A Student's Perspective on Assessment and the Affective Domain.

To the Editor: In the most recent version of the “Draft Standards 2016” from the Accreditation Council for Pharmacy Education (ACPE), the first 4 standards are adopted from the educational outcomes released by the Center for Advancement of Pharmacy Education (CAPE) in 2013. The draft standards also express an increased emphasis on assessment.1,2 For the first 3 Standards, foundational knowledge, essentials for practice and care, and approach to practice and care, this does not present a new issue. These are fairly straightforward education outcomes that have been represented in past accreditation standards, and schools should have plenty of experience assessing them. The fourth standard, on the other hand, presents a challenge. Originally introduced in the 2013 CAPE Educational Outcomes, this standard focuses on professional and personal development. The key elements of Standard 4 (self-awareness, leadership, entrepreneurship, and professionalism) are difficult to define and assess, as the guidance document for the accreditation standards admits.3 Much attention is being paid to how colleges and schools of pharmacy will integrate Standard 4 in their curriculum and provide documentation of Standard 4 assessments. What may not be getting enough attention is how schools will inform students about these changes. I would imagine many schools make announcements about the revised standards and educational outcomes to their students, who are sure to have questions. Regarding Standard 4, they will want to know how and when they will be assessed and what the results of those assessments will mean. The driving force behind this concern will likely be the students’ discomfort with ambiguity. As a fourth-year pharmacy student, I can tell you we want to know, in black-and-white terms, what we have to do. Similarly, we want to be evaluated as objectively as possible. This discomfort is difficult for many students to overcome. In a survey of new graduates, Droege found that most were intolerant of ambiguity in general, and many did not value “acceptance of uncertainty” as a desirable trait,4 and, thus, had little desire to increase their tolerance of ambiguous situations. Prerequisite courses, especially those revolving around math and basic sciences, may have conditioned students to rigidly define “right” vs “wrong” answers. However, it is much more difficult for assessments to distinguish appropriate levels for Standard 4 elements. Students may be troubled because benchmarks for the Standard 4 key elements might not be clear cut. The council encouraged schools to develop innovative assessment approaches because established assessment tools were unable to measure Standard 4 elements.3 However, students may be concerned whether those new methods are reliable compared to traditional assessment tools. While assessment of Standard 4 will be somewhat ambiguous, the consequences of the results must not be. At the school level, it may be easy to understand the impact of student performance in assessments. Schools are expected to utilize analysis of assessment measures for continuous quality improvement efforts.1 For the student, the consequences of assessments of Standards 1-3 are well-known. For example, if a student does poorly on an examination (an assessment tool of Standard 1), a simple calculation reveals the impact on that student’s grade. This is a black-and-white scenario students are familiar with. However, students may not know what will happen to them if they fail to meet expectations of the affective domain. Without that knowledge, students may make many – sometimes false – assumptions. They may believe they will be held back from advanced pharmacy practice experiences or course progression, or that they will have to complete a remediation process. Conversely, because assessment of Standard 4 qualities may be somewhat subjective, students may be under the impression that the results of those assessments will not impact them. Introducing students to revised accreditation standards and educational outcomes could create challenges, but pharmacy schools can adopt strategies to meet them or even strategically turn them to their advantage. Moreover, instead of an obstacle, this may be an opportunity to show students that they will deal with gray areas in practice, including employer evaluations. Providing students with an overview on how novel assessment methods are developed and the reasoning that goes along with them could go a long way in validating those methods in students’ minds. Schools should be explicit and address this issue early on to rectify any misconceptions students might have. No matter how schools end up informing students about the new accreditation standards and educational outcomes, there is an opportunity to involve students in reflecting on their education. It will be a chance to introduce the standards and outcomes for the first time. Reviewing these documents could give them insight, as it did for me, on how their curriculum is planned. An appreciation for this organization may boost student enthusiasm for individual assignments and courses. For students familiar with previous ACPE outcomes and standards, the importance of Standard 4 qualities can be reinforced so students can understand the changes. In either case, there is an opportunity for reflection, which is important to developing the Standard 4 qualities we are trying to assess in the first place.