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A problem based learning, case study approach to pharmaceutics : Faculty and

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A Problem Based Learning, Case Study Approach to
Pharmaceutics : Faculty and Student Perspectives

Ian S. Haworth1, Stuart P. Eriksen, Susan Hikmat Chmait, Laurie S. Matsuda, Peggy
A. McMillan, Emily A. King, Jacqueline Letourneau-Wagner and Karen Shapiro
School of Pharmacy, University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90033-1086

The two-semester PharmD-level I Pharmaceutics course at the University of Southern California School
of Pharmacy has been taught using a student-centered, problem-based learning (PBL) approach for the
last five years. The most important element of the course is the assignment of two case studies in each
semester, and the performance of these case studies by groups of students. The intention of the course
is to emphasize group working, cooperation and collective achievement as being equally important to indi-
vidual effort and grades. The course involves the participation in lectures and discussion groups of facul-
ty, students and teaching assistants, and of student ‘mentors’ - students who took the course in the pre-
vious year. Over a five-year period instructors have designed and then refined the approach within the
constraints created by a class size of about 170 students. Described are experiences to date in the teach-
ing and administration of the course, from a faculty perspective. Provided are a number of suggestions
regarding the most effective structure of the course, the appropriate methods of evaluation, the potential
pitfalls, and the demands of such a course on both students and faculty. To help the reader understand
further the impact of the PBL approach on students, several students, who have both taken the course,
and then acted as mentors, provide an independent, student perspective on the teaching approach. Their
perspective is presented in the final part of the manuscript.

INTRODUCTION Pharmacokinetics(5) and Pharmaceutics(6, 7) have been

The usual basic pharmaceutics courses, taught in the first described, but the comparative advantages of each are still
professional year, have traditionally been given in the lec- unclear. Some evidence for an improved retention of
ture-examination format. This approach has been defend- knowledge obtained through the PBL approach, compared
ed by the idea that there exists, for this subject, a body of to more didactic approaches, has been presented(8,9), but
information and data to be transmitted to the student and, there is still considerable disagreement over this issue.
after this has been presented (the lecture), the attainment In 1993, faculty in the Department of Pharmaceutical
of this information can then be tested (the examination). Sciences of the School of Pharmacy at the University of
This method may not provide the best way of achieving Southern California were challenged to change to a stu-
what is actually desired for the student of any college dent-oriented, case-study approach to the teaching of
course, i.e., understanding the concepts involved in the Pharmaceutics to a class of 170 students. The design of the
course and the ability to use these concepts. However, stu- course, and the subsequent modifications that we have
dent-centered methods used in other fields, and in more made, in response to this challenge, as well as the success-
clinical areas of the pharmacy curriculum(1), have tradi- es we have achieved and the difficulties we have faced, are
tionally not been considered suitable for the basic sci- described in this paper. An interesting and thoughtful
ences. analysis of PBL applied to Pharmaceutics has been pre-
The practical implementation of student-oriented, sented by Duncan-Hewitt (10) and many similarities
case study-based courses varies widely, but all these teach- emerge between this and our own experiences. In particu-
ing approaches are generally labeled as Problem-Based lar, these revolve around the anxiety apparent amongst
Learning (PBL). The attempts that have been made to many students as they try to deal with the PBL approach
extend the teaching of the basic sciences in the case study for the first time, and the difficulty, for such a large class
direction usually retain lectures and exams, but perhaps size, of establishing sufficient faculty-student contact to
add cases or essay questions to the testing aspect. calm these anxieties. Addressing these problems has
Discussions, when included, are most often ‘demi-lectures’ meant that the course structure has been and is still in
as the students usually do not have their inquisitive-dispu- some flux, but it has been concretized sufficiently to per-
tative ‘center’ sufficiently well developed to allow useful mit an intelligent presentation of the basic structure and
discussions. A number of examples of workable models for philosophy. More detailed aspects of the course, such as
such courses in Medicinal Chemistry(2,3), Therapeutics(4), the utilization of computer-based case studies, which is an
integral part of the program, have previously been pre-
sented in other papers(11,12)
1
Corresponding author.

398 American Journal of Pharmaceutical Education Vol. 62, Winter 1998

Table I Grading system used in each semestera
Faculty Mentor Peer
Case report Interview evaluation evaluation evaluation Total
Case Study 1 160 50 30 30 30 300
Case Study 2 160 50 30 30 30 300
Final examination 400
Total 1000
a
The breakdown of points awarded for each case study is shown. More details are given in the text

