INSTRUCTIONAL DESIGN AND ASSESSMENT Curriculum Reform in Finnish Pharmacy Education

American Journal of Pharmaceutical Eucation 2009; 73 (8) Article 151. INSTRUCTIONAL DESIGN AND ASSESSMENT Curriculum Reform in Finnish Pharmacy Eucation Nina Katajavuori, PhD, a Katja Hakkarainen, MSc, b Tiina Kuosa, MSc, c Marja Airaksinen, PhD, a Jouni Hirvonen, PhD, a an Yvonne Holm, PhD a a University of Helsinki, Faculty of Pharmacy, Finlan b Noriska Högskolan för Folkhälsovetenskap, Göteborg, Sween c PharmaPress Oy, Helsinki, Finlan Submitte January 8, 2009; accepte May 10, 2009; publishe December 17, 2009. Objective. To improve pharmacy eucation through integrating theory an practice, coherent constructively aligne course entities, an enhance eep-level learning. Design. The reform was conucte collaboratively with faculty an staff members, stuents, an stakeholers in pharmacy. The curriculum, syllabus, an teaching methos were assesse through evaluations an research, conucting core content analyses, an measuring the workloa of pharmacy eucation courses. The new curriculum, launche in August 2005, consists of 6 strans, comprise of ifferent courses which run through the entire program. Assessment. Three years after the introuction of the reforme curriculum, the results of the reform are being evaluate. Ongoing assessments of teaching an learning will reveal how the eucation at the faculty level has evelope since the reform. These assessment proceures are an integral part of the faculty s quality assurance program. Conclusion. The integration of practical training an theoretical stuies was improve with personal stuy plans introuce to enhance stuents learning. Keywors: curriculum, pharmacy eucation, Bologna process, Finlan, curriculum reform INTRODUCTION European ministers of eucation signe the Bologna Declaration in 1999 1 to create a European Higher Eucation Area (EHEA) by harmonizing the structures of European university egrees, improving the transparency of the egrees, an promoting mobility an cooperation throughout Europe. At the same time, stuent-centere learning an the shift from knowlege transmission to enhancing stuents knowlege became more emphasize in higher eucation. 2 To achieve optimal learning outcomes, the focus of curriculum esign lies in the learning process, not only in the content of the curriculum, lectures, assignments, an practical perios. Constructive alignment combines a stuent-centere focus in teaching, alignment among curriculum objectives, teaching, an learning activities, an the assessment of the process an its outcomes. 3,4 Content, teaching, an assessment methos shoul foster eep-level learning, an achievement of the objectives of the curriculum an iniviual stuy courses. Corresponing Author: Nina Katajavuori, Peagogic University Lecturer, University of Helsinki, Faculty of Pharmacy, Viikinkaari 5, Helsinki, Finlan. Tel: 1358-50- 5537922. E-mail: nina.katajavuori@helsinki.fi 1 While higher eucation is base on arts an sciences an can be consiere theoretical, grauates must be prepare for professional practice in iverse an constantly eveloping settings. 5 As pharmacists practice in a variety of settings, eg, community an hospital pharmacies, regulatory an other authorities, the rug inustry an research, pharmacy schools an colleges are challenge to prepare stuents to confront these multiimensional, ynamic forces in society. Thus, pharmacy grauates must commit themselves to lifelong learning an continuous evelopment after grauation, as ientifie by the Worl Health Organization (WHO) an the International Pharmaceutical Feeration (FIP), to meet the requirements of an evolving society. 6 Furthermore, practicing as a pharmaceutical expert requires the ability to think analytically, clearly, critically, an to interpret scientific evience. Curriculum esign an teaching practices influence the evelopment of scientific thinking an lifelong learning skills, 7-10 an thus were consiere essential attributes when eveloping the eucational curriculum of future pharmacists. In Finlan, the Bologna Process was le by the Ministry of Eucation. The curriculum reform process of the Faculty of Pharmacy, University of Helsinki, Finlan, was viewe as an opportunity to evelop pharmacy eucation to reflect moern concepts of learning an

