Pharmacy for the Curious

understanding of course material. 4, 5 In this approach students study
course material ‘strategically’ for examination success, rather than to
develop clinical competence. 4 For example, they study material based
solely on past exam questions rather than learning objectives.

Students employing any of the learning approaches described above may do
so in active or passive ways.4 ‘Passive-learning’ requires minimal effort on
behalf of the student, who is at risk of becoming apathetic and disengaged.
6 ‘Active-learning’ requires the expenditure of effort which reinforces
student engagement, knowledge-retention and deep-learning. 4

Students commonly prefer to use ‘strategic’ approaches to learning rather
than ‘deep-learning’ ones and academic success at medical school has been
shown to correlate with a ‘strategic’ approach. 4, 7 Ultimately, these
approaches cannot be expected to nurture deep understanding of a subject
nor development of the attributes of a ‘good doctor’. Students need to be
reminded that their ultimate goal is to become ‘good doctors’, not to pass
examinations. At ANUMS our goal is therefore to encourage concurrent
active and deep approaches to learning.

The Map: Curriculum Alignment and Course Integration

The pathology curriculum needs to be formulated, embedded and delivered
within a wider medical school program so that students may readily
identify its relevance as the basis of Medicine. Pathology educators need to
be a visible and persistent presence at university meetings where
curriculum and examinations are discussed, in order to defend, promote
and preserve the vital pathology curriculum within the overarching medical
education framework. At ANUMS, a member of the pathology staff is also a
member of every curriculum and examination committee. This serves the
critical functions of integrating and aligning the pathology curriculum with
that of other specialties (interdisciplinary communication) and efficiently
planning a curriculum with explicit and relevant learning objectives.6

For example, in our program we have aligned the learning of pathology in
the first two years with anatomy and histology and in the latter two years,
with the major clinical disciplines of medicine, surgery and women’s health.
The pathology course structure should be fashioned to build knowledge
progressively; the so-called ‘spiral approach’. Being aware of the students’
knowledge base at particular stages enables teaching material to be pitched
to the correct level, with adequate opportunity for revision and repetition.
Students and teachers need to be familiar with this framework and we have
achieved this is by enabling student and staff access to the entire pathology
curriculum via an online pathology portal. We have clearly indicated the
required knowledge via written learning objectives at the commencement
of each learning task.

Within any teaching environment there is also a ‘hidden curriculum’ which
is essentially “the set of influences that function at the level of
organisational structure and culture”. 8,9 This unintended, subliminal,
‘hidden curriculum’ may have both positive and negative consequences (for
example. loss of idealism) on student learning, amounting to
‘enculturation’.9 A valuable culture is one which values collaboration over
competition, student responsibility and a learner-centred environment. 3,
8,10 The ANUMS, through its teachers and course design, aims to foster such
a culture.

The Messenger: The Teachers

The ‘messengers’ are the pathology educators who deliver the curriculum
and they are crucial to inspiring learning. The pathology educator should be
enthusiastic, genuinely interested in their topic and passionate about
teaching and learning. 3,4 An educator must be knowledgeable, have
contemporary expertise and authentic clinical experience. 3, 7 Our teachers
are medical practitioners working in clinical pathology and participating in
research.

Research shows that “wanting to give back to the profession” and altruism

are two important motivations for clinicians to teach. 11 These teachers
however also require sufficient departmental time and resources to permit
this and they should be given adequate opportunity to further their
professional development, for example, by attending courses. 3,10 All
pathology staff at ANUMS are encouraged to complete a Graduate
Certificate in Higher Education and those who have completed this have
found it invaluable in their educational approach.

Teaching should ideally be a reciprocal relationship characterized by trust,
mutual respect and collaborative learning. 3 Teachers learn from students,
especially when asked challenging questions or given feedback, and this
trust and respect is fostered by their continual demonstration of
commitment. 3 Aligning examinations with learning objectives and
demonstrating commitment to teaching may be evidenced by punctuality,
giving encouragement, displaying empathy and maintaining a consistent
and approachable persona. 3,4,10

It is important to cultivate and maintain a relationship with students whilst
clearly upholding professional boundaries. Teachers are role models for
their profession and can inspire students to follow their speciality. They
also comprise an important element of the ‘hidden curriculum’. 9 Our
program aims to support, value and engage educators who are positive role-
models for students, and who promote learning and the vocation of
pathology.