GOALS AND OBJECTIVES OF THE COURSE DESIGN different skills than individual work or study. Although
There were three fundamental objectives in our original the concepts can be taught in principle, they are best
course design. These were: (i) to promote student-led learned by practice. In order to foster group functioning,
learning; (ii) to give students experience in group func- all recommended reading, homework, and case studies
tioning; and (iii) to develop meaningful evaluation meth- require time far in excess of that available to any one stu-
ods that are responsive to the nature of the course. Our dent in the course. Students can only get the work done
current thoughts on the successes and failures in each of through group efforts, and, in conjunction, must provide
these areas are summarized below. In understanding these the results of that research effort in a meaningful written
thoughts and the following discussion on the course struc- and verbal form to the other members of the group.
ture, it is important that the reader recognizes that the Working as part of a group (and depending, to some
class size is approximately 170 students, and, given the extent, on that group’s efforts for their grade) has been
demands on faculty time, that this leads to a necessity for found to be difficult for many students, whose education-
compromise between ideal and practical approaches. A al success to this point in their careers has been largely
fourth area, the development of leadership skills amongst based on their being ‘individual’ workers and learners.
the students and student mentors, has emerged as we have However, students soon learn the benefits of good leader-
proceeded with the class. This is not dealt with in a specif- ship and ‘doing their part’. Leaders develop and ‘appear’
ic manner, but should be apparent in the description of the quickly, as do those that can explain what they have read
activities of the students and the mentors in this and sub- to the group. The group leader is appointed at the start of
sequent parts of the paper. the academic year and then changed several times over
the year, through an internal group decision. In contrast to
Student-Led Learning. To enhance retention of the funda- other PBL approaches(10), we have largely resisted the
mental concepts involved in pharmaceutics, the main temptation to interfere with the workings of each group.
objective was to develop self-motivated learning. While At the beginning of the year we provide some basic writ-
concepts should, and perhaps must, be presented by facul- ten instructions (see Appendix A) on the role of the group
ty members who have a clear understanding of the utility leader and on group functioning, and additional material
of, and reasoning behind, those concepts, it should be the on the student-mentor relationship, and on the case study
student’s responsibility to seek sources of that information method. This material is supplemented by faculty-led dis-
that were both understandable and meaningful for cussions on the same issues in the early part of the year.
him/her. This approach is designed to develop familiarity
with a wide spectrum of the pharmaceutical literature and Meaningful Evaluation. The most difficult goal to accom-
begin the development of the ancillary, but no less essen- plish has been to develop meaningful methods of evalua-
tial, skill of evaluating that literature (e.g., ‘don’t believe tion for the individual efforts of each student. The essen-
everything you hear or are told,’ ‘I never understand what tial problem is that, while instructors want to encourage
author X writes’, etc.). group working and cooperative effort for the benefit of
Our approach to this has been an attempt to foster the all, the same instructors are still faced with the necessity of
idea that there are actually few ‘right answers’ to the assigning grades on an individual basis. This leads to a
application problems faced by the pharmacist, including contradiction which has been difficult to resolve.
those examples presented while in school and, to an even The first efforts included no comprehensive, individ-
greater extent, those to be faced after graduating and ual evaluations at all. All student grading was based on the
beginning practice. There are, of course, ‘right answers’ to group case study reports (one grade for all group mem-
specific technical and scientific questions. The students bers) modified for each student based on evaluations of
are urged to consider ‘correct’ applications of their knowl- their participation by their peers in the group. This proved
edge to be only those that they can logically defend with to be more valuable in concept than in practice. Students
either literature citation or scientific reasoning. They are were very reluctant to grade their group members; but
encouraged to use information from all current and previ- were quick to complain about those that did not do their
ous classes for this defense. They are further encouraged share. To address the issue of individual participation in
to file this information in some retrievable manner for the group effort in completing the case studies and other
future use. assigned work, we have since tried to incorporate some
faculty evaluation of this part of the course. However, this
Group Functioning. Both the business and the scientific was felt to be feasible only when done in small groups and,
world function as group efforts, quite in contrast to the in a large class, insufficient contact with some students or
lecture/exam, academic world. Group efforts require quite groups made meaningful evaluations extremely difficult.
After trying several different approaches, the follow-