American Journal of Pharmaceutical Eucation 2009; 73 (8) Article 151. teaching in higher eucation. The reforme bachelor s an master s egree programs were launche in August 2005 an 2006, respectively, after eveloping the curriculum by: combining courses an forming larger coherent entities, improving the integration of theory an practice, an fostering eep-level learning. In accorance with the Bologna Declaration, the Finnish Ministry of Eucation instructe colleges an universities to aopt the 2-cycle egree system an the European Creit Transfer an Accumulation System (ECTS) by August 2005. 11 The 2-cycle system enables stuents to obtain a 3-year bachelor s egree an continue with a conitional 2-year master s egree. The University of Helsinki complie with the instructions an provie further irectives for its faculties an epartments. 12,13 Prior to the Bologna Process, pharmacy eucation in Finlan consiste of a 3-year bachelor of science in pharmacy egree an a 2-year master of science in pharmacy egree to be complete after the bachelor s egree. At the University of Helsinki, the Faculty of Pharmacy accepts approximately 140 stuents annually for the bachelor s egree program an 55 for the master s egree program. 14 Nationally, the 3 Faculties of Pharmacy at the Universities of Helsinki, Kuopio, an Åbo Akaemi reache a consensus with the goals for the BSc an MSc egrees in pharmacy (Appenix 1). In aition, the Directive 85/ 432/ETY outline European pharmacy eucation at the time of the reform. 15 Since October 2007, the Directive 85/432/ETY has been repeale an replace by the Directive 2005/36/EC on the recognition of professional qualifications. 16 The bachelor s an master s egrees, esigne to prepare stuents for professional practice, inclue 6 months of practical training in a community or hospital pharmacy. The reform ae elective courses to the bachelor s egree. The master s egree aims at eveloping further the stuents scientific skills an inclues a 5-month research project at the en of the egree. In Helsinki, the fourth year (first year of the master s egree) has consiste traitionally of compulsory courses, while uring the fifth year, stuents conuct avance stuies in the iscipline of their choice. In Finlan, grauates with the bachelor or master of science in pharmacy are eligible to practice as pharmacists, however, only pharmacists with a master s egree may own a community pharmacy. 17 In aition to the Bologna Process, eucation at the Faculty of Pharmacy has been enhance continuously base on nees arising from external an internal evaluations. 18-21 For example, in the 1990s, the number of pharmacy practicerelate courses, such as pharmacotherapy, was increase, an more stuent-centere teaching methos an problem-base learning were applie to the curriculum. 2 The objective of our stuy was to escribe the curriculum reform process an give a preliminary assessment of the results of it. DESIGN In 2004, the contents of iniviual stuy courses an the entire bachelor s an master s egree programs were evaluate utilizing core content analyses. 11,12 Core content analysis was use to evaluate the content of egrees, moules, or courses, to ientify unintentional overlapping, an to assess the workloa of the curriculum. Teachers responsible for each course efine the contents into 3 categories: core contents (must know), aitional contents (shoul know), an special contents (goo to know), with the core contents proviing the essential scientific or practical competencies. In aition, the goals of the courses, appropriate teaching methos, an possible overlap were assesse. Base on the assessments, courses were categorize to form larger coherent entities, ie, strans (Table 1), that woul support the achievement of the goals of the curriculum reform. Evaluation of Teaching an Learning Base on evaluation an peagogic research of teaching an learning at the Faculty, the curriculum, syllabus, an teaching methos were accesse. 18-21 Stuies showe that stuents foun the previous curriculum fragmente an consiere the theoretical stuies challenging. Trens of surface-level learning also were emonstrate which was manifeste in fact memorizing an ifficulties knowlege application by the stuents. 19 The 6-month practical training enhance stuents eep-level learning an facilitate linking theoretical stuies with practice. 21 However, the quality of precepting in ifferent pharmacies was reporte to vary. 20 An international evaluation panel also suggeste that the 6-month experiential training shoul be utilize in the curriculum more effectively. 18 The commitment of the entire organization has been emphasize as a prerequisite for successful eucation Table 1. The Strans of the Reforme Bachelor s Degree are Sprea Over 3 Years (ECTS 5 European Creit Transfer an Accumulation System) Stran Name ECTS 1 Scientific thinking an professional 40 evelopment 2 From molecule to rug preparation 56 3 Patient an meication therapy 40 4 Meicines an society 12 5 Interaction an communication 14 6 Optional stuies 18