Methods: How the Curriculum is Delivered.

Gardner’s theory recognises that humans possess a range of intelligences
(linguistic, logical-mathematical, spacial, bodily-kinaesthetic, musical,
interpersonal, intrapersonal, naturalistic, and existential).12 This
undoubtedly results in individual student preferences for various learning
modalities. The pathology curriculum should be delivered in a way that
attempts to support students of all intelligence types to learn effectively.

For example, limiting a pathology curriculum to only formal lecture
delivery is a ‘one-size-fits-all’ approach which is unlikely to suit or please all
learners and which may unintentionally result in student disengagement.13
At ANUMS we employ the following diverse educational formats:

 Formal lectures.
 Laboratory (small group) sessions.
 Problem-based learning (years 1 and 2) and case-based learning

(years 3 and 4).
 Portfolio items (anatomical pathology laboratory visit and

coronial autopsy attendance).
 Clinicopathological correlation sessions (case-based small group

discussions/problem-based learning facilitated by a pathologist
and another clinician, either a surgeon or physician) utilising
microscopic slides and non-potted surgical specimens that the
students can touch with gloved hands. Such tactile learning
encourages an active learning strategy that can engage students
who respond better to kinaesthetic learning.
 Fixed-resource sessions (sequential lectures on a topic delivered
by various medical specialists with synchronous
multidisciplinary attendance) which facilitates integrated and
deep learning of a particular topic. This also reinforces the
important role of pathologists in disease diagnosis that often
guides further treatment and provides important prognostic
information to the patient and other members of the treating
team.

In addition, we have developed the following auxiliary learning resources to
supplement the curriculum:

 Internet-based resources (E-learning resources). These internet-
resources include copies of written course handbooks,
PowerPoint lecture presentations, audio lecture recordings,

supplementary video resources, practice quizzes, useful scientific
articles and links to useful pathology websites. Such resources
have been shown to be effective teaching strategies as they focus
on facilitating student learning rather than simplecontent
distribution.13 They also place students in control of their own
learning and remedying gaps in their knowledge. Development
of, as well as regular updating of E-learning resources may be
time-consuming, but students increasingly view these E-
resources as invaluable.
 The Professor B. Herdson pathology museum: This is a learning
resource consisting of a large number of potted organs of
predominantly surgical specimens. These are arranged according
to body system, with accompanying case histories, macroscopic
and microscopic descriptions. A medical student has recently
developed a smartphone application that scans barcodes on the
organs and provides links to descriptive information about the
disease processes displayed. Quizzes, in the form of questions
and answers related to these specimens, are available for student
revision. Student feedback has indicated their preference for this
resource over photographs to better understand disease
processes

Deep approaches to learning are encouraged by teaching settings which
encourage active learning.3-5 Such as team-based learning and case-based
discussions. These have been shown to be of benefit to pathology students,
especially those in the lower-performing quartiles.14 Problem-based-
learning (PBL) requires students to investigate multiple sources of
information, brainstorm, integrate knowledge, self-reflect and think
critically8, 10, 15.

In addition, students are required to engage, answer questions, learn
collaboratively, understand learned information within its context and grow
to understand their own limitations. Traditionally passive methods of
learning such as formal lectures may transform into active-learning

exercises by verbally questioning students, or performing class quizzes.
These later activities are core to our teaching methods. At ANUMS,
students are required to observe a coronial autopsy, as well as visit the
anatomical pathology laboratory to observe organ specimens on their
journey from receipt in the laboratory to becoming glass slides on a
pathologist’s desk. Implicit in the concept of these ‘portfolio’ items, is
student reflection on the experience16, which is an interesting, not to
mention an active learning process.

Teaching is a type of performance. The challenge for an educator is to
engage and entice students to learn. Personal charisma and likeability are
obvious assets to any teacher; nevertheless anyone can enhance their
teaching ability by focussing on improving simple aspects of their lecture
delivery and teaching style. Some techniques we have found useful include:

 Providing well-planned, clearly structured lectures with
appropriate cues taking students from point to point. For
example, "The four major concepts are . . .”