American Journal of Pharmaceutical Education Vol. 62, Winter 1998 399

ing has been found to be an effective, if not ideal, com- the assignment of case studies, which provide a basis for
promise between stressing group effort over individual the full integration of the presented concepts. Two such
gain, while still recognizing outstanding students and pro- cases are given in each semester. Because group operation
viding sufficient incentive to contribute fully to the group is required, both for the case studies and in the discussion
effort. The breakdown of grading over the semester is sections, the student groups also meet informally several
summarized in Table I, and is explained as follows: times each week to distribute work assignments, collect
• There are two case studies assigned during each results and discuss problems. The frequency, places and
semester and about four weeks allowed for their com- times for these are worked out by the students themselves
pletion; these are group efforts and are quite sophisti- and implementation is the responsibility of the student
cated. A number of these cases have been described group leader (see below). Appendix C shows a typical
previously(11) and a typical case study is shown in schedule for the year. The development of the course
Appendix B. A final ‘mini-case’ is also required, to be structure is described in detail in the following sections.
done individually and in the final examination room,
where conceptual understanding and ability to use Weekly Course Structure. We have experimented with
these concepts is evaluated. Each case study is worth two different course structures. Initially, we devoted each
30 percent of the course grade in each semester, and week to a different concept. On the first meeting day of
the examination is worth 40 percent. the week, the concept was presented by a faculty member
to the whole class. This presentation is, in actuality, a lec-
• Each group is graded jointly on their case report and ture, but its structure and purpose is quite different from
the same grade is received by all group members for the usual course lecture. The concept presentation is
this part of their grade, which represents about 53 per- intended not so much to teach, develop, or derive the con-
cent of the case grade (and 16 percent of the final class cept for the week, as it is to introduce that topic and define
grade) for each case. the scope the students are intended to cover in their read-
• Each group member is graded by the faculty (who see ings. The reading assignments, key objectives and several
the group several times during each case study in for- illuminating questions for each concept are all in the stu-
mal discussion sessions, with rotation of faculty dent’s hands from the beginning of the semester. These
amongst the groups), the group’s mentor (a Level II reading assignments include papers, chapters and/or
student, who also meets with the group at least once whole sections of texts. On the next meeting day the stu-
each week - see below), and by each of the other mem- dents meet with their mentor to discuss the questions and
bers of the group (the peer grade, with the grade for assign reading based on the suggested sources. The men-
each student being determined as an average of all the tor serves to clarify and discuss the concepts introduced
grades from their group peers). The basis for these that week. On the third day the group meet with their fac-
grades are attendance, participation, effort, contribu- ulty discussion leader for a further discussion of the con-
tion to group discussions and the ability to function cepts of the week. In these meetings it is assumed that the
within the group. The faculty, mentor and peer grades key questions are answered (a group answer for this is
are, of themselves, only a small percentage of the over- required) and that the reading has been done, so the dis-
all grade (each is 10 percent of the case study grade), cussion begins from that standpoint. The discussion is
but collectively they provide a general, albeit limited intended to develop understanding of the meaning and the
and not always entirely accurate, picture of the efforts use of each concept in pharmaceutical situations.
of each student. We stress that, while this approach is Although the above schedule worked reasonably well,
used as part of the determination of the final letter and the components within it have largely been retained in
grade, it also provides us with a means of identifying the new schedule, it was also found that the concepts were
students who may be having some problems in the learned and retained in a somewhat fragmentary manner. To
course. This is particularly important, given that the address this issue, we have now moved to a schedule
course is offered to Level I students, and that the (see Appendix C) in which six concepts are presented in
absence of the ‘traditional’ mid-term examination successive lectures over three weeks, and then six faculty-
gives us no other means of assessing student progress. led discussion sessions are held over the next three weeks,
in which a more broad-based discussion is possible, and in
• Group interviews by a faculty member are held imme- which the integration of a significant amount of material
diately after the reports are completed. Evaluation of can occur. This sequence of three weeks of lectures and
each student’s contribution to the case report and three weeks of discussions occurs twice through the semes-
their understanding of the other parts of the group’s ter, and four times over the entire year. A further advantage
report has been found to be quite straightforward of this approach is that the three weeks of discussion coin-
using this procedure. This grade accounts for about 17
percent of each case study grade. cide with the period devoted to performance of the case
studies, and the due date for each case study is set for the
COURSE STRUCTURE
end of the three week discussion period. This has allowed
us to much more effectively discuss the case with the stu-
The course is structured in the following manner. The tra- dents, and to guide them in their problem-solving, thus
ditional transfer of information through the lecture addressing one of the concerns regarding student anxiety
addressed to the whole class is largely replaced by concept and problem-based learning. In this schedule the mentor
presentations which are still in a lecture-format, although sessions retain the same character as that described above,
with a somewhat different purpose and by discussions with and are still used to explore more specific concepts on a
faculty and with mentors. Attendance is required at the weekly basis, and to discuss assigned weekly questions.
presentations and discussions. Overlaying this structure is

