. The learner-centered approach was effective in promoting several domains of motivation and learning strategies in a third-year pharmacotherapy course. Keywords: learner-centered teaching, pharmacotherapy, motivation, learning, Motivated Strategies for Learning Questionnaire, therapeutics INTRODUCTION Given the rapid development of new technology and drugs, doctor of pharmacy (PharmD) students must be motivated to become lifelong learners rather than allowed to learn ''just what is necessary to pass the test'' if they are to provide quality care to their future patients. 1 Numerous factors influence student motivation. While some research findings suggest that as students progress in their curriculum, they become more intrinsically motivated (ie, they are more interested in increasing understanding and achieving competence), 2 others suggest that during their first year, PharmD students' motivation shifts from a mastery orientation (defined as a ''desire to develop competence'' 3 ) to academic alienation (defined as ''no desire to develop or demonstrate competence'' 3 ). Learner-centered teaching is an approach in which students have control over the learning process. 5 With the learner-centered approach, instructors function as facilitators of learning rather than lecturers. In this way, ''teachers do less telling; students do more discovering. '' 5 The roles of the teacher in the learner-centered approach are to design the course such that it creates a climate for optimal learning; model the appropriate expected behavior for the students; encourage students to learn from and with each other; and provide more feedback throughout the process. 5 Usually a menu of optional activities or assignments is presented to the students. In this way, the learner-centered method also gives students more options that allow them to serve their own learning needs. Course content is still introduced and utilized but in a more individualized way. Application of the content is also emphasized and used to develop critical-thinking skills. Learner-centered teaching forces students to play an active role in their education, as opposed to the more passive role traditionally used. In other disciplines, the learnercentered approach promoted more in-depth learning and facilitated students' development into independent learners. DESIGN Course Restructure The fourth and last course of the required pharmacotherapy series in the PharmD curriculum at the Virginia Commonwealth University (VCU) School of Pharmacy was redesigned using a learner-centered approach, with the purpose of shifting students' reliance on faculty's lectures to students learning on their own and from each other. Students enrolled in the third-year course during spring 2007 were randomly assigned to groups of 5 to 6 members, and each group was assigned a patient case with multiple drug-related problems designed to allow students to apply their critical-thinking skills. Each group was responsible for working through the case and writing a SOAP (Subjective, Objective, Assessment, and Plan) note that detailed a course of recommendation and alternative options. In addition, the group had to submit a list of key learning points about the case and a reading reference that provided background for others. Submitted SOAP notes, key learning points, and reading materials were then approved (or returned with comments) by the faculty discussant before distribution to the whole class. During each class session, each group would present their case and workup to the class. After a question-and-answer session, another group would be randomly chosen to critique the presenting group. This critiquing exercise was introduced such that all students, and not just the presenting group, would be prepared for the class session. Lastly, the faculty discussant would comment on the case and the group's approach. In this manner, collaborative and self-directed learning styles were employed to fully engage students in the class. The students were able to learn from each other while the course faculty member was able to serve more as a guide than a lecturer. In addition to the required presentation, each presenting group had the option to revise and resubmit their SOAP note after the class session. Also, there were several optional assignments that students could choose to undertake, such as writing a chart documentation note for each case, keeping clinical notebooks (or ''peripheral brains''), and constructing a new patient case as a group on a given list of new disease state topics. Survey Instrument To assess students' motivation and strategies for learning, a previously validated instrument, the Motivated Strategies for Learning Questionnaire (MSLQ), was used. 9-11 The MSLQ is an instrument to measure students' motivation and approach to learning. It has been successfully used in a variety of educational research, including pharmacy education. The MSLQ consists of 6 motivational and 9 learning strategies subscales. The 6 motivation subscales measure intrinsic goal orientation (focus on learning and mastery), extrinsic goal orientation (focus on grades and approval from others), task value (students' judgments of how interesting, useful, and important the course content is), control of learning beliefs (students' beliefs that outcomes are a result of one's own effort rather than extrinsic factors such as luck or the instructor), self-efficacy, and test anxiety. The 9 learning strategy subscales measure rehearsal, elaboration, organization, critical thinking, metacognitive self-regulation (students' use of strategies to control and regulate their own cognition, which include goal setting, monitoring one's comprehension and adjusting methods depending on the task), effort regulation (persisting in the face of difficult or boring tasks), peer learning, and help seeking. The MSLQ consists of 81 questions, which the students rated using a Likert scale from ''15 not at all true of me'' to ''7 5 very true of me.'' A high score in a subscale meant a student reported possessing a high degree of that particular attribute. The MSLQ was administered before the course began and again at the end of the course to assess the change in students' motivation and learning strategies during the course. The students were instructed that completion of the questionnaires was voluntary. In addition, the students completed the questionnaires in an anonymous manner. At the end of the semester, in addition to the 81 questions contained in the MSLQ, students were asked to rate the perceived effectiveness of the learner-centered approach, the degree to which each assignment facilitated their learning, their level of preclass preparation, and demographic information (gender, career plans, prior academic degrees, self-reported cumulative grade-point average, and examination scores). Analysis For our primary objective to determine the effect of learner-centered teaching on student motivation and learning strategy, we first confirmed that data were normally distributed, and student's responses to the MSLQ at the end of the course were compared to those at baseline