Number of Citations: 0

Submitted: 1 July 2019
Accepted: 17 December 2019
Published online: 1 September, TAPS 2020, 5(3), 42-53
https://doi.org/10.29060/TAPS.2020-5-3/OA2166

Eng Lai Tan¹, Sook Yee Gan¹, Wei Meng Lim¹, Peter C. K. Pook¹ & Vishna D. Nadarajah²

¹Institute for Research, Development & Innnovation, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia; ²IMU Centre for Education, School of Medicine, International Medical University, Kuala Lumpur, Malaysia

Abstract

Practice Highlights

• Competencies from research projects need to be transparent to both students and supervisors.
  
• Diversity of research projects should reflect the different career pathways of pharmacists.
  
• Ethical and professional dilemmas from research projects is opportunity for reflective learning.

I. INTRODUCTION

The Pharmacy profession has undergone tremendous changes over the years, and its scope has expanded. The roles of Pharmacists have extended beyond the traditional boundaries of drug preparation and distribution to ensuring that optimal therapeutic outcomes are achieved through patient-centred cognitive services (Bond, 2006; van Mil & Fernandez-Llimos, 2013). Pharmacists play increasing roles in patient education and counselling, health promotion and disease prevention, disease state management as well as being engaged in inter-professional consultation with other healthcare professionals in specialised patient settings (Holland & Nimmo, 1999; Tsuyuki & Schindel, 2008). The new roles for pharmacists evolve in parallel with evidence-based medicine (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). Therefore, research skills are essential for both the practice and advancement of the pharmacy profession. In pharmacy, as in all undergraduate science programmes, research is a critical and essential component of the curriculum, although for pharmacy, being a professional degree, competency for practice takes precedence in the priority of the curriculum (Nykamp, Murphy, Marshall, & Bell, 2010). Nevertheless, there is a need to build a strong research program and culture within a pharmacy degree curriculum through sustainable educational initiatives that complement rather than compromise competencies needed for practice. Research being a critical part of scholarship is necessary for inculcating the attributes related to professional competency such as creative and critical thinking as well as problem-solving. Moreover, research also improves student learning skills and encourages the pursuit of research-related careers (Banks, Haynes, & Sprague, 2009; Nykamp et al., 2010).

The implementation of research in pharmacy curricula varies between institutions. Many colleges and universities require students to undertake coursework in research methodology, biostatistics, drug information, and literature evaluation, but only a small fraction of them chose to complete an extensive project with data collection, analysis, and reporting research findings (Murphy, Peralta, & Kirking, 1999). However, increasing emphasis and proportion of time allocated for actual data collection and analyses over the years attest to the recognition of research experience in pharmacy training (Murphy, Slack, Boesen, & Kirking, 2007). Undergraduate or first-degree research training requires a supportive environment and intellectual partnership amongst students and their faculty mentors. Through research, these students are able to apply knowledge gained in the classroom as they define new problems and formulate new research questions (Ash Merkel, 2003). Incorporating research into the curriculum is important as a means of inculcating scholarship in the community of learning, to motivate undergraduates to become independent thinkers and to prepare students for graduate programs (Adamsen, Larsen, Bjerregaard, & Madsen, 2003). A study by Tan revealed that undergraduate students who were guided by suitable research mentors experienced improved thinking, communication, and interpersonal skills. They also manifested heightened levels of self-confidence, resourcefulness, goal-consciousness, creativity and responsibility towards others. These were in contrast to the general feeling of insecurity and uncertainty at the beginning of the research endeavour (Tan, 2007).

Investing in research is often regarded as a costly endeavour which involves dedicated time from faculty members (Nykamp et al., 2010). Furthermore, providing research opportunities for undergraduate students inevitably involves internal funding as well as the involvement of considerable time and proportion of the faculty member. Several major barriers to implementing undergraduate research have been reported. Among these include a lack of faculty members with appropriate expertise and sufficient time for research supervision; other major impediments include the lack of dedicated time for data collection, opportunities, funding, training and support (Nykamp et al., 2010; Paalman, 2002). The logistics of managing research projects for a large number of students have been reported in some studies to be difficult or impossible. Universities have the option of eliminating laboratory experience from their undergraduate research project because of costs associated with maintaining laboratory personnel and the acquisition of expendable laboratory supplies and major equipment (Brandenberger, 1990).

