Interactive Online Journaling
in Pharmacy Service-Learning
Jeri J. Sias, Pharm.D., Clinical Assistant Professor
University of Texas at El Paso/Austin
Cooperative Pharmacy Program
Abstract
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Purpose: 1) To describe the use of interactive on-line journals in pharmacy service-learning experiences 2) To share lessons learned
Background: In Fall 2001, service-learning was implemented at the University of Texas at El Paso/Austin Cooperative Pharmacy Program to facilitate pharmacy students' understandings of health care and pharmacy issues on the US-Mexico border and to engage students in nontraditional health care environments. The service-learning experience was designed as a longitudinal two-year process. Students participated in a semester-long orientation to border health and research topics and then initiated their 1 to 1 1/2 years of service and community project development. To evaluate student perceptions and encourage discussion, critical thinking, problem solving about border health issues, the pharmacy program looked for a reflection-component process.
Rationale: The primary reason for using the interactive on-line journals was to document current and changing students' perceptions of the community, health care, and pharmacy issues and needs on the US-Mexico border. Program Development: During the service-learning orientation, pharmacy students learned how to use thejournalplace.com and were placed in on-line clusters. They periodically reflected on health and pharmacy issues facing the US-Mexico border and on their experiences in community agencies. Students were able to document their "on-going understandings" of a topic, discuss issues and experiences within "clustermate interactions", and describe changes in their perceptions and beliefs in "evolving understandings." The instructor was able to provide feedback and comments to each student. Results: The journal reflections received mixed reviews from the two student classes that have participated. Individual students provided thoughtful reflections. However, students were not accustomed to the on-line journal dialogue format and were reluctant to use the "clustermate interactions." Further, the students did not realize how their perceptions changed and so they often did not write reflections in the "evolving understandings." 1) The instructor learned to develop more targeted questions to encourage students to dialogue within their clusters and to reflect on changes they see in the community and their health care professional roles.
2) The instructor will use more of the student journals as points for discussion during class. This process should help facilitate student use of the journals.
Summary: The on-line journal provided a method to document short- and long-term (2 years) changes in student perceptions of their health care role in the community and encouraged on-line dialogues among students and the instructor.
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Outline
I. Background to the Cooperative Pharmacy Programs
II. Rationale for Service-Learning
B. Document changes in student perceptions over time
III. Program development
B. Service-learning site reflections
V. Results
VI. Lessons Learned
VII. Summary
In Fall 2001, the Cooperative Pharmacy Program of the University of Texas at El Paso (UTEP) and the University of Texas at Austin (UT-Austin) incorporated interactive online journal reflections as part of the Doctor of Pharmacy service-learning experience. The online journaling provided faculty an opportunity to document changes in student behaviors and understandings of their community and issues facing the US-Mexico border as shaped by their service-learning experiences over a two-year period. Students were able to express current views of their community and role as a pharmacy professional, exchange thoughts between each other in cluster groups, and see changes in their own perceptions.
Rationale for Service-Learning
As a US-Mexico border city, El Paso has unique demographic and health care issues not found in most parts of Texas or the nation. Health care realities include use of medication and herbs from the neighboring Mexican city of Ciudad Juárez, decreased access to health care services, and a deficit in the number of health care providers. Due to the pharmacist shortage in El Paso, the workforce needs to be nearly doubled. College-age students from El Paso have not traditionally considered pharmacy as a viable career option secondary to distance (the closest pharmacy school in Texas is approximately 450 miles from El Paso) and expenses of living outside of El Paso. Reasons for establishing the UT-Austin Cooperative Pharmacy Program in El Paso include providing opportunities for El Pasoans to attend pharmacy school, to diversify the pharmacy workforce, and to help alleviate the pharmacy shortage in this region. Students recruited into the Pharmacy Scholars Program complete their pre-pharmacy work in El Paso, attend UT-Austin College of Pharmacy for the first two years of the professional program, and finish their Doctor of Pharmacy degree work at the University of Texas at El Paso. Prior to starting their pharmacy degree, pharmacy scholars sign a contract where they agree to complete at least 40 hours of community service upon returning to El Paso for their final two years of study. The program has been in existence for nearly six years with the first group of students returning to El Paso in Fall 2001.
As the first group of pharmacy scholars returned to El Paso, the Cooperative Pharmacy Program wanted to identify ways to incorporate service-learning into the students' educational experience. The faculty believed that pharmacy students completing their degree in El Paso would benefit from an exposure to health care on the border. The program decided upon a non-graded two-year longitudinal experience including an orientation to healthcare in the border community, 40 hours of service, and completion of a community project. Reflections have become an integral part of service-learning in other academic settings by providing students an opportunity to critically evaluate themselves and their served communities. Online journaling was an easily accessible forum for students to write their own thoughts and to learn from each others' experiences. For the program, using the interactive on-line journals gave the faculty a method to document changes in student perceptions over time of the community, health care, and pharmacy issues and needs on the US-Mexico border.