400 American Journal of Pharmaceutical Education Vol. 62, Winter 1998

Case Studies. Case studies are assigned in approximately them well in their professional lives.
the third and eighth week of a 14 week semester, and each
group (of six or seven students) is given about four weeks Student Group Discussion Leaders. Each group is
to complete their report. As exemplified in Appendix B, requested to select a leader to serve as the guide for
and also in related papers dealing with computer-based case research assignments, resulting reports, case work, and
studies in the course(11,12), the case studies are complex meetings. At the beginning of the first semester (as the
problems which require considerable sophistication and students are unfamiliar with their cohorts) the leader is
background reading in order to arrive at an appropriate selected by the faculty. A different leader is selected after
answer. Much of the material required for answering the each case is completed; giving four students experience of
case study has not formally been covered in the lecture pre- leadership for each group of six or seven students over the
sentations, and this forms the basis of the faculty-led dis- two semesters. Some minimal guidance is provided to
cussions during the case study period. This has been found these leaders (Appendix A) and their skills improve visi-
to be particularly effective, because the students then have bly with each case study.
a reason to engage in these discussions (since they are hav-
ing to address problems within their case study) and, when Mentors. As problem-based learning is foreign to nearly
the system works most effectively, they are already formu- all of our entering students and as few grades are provid-
lating questions from the background case study reading ed to inform them on their course progress, ‘engineered’
which might be answered in the discussion periods. For contacts with members of the previous year’s class
example, the question might arise ‘How can I know the ion- (referred to as mentors) help to increase student comfort
ization state of my drug at my formulation pH when I can- and performance level. These mentors are selected by the
not find its pKa anywhere in the literature?’, which might course faculty based on their performance in the class,
be effectively answered by a discussion of the empirical their communications skills and their willingness to act in
Hammett-Taft approach to pKa calculation(13). the mentor capacity. They are paid a small stipend and are
Based on informal conversations with faculty in other described in their transcripts as having received a
pharmacy schools, this version of problem-based learning ‘Leadership Fellowship’. The function of the mentors is
and of case-study implementation varies somewhat with not to lecture, not to answer key questions and not to help
that used elsewhere. Typically, relatively discrete case directly in the preparation of the case reports. Their role
studies are given which can be answered in a formal sched- is to provide advice as ‘big brothers or sisters’, and they
uled class period, and cover a relatively specific concept have proved to be particularly influential and are an
each week. Rather than taking this approach, our case essential element in the course.
studies are complex, require several weeks of group effort
to answer, and involve the understanding and integration Teaching Assistants. Since at the University of Southern
of a number of different concepts. For the range of con- California there is an active PhD program. Graduate stu-
cepts covered over the year, see Appendix C. The com- dents (TA’s) are used to supplement the faculty activity in
plexity of the case studies increases as the year progresses, discussion sections. Our current feeling is, however, that
as each case incorporates material from earlier in the year. the level of discussion and interaction preferably requires
This approach has advantages with respect to integration the participation of more senior graduate students. Even
of material, but also places considerable demands on both then, this is still a difficult task for TA’s who, themselves,
students and faculty. It probably also requires more exten- have not usually been involved in this type of teaching,
sive faculty-student contact, because the potential for stu- and perhaps do not have the requisite pharmaceutical
dents to go astray in answering the case is considerable. experience. The discussions demand considerable skill
and experience, skill both in leading discussions (a very
ROLES OF INDIVIDUALS AND GROUPS IN THE different skill than that required for lecturing or for per-
COURSE forming research), as well as in finding suitable applica-
The course is based on the activities of a number of dif- tions of the concepts being considered. Nonetheless, many
ferent groups and individuals, in addition to the faculty, as of the TA’s that have been involved in the course have
described above. responded very well to the challenge, and have enhanced
considerably their own teaching abilities.
Student Groups. Case studies are performed by groups of
six or seven students, giving a total of 26 groups (and FACULTY PERSPECTIVE: COMMENTS AND
hence the requirement for the writing of two sets of 26 CONCLUSIONS
similar, but substantively different, case studies each The major problem remains the evaluation of individual
semester - see Appendix B for a typical approach). The performance and contribution. While still difficult, we
groups do not change over the whole year, and only in cer- believe this can be done effectively using the approaches
tain circumstances are students allowed to transfer described above. These provide sufficient contacts with
between groups. In insisting upon this, we wanted to stress each student to allow individual evaluation. While evalua-
that the professional environment may not be filled with tion on the basis of individual interviews (without
colleagues whose views always coincide with your own, ‘grades’) would appear to be ideal, in classes of any size
and that compromise and the development of working this is not feasible, and numerical grades are still used.
relationships is an essential element in any successful pro- Group operations remain difficult for students. Problems,
fessional enterprise. This insistence can lead to conflicts, while infrequent, are sometimes rancorous and group
but we believe that, for certain individuals, it can provide leaders must be reminded frequently to bring these to fac-
invaluable insights into their personalities which will serve ulty attention, not so much for grading purposes, but for