Literature and contextual delivery of pharmacy programs across the world suggest the need to determine the impact of incorporating a research program for an undergraduate pharmacy curriculum (Awaisu & Alsalimy, 2015; Bunnett, 1984; Chopin, 2002; Doerschuk, 2004; Osborn & Karukstis, 2009; Warner, 1998). Will a semester dedicated to entirely research help students achieve the graduate competencies for the pharmacy profession through experiential learning? Hence, this study was conducted to evaluate the impact of a dedicated semester-long research program in an undergraduate pharmacy curriculum.

Before the commencement of the research semester, students select their research projects from a range of areas relevant to Pharmacy that include pharmacy practice, pharmaceutical technology, pharmacy chemistry and life sciences. These projects could be further categorised as laboratory-based, community-based or education research. Through the student mobility program and unique research partnership with other local and overseas institutions, students have opportunitiesto conduct their research projects in these external institutions. Students then defend their project proposals in the Research and Ethics Management Committee which ensures the quality, suitability and ethical aspects of a research project. In the Research Methodology module, students are given theoretical instructions in conducting a literature review, scientific writing and research ethics as well as training in statistics. The research semester spans a period of 16 weeks and should, therefore, be designed to provide an immersive experience in the rigours of research. This study measures the impact of the implementation of dedicated research semester on students’ perceived competencies related to research writing, presentation and critical thinking skills, ethical knowledge and preparedness to undertake research.

II. METHODS

This study is part of the regular programme audit conducted by the School of Pharmacy, the findings of which had been reported to the school’s curriculum and examination committee for quality assurance purpose. Student feedback was sought from final year undergraduate pharmacy students at the International Medical University in Kuala Lumpur, Malaysia in the second half of 2016. Students’ participation was on a voluntary basis after informed consent was obtained and was also a part of the periodic curriculum assessment conducted by the School of Pharmacy. Feedback was obtained from students using an online questionnaire before and after the research project. The questions were developed to measure a student acquiescence of specific perceived competencies relevant to pharmacists as informed by the literature. The face and content validity of the questionnaire were conducted with a small cohort of undergraduate pharmacy students prior to the survey. The pre-research online questionnaire consisted of questions related to the nature, types and placement sites of the projects as well as factors affecting students’ project preference. Ranking questions were also included for students’ self-assessment of their writing, presentation, critical thinking and research skills. In addition, there were also open questions that solicit information pertaining to students’ perceptions about their preparedness to undertake a research project, their knowledge about ethics in research and their anticipated career options. Where Likert-scale was used, the scores from each respondent were added up to achieve the final total. Wilcoxon sign-ranked test was used to compare all ranked data pertaining to students’ perception of their competencies.  The post-research survey consisted of similar questions found in the pre-research questionnaire but with an additional section on evaluating the impact of research projects that the students have undertaken. It contained questions to solicit students’ perceptions on the enhancement of their knowledge in specific subject matter, the achievement of research objectives, the challenges they faced during the implementation of research project, skills developed and gained through the research project as well as the aspects of research ethics which are applicable to their future profession as pharmacists and the impact of research experience on their employment potential. All statistical tests were performed using SPSS Statistics and Microsoft Excel.

III. RESULTS

A. Study Population

Out of 180 students, a total of 113 responses was received in surveys conducted prior to and after the commencement of their research projects in the year 2016. These students were supervised by academic staff from all the four departments of the School of Pharmacy, namely life sciences (31%), pharmaceutical chemistry (21%), pharmaceutical technology (10%), pharmacy practice (22%) as well as the School of Dentistry (2%) and the School of Medicine (14%). Eighteen students were involved in community-based or education research while 95 students conducted lab-based research including those who were attached to other local institutions (eight students) or international partner universities (seven students) through collaborative research.

