Animal-Centered Learning Activities in Pharmacy Education

Abstract

Objectives

To assess the contribution of animal-centered activities to students achieving learning outcomes in a veterinary therapeutics course.

Design

Qualitative methods were used to assess the outcome of using “hands-on” animal interactions as tools of engagement in the course. Reflective commentary on animal-centered activities was collected and analyzed.

Assessment

Animal-centered learning activities are effective tools for engaging students and facilitating their understanding and application of veterinary therapeutic knowledge, skills, and attitudes. Analysis of qualitative data revealed themes of professional caring and caring behaviors as a direct result of animal-centered activities. Elements of empathy, caring, compassion, and self-awareness were strong undercurrents in student's comments.

Conclusions

Animal-centered learning activities provide an innovative learning environment for the application of veterinary pharmacy knowledge, skills, and attitudes directly to animal patients. The use of animals in the course is a successful active-learning technique to engage pharmacy students and assist them in developing caring attitudes and behaviors beneficial to future health care providers.

INTRODUCTION

The integration of live, animal patients into a typically human-focused pharmacy curriculum is innovative. The course itself is unique in that it provides instruction on a specialized practice area of pharmacy,¹ and is only one of a few veterinary pharmacy courses offered by an accredited school of pharmacy in the United States. The use of animals as tools of engagement is an active-learning technique that can facilitate students applying their new knowledge, skills, and attitudes directly to animal patients and, hopefully, to human patients in future practice.

Veterinary Therapeutics (PHA 380) is a 2-credit hour elective course that provides instruction on common disease states affecting animals and the human- and veterinary-labeled drugs used to treat these disease states or conditions. The course focuses on veterinary disease states, therapeutic treatment options of human- and veterinary-labeled drugs, and the legal/regulatory issues that affect proper drug use in animals. Students experience a wide variety of animal interactions during the course. Animals are frequently brought into the classroom to serve as case studies and to provide information from the owner to students on drug therapy monitoring parameters and administration techniques. When it was not feasible to bring the animals into the classroom, students participated in animal-centered learning activities outside of the classroom via fieldtrips and service-learning projects. Many of the animals were diagnosed with disease states discussed during class, thus allowing practical application of the knowledge, skills, and attitudes gained in the course. These active-learning experiences provide students with “hands-on” interactions with dogs, cats, reptiles, and horses.

The course content focuses on 3 main areas: veterinary disease states and supporting informatics, legal and regulatory issues, and veterinary pharmaceutical classes. The information on veterinary disease states provides an introduction to veterinary therapeutics by detailing the pathology, signs and symptoms, diagnosis, pharmacotherapeutics, and prognosis for the 15 most common disease states affecting companion animals (dogs, cats, and horses). Print and Internet-based references that can assist future pharmacists in their practice of veterinary pharmacy are listed and described.

The course emphasizes legal and regulatory issues that influence the practice of veterinary pharmacy. Critical documents influencing veterinary medicine are presented to give students valuable guidance and direction with regard to veterinary pharmacy and compounding. These regulatory documents are particularly useful in giving direction to future pharmacists regarding compounding for companion animals (non-food animals) versus food animals. Current topics from veterinary medicine and veterinary pharmacy are presented to supplement the readings on regulatory issues and document the need for a clear understanding of guidance documents and acts that directly affect the practice of veterinary pharmacy.

The third area of content focuses on broad pharmaceutical classes and their uses. Introductory information on heartworm preventatives is presented along with a discussion of the disease state. Common cancers affecting companion animals are presented and the use of chemotherapeutic agents in this population is discussed. A section on anesthetic and analgesic use that lists drug names, indications, and dosages is also included.

Students take self-assessment quizzes after each topic, and there are 2 examinations in the course. The final course grade is comprised of 2 examination scores, participation in the course discussion board, answering reflective questions, and attendance/attitude in the service-learning project.

DESIGN

The overall objective of the course was to provide students with knowledge, skills, and attitudes that can positively impact educational, veterinary, and economic outcomes by applying their drug knowledge resources to veterinary situations. The comprehensive drug knowledge and unique perspectives of pharmacists trained in veterinary therapeutics can be a valuable resource to veterinary medicine and animal health for the ultimate benefit of animal patients. Table 1 lists the specific course objectives for veterinary therapeutics.

Table 1.