American Journal of Pharmaceutical Eucation 2009; 73 (8) Article 151. evelopment. 22-24 Thus, collaboration among teachers, an among teachers an stuents, was highlighte in the reform process. The curriculum reform was planne, organize, an supervise by the Stuies Committee of the Faculty, chaire by the Vice Dean of Eucation. The Eucation Committee appointe a curriculum reform working group consisting of 1 member from each of the Faculty s 6 Divisions (Biopharmaceutics an Pharmacokinetics, Pharmaceutical Biology, Pharmaceutical Chemistry, Pharmaceutical Technology, Pharmacology an Toxicology, an Social Pharmacy) an 1 stuent member representing all stuents of the Faculty. In aition, a fulltime planning officer was employe through funing from the Ministry of Eucation to coorinate the reform. While the working group an the planning officer coorinate the moifications, all Faculty personnel an stuents were encourage to contribute throughout the reform process. For example, teachers contribute ieas for new teaching an assessment methos, reorganization of course content, an course scheuling. Stakeholers in Finnish pharmaceutical settings were invite to participate in the curriculum reform to ensure that the courses woul meet the requirements of the real worl. In 2004-2005, the Faculty organize iscussion panels for the stuents, teachers, an stakeholers, who inclue representatives from professional associations, community pharmacies, the pharmaceutical inustry, an governmental authorities. Key elements of the reform were iscusse, an issues raise were consiere for further curriculum evelopment. Base on the assessment exercises, the following key issues were emphasize in the curriculum reform: improving the integration of theory an practice; forming coherent an logical course entities; an fostering eeplevel learning. The ECTS system for efining the workloa an assessing the courses an egrees was implemente accoring to the requirements of the Ministry of Eucation 11 an the University of Helsinki. One acaemic year represents 1,600 working hours an grants 60 units. Half of the workloa for each course was esigne to be performe in contact with teachers, an the other half as inepenent stuy. Contact hours an inepenent stuy hours were calculate, compare, an ajuste in conjunction with the core content analyses, an the workloa was matche with the ECTS units assigne for each course, stran, an egree. 3 ASSESSMENT AND EVALUATION Reforme Curriculum Structure The reform curriculum consists of a 5-year entity (master s egree) that inclues the 3-year bachelor s egree as an integral part. The reforme structure of the bachelor s egree consists of 6 broa stuy entities, known as strans, that are sprea over the entire bachelor s program (Table 2). Courses in the strans are esigne in a continuum aroun the theme of each stran. Within the strans, teaching is provie collaboratively by multiple isciplines at the Faculty. One aim of this esign is to help the stuents achieve a comprehensive unerstaning of Table 2. Structure of the Reforme Bachelor s Degree (180 ECTS a ) Stran ECTS 1 Scientific thinking an professional 40 evelopment Introuction to university stuies 4 in pharmacy Practical training perio 30 Bachelor thesis an maturity test 6 2 From molecule to rug preparation 56 Mathematics 3 Statistics 2 Basics of chemistry 3 Organic chemistry 3 Pharmaceutical chemistry, lectures, 12 an laboratory classes Pharmaceutical technology, lectures, 16 an laboratory classes Pharmaceutical microbiology, lectures, 5 an laboratory classes Biopharmaceutics an pharmacokinetics 6 Pharmacognosy, lectures, an laboratory 6 classes 3 Patient an meication therapy 40 Basics of biosciences in pharmacy 4 Human biology an health 9 Systematic pharmacology 12 Pharmacotherapy 6 Patient eucation an counselling 3 Phytotherapy 2 Toxicology 3 Biopharmaceutics an pharmacokinetics 1 4 Meicines an society 12 Pharmaceutical legislation 3 Pharmacy management 4 Meicines in healthcare 5 5 Interaction an communication 14 Information an communication technology 3 Foreign language 5 Communication skills 1 Secon national language (Sweish/Finnish) 5 6 Optional stuies 18 Minimum 3 ECTS units from other faculties a ECTS 5 European Creit Transfer an Accumulation System