Most students of the cohort were successfully allocated to the project which was their first (61%), second (20%) or third choice (6%) although some (13%) were not allocated to the project of their choice. Interestingly, the main factor affecting the pharmacy students’ preference was research interest (61%). Some students selected the project based on their choice of supervisors (19%), their peer’s choice (10%) while other did not have a specific preference (10%).

B. Students’ Ratings on Preparedness, Ethics Understanding, Writing and Presentation Skills

In quantitative measures, we evaluate the percentage distribution of student ratings before and after the implementation of research projects pertaining to preparedness to undertake a research project, understanding of research ethics, writing skill and presentation skill. For preparedness to undertake a research project, students are more prepared to undertake a research project in the future, the percentage rating for good had increased from 30.1% to 40.7% (Appendix). However, the frequency distribution of the outcome measures of students’ preparedness after the project implementation was quite similar without any significant difference to before project implementation (p=0.472) (Figure 1A).

Before the research project, approximately 32.8% of students rated themselves for having good and excellence understanding in research ethics. However, after the research project, the percentage has increased to 45.1%. Statistical analysis showed significant improvement for the understanding of research ethics (p=0.002; Figure 1B).

There was 23.9% and 35.4% of students rated themselves for having good and excellent writing skill and presentation skill respectively. After the research project, the improvement is promising as the percentages had increased to 35.4% (p=0.001; Figure 1C) and 51.3% (p=0.001; Figure 1D) respectively.

Note: The ratings before and after project implementation were compared and statistically analysed using the Wilcoxon signed-rank test.

Figure 1. Percentage distribution of student ratings before and after the implementation of research projects pertaining to their
(A) Preparedness to undertake research project (Mean value before=2.34, after=2.39, p=0.472);
(B) Understanding of research ethics (Mean value before=2.19, after=2.46, p=0.002);
(C) Writing skill (Mean value before=2.12, after=2.30, p=0.001); and
(D) Presentation skill (Mean value before=2.33, after=2.54, p=0.001).

C. Students’ Preparedness to Undertake a Research Project

Before the implementation of the research project, most students considered themselves well-prepared as they have improved their knowledge on the subject matter through personal reading and consultation with the respective supervisor (Table 1; Appendix A). They were well-informed about the research approach and techniques. However, these attributes were found lacking in those who have identified themselves as poor in preparation because they had less confidence and did not know what to expect. Students stated that they were now prepared to undertake research in the future because they have gained knowledge and exposure in research as well as trained with various laboratory and research skills (Table 1).

D. Students’ Self-Assessment of Their Writing and Presentation Skills

The surveys also considered students’ self-assessment on their writing and presentation skills. Overall, there was a significant improvement in both skills after the implementation of the research projects. They have contributed their improvement to the reading of journal articles, writing and presenting the research proposal and dissertation. Moreover, students perceived that writing a scientific report was different from writing other reports (Table 1). They found that it was challenging to discuss gathered information or results critically in a constructive manner as well as to ensure a good flow of content and clarity of the paper. As for presentation, some stated that stage fright affected their performance while others found that the question and answer section was quite challenging (Table 1).

E. Students’ Perceptions of Research Ethics

Students’ perceptions of their understanding of research ethics are shown in Table 1. They have related unethical practices as manipulation of data, dishonesty in data reporting as well as lack of objectivity and confidentiality (Table 1). They described good ethical practices as fairness, accountability, peer respect, minimising harm as well as respect for human dignity and rights. Students were able to learn about ethics through their research projects (Table 1). However, some of them indicated that they might have sound ethical knowledge but found themselves inadequate to make decisions and were unsure about how to apply it. Students were, however, able to identify several aspects of research ethics which are applicable to their future profession as pharmacists. These professional values include honesty, informed consent, evidence-based practice, patient safety, confidentiality, punctuality, integrity, responsibility and respect for others.