American Journal of Pharmaceutical Education Vol. 62, Winter 1998 401

working through those personal difficulties which stand in broad knowledge base, but more importantly with the abil-
the way of the student’s understanding of the material. ity to draw from this knowledge long after the course ends.
From a faculty perspective, the course provides two Initially, the course seems radically different from any
major demands which are perhaps beyond those typically other basic science course. The conventional series of lec-
encountered in the lecture/examination format. First, tures interspersed with two or three exams is replaced by
because students are openly encouraged to ask questions fewer lectures and many more discussions, group interac-
throughout the semester, because there is an open-door tions, research and brainstorming for logical conclusions to
policy regarding student-faculty interaction. With 170 stu- posed pharmaceutical questions. Needless to say, con-
dents in the class, the effects on faculty time are obvious. fusion and frustration are initially widespread. However,
Second, students are provided with a case study that has as the routine becomes more familiar, frustration is
26 variations and a number of inter-related sections, and replaced by acceptance and eventually appreciation.
that can be answered in a large number of ways, the course Looking back at the experiences of completing the course
demands the faculty to constantly react to and advise on as students and then helping to lead the course as mentors,
student theories and ideas (some of which are extremely there are many areas of the course which are integral to
imaginative and interesting). This type of interaction is at the learning experience that can be discussed. The follow-
the very heart of the course, because it is challenging the ing is a discussion of these areas with suggestions to max-
students to think for themselves, rather than simply imize the learning experience for the students.
digesting the ‘accepted wisdom’, but it is also demanding
of the faculty, and requires a breadth and depth of under- Group Dynamics. One of the most fundamental aspects of
standing of many, diverse subjects. This is further empha- this course is the experience gained in group dynamics. As
sized by the material covered in the year, which ranges future members of health care delivery teams, our ability
from basic physical chemistry to cell biology to pharma- to function in groups will be essential. Unfortunately,
ceutical formulation and delivery. group friction is bound to arise in any situation where indi-
After five years of experience, it is our belief that this viduals must work long hours together to obtain a goal. In
approach, while demanding to administer, is effective in the context of the course, problems usually develop due to
meeting the objectives outlined above. We are unable to lack of experience in working with others and adjusting to
provide quantitative information to support this, because the idea of depending on other students. For instance, stu-
of the relatively short time since the course was first dents depend on each other to share the workload of
designed, and so we base this belief mainly on the reac- acquiring the information necessary to answer the case
tions of students to the course. Given the considerable study questions. This ultimately leads to the same case
change in the approaches taken, compared to those most study grade for all members in the group. At the time, stu-
students are familiar with, we believe that the generally dents find this to be frustrating, because it requires group
positive comments we have received are encouraging. The meetings (time spent outside of scheduled classes) and a
following section of the manuscripts reflects these opin- dependence on other students to learn the material. Later,
ions, and was independently written by several students however, students look back to appreciate the experience
who have been closely involved in the course over a two as it simulates a ‘real world’ work environment where
year period, first as students and then as mentors. depending on others and working together is necessary to
achieve a final goal. To minimize group friction and help
A STUDENT PERSPECTIVE nurture smooth group functioning, group leaders need to
The Pharmaceutics course at the University of Southern utilize the guidelines provided in the course syllabus and
California School of Pharmacy has been taught using a actively take on the duties of the leader. Group members,
student-oriented, case study approach for the last five on the other hand, must learn to follow the direction of the
years. The course from a faculty perspective has been leader. Students quickly learn that group cooperation is
described above. As former students and then mentors of essential for individual success, and most agree that it is
this course, we draw on our experiences to evaluate the best if faculty intervention is discouraged in order to train
case study method and discuss, from the students’ per- students to work together in often stressful situations.
spective, characteristics which are imperative for success With time, students learn how to work out internal dis-
of the course. Much of what is written reflects the authors’ putes and carry on with group business. To facilitate
experience in discussing issues with other students over a progress in this respect, complete guidelines describing
two-year period as students, and then as mentors, and is group leader and member responsibilities that students
not necessarily the opinion of the authors specifically. can refer to might be provided. This is analogous to a job
To the student, a class has been successful if two things description used in the real work environment. However, it
are accomplished. First, at this level of education, the stu- should be emphasized that faculty intervention in group
dent is interested in obtaining the largest knowledge base disputes is strongly discouraged.
possible within the constraints of a semester. And second-
ly, the student strives to retain as much of this newfound Faculty - Student Interaction. This course is often student-
knowledge as possible. All too often, students struggle led in the sense that much of the learning occurs during
through courses spending endless hours studying and group discussions and individual research rather than in lec-
memorizing only to forget almost everything merely ture. The obvious advantage to this technique is that stu-
weeks, if not days, after the exams. Such courses are not dents retain more information longer and learn how to
classified as ‘successful’ to the student. On the other hand, obtain information from the most current resources.
the Pharmaceutics course, which is organized in an uncon- However this method also demands faculty support. On
ventional manner, leaves the student not only with the very several occasions during the course, the students are