Development of Service-Learning Component
After orienting students to "The Journal Place", students completed a waiver so that they would understand that their journals may be viewed by other students and used to improve the educational process. Students were given guided reflection questions throughout the two years (see reflection assignments) and were placed into clusters of two to three to provide for online reflection exchanges. The instructor was also able to respond to each student privately or publicly.
The sections of the student journals in "The Journal Place" included the following:
Community Service-LearningUTEP/UT-Austin Cooperative Pharmacy Program Waiver to use materials (sample)
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Date |
Reflection Assignment |
Due Date |
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Reflection #5 Oct 14, 2002 Culture and medicine |
1. Comment on the following through the
discussion questions: “The doctor cures the disease, but the
indigenous healer heals the illness.”
What points made during the class
discussion on story of Lia in "The spirit catches you and you fall down"
confirm or disagree with your understanding of the culture of medicine?
2. What are considerations you may need to take in serving your community as a pharmacist? What are the constraints that exist to address the cultural needs in current pharmacy settings? What do you think are some solutions?
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Noon Monday Oct 28, 2002 |
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Reflection #4 Oct 7, 2002 Promotores de salud Lorenza Zuniga
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1. Respond to your clustermate briefly regarding
alternative medication use in the US-Mexico Border.
2. What do you think are some of the role(s) of the promotora in the community? How can the promotora provide critical connections to the community? How do you think you can learn more about the pharmacy needs of the community through the promotora? 3. If you have a new evolving understanding, jot down some thoughts in this section. |
Noon Monday Oct 14,2002 |
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Reflection #3 Sept 30, 2002 Complementary Alternative Medication on the US-Mexico Border Dr. Armando Gonzalez Stuart |
1. Respond to your
clustermate(s) regarding any of their previous entries. (Click on their
picture in the upper right corner where you may respond to them) Do you
agree or disagree with them?
2. Describe your perceptions of herbal and medication use on the border that were confirmed or challenged by this presentation. Do you think it is wise or not to obtain medications from Mexico? Why or why not? What do you think would be the ways you could help address the use of products from Mexico as a pharmacist? What other perceptions do you have? Identify 2-3 problems and/or benefits of alternative medication use on the border. 3. If you had any new evolving understandings regarding health care or herbal/medication use, please jot down some notes in this section. |
Noon Monday Oct 7, 2002 |
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Reflection #2 Sept 16, 2002 Health on the Border Dr. Laurance Nickey |
1. Respond to your clustermates. Do you have similar questions to them? Why or why not? 2. What new information did you learn about healthcare in the border region from Dr. Nickey’s presentation? What are some of the ways that the US & Mexico can (or already have) work together to solve health care problems? What areas of pharmacy are affected by border dynamics that may be different from other parts of Texas or the country? 3. If you had any new evolving understandings, please jot down some notes in this section. |
Noon Monday Sept 23, 2002 |
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Reflection #1 Aug 26, 2002 Introductions
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Recall the time you were leaving for pharmacy school. What did you look forward to? What were your apprehensions? Describe how those perceptions were true or not true and why. How do you think you have changed or grown? Now that you are completing your final years of your professional doctorate, what are you looking forward to? What are you apprehensions? What do you think your role will be as a pharmacist in the communities where you will work? What do you want to learn about your community? List three questions that you hope to answer about the border community during the next few months.
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Noon Monday September 9 |
Journal Reflections
Spring-Fall 2003
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Comment briefly about your cluster mate’s experiences in the “dialogic” section. |
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Describe the type of service you provided or observed that was most meaningful to you and why? Would you want to continue working with this organization and in what capacity? Why or why not? What do you think your role as a pharmacist could be with this organization that is different from when you first started?If you were to talk about this experience with other people, what would be the most important message that you would want to share with them. |
Student reactions were mixed regarding use of the interactive journaling. Individual students provided thoughtful reflections. However, students were not accustomed to on-line journal dialogue format and were reluctant to use the "clustermate interactions." Further, the students did not realize how their perceptions changed and so they did not often write reflections in the "evolving understandings." Still, many of the student reflections were well constructed and provided feedback to the instructor of their interpretation of their community and health care role.