Course Objectives for Veterinary Therapeutics

It was hypothesized that veterinary therapeutic principles taught in the context of an animal-centered approach using live animal interactions would be an engaging and effective teaching method. The use of animals in the pharmacy curriculum is rare, but has the potential to engage students in a manner that supports the course learning objectives. Animal-centered learning activities allow students the opportunity to apply practical knowledge, skills, and attitudes gained in the course to animal patients while at the same time instilling caring attitudes and behaviors in future pharmacists. Structured, animal-centered activities occurring throughout the course are designed to give students “hands-on” exposure to animals. Examples of animal-centered learning activities are described below.

Learning Activities Involving Live Animals

A local herpetologist was invited into the veterinary therapeutics classroom for a guest lecture on disease states and physical conditions unique to reptiles. The guest lecturer brought her king snake, Burmese python, and turtle for the hands-on demonstration. Figure 1 show a pharmacy student interacting with the Burmese python. Most students were receptive to handling the snake while other students were fearful. The herpetologist described the environmental conditions that are necessary for maintaining the health of reptiles, and discussed conditions that typically involve a snake's skin and how important the integrity of the skin is to this species.

Figure 1.

Pharmacy student interaction with a Burmese python.

The herpetologist provided the students with a listing of medications commonly used to treat infectious disease of the skin in reptiles. This activity provided students with an opportunity to develop “non-linear” critical-thinking skills needed when dealing with animal species in unique circumstances. This information provided a practical example to the students for why veterinary pharmacy is a specialized area within pharmacy practice.

The reptiles were a stark contrast to the “warm and fuzzy” epileptic dog that visited the classroom earlier in the semester. Students realized that reptiles could potentially be their patients and these animals are due the same level of respect as dogs and cats, animals that are frequently viewed as more appealing. The learning experience provided an opportunity to compare and contrast these feelings to situations in pharmacy practice in which the pharmacist has to care for human patients who they may dislike but must be empathetic toward.

The class took a field trip to a draft horse farm located about 20 miles north of Omaha, Nebraska. This farm was chosen because of its proximity to the pharmacy school, its use of compounded medications in horses for reproductive management, the farm owner's willingness to share his horse care experiences and challenges, and the opportunity to view an animal diagnosed with equine protozoal myeloencephalitis (EPM), a condition discussed in class.

Students received a thorough briefing from the owner on reproductive disorders in equines, specifically draft equines. It created an opportunity to compare and contrast reproductive disorders in female horses to infertility in human female patients as the medications, procedures, and monitoring are similar. Additionally, students received instruction on the use of compounded estrogens and progestin which are administered to female horses to augment ovulation and conception.

This learning experience allowed students to evaluate the appropriateness of compounded medication use in a non-food animal and practically apply the unique legal and regulatory restrictions of compounded drugs to veterinary medicine and animal patients. Concerning the horse with EPM, students commented on the marked muscle atrophy and overall lack of coordination of movements that is typical of this disease presentation. Students were clearly able to recognize the physical signs displayed by the animal and compare this presentation to that of a horse with normal muscle tone and ambulatory movement.

Animal Necropsy

Students viewed a necropsy (veterinary equivalent of autopsy) of a beagle dog by a local veterinarian who is also a pharmacist (Figure 2). This learning experience provided unique insight into the anatomical differences of dogs and humans. The animal's organs were harvested off-site and brought to campus for a hands-on demonstration and explanation by the veterinarian. Students were able to feel the pancreas of a dog and discuss aspects of diabetes mellitus in canines. While students gained a great deal of new knowledge with the exposure to the anatomical structures of a different species, the majority of students wanted to know how the animal was euthanized to obtain the harvested organs, and whether the dog experienced any pain or suffering during the process. Thus, the learning experience allowed students the opportunity to discuss euthanasia solutions (Class II narcotics) and the administration of these drugs with the veterinarian. Students offered caring commentary about the animal's state prior to euthanasia and were sensitive to the fact that an animal's life was taken for the purpose of furthering their veterinary therapeutic education. This was another display of caring behavior by the students.

Figure 2.

Pharmacy students observing a necropsy.

Service Learning Experience

Embracing the service-learning mission of Creighton University, each student in the veterinary therapeutics course spent a single, 2-hour period as a volunteer dog walker at the Nebraska Humane Society (NHS) in Omaha. The NHS relies heavily on volunteers to fulfill its mission, and they are receptive to having the students come to the facility on a regular basis to exercise dogs and perform basic obedience training to help socialize the animals and make them more adoptable.