American Journal of Pharmaceutical Eucation 2009; 73 (8) Article 151. the pharmacy profession an pharmaceutical research isciplines. Diminishing a fragmente stuy structure is an aitional aim, which was an earlier problem 25 that hinere learning, as well as progress towars practicing pharmacy an in research. 7,26 To improve the integration of theory an practice, the 6-month experiential training was ivie into two 3- month perios, one at the en of the secon year an one at the mile of the thir year. During both training perios, stuents were instructe to translate theory into practice an reflect what they learne through assessments in a training manual, which was an integral part of the training. Following both training perios, each stuent s training manual was assesse an iscusse by the training coorinator of the Faculty. Because previous research inicate that practical training lacke structure an clear objectives, uniform, high-quality training was emphasize. In the mile an at the en of both training perios, stuents an preceptors were instructe to iscuss the stuent s performance, learning, an evelopment, an to set goals for learning uring forthcoming theoretical stuies an future practice. 20,21 Practical experience shoul be integrate with theory to foster the evelopment of expertise. 8,21,27,28 The structure of the master s egree is presente in Table 3. A stran entitle Drug Development Process (20 ETCS units) was evelope an taught collaboratively by all ivisions uring the fourth year. This stran provies a comprehensive, logical overview of rug evelopment, from rug iscovery an rug formulation, to pharmacovigilance. Another large stran, Economics an Leaership, was evelope to introuce these important aspects to every masters-level stuent, regarless of the iscipline. 6 Fostering Deep-Level Learning Developing self-iscipline is crucial in acaemics. 19,30 Thus, an introuctory course was evelope to familiarize stuents with the pharmacy profession, orient them to active learning in higher eucation, an assist them in progressing in their stuies. During the first semester, 5 tutorial sessions were hel for groups of 10-12 first-year stuents, each group having 1 teacher an 1 secon-year stuent as tutors. The themes of the tutorials were: (1) motives, goals, an expectations for stuying, (2) group work an group ynamics, (3) stuying an establishing a personal stuy plan, (4) introuction to employment opportunities in pharmacy, an (5) ethics in higher eucation an research, an introuction to scientific writing. Stuents were encourage to aopt the philosophy of active learning, to consciously evelop skills in scientific, critical thinking, to assess their own evelopment, an to 4 Table 3. Structure of the Reforme Master s Degree (120 ECTS a ) ECTS General stuies 34 Basics of analytics 4 Drug evelopment process 20 Drug iscovery an evelopment 4 Non-clinical research 6 Drug formulation 4 Clinical phases an introuction to biostatistics 2 From evelopment to rug use 4 Personal stuy plan 1 Economics an leaership 9 Optional stuies 16 Avance stuies 70 Stuies on one of the following subjects: 30 Biopharmaceutics Pharmacognosy Pharmaceutical Chemistry Pharmaceutical Technology Pharmacology Social Pharmacy Master s thesis in the chosen subject 40 a ECTS 5 European Creit Transfer an Accumulation System set goals for learning. To familiarize the stuents with the pharmacy profession, they interviewe pharmacists in working environments an reporte key finings in tutorial sessions, where requirements of professional practice an the nee for lifelong learning were iscusse. The faculty s stuy guie an Web site present the goals of the course, core content, an metho of assessment, which facilitates the stuents orientation to an requirements of each course. 31,4 Teachers also are encourage to evaluate an evelop their teaching practices towars constructive alignment. 4 In constructive alignment it is important that goals, teaching methos, an assessment blen together, encouraging the same type of learning. Evaluation matrices for bachelor s an master s theses were constructe to harmonize evaluation practices an to assist the stuents in unerstaning the requirements of the BSc an MSc theses. Stuents awareness of the assessment criteria facilitates helps them set goals for learning, which enhances eep-level learning. 32,33 Self-reflection, personal stuy plans, an learning portfolios enhance eep-level learning, 34-36 therefore personal stuy plans were incorporate into the bachelor s an master s egrees. Personal stuy plans assiste the stuents in planning their stuies, supporte their learning abilities, an prevente unnecessary elays in grauation.