 Using transitional markers: these are highly effective for helping
students to understand parts, relationships, and reasons. For
example, "Now that we have examined the theory, let's look at
the application". Statements like this help students to organise
their notes and minds.3, 17

 Explaining material via clear and simple English terminology
with gradual incorporation of medical language. 3

 Using written material: (e.g. PowerPoint slides) only as a guide
for delivery (don’t just read out what is written on the slides) and
providing these to the students for independent learning.

 Employing visual and verbal illustration techniques. Verbal
illustrations are the “war” stories: something that happened to
you or a patient which you remember that vividly exemplifies the
point you are making.17

 Teaching incrementally and providing feedback. 17

 Moving around and asking questions: this helps students to pay
attention and personalises your discussion. Attention and
retention increase in direct proportion to speaker proximity. 17

 Using gestures to emphasize key learning: point, draw a line in
the air or on board or make a face. Students follow someone
moving and seeing a little animation helps maintain interest.

 Modulating one’s voice: students will write down whatever you
say loudly or emphasize: e.g. "And this is especially important",
"Here is the key concept”. This helps your audience preferentially
retrieve the ‘gold’ in your talk.17

 Being enthusiastic and using humour facilitates student rapport
and enjoyment. 17

 Summarizing and repeating: a typical listener actually hears ~
20% of what you say: TV advertisers name products at least 5
times in a commercial and rerun each commercial endlessly to
achieve fact retention.17

 Introducing and summarising lecture material: the first and last
5 minutes of a class are remembered best by students and this
assists fixation of session content in students’ minds. 16

 Asking questions both of the students and fellow teachers in
group teaching situations.

The Menu: Course Content and Learning Objectives

Course material should be up-to-date, relevant to future practice and, in
medicine, aligned with the curriculum of other clinical specialities. It is
necessary to be mindful that most students will never end up training as
pathologists and transmitted knowledge needs to be appropriate for the
level of students rather than trainee pathologists. Additionally, the course
content should be appealing, memorable and interesting.

One way of ensuring that the course content is both ‘nourishing’ and
‘appealing’, is to use the tools of story-telling, with frequent reference to

real-life examples and personal anecdotes demonstrating real-life
applications of knowledge.17 For example, instead of stating that
“pleomorphic undifferentiated sarcomas are most common in middle-aged
to older adults”, tell the story of the patient: “This sarcoma is from the
upper thigh of a 76 year-old clergyman who noticed that when he prayed
one buttock had become bigger than another”. Always try to relate factual
knowledge to its clinical significance or application.

For example, when teaching students how collagen fibres are formed in a
connective tissue lecture, mention how this is important to know, because
collagen fibre formation is defective in diseases like scurvy, and
Osteogenesis Imperfecta. When teaching students about the histological
layers of the large intestinal wall one could explain how this knowledge is
applied when staging colorectal cancer.

When ordering from a menu in a restaurant the served meal should be
readily predictable from the menu description, and likewise, when teaching
Pathology, the learning material should be strictly aligned with the learning
objectives. These should be clearly stated at the beginning of a learning
exercise and should employ action verbs based on Bloom’s taxonomy, so it
is clear to the student what can be assessed.18

Teaching material needs to be delivered at an appropriate pace, in an
incremental and logical fashion, with regular feedback and assessment3,4.
Dividing learning up into small and easily mastered units which ‘build’
upon previous learned knowledge is the key. Information overload is to be
avoided as it can overwhelm students, cause burnout, erode self-confidence
and discourage attempts at a deep approach to learning. 14

The Measurement: Value of Formative and Summative
Assessment

Students actually prefer regular and frequent assessment, and whether
formative or summative this fosters motivation for learning. 19 Conversely,

assessment-overload may create undue fear in students which encourages
their use of surface learning strategies.3, 4Assessment of student
competence should always be aligned with learning objectives and should
give students an insight into their performance, so that they may identify
knowledge deficits and correct them. 3,4,7 ,20 It is well known that each type
of testing platform has intrinsic flaws and limitations.19 To counteract this,
a variety of assessment tools are required which should be validated3,7.

At ANUMS, we employ a variety of summative examination formats to test
the pathology curriculum. These include multiple choice questions, short
answer questions, extended-matching questions, multidisciplinary case-
based written questions, oral viva examinations, portfolio items, and
station-based practical examinations. We encourage problem solving and
the testing of application of knowledge, rather than the regurgitation of
facts, to encourage a deep approach to learning.