402 American Journal of Pharmaceutical Education Vol. 62, Winter 1998

required to develop an understanding of a concept which dents should be provided with a primer at the onset of the
has not yet been introduced in lectures. It is imperative that course. This primer should have detailed information on
the faculty be available to clarify confusing concepts and how to access and utilize basic programs on the computer,
direct students on the right track, and an open door policy and introduce the student to on-line and library resources.
is essential. However, to a certain extent, the faculty should Such a primer would prevent confusion dealing with basic
also encourage students to be as self-reliant as possible. It is logistics and direct students to focused research, study and
beneficial for students to get some direction when they hit analysis. Another component of the course, the com-
an obstacle that they cannot overcome on their own. pounding laboratory, is felt to be very important by most
However, students should not need to check in with a fac- students, because it allows the student hands-on experi-
ulty member at every step of the process, and a compromise ence with all the basic pharmaceutical techniques, and
between guidance and ‘spoon-feeding’ should be sought. reinforces concepts discussed in the abstract during discus-
sion sessions (note, the compounding laboratory is now no
Mentors. Mentors provide a perspective that can only longer a formal part of the course described in this manu-
come from one who has recently completed the course. As script). For such laboratories to be successful, it is impor-
time goes on, the mentor evolves from acting as a ‘big tant that student have access to a comprehensive laborato-
brother’ or ‘big sister’ to a source of information and guid- ry manual and adequate laboratory equipment, and that
ance. The mentors are called on to draw from their own the laboratories are performed by small groups of students.
experiences as students to help the students in their groups.
It is easier, being students themselves, for mentors to see Relevance of Coursework. As a final evaluative measure, a
the students’ perspective and to work at the students’ level discussion of the outcome of this course is necessary. The
to help guide them. We believe that, for a successful men- authors believe that the case study method helps put phys-
toring program, consistency between mentors is important. ical chemistry into a clinical context. By doing research
Such consistency would best be obtained by providing and searching for solutions to pharmaceutical cases, stu-
mentors with a mandatory training session in being facili- dents are placed in a unique position to determine the rel-
tators. The mentors should also be provided with complete evance of physical chemistry to the pharmacist. While the
responses to the weekly lecture questions so that they may course is considered difficult by many students, most gen-
better maintain consistency and accuracy. erally agree that the challenge is worthwhile as it develops a
knowledge base that is important for any pharmacist to
Critical Thinking. Critical thinking is an essential skill for have. As a discipline, Pharmaceutics is a demanding
any health care professional. Pharmacists are called on course introducing concepts which are new to most stu-
daily to draw on their knowledge and experience to make dents. As a class, group and student-oriented teaching are
professional decisions. The skill of critical thinking has not also foreign to most students. Thus, as may be expected,
been previously developed in most students. Since this confusion and frustration are initially widespread. The
course revolves around critical thinking, this presents a suggestions previously made should minimize confusion
challenge to most students. In this course, students are and help direct students. The outcome is that the student
required to look at current pharmaceutical theories, which obtains, for himself or herself, a knowledge base which
don’t always necessarily agree, and then analyze them and can be accessed again and again for years to come.
try to put them to use. Since most students don’t have too
much first-hand experience with the pharmaceutical theo- Acknowledgment. The authors want to acknowledge the
ries, considerable research, reading and discussions with excellent contributions of Drs. John A. Biles, Michael B.
fellow students, mentors and the faculty are necessary. Bolger, Curtis T. Okamoto and Vincent H.L. Lee to the teach-
After this ‘gathering’ of essential information and opin- ing and administration of the course over a period of years.
ions, the student must then put all this together and final-
ly come to a conclusion. The faculty emphasis of the Am. J. Pharm. Educ., 62, 398-405(1998); received 3/19/98, accepted 7/23/98.
importance of supporting ones position rather than References
searching for a single correct answer is essential, because (1) Raisch, D. W., Holdsworth, M.T. , Mann, P.L. and Kabat, H.F.,
it encourages critical thinking rather than random search “Incorporating problem-based student-centered learning into phar-
for what one source may support as a probable solution. macy externship rotations,” Am. J. Pharm. Educ., 59, 265-
272(1995).
(2) Roche, V.F., “The use of case-studies in medicinal chemistry
Resources. The case study method requires that students instruction,” ibid., 57, 436-439(1993).
with different educational and skill levels work closely (3) Currie, B.L., Chapman, R.L., Christoff, and Sikorski, L., “Patient-
together. The class is made up of a diverse student pool related case-studies in medicinal chemistry,” ibid., 58, 446-
ranging from students with only two years of undergradu- 450(1994).
ate experience to students with many years of pharmacy (4) Hartzema, A.G., “Teaching therapeutic reasoning through the case-
study approach: Adding the probabilistic dimension,” ibid., 58, 436-
experience. Such a variety of skills is desirable as each 440(1994).
group is bound to have members with different strengths to (5) Sims, P.J., “Utilizing the peer group method with case-studies to
provide the group. However, it also means that students teach pharmacokinetics,” ibid., 58, 73-77(1994).
are starting at different levels and must be provided with (6) Duncan-Hewitt, W.C., “Formulation problem-solving as an alterna-
tive to traditional pharmaceutics,” ibid., 56, 242-251(1992).
some basic resources that they can be functional in areas (7) Sims, P.J. ‘Utilizing the peer group method with case-studies to
which are less familiar to them. A good example is com- teach pharmaceutics,” ibid., 58, 78-81(1994).
puter technology. While some students can develop pro- (8) Kabat, H.F., ‘Innovation in education : Problem-based learning,’
grams of their own, others cannot even log on to a com- Tomorrow’s Pharmacist, 18, 3-5(1996).
puter. To avoid unnecessary confusion and frustration, stu (9) Hmelo, C.E., Gotterer, G.S. and Bransford, J., “A theory-driven
approach to assessing the cognitive effects of PBL,” Instructional