American Journal of Pharmaceutical Eucation 2009; 73 (8) Article 151. The plan was esigne to serve as a learning portfolio to enhance self-reflection skills require for lifelong learning. Stuents complete their personal stuy plans uring the first semester each year an upate them annually. Teachers provie feeback on the stuy plans annually through lectures an tutoring, an the stuents iscusse their plans in peer groups. Stuents were encourage to evelop their learning skills an assess their motives, goals, an expectations for stuying. Pharmacy stuents receive feeback an avice on improving their learning skills through continuous assessment of their approaches to, an experiences from, teaching an learning. 36 Upon completion of bachelor stuies, stuents evaluate their evelopment an set goals for continue professional evelopment. Progress an results of the curriculum reform were evaluate systematically. A stanarize course evaluation form was use, allowing teachers to evaluate stuent feeback, inform stuents about the essential viewpoints, an provie information about the intene changes to the curriculum. Iniviual strans, the entire curriculum, an general teaching practices were evaluate by using the ETLQ, which is inclue in stuents personal stuy plan. 37 Stuents receive feeback on learning strategies from the questionnaire an use this to improve their stuy skills. Information collecte was iscusse an evaluate first in the Stuies Committee, uring the biannual feeback sessions for teachers an stuents, an also uring the faculty s staff evelopment sessions. The integration of theory an practice, precepting systems, an feeback from pharmacies uring an after the 3-month experiential perios were also evaluate systematically, an iscusse uring the annual continuing eucation ay for practice preceptors. DISCUSSION Three years after the introuction of the reforme curriculum, the results of the reform are being evaluate. Ongoing assessments of teaching an learning will reveal how the eucation at the faculty level has evelope since the reform. The implications of the moifications in the practical training also will be stuie. These assessment proceures are an integral part of the faculty s quality assurance program. The Faculty of Pharmacy at the University of Helsinki is committe to the continuous, comprehensive, an systematic evelopment of pharmacy eucation an the pharmacy profession. The University s Program for the Development of Teaching an Stuies urges that an acaemic egree of high quality shall aim at profoun, research-base competence an expertise consisting of 5 5 main elements 38 (Figure 1). Although the curriculum reform at the faculty of pharmacy has touche on many of these elements, further evelopment nees also have been ientifie. Base on scientific evience an the strategic irection of the university, the faculty s implementation strategy for teaching in 2007-2009 promotes 5 priority areas: constructive alignment, the evelopment of expertise, research-base teaching, international visibility an cooperation, an stuent participation in the faculty s activities, teaching, an learning. To reinforce a seamless implementation of the stran moel, proceures to foster cooperation among teachers, increase stuent participation in eucation esign, an appropriate peagogic eucation for the teachers are being evelope. Teachers an stuents are encourage to share experiences an goo practices through regular meetings an feeback sessions. An interview stuy reveale that teachers at the faculty are motivate to evelop their teaching an assessment practices, but require further assistance. 39 Shifting the behavior of the teachers towars a stuent-centere approach remains challenging. Since teachers approaches to, an conceptions of, teaching affect stuents approaches to learning, 2,40,41 peagogic training of teachers an improve teaching practices are currently being emphasize. In May 2007, the University of Helsinki aware the Faculty of Pharmacy with a grant an the status of High- Quality Eucational Unit for its ongoing efforts to improve pharmacy eucation. In November 2008 the Faculty of Pharmacy receive the status of National Center of Excellence in Teaching. The awars encourage the faculty to evelop further pharmacy eucation base on scientific evience from Finlan an elsewhere. Figure 1. The components of an acaemic egree of high quality accoring to the University of Helsinki, 2006.