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Sample
#1:
Dr. ______ provided many staggering facts/numbers about the border region that I had often wondered about, but never really knew. For example, the border population is predicted to be 23 million by 2025! This number is just staggering. There are 61 million people crossing the border from Juarez to El Paso!! What Dr. ______ said was right, it is just not the fact that these people are crossing the border, but are brining with them diseases. I was a bit surprised and saddened by the stat of El Paso being the 5th poorest city in the U.S. I was surprised, for although it does seem the poorest of the cities in Texas, I didn't imagine it to rank so high in the U.S. Despite the poverty, the attitudes of the people here seem so positive and resilient. How is it we manage to be the 4th best in immunizing our children by age 2 when we are the 5th poorest? Who is funding this? Being to Socorro and then having Dr. ______ tell us that it was a combination of 200 colonias was mind boggling. Who put them together? How did they put them together? The intricacies are intriguing. All in all, I enjoyed his lecture very much and he opened my eyes to many things about El Paso I had never known, despite living here for the past 8 years. |
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Sample #2:
"I was informed with what Dr. ______ told us about the ugly side of borderland last Monday. What surprised me was the fact that, even though he sounded to know about the deep problems more than anybody else, he announced himself as a proud resident of the region for generations. When talking about the region, it was like he was talking about himself. An integral relation between him and his environment was apparent, a relationship in which he looked for trouble rather than running away from it. I did not know Dr. _______ before at all, but just because of that positive attitude of his, I think he is my hero. I have lived in many different places, in my lifetime, and I know as a fact that every place comes with some advantages and some disadvantages. For example, I remember the green Austin and its mold problem. I think most of people learn how to get used to problems, while some others... run away from them, but there are only very few who stay and try to challenge the problems of their environment. I think our main problem in the region is not that so many people live by the so-called Aqua Negras, but that so few minds are thinking of ways to fix it. I learned from Dr. ______ that our problems will be solved one by one. We have come a long way, so far. The borderland will survive and progress. The rate will be accelerated only if educated and specialist individuals get sensitized and participate in identifying and solving these problems." |
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"Like
you, I was surprised by some of the stats that were presented to us. I
was very surprised as well when it came to learning about our rank in
the list of poorest cities. I didn't expect that. After growing up in
El Paso, I was even surprised to learn about it being made up of 200
or so colonias. I never saw my neighborhood as a "colonia." This just
goes to show how it is important to get the facts straight about what
really consitutes a colonia rather than just assuming that it is this
utterly poor neighborhood with very poor people living in shacks. This
wasn't what I grew up in at all. I guess we need to get better
information
before making
judgments. Plus, being better informed will make us better
practitioners."
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"On the statement, "the
doctor heals the disease, but the indigenous healer heals the illness", I
find that the doctor's job is one of routine, "follow a protocol", type of
work. They cure the disease the way that they learned how, without much
thought or feeling into it. They are very "by the book." The indigenous
healer to me appears more mindful of their work, taking many things into
consideration. They approach the illness as a separate entity almost and
acknowledge it. They feel the illness has a purpose for being there and it
is their job to rid the illness, but in a different manner than the
westeren culture does it. It is almost as if they acknowledge the illness,
and the reason it is present, and give it a reason to leave. This is very
different from Western ways. This way, the illness leaves and the patient
is healed "by spiritual means". There is nothing spiritual about western
medicine. I was very surprised by the story of Lia ["The Spirit Catches
You and You Fall Down", Fadiman A]. I couldn't believe many of the things
that they believe in. Their views are so different from the Western
culture. I am very aware that there are many cultures of medicine,
however, I think it was good to reinforce these differences. Although
there are many cultures that are not so extreme, it still plays a big
difference when you are trying to treat them in a different culture and
trying to impose your culture on to theirs. One should be cognizant of
this differences when trying to treat patients in the western world.
As a pharmacist, we need to realize that there are different cultures of medicine and take these into account when we are trying to counsel patients. They may not want to take the medications they are prescibed, or they may want to use something else as an adjunct to their therapy and it is important that we know this. Certain constraints that exist include a limited knowledge on different cultures and also, limited products available for people. In our society, we only carry things and recommend things that we believe are helpful to our patients. However I am sure that there are many other things that are available elsewhere that work just as well. We are very narrow minded and follow things just so. I think that communication with patients is very important in this situation. In our society, we are not going to change our methods of performing medicine, however, if we can get an idea of somebody else's culture, then perhaps we can tailor our way to meet their standards along the way." |
1. Incorporate guided questions. Students reflected more critically with guided questions. Also, students were often confused by the "clustermate interactions" and "evolving understandings" and would choose not to make notes in these sections. As the course developed, each reflection assignment had a component that required students to respond to their classmates or encouraged students to make a self-evaluation of the changes in their own understandings.
2. Use student journals as points of discussion for class. Students were more likely to write critical reflections if classroom discussion followed the assignment and incorporated their journal responses.
3. Assign a grade to the reflections if possible. Given the nature of the program, it was not possible to assign grades or credit for the assignments. This situation made it difficult to receive some journals on time and with critical reflection.
4. Print and share a final copy of journals to students. Students may not be able to access journals after a course is completed. If possible, encourage students to save copies to a diskette or print a final copy of their journals. Consider distributing their first journals to students at the end of the course. Discuss the changes or perceptions students have experienced.
Online journaling provided an excellent mechanism for the pharmacy program to document longitudinal service-learning experiences. The forum encouraged on-line dialogues among students and with the instructor. Development and changes in student perceptions of their community and role as pharmacists were noted over time.