Aligning hearts and minds: creation of an integrated cardiovascular pharmacy course
Authors: Kruidering Marieke , Tuan Rupa , Fulton Tracy , Mitrovic Igor , Youmans Sharon L. , Shin Jaekyu 
Published: April 2020

BackgroundIn order to train pharmacy students to function within a large, complex healthcare system, the curriculum needs to integrate disciplines, theory and practice (1,2). Moreover, curricular integration is explicitly called for in the accreditation standards for pharmacy programs in the US(3).The UCSF School of Pharmacy launched a new, three‐year curriculum in 2018 that focuses on using pedagogic strategies that facilitate integrative learning, such as ability‐based outcomes to define learning expectations, case‐ and problem‐based learning, capstone courses, experiential learning, and comprehensive authentic assessment(4). Here we report on the design of and early outcomes from an integrated cardiovascular block.MethodsThe overall course objectives for the cardiovascular (CV) course were developed in a multidisciplinary team to address “what skills and knowledge does a PharmD student need to succeed in clinical rotations?” Anchor cases cover key conditions and serve as the springboard to basic science topics and to illustrate its relevance to clinical practice. Relevant session objectives were selected and modified in collaborative, multidisciplinary team meetings. An interactive process narrowed down the topics to fit in the template calendar. Instructors used session objectives to design online and in‐class learning materials and assessments.Weekly, required formative assessments included case‐based 10–12 constructed response questions with detailed answer keys. Summative exams followed a similar format as the formative assessments and contained MCQs.Pharmacology items on summative exams in the legacy and current CV courses were categorized by Blooms Level 1–4 (1: define/identify, 2: explain/recall, 3: apply, 4: evaluate), and an average Bloom’s score per exam was calculated. Student evaluations were collected using Evalue.ResultsWeekly anchor cases are acute coronary syndrome, chronic stable angina, dyslipidemia, heart failure, and arrhythmias. Each week, relevant disciplines (physio, biochem, anat pcol, therapeutics, biostats, etc.) focus on the cases, while the experiential arm provides relevant clinical skills and experiences.

○ Legacy curriculum: Blooms Level per exam: ave 2.2 SEM=0.06)
○ New curriculum: Blooms Level: ave 3.45 (SEM=0.14)
○ Student performance on PCOL questions, some of which are multidisciplinary ranged from 79 – 99%
○ Lower performance was associated with multidisciplinary questions
○ Passing rate on 3 exams ranged from 91–97%
○ Students listed integration, clinical cases and formative assessments as strengths, and high workload and integration of inquiry as areas for improvement.Discussion

○ Integration requires frequent meetings and adaptation of teaching materials driven by a list of essential knowledge and skills, per condition provided by therapeutics.
○ Centralized, administrative course support is essential in both design and implementation phases.
○ Lower student performance on multidisciplinary questions indicate that students are learning to apply knowledge to clinical scenarios.ConclusionFrequent, collaborative meetings are important in creating an integrated course.Evaluation and exam performance data show that this course teaches students to apply pharmacology knowledge to clinical cases.