To facilitate this activity, the instructor had to first become a trained volunteer in order to direct the activities of the students and was required to accompany the students on each visit to the NHS, to ensure the facility's policies and procedures for dog walking are maintained. Upon arrival at the NHS, all students received a tour of the facility (administrative offices, open adoption areas, surgery suites, physical assessment room, overflow kennels, library, quarantined animal kennels, and crematoriums). Students paired up and walked 3-4 dogs individually for 15-20 minutes each. Students were also instructed in basic dog obedience training to help the students train the dogs behaviors that would optimize their ability to be adopted. Figure 3 shows a pharmacy student walking a dog at the NHS.

Figure 3.

Pharmacy student walking a dog at the NHS.

The large numbers of dogs and cats residing at the NHS at any given time provide a wonderful opportunity for students to see examples of animals diagnosed with diseases and conditions discussed in class (eg, hypothyroidism, osteoarthritis, separation anxiety, and heartworm disease). Many of these animals were receiving medications for their diseases, and the students were able to see the practical uses and applications of human and veterinary medications in the management of these conditions. Students were directed to read the medication treatment sheets for the dogs. Medication name, indications, dosages, and administration directions were provided in the treatment sheets, and students were able to view the animal's presenting condition and tie the drug indications to the disease or condition.

This learning activity was an excellent opportunity for students to see the practical medical management of diseases in canines and felines and allow students to accomplish the following learning objectives:

• Compared and contrasted the most common disease states affecting companion animals, with particular emphasis given to pharmacotherapy decision making.

• Applied concepts from the disease state course work by identifying appropriate drug therapy choices for the betterment of animal health.

• Identified an animal patient-pharmacist relationship in the context of a therapeutic relationship.

• Demonstrated caring attitudes and behaviors regarding illness behaviors exhibited by animals and animal owners.

Pedagogy/Andragogy

Published research on the use of animals as teaching tools for empathy, compassion, or caring in human health care curriculums is scarce. One recent article supports the idea that human attitudes to animals may be indicative of human-human empathy.²

The inclusion of animals in the curriculum reflects a teaching philosophy that is truly student focused. Hands-on animal centered activities are one example of active learning in the classroom that has practical application to the practice of veterinary pharmacy. The animal-centered activities can give students a new way of defining their patient population; specifically, that animals can be their patients as well as humans.

Lee Shulman, in Teaching as Community Property,³ defines engagement as one of the most important aspects of learning. Shulman states “learning begins with student engagement, which in turn leads to knowledge and understanding. Once someone understands, he or she becomes capable of performance or action. Critical reflection on one's practice and understanding leads to higher-order thinking.” Thus, students were given the opportunity to reflect on the animal-centered learning activities and recognize any new knowledge or skills acquired that would have practical application to the practice of veterinary pharmacy and to caring for human patients.

ASSESSMENT

Qualitative methods were used to assess learning outcomes from participation in the animal-centered learning activities during the course. Two measurements were taken during the semester. First, students provided written responses to 6 reflective questions. Second, after completing the service project, each student was required to answer 3 reflective questions about his/her NHS experience. The qualitative data gathered were analyzed with the assistance of a team of experts using the open-coding method to determine themes and constructs.

The reflective questions used in the veterinary therapeutics course were:

• What are your reasons for taking this course?

• How has this course applied concepts gained in previous pharmacy courses to the subject of veterinary therapeutics?

• List 3 things that you have learned so far.

• What is the connection between this course and your role as a pharmacist?

• What was different about this course compared to other courses that you have had in the pharmacy program?

• Describe what effect (if any) your experiences with animal disease states had on your professional attitude towards being a caring health care provider.

The NHS specific reflective questions were:

• Describe 2 things that you learned from this experience

• How has this activity shaped your perceptions as a future health care professional?

• How did you demonstrate a caring attitude or behavior with regard to the animal interaction?