American Journal of Pharmaceutical Eucation 2009; 73 (8) Article 151. SUMMARY The curriculum reform process was seen as an opportunity to evelop not only the content of the egrees but also to improve the quality of learning, an further, to improve the integration of theory an practice. In orer to be successful active involvement by teachers, stuents, an stakeholers was neee, which is why iscussion forums were hel. The ifferent courses in the curriculum were organize into broaer entities, which we calle strans, an the reason for this was that the stuent woul get a better overview of the content. A successful curriculum reform an the enthusiasm among faculty members have forme an excellent basis for further evelopment work. REFERENCES 1. Anonymous. The Bologna Declaration of 19 June 1999: Joint eclaration of the European Ministers of Eucation. Available at: http://www.bologna-berlin2003.e/en/main_ocuments/inex.htm. Accesse November 23, 2009. 2. Trigwell K, Prosser M, Waterhouse F. 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American Journal of Pharmaceutical Eucation 2009; 73 (8) Article 151. 33. Zimmerman BJ, Kitsantas A. Developmental phases in selfregulation: Shifting from process goals to outcome goals. J Euc Psychol. 1997;89(1):29-36. 34. Riley-Doucet C, Wilson S. A three-step metho of self-reflection using reflective journal writing. J Av Nurs. 1997;25(5):964-968. 35. Snaen D, Thomas M. The use of portfolio learning in meical eucation. Me Teacher. 1998;20(3):192-199. 36. McCombs BL. Self-regulate learning an acaemic achievement: a phenomenological view. In: Zimmerman BJ, Schunk DH, es. Self-regulate learning an acaemic achievement - theoretical perspectives 2n e. Mahwah, New Jersey: Lawrence Erlbaum Associates; 2001: 67-123. 37. Economic an Social Research Council - Teaching an Learning Research Programme Enhancing teaching-learning environments in unergrauate courses. Experiences of teaching & learning questionnaire (ETLQ). Economic an Social Research Council, 2002. http://www.tla.e.ac.uk/etl/questionnaires/etlq.pf Accesse June 10, 2009. 38. University of Helsinki. Programme for the evelopment of teaching an stuies 2007 2009. Helsinki University Printing House, 2006. http://www.helsinki.fi/opetus/materiaali/ Opetuksen%20ja%20opintojen%20kehitt_ohjelma%202007-2009.pf Accesse October 29, 2009. 39. Postareff L, Katajavuori N, Linblom-Ylänne S, Trigwell K. Consonance an issonance in escriptions of teaching of university teachers. Stuies in Higher Eucation, 2008;33(1):49-61. 40. Trigwell K, Prosser M. Congruence between intention an strategy in university science teachers approaches to teaching. Higher Euc. 1996;32(1):77-87. 41. Kaartinen-Koutaniemi M, Katajavuori N. Enhancing the evelopment of pharmacy eucation by changing pharmacy teaching. Pharm Euc. 2006;6(3):197-208. Appenix 1. Goals of the Bachelor an Master of Science in Pharmacy egrees set by the teaching units (University of Helsinki, University of Kuopio an Åbo Akaemi). In aition to the minimum requirements specifie in Directive 2005/36/EC of the European Union an of the Council for pharmaceutical eucation, stuents pursuing the bachelor of science in pharmacy egree must obtain theoretical an practical competencies for: acting in pharmaceutical positions in all sectors of healthcare; unerstaning the characteristics of rugs an excipients; the preparation an quality control of meicines; patient counseling in the use of prescription an self-care meications, the assessment of symptoms an referral to meical care; the recognition, assessment, an follow-up of problems in meical treatment an health promotion; scholarly thinking an inepenent, critical ecision-making maintaining an upgraing professional competence, pursuing specialist stuies an stuies leaing to the Master s egree. Pharmaceutical eucation is base on scientific research an professional practices in the fiel. The eucation must provie aequate communication, language, an cooperation skills, an lay a founation for professional ethics. In aition to the requirements set for the egree of bachelor of science in pharmacy, stuents pursuing the master of science in pharmacy egree must obtain theoretical an practical competencies for: scientific an professional postgrauate training; research an evelopment of rug molecules an pharmaceuticals, as well as research on rational an cost effective use of meicines; superior, expert, consultation an evelopment in the pharmaceutical sector of healthcare. Pharmaceutical eucation is base on scientific research an professional practices in the fiel. The eucation must provie aequate communication, language, co-operation an leaership skills an furnish expertise in economics an aministration. 7