For example, asking students to interpret a full blood count, rather than
simply list what is abnormal, or to describe a real surgical specimen and
suggest a differential diagnosis. In written exam formats, utilising stems
that describe patient scenarios reinforces learning for clinical competence,
not examination success. We always aim to show the relevance of their
assessment to becoming “good” doctors.

Formative assessments may be done spontaneously in the classroom; for
example by discussion, observation, asking questions and doing quizzes19,
or they may also be planned, formal events. We regularly include two to
three multiple choice questions covering key content in lectures that are
answered by students in class and then discussed. This is in addition to
formal formative assessment examinations.

The Meditation: Reflection and Self-improvement

The final ‘M’ is meditation. Self-reflection leads to self-improvement. Self-
improvement can be divided into scientific (pathology-related) knowledge

and teaching skills knowledge. Whilst continuing education in both
disciplines is important, formal and informal evaluation of the program and
it’s teachers by students and teaching staff is also vital. Regular qualitative
and quantitative assessment is essential using “in house” and formal
university-sanctioned feedback forms.

We have found evaluation of our course has been an important driver for
self improvement. It is important that those who provide feedback are
informed of the outcome (for example, whether a change in the course
content or delivery is made) to promote student engagement in future
evaluation activities.2 To avoid evaluation “burnout” once a program is
established, a targeted review of particular aspects of the course, rather
than a whole course review, is recommended.

Other tangible measures that assist with evaluation of a course include
student success in examinations and the quality of their answers to written
or verbal examination questions. More informal gauges of a program
include students’ asking of quality questions which demonstrate
understanding and deep-thinking about course content. We regularly
encourage our students to provide short written appraisals of our
laboratory practical sessions, inviting comments on any “muddy” moments.
They write these down and hand them-in anonymously at the conclusion of
the practical and we subsequently discuss these “muddy” moments at the
next class. This has proved to be an inestimable barometer of student
understanding (and misunderstanding!).

Conclusion

Inspiring the learning of pathology, whether undergraduate or
postgraduate, requires the same ingredients. The course needs to have a
student-centred focus that delivers a well-designed program with clearly-
stated learning objectives. A range of teaching and assessment methods
need to be used, with delivery given by committed teachers who actively
encourage reflection and a desire for continuous self-improvement.

Importantly, this needs to occur in an institution that values the teaching of
pathology. As stated by Mark Van Doren, “The art of teaching is the art of
assisting discovery”1 and this is pivotal to the understanding of disease,
which is pathology.

References

http://adulted.about.com/od/teachers/a/teacherquotes.htm

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the what, why and how of inspiring medical students to learn. In: Inspiring
Academics. Learning with the world's great university teachers. 2011 Open
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Ramsden P. Learning to Teach in Higher Education. 2000, Routledge
Falmer, London. ISBN: 0-415-06415;

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for Medical Education. Med Educ. 1986; 20: 162-175.

Ferguson E, James D and Madeley L. Factors Associated with success in
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957.

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On. A Review of Its Effects on Knowledge and Clinical Performance. Med
Princ Pract. 2009; 18: 1-9.

Reid W.A, Duvall E and Evans P. Can We Influence Medical Student’s
Approaches to Learning? Med Teach. 2005;27(5): 401-407.

Maudsley G and Strivens J. Promoting Professional Knowledge,
Experiential Learning and Critical Thinking for Medical Students. Med
Educ. 2000; 34: 535-544.

Lempp H, Seale C. The Hidden Curriculum in Undergraduate Medical
education: Qualitative Study of Medical Students’ Perceptions of Teaching.
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Kolb AY, Kolb DA. Learning Styles and Learning Spaces: Enhancing
Experiential Learning in Higher Education. Acad Manag Learn Educ. 2005:
4(2): 193-21210.

Dahlstrom J, Dorai-Raj A McGill D et al. What Motivates Senior Clinicians
to teach Medical Students? BMC Med Educ. 2005. 5;27.

Kanthan R, Mills M.E. Multiple Intelligences in Undergraduate Medical
Education. JAIMSE. 2005; 15 49-56.

Ruiz J. G, Mintzer M.J and Leipzig R. M. The Impact of E-learning in
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396.