Results of the theme analyses revealed students learned important concepts, attitudes, and behaviors that improved their ability to care for animal patients. This knowledge could be applied to the human pharmacy practice setting as well. Students reported a gain of new knowledge and confidence with the veterinary therapeutics subject matter, and themes of professional caring and caring behaviors were identified. Students reported that they had a knowledge base and foundation from which they could provide care to animal patients through counseling and insightful communication with veterinary professionals. Students also voiced a new appreciation for the human-animal bond and how caring and disease treatment are not limited to humans. The results triangulate previous work reporting the positive educational outcomes of a continuing education course in veterinary therapeutics for practicing pharmacists, and an online course in veterinary therapeutics for pharmacy students by the author.^4,5

Theme analysis of students' responses to questions regarding the NHS experience suggested that students learned empathy, compassion, the importance of physical assessment skills, strategies to work with difficult patients, and self-awareness. Additionally, students recognized similarities between animals and pediatric and geriatric patient populations as well as the importance of volunteerism and service. Students clearly responded to the use of live animals in the curriculum and felt that animals were a positive teaching tool. The magnitude of caring-based comments in the reflective commentary was significant and reflected the learning of non-cognitive affective concepts. Students were overwhelmingly positive in their feedback about this activity, and themes of caring and compassion were easily identifiable in the reflective commentary. This finding triangulates previous work reporting the use of animal models and scenarios used in the teaching of caring behaviors and attitudes for pharmacy students.¹

Student evaluations of the course, instructor, and teaching techniques were overwhelmingly positive. Qualitative and quantitative data from the course and instructor evaluations supported this and reflected students' perspectives and opinions. Commentary from the reflective questions and course evaluations indicated that students appreciated and valued the animal interactions. The caring statements and themes intermingled among reports of increased knowledge about veterinary disease state and drug therapy suggest the course was delivered successfully. Positive references to the course structure, animal-centered learning experiences, and the student-focused curriculum dominated the free text commentary on the course evaluation. Constructive comments centered on students asking for more hands-on animal interactions. Additional comments were complementary of the format, teaching skills, course materials, web site organization, and emphasis on student learning.

DISCUSSION

Veterinary therapeutic principles taught using an animal-centered approach with live animal interactions can be an engaging and effective teaching method. Animal-centered learning activities provided an innovative learning environment for the application of veterinary pharmacy knowledge, skills, and attitudes directly to animal patients. The use of animals in the course is an unusual teaching tool capable of assisting students in developing caring attitudes and behaviors that are beneficial to a future health care provider.

From a purely technical perspective, this course and the innovative teaching approach taken are in response to the growing need for pharmacists to be able to provide pharmaceutical care to animal patients. Pharmacists trained in veterinary therapeutics can be a valuable resource to veterinary medicine to the ultimate benefit of animal patients.

From a patient care perspective, students participated in “hands-on” animal-centered activities whereby they learned important concepts of caring, empathy, and compassion: skills that contribute to the care of animal or human patients. Students are expected to graduate and become competent professionals. If a course using hands-on animal interactions either teaches or reinforces caring behaviors within a developing pharmacist, then those caring behaviors will likely be expressed across all patient populations in the pharmacists' delivery of pharmaceutical care.

Growing up in a small, rural, farming community, I had the opportunity to become involved with livestock projects as a youth in 4-H and FFA. I learned a great deal about animal husbandry, animal science, animal welfare, food-animal production medicine, and the immense amount of hard work that it takes to properly care for animals. Today, I take great joy in incorporating the life lessons that I learned back on the farm into my day-to-day responsibilities as a teacher in pharmacy academia. Combining my farm-girl background with my professional education to provide instruction to future pharmacists on topics specific to veterinary therapeutics seems a natural fit. That combination has served me well and it has enabled me to be an innovative, creative, and effective teacher.

I take great pride in being a student-oriented faculty member. I have retained the ability to view things from the student perspective and I am constantly aware of student preferences and needs. When developing this course, and the structured animal-centered activities within it, I thought back to when I was a pharmacy student and how I would have liked the information to have been presented to me. This teaching innovation is the combination of my student-focused approach to teaching with the known benefits of active learning and engagement. Knowledge of these entities provided the impetus to incorporate the animal-centered activities into this course. Hands-on contact with animals provided a learning environment so unique to the human pharmacy curriculum that it has been described as a “memory maker” by former students. Knowing that my course and the methods that I have used to enhance student learning will be remembered by students for years after graduation is extremely rewarding. The time commitment and physical work that it takes to incorporate so many animal-centered activities into this course demonstrates my commitment to the student learner and reflects my student-focused teaching philosophy. The positive feedback received from students who have completed the course has made the teaching experience rewarding and enjoyable.

SUMMARY

Students appreciated the highly interactive nature of this course and came to the realization that animals as well as humans could be their patients. The outcomes reported in this manuscript were reflective of multiple assessments on the use of animal-centered learning activities and triangulate previously reported outcomes. Values and attitudes such as caring and empathy can be difficult to teach and assess. There is potential to instill these attributes into student pharmacists through innovative teaching methods.