	Students’ Comments
	Before Undertaking Research Project	After Undertaking Research Project
Preparedness to undertake research	Done literature review and in the progress of writing proposal. Have a good insight into the knowledge and method of the research project. Under the guidance of a responsible and approachable supervisor, I am quite well prepared so far. I always feel that much information regarding my research project has not been fully understood. I do not think that I am fully prepared to handle everything on my own right now.	Through this research project, I have learnt to be independent as well as gained basic research skills (such as cell culture, aseptic technique, learning how to design a protocol for an experiment through reading articles). I am more confident in doing the experiment by myself and in analysing data. There are still a lot of lab instruments that have yet to be learned. I am not very confident in handling a whole project on my own yet.
Research ethics	I have learnt that I should report my results based on real and actual data. I understand the importance of being honest about our results and be responsible for everything that we do. I only know that the written consent form is important and that I cannot disclose the information of the participants to anyone.	I have learnt a lot about professionalism. I am clear that one of its implications is never to change any result or take any shortcut in order to obtain results. I have learnt to prioritise research ethics more than having perfect data.
Writing skill	Unable to describe an idea clearly. I am poor in explaining and discussing results. Grammar issue and poor in vocabulary. To write a simple essay may be easy but writing a scientific article requires much scientific writing skills.	I have a good flow of word processing with least or no grammatical errors. My sentence structures are straight forward and convey ultimate points to the readers. Reading journal articles had enhanced my writing skill. I am fully aware of the content I want to write. My level of writing skills heightened during past 6 semesters
Presentation skill	Lack of confidence. Find difficulty in conveying messages during presentation especially when answering questions. I cannot speak English fluently. Having stage frights.	I am able to convey my message clearly, influence and attract the attention of the audience. I have learnt how to speak more confidently in front of the public. I can present well because I do not have stage fright. I can present my ideas fluently, but I would need improvement on the question and answer session.

IV. DISCUSSION

This study confirmed that preparation for the research semester enhanced knowledge in topics of interest, research and collaborative skills for students. Through the research program, they are able to appreciate, explain, apply and relate the knowledge gained from research to lessons learnt in lectures. This exposure has enhanced their confidence in pursuing the research topics of interest after graduation. It would also improve their capability to work independently. This agrees with studies that confirmed that hands-on research experiences have been recognised to provide the best learning tools that enhance students’ learning, especially when done in collaboration with peers (Ash Merkel, 2003). The research program experience also had a positive impact on ethics and professionalism. Different instructional methods have been shown to be important for the comprehension of ethical knowledge, particularly those that involve intensive students’ participation and role-play (Guérin & Bussières, 2017). The research program described in this study provides the opportunity for application and comprehension as it requires full student participation for one semester and with preparation in the prior semester. The importance of engaging students in ethics and professionalism issues has been shown in a few studies related to pharmacy. In a study that compared the understanding of pharmaceutical ethical statements between pharmacy students and hospital pharmacists, a significant difference in understanding was reported in areas that were assessed, particularly in clinical research, advertising and marketing, dispensing medication, pharmaceutical care and code of ethics. The probable reason for this is knowledge in professional ethics obtained during undergraduate training might not be readily translated to actual professional practice (Guérin & Bussières, 2017). The importance of the right training in instilling ethical knowledge was again emphasised in another study in which the effectiveness of an early professional development series in a pharmaceutical care laboratory (PCL) course for first-year pharmacy students that highlighted the application of the Oath of a Pharmacist and the Pharmacists’ Code of Ethics. The results showed that while students entered their training with a strong appreciation for professionalism, they felt more confident in applying the Oath of a Pharmacist and the Pharmacists Code of Ethics to dilemmas in practice following each new learning activity that required active participation and application (Smith & Dinkins, 2015).

It was also noted that the research program could enhance skills related to scientific communication. Good writing and presenting skills are not naturally acquired skills but must be developed through multiple practice experience. Prior to the research program, these students have undergone several tasks that provided training to improve writing or presentation skills, namely assignments, practical reports, case reports, seminars and examinations in form of essays which were associated with the respective course. In addition, self-confidence was reported to be correlated with the writing ability or performance (Pajares & Johnson, 1994; Ranelli & Nelson, 1998). Another contributing factor to scientific communication is proficiency in the language of communication. Writing might pose a challenge to students who have poor language proficiency especially when it is a second language to students (Chokwe, 2013). In the context of this study, it is English language proficiency as the undergraduate pharmacy program is delivered in English while all students in this program are not native English speakers, but use English as a second language. 