American Journal of Pharmaceutical Education Vol. 62, Winter 1998 403

 Sci., 25, 387-408(1997). ing member of the group at all times. You must make every
(10) Duncan-Hewitt, W.C., “A focus on process improves problem- effort to be present or to be adequately excused.
based learning outcomes in large classes,” Am. J. Pharm. Educ., 60, One member of your group has been assigned to be the ini-
408-416(1996). tial leader of the group, and he/she will be responsible for seeing
(11) Haworth, I.S., Bolger, M.B., Eriksen, S.P., “The use of computer-
based case studies in a problem-solving curriculum,” ibid., 61, 97- that the group’s first case study is completed as assigned, that all
102(1997). people in the group have a part to play and, of even more impor-
(12) Bolger, M.B., Haworth, I.S., “PharmLabTM : A computer program tance, that all do their share of the work on the first case study.
for the calculation and visualization of drug degradation pH rate You will each be required to maintain a record of your impres-
profiles,” ibid., 61, 281-287(1997). sions of the contributions of each member of your group, and
(13) Perrin, D.D., Dempsey, B. and Serjeant, E.P., pKa Prediction for provide a grade for each member following completion of the
Organic Acids and Bases, 1st ed., Chapman and Hall, London case study. This record and grade will be collected anonymously
(1981), and references therein. when the case reports are handed in. The leader is critical to the
functioning of the group (please see the attached document for
details of the role of the leader).
APPENDIX A: MATERIAL PROVIDED TO STUDENTS We do understand that group-based working is not your
ON THE ROLE OF THE GROUP LEADER AND ON usual method of study or learning, and that it is a skill that must
be learned and practiced. Our purpose is to provide this practice
GROUP FUNCTIONING and, in operation, to identify any group function problems you
may have. There may be some problems in your group, e.g., per-
The following material (presented here in an abbreviated form) is ceptions of inequity in work assignments or work quality, dis-
given to the students at the beginning of the year, and provides agreements, or personality conflicts. This is not abnormal, and it
some background information on key issues in the course. The is the responsibility of the leader and other members of the group
material is reinforced further by class discussions of these issues. to solve these problems. These may also be problems similar to
those that you will face in your future professional life. We expect
What is a Group Leader and What Does He/She Do? that you will try to deal with them using persuasion, diplomacy,
The efficient functioning of a group demands that someone be and appeals to effort for the good of the group. We would much
‘in-charge’ of that group, to set goals (with the assistance of the prefer that you only report problems to the faculty as a last resort.
group) and to ‘run’ the meetings. In order for your group to ‘get Two case studies will be assigned during each semester.
started’, the faculty has selected one member of your group to These are very complex assignments and will require you to
act in that capacity at the beginning of the Fall semester. After work with your group outside of class, either in the library or at
each case study has been completed, you will be expected to some other place of your group’s choosing. The case study report
select your next leader. A new group leader must be selected for will be due about four weeks after assignment. Following sub-
each new case study. Thus four of you will have the opportunity mission of the report, the group members will meet with a facul-
to be a group leader over the year. Please realize that this task is ty member (the interview) and be asked about the report. You
neither easy nor always pleasant. Someone with the skill to work will be expected to be able to discuss what you did and to
with people and the willingness to make often unpleasant deci- describe how your work fits into the overall report. The report
sions is required, and the results of your case studies will depend and the interview will be graded on content, scientific logic,
somewhat on the effective functioning of the leader you select. imagination and creativity, and each member will receive the
A few guidelines for Group Leader functions may help. same grade for the report made. Each member may receive dif-
These are not all of the activities the leader will find him/herself ferent grades from the interview. A full breakdown of grading
doing, but should serve as an adequate starting point. The leader for the course will be provided in the detailed syllabus.
will: (i) call and conduct team meetings; (ii) make assignments to
each team member either in preparation for class discussions or
case study work; (iii) coordinate all aspects of the completion of
case studies, including the writing, final editing, and submission APPENDIX B.: SAMPLE CASE STUDY
of the group report; (v) continuously evaluate the performance
and contribution of each team member to the case study, coun- This case study is representative of that given as the third of
seling those members whose performance is detracting from the the year. Case studies given at an earlier stage of the course
performance of the team, and directing those students to the would focus more explicitly on specific physical chemistry con-
mentor or a faculty member for assistance; (vi) work to develop cepts, such as pKa, the use of buffer solutions, isotonicity, solu-
one or two group members to be future leaders; and (vii) fairly bility, or chemical kinetics. In the following case study these con-
assign each group member a share of the responsibility for read- cepts are included in a less explicit manner, and the students are
ing background material for case studies and class discussions expected to integrate them into the formulation problem. For
and for briefing the rest of the group on the important points in concepts covered in the course, see Appendix C.
the background material. The Ear, Nose and Throat department of your hospital has
been doing research into new and sometimes previously unused
Group Functioning in Pharmaceutics I and II combinations of older drugs, for use as nasal sprays to relieve
Each of you have been assigned to a group of six or seven peo- severe nasal inflammation and congestion. These products will
ple. You will remain in this group for the duration of be used in their research projects on youth and young adults
Pharmaceutics I and II, and only under extreme circumstances (ages 12 - 21 years, anticipated body weights are 100 to 175
will changes in the group be considered. You will be expected to pounds).
do your work as part of this group for both in-class discussions Your group has been given the task of proposing an initial
and the out-of-class projects (case studies) assigned to you. After formulation for a batch of five liters of one of these products.
concepts have been presented in the lecture blocks, your group This batch is expected to last for about three months. The cus-
have discussion meetings with the TAs and faculty members. tomary application (dose) is to be ‘two sprays’ into each nostril.
These discussions are important, they are graded, and they are Your spray containers have been calibrated to produce 0.125
part of the class. Information will be discussed regarding the cur- cc/spray and the medication will be applied four times per day.
rent case study, and the answers to the weekly key questions will Your formulation (four sprays) is to contain X mg of Insoluble
be discussed and collected. You will be judged on your ability to Drug A and Y mg of Soluble Drug B.
contribute to the discussion, and so you must act as a contribut Please propose a suitable and defensible formulation for the

404 American Journal of Pharmaceutical Education Vol. 62, Winter 1998

ENT request and discuss your reasoning for proposing this for- (iv) The particle size most suitable for such insoluble drugs as
mulation. If you feel that quantitative data are required for ade- might be present and how as well as why this might be
quate responses, seek that data, and, if it is unavailable, make expected to affect the availability and the efficacy of the
educated estimates of the needed values. Please limit your dis- drugs.
cussion to 10 pages and to the following concepts : (v) Molecular interactions between the drugs, and if undesir-
(i) The ‘comfort’ and acceptability, as well as the appearance, of able, how these may be overcome.
the final product. The case study was given to all the groups, but the specific
(ii) The stability of the drugs in the solution; do you anticipate drugs and/or doses chosen were different for each group. These
the stability to be sufficient to allow the use of the 5 liters for were chosen from the following table, with one soluble drug and
the desired three months? one insoluble drug for each group, thus creating different prob-
(iii) The effects caused by the increased nasal mucous one might lems for each formulation.
expect in conditions such as this.