Chapter 16: Why Study Pharmacy? - Zubin
Austin, PhD

Zubin Austin BScPhm MBA MISc PhD
Professor and Research Chair at the Leslie Dan Faculty of Pharmacy

University of Toronto

Dr Zubin Austin BScPhm MBA MISc PhD is Professor and inaugural
holder of the Ontario College of Pharmacists Research Chair at the Leslie
Dan Faculty of Pharmacy, University of Toronto. His research interests
include health professionals education and development. He has
published over 90 peer reviewed manuscripts and authored three
textbooks. He has won awards for his research from the Association of
Faculties of Pharmacy of Canada, the American Association of Colleges of
Pharmacy, and the Canadian Pharmacists' Association. He is also an
award winning educator having received the Province of Ontario's
Leadership in Faculty Teaching Award, the University of Toronto's
President's Teaching Award, and he has been named undergraduate
Professor of the Year by students on 15 separate occasions.

Rewards And Opportunities Associated With Professional
Education

In today’s world, educational choices matter more than ever. Opportunities
for those without post-secondary education are becoming fewer and less
attractive, and the demands of the employment marketplace continue to
drive students’ desire to attend university or college. While there is clearly
a strong and important link between future career success, income
potential and successful completion of a post-secondary academic
qualification or degree, it is equally important to consider the value of such
programs in helping individuals achieve their potential to live a happy and
productive life serving their communities.

The profession of pharmacy is attractive to many students as a potential
career option: it offers the possibility of long-term stable employment
within a professional setting where knowledge (rather than brute force) is
valued, and where working conditions are generally comfortable and
pleasant. When asked, many students indicate their interest in pharmacy
as a career stems from their desire to apply their skills and talents within a

health care context. Many pharmacy students can be characterized as
“vocationally pragmatic”: rather than simply study for the sake of study,
they are interested in the rewards and opportunities associated with
professional education, not the least of which include salary, status, and
title.

While this type of thinking is, of course, completely understandable in
today’s unsteady economic times, it may also be helpful to reflect upon
other factors that may be important in driving academic and career choices.
While practical considerations (employment prospects, salary potential,
job-related stability, etc.) are important, you are well advised to also
remember that most new graduates will be working for a minimum of forty
or forty-five years, and the quality of that working life and experience will
play a central role in defining personal happiness and success.

How To Find Work That Is Both Personally Meaningful
And Financially Rewarding?

When you reflect upon potential career choices that may optimize personal
happiness, not just financial or professional success, it is most important to
understand yourself: what drives you, what makes you happy, what
irritates you, what would you rather avoid? Self-understanding is crucial to
successful planning, and will allow you to avoid making decisions simply to
please others, or to ensure short-term gain at the expense of longer-term
unhappiness. In an ideal world, it is possible to find work that is both
personally meaningful and financially rewarding, but in most cases, finding
a balance between the two will be necessary.

One way to approach this question is to talk with other people (frequently
older people) who have already struggled with these kinds of questions and
decisions. Speaking with pharmacists about their experiences and insights
may be a useful way of shaping your thinking and decision making. While
you are not likely to find one individual who maps perfectly onto your
personality, interests, and hopes, you can learn much from simply listening

to others’ stories and reflecting on how these align – or do not align – with
your own.

How Can You Possibly Choose Anything?

As a mid-career academic at Canada’s largest university, I have had the
great good fortune of having pharmacy be a long-standing and positive
influence in my life, both professionally and personally. I selected
pharmacy as a degree program of study at university when I was barely 18
years old: as I look back on that decision, I am astonished by how careless I
was! Like many of you, I was a strong student, with particular interests in
maths and sciences, but without any specific notion of how I wanted to
apply these strengths to my future studies and life. Throughout secondary
school I was told I could be “anything I wanted”. All those options sounded
nice but were also a bit paralyzing: when you can do everything how can
you possibly choose anything?

In my time (the early 1980s) pharmacy seemed like a good choice for
someone who didn’t quite know what they wanted to do or be when they
grew up. It left you a lot of options: I could go into business, work in a
hospital, or carry on my studies in the future. Not having strong
preferences one way or another for a career, pharmacy seemed a fine
enough choice.