Participation in oral presentations was shown to enhance students’ critical-thinking and problem-solving skills especially when followed with a question and answer session. In addition to enhancing student learning experience and reflection, it provides an opportunity for students to evaluate their own as well as their fellow classmates’ presentations and develop their skills in providing constructive feedback (Hunter, Laursen, & Seymour, 2007). Moreover, the need for troubleshooting, critical analysis of the results and problem-solving during the course of the project contributed to the development of these skills. The benefits of faculty-mentored research projects have been well-recognised and shown to facilitate active learning, cultivate self-confidence as well as enhance students’ critical-thinking and communication skills (Bauer & Bennett, 2003; Lopatto & Tobias, 2010). Translating classroom teaching and reading into hands-on learning activities has been reported to promote personal skills development and enhance the learning experience (Chopin, 2002). The research programme has provided students with an insight into research and development, hence opening a new career option. It was noted that students with research experience were more prepared to pursue careers in science (Lopatto, 2007). Importantly, our findings suggest the skills and competencies gained from the research projects are aligned to the expanding roles of pharmacists that require evidence-based practices as reviewed by Bond (2006) and van Mil and Fernandez-Llimos (2013).

Several important practical points pertaining to the implementation of undergraduate pharmacy research projects are worthy of considerations. Perhaps the most important being the importance of a 16-week immersive experience in the rigours of research. In the current study, the number of laboratory projects exceeded the projects related to pharmacy practice and pharmacy education. A possible solution to this would be to encourage staff who are practising pharmacists to develop research ideas with their counterparts from other areas of expertise such that there are diversity and relevance of these research projects for future practice. Moreover, only perceived students’ competencies are addressed in this study and follow-up studies with objective measurement of competencies will be carried out.

V. CONCLUSION

Overall, the Pharmacy students surveyed in this study indicated that the impact of a research program has offered them an immersive experience to develop various skills and increased their perceived competencies, knowledge as well as confidence in carrying out research work in diverse disciplines. For academics implementing research programs for undergraduate pharmacists, this study also shows some of the challenges students faced.

Notes on Contributors

Eng Lai Tan (E.L.T.), PhD., is an Associate Professor in the Department of Life Sciences, School of Pharmacy, International Medical University (IMU). He is also the associated Dean of School of Postgraduate Studies, IMU.

Sook Yee Gan (S.Y.G), PhD., is an Associate Professor in the Department of Life Sciences, School of Pharmacy, IMU.

Wei Meng Lim (W.M.L.), PhD., is a lecturer in the Department of Pharmaceutical Technology, School of Pharmacy, IMU.

Vishna D. Nadarajah (V.D.N.), PhD., is the Pro-vice Chancellor of Education.

Peter C.K. Pook (P.C.K.P.), PhD., is the Deputy Vice Chancellor of IMU.

E.L.T., S.Y.G., V.D.N. and P.C.K.P. were involved in the design of the work. E.L.T. and S.Y.G. have administered data collection through surveys. E.L.T, S.Y.G. and W.M.L. conducted data analysis and interpretation. E.L.T and S.Y.G. drafted the article. V.D.N. and P.C.K.P. initiated the study and revised it critically. All authors approved the final version for publication in TAPS.

Ethical Approval

This study was exempted by Institutional Review Board (IRB). This study is part of the regular programme audit conducted by the School of Pharmacy, the findings of which had been reported to the school’s curriculum and examination committee for quality assurance purpose.

Acknowledgements

The authors wish to thank Semester 7 Pharmacy students who had participated in the surveys.

Funding

No funding source was required.

Declaration of Interest

The authors report no declaration of interest.

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*Eng Lai Tan
School of Pharmacy,
International Medical University
126, Jalan Jalil Perkasa 19,
Bukit Jalil, 57000
Kuala Lumpur, Malaysia
Tel: +603-2731 7466
Email: englai_tan@imu.edu.my