Design and Evaluation of a Student Created Oral Exam Format in a Pediatric Elective

Background: Flipping the classroom is one way to address students’ tendency to passively learn in the pharmacy curriculum, a habit which could lead to decreased readiness for the experiential fourth year. As flipped classrooms become more common, novel student assessment methods are needed. Student-created exam questions have been reported in the literature, as have student-presented patient cases. Though mock patient counseling has been used frequently in pharmacy education, and creation and enactment of employment-related scenarios has been reported in business education, student-created patient cases have not been described as a method of assessment.

Innovation: In our pediatric pharmacotherapy elective for third-year pharmacy students at Butler University, we utilized student-created oral case presentations for assessments in place of written examinations. Though case presentations have been utilized as part of the pharmacy curriculum within the Therapeutics course series, these cases are provided to the student, at which time the student evaluates the case and provides his or her recommendations. In our course, the student was responsible for creating the patient case (including baseline patient information and inclusion of drug- or disease-based problems). The students built their cases into web-based action maze using the free software Quandary. Students then individually presented their patient case with potential treatment options to peers and faculty, asking the audience to make decisions and justifying their primary treatment selection with supporting literature and logic. Presentations were evaluated using a rubric created specifically for the assignment with three main categories: case pharmacotherapy, the Quandary build, and presentation and communication skills.

Results & Conclusion: Rubric inter-rater reliability as measured by intra-class coefficient (ICC) indicated a strong rubric. The overall ICC was 0.918 (0.765-0.973). Evaluation of the case pharmacotherapy showed the highest ICC (0.876) while the evaluation of the actual quandary build demonstrated some room for improvement with the lowest ICC (0.641). As the students created their own case parameters, the responsibility for truly understanding and engaging with the pediatric material was flipped to the learner. Creation of a patient case for presentation requires in-depth knowledge of the disease state, characteristics of affected patients, age-specific pharmacokinetic changes, and evidence-based treatment options. As instructors, this required a totally different mode of student support and preparation for assessment or “exams”. Instead of spending time writing exam questions, which is a time consuming but comfortable practice for faculty, time was spent creating the rubrics and providing support and feedback to our students as they developed their cases. Instructors learned to provide support to the students earlier and provide examples to facilitate the students in this activity, outside of their comfort zones. Overall student performance and response was both impressive and encouraging.