Today, I cannot imagine what a good decision I made, despite the
somewhat careless way in which that particular choice happened! What
intrigued me about pharmacy – the options it presented – has been an
important part of my professional and personal happiness ever since. I
could not have imagined in the 1980s how many doors a pharmacy degree
and license would open for me in the future, and how many different
pathways would present themselves to someone who was a pharmacist. In
my own career, I have had interesting opportunities in hospital/clinical
practice, but also with information technology, education, business
administration, public speaking, and television presenting to name a few.

Eventually, I decided to continue my education and completed a PhD which
led me to an academic/research career at Canada’s largest pharmacy
school, which in turn has opened innumerable opportunities for me in
terms of international lectureships and presentations.

Flexibility And The Opportunity To Be Entrepreneurial
With Both Career And Life

The aspect of pharmacy that has been most rewarding for me is its
flexibility and the opportunity to be entrepreneurial with both career and
life. People in general are “interested” when one is introduced as a
pharmacist: they assume a certain level of intelligence, experience,
personality, and ability exists, and this goodwill translates into
conversations and relationships, which turn leads to opportunities.
Pharmacy, like many career options, can be whatever you want it to be: the
key of course is to not limit yourself, your options, and your imagination.
While traditional community or hospital pharmacy practice may indeed be
an excellent option for some individuals, it need not be the only thing
everybody considers.

I have had greatest personal and professional success in blending my
pharmacy interests, degree, background, and experience with other
(sometimes seemingly tangential) fields of study. For example, a degree in
business administration, information science, or education blended with a
pharmacy degree provides unique opportunities to develop niches that are
well regarded and respected within the academic and professional
communities alike.

A pharmacy degree provides outstanding academic preparation: pharmacy
graduates must have strong verbal and non-verbal skills, quantitative and
qualitative analytical skills, people and technical abilities, etc. While the
knowledge base and content of a pharmacy degree is, of course, related to
pharmaceuticals, the critical thinking, self-discipline, time-management,
and interpersonal skills that develop over the course of the degree are

equally important in helping to shape future options and opportunities.

Make The Most Out Of Your Career, Your Life, And Your
Opportunities!

Pharmacy may or may not be the right choice for everyone but for most
people, the knowledge, skills and values acquired during the study of the
profession itself will be valuable in some way in the future. While of course
the stability of the profession, salary potential, and prestige are “nice”
features, the real value of the degree and the profession becomes apparent
when one considers the various options and opportunities that are opened
when one becomes a pharmacist.

Pharmacy blends well with virtually every other discipline: business, law,
information technology, education, public health, policy and government,
etc. Understandably, many young people may not “know” for certain what
they want to do when they grow up, yet feel pressured to select something
sooner rather than later. For those who select pharmacy, the very good
news may be this: pharmacy can be a wonderful end in itself, or merely the
beginning of a trajectory you cannot possibly imagine today. The choices
and options will be yours – seize them and make the most out of your
career, your life, and your opportunities!

i World Health Organization. World Health Statistics. Available at:
http://www.who.int/whosis/whostat/EN_WHS10_Full.pdf. Accessed September 3,
2010.
ii Nations, U. (2012). "Populaton Facts 2012/2." Retrieved August 7, 2014, from
http://www.un.org/esa/population/publications/popfacts/popfacts__2012-2.pdf.
iii World Bank (2014). "Data Health." Retrieved August 4, 2014, from
http://data.worldbank.org/topic/health?display=default.
iv WHO (2014). "Maternal Moratlity." Retrieved August 4, 2014, from
http://www.who.int/mediacentre/factsheets/fs348/en/.
v WHO (2014). "UN: global child deaths down by almost half since 1990."
Retrieved August 4, 2014, from
http://www.who.int/mediacentre/news/releases/2013/child_mortality_causes_2013
0913/en/.

vi WHO (2014). "Medi Centre Tuberculosis." Retrieved August 4, 2014, from
http://www.who.int/mediacentre/factsheets/fs104/en/.

vii UNAIDS (2014). "Fact Sheet." Retrieved August 4, 2014, from
http://www.unaids.org/en/resources/campaigns/globalreport2013/factsheet/.

viii WHO (2014). "10 Facts on Malaria." Retrieved August 4, 2014, from
http://www.who.int/features/factfiles/malaria/en/.

ix World Bank (2014). "Data Life expectancy at birth, total (years)." Retrieved
August 4, 2014, from http://data.worldbank.org/indicator/SP.DYN.LE00.IN.