Insoluble drug A Dose (4 sprays) Soluble drug B Dose (4 sprays)

Prednisolone 2mg or 3mg Ephedrine Sulfate 100mg
Prednisone 2mg or 3mg Terbutaline Sulfate 0.5mg
Triamcinolone 2mg or 2.5mg Theophyline Ethylenediamine 40mg
Dexamethasone 0.6mg or 4mg Theophyline Hydrobromide 40mg
Oxymetazoline Hydrochloride 0.05 or 0.1 mg
Xylometazoline Hydrochloride 0.1 or 0.2 mg

APPENDIX C. DETAILED COURSE SCHEDULE

A representation of the detailed schedule of lectures, case stud- tor for two hours each week (every Friday - these meetings are
ies and discussion groups is shown below. The scheduled dates occasionally replaced by case study interviews), and a computer
and topics are based essentially on those used for the 1997-98 laboratory is held every week in Pharmaceutics I. The case stud-
academic year, but also incorporate some minor changes ies ‘build’ on each other and all concepts discussed in earlier
(regarding the order of concept presentation) that we project for cases are used in later ones. An indication of the general scope
the 1998-99 academic year. In addition to the scheduled lectures of each case study, and its position in the course, is given below.
and meetings detailed below, each group meets with their men

Course Overview and Organization (two two-hour lectures)

Aug.28th : Introduction to the Course ; Sept. 2nd : Case Study Method
Lecture Block 1 : Physical Organic Chemistry (six two-hour lectures)
Sept. 4th : Functional Group Chemistry Sept. 16th : Case Study 1 Assignment : solution formulation,
Sept. 9th : Chemical Energetics physicochemical properties, pKa, degradation, shelf life, buffer
Sept. 11th : Chemical Equilibria solutions. Oct.l6th: Due Date. Oct. 17th & Oct. 24th : Interviews
Sept. 16th : Acids and Bases / pKa
Sept. 18th : Buffer Solutions / Isotonicity Discussion Block 1 (1 hour / group): Sept. 25th; Sept. 30th; Oct.
Sept. 23rd : Kinetics and Drug Stability 2nd; Oct. 7th; Oct. 9th; Oct. 14th
Lecture Block 2 : Molecular Interactions (six two-hour lectures)
Oct. 16th : Non-Covalent Interactions Oct. 28th : Case Study 2 Assignment : protein binding, ligand-
Oct. 21st: Protein Binding receptor interactions, solid dosage forms, simple absorption.
Oct. 23rd : Solubility and Rate of Solution Dec. 1st: Due Date. Dec. 2nd & Dec.4th : Interviews
Oct. 28th : Partitioning
Oct. 30th : Solid Dosage Forms I Discussion Block 2 (1 hour / group) : Nov. 6th; Nov. 11th; Nov.
Nov. 4th : Solid Dosage Forms II 13th; Nov. 18th; Nov. 20th; Nov. 25th
Lecture Block 3 : Biphasic Systems (six two-hour lectures)
Jan. 8th : Surface Chemistry : Liquid/Liquid Jan. 20th : Case Study 3 Assignment : formulation of dispersed
Jan. 13th : Surface Chemistry : Liquid/Solid systems, physical stability, preservation, sterility. Feb.17th :Due
Jan. 15th : Solubilization and Micelles Date. Feb.19th & Feb.20th: Interviews
Jan. 20th : Emulsions
Jan. 22nd : Suspensions and Rheology Discussion Block 3 (1 hour / group) : Jan. 29th; Feb. 3rd; Feb.
Jan. 27th : Preservatives / Sterility 5th; Feb. 10th; Feb. 12th; Feb. 17th
Lecture Block 4 : Drug Delivery and Absorption (six two-hour lectures)
Feb. 24th : Cellular/Membrane transport I Mar. 5th : Case Study 4 Assignment : absorption, specific deliv-
Feb. 26th: Cellular/Membrane transport II ery approaches, drug transport, incorporation of earlier materi-
Mar. 3rd : Oral Delivery al. Apr. 9th :Due Date. Apr.10th & Apr.14th: Interviews
Mar. 5th : Transdermal Drug Delivery I
Mar. 17th : Transdermal Drug Delivery II Discussion Block 4 (1 hour / group): Mar. 24th; Mar. 26th; Mar.
Mar. 19th : Ophthalmic Drug Delivery 31st; Apr. 2nd; Apr. 7th, Apr.9th

American Journal of Pharmaceutical Education Vol. 62, Winter 1998 405

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