Transcript Slide 1

Fairytale Creative Writing to Improve Comprehension of Immunological Mechanisms
Ian C. Doyle, Brad S. Fujisaki, Jennifer M. Jordan
Pacific University School of Pharmacy – College of Health Professions – Hillsboro, Oregon
Evaluation & Assessment
Introduction
Pacific University School of Pharmacy utilizes a modified block curriculum,
combining didactic lecture and student team active learning techniques. Basic
immunology is taught during the P1 year, with pharmacotherapy introduced in
the P2 curriculum. Knowledge of the immune system has significantly expanded
during the past decade, as has the number of medications that target specific
immunological messengers and pathways.
Presentation medium included “silent film” with narrator, drawings via overhead projection with narration, and simple story-reading. Groups demonstrated self-initiative,
sharing their respective fairytales via the electronic course management system (Blackboard CE 6).
Forty-six students voluntarily completed activity evaluation after completion of 2 week block & exam.
It is imperative that pharmacists understand the pathophysiology of the immune
system and how medications interact with its function. Pacific uses 6-hour class
days which allows for didactic lecture to introduce a topic, with subsequent time
for application and synthesis. The purpose for this creative writing assignment
was to advance the level of comprehension of complex immunologic mechanisms
and medications presented in lecture, and to synthesize information within and
between pharmacy student teams. Presentation of student-developed material
needed to be simple and memorable, like a children’s story. As fairytales capture
our attention and are repeated from generation to generation, it was this story
format that students were challenged to create and pass on to their peers.
Inspiration for this activity came from being in close proximity to Disneyland
while attending ASHP MCM 2010. Literature searches in the Medline, IPA, and
ERIC databases did not yield reports of creative writing as an exercise to increase
comprehension of topics related to pharmacy curricula.
Instructional Design
Expected Outcomes:
 Alternative and novel learning experience to comprehend, analyze, and synthesize immunologic pathways
which will enable students to achieve 90% competency on topic-associated examination questions.
Educational Environment:
 2nd professional year (P2) in a 3 year program
 PHRM 680: Clinical Sciences – Immunology
 Class size: 96 students. Work groups: 14 pre-assigned teams of 6 to 7 students
 Preliminary development & implementation:
 5 scenarios (1 scenario randomly assigned to student group)
 Time investment:
 Residents (earning teaching certificate) :
Content review: 4 hours
Activity development : 10 hours
 Faculty review: 6 hours
Pedagogy:
 7 hours of didactic immunology content prior to activity.
 3 faculty & 2 residents facilitated student groups during activity.
 Faculty familiar with immunology; Facilitator guide (key) provided; No additional preparation.
 Faculty and residents asked probative questions after presentation. Provided correction and feedback.
Andragogy:
 45 minutes: Create group fairytale, knowing that they may be chosen to present fairytale to the class.
 Create and present the fairytale in any medium, with deliverable content not to exceed 10 minutes.
 50 minutes: Five groups randomly chosen to present their fairytale.
 Groups presented fairytales in order of immunologic cascade.
Summary & Discussion
Content:
 Pre-assigned text reading:
Identified in syllabus (DiPiro, 7th Ed.)
 Example:
Scenario D:
T cell dependent naïve B cell activation and differentiation:
Create a tale about how an activated Helper T cell causes B cell’s activation, differentiation
and makes antibody-antigen complexes.
Characters:
a) Activated Helper T cell
b) B cell
c) Plasma B cell
d) Memory B cell
e) Antibodies (Ig)
f) Antigens
Accessories: Cytokines
Villain/hero: Rituximab (Rituxan)
Facilitator Guide:
Example Answer:
B cell’s receptor (BCR) recognizes its cognate antigen (actually, the epitope of the antigen).
(Complement opsonized to the antigen can boost the BCR signaling [co-receptor]).
T helper cell, via CD40L, ligates B cell CD40 receptor as 2nd required signal.
The activated B cell, produces antibodies (Ig)… usually IgM at first.
(T helper cells secrete cytokines that can class switch B cells to make other Ig types).
B cell matures to become either plasma cell (makes tons of Ig), or a memory B cell.
Antibodies (Ig) opsonize antigens. These complexes become target for phagocytosis.
Clinical relevance: The adaptive or B cells portion of the immune system allows for
specificity. Memory B cells allow for quicker response with next encounter with pathogen.
Drug’s Role: Rituximab is a humanized chimeric anti-CD20 monoclonal antibody. It
works by binding to the CD20 receptor that is widely expressed on B cells and inducing
apoptosis. The exact mechanism is unclear but one component is thought to be due to the Fc
portion of rituximab mediating antibody-dependent cell-mediated cytotoxicity (B cell
becomes target for lysis due to binding by rituximab).
Survey evaluation occurred following the examination, which may imply additional
significance to students’ perceived value. These results may suggest alternative
learning activities that foster improved learner comprehension of complex biologic
processes. Future research should evaluate whether activities such as fairytale
creative writing (or allegory) improves long-term retention of this type of content
material. Insight into whether assessment performance can be connected to
perceived effort is also warranted.
Improvements for future application:
 Use of “fairytale” in classroom may portray beliefs no longer socially
appropriate, or are culturally biased. Rather, write a “story”.
 Increase knowledge by assigning all 5 scenarios to each student group (Make
Chapters!). Concern: excessive class time requirement, which may have
diminishing return on student interest or perceived value.
 Faculty to have increased facilitator role during presentation.
 Record & post all presentations on course management system for review.
 Award course credit for presentation’s creativity and accuracy.
 Reinforce the importance and requirement of completing assigned pre-class
readings.
Contact Information
Ian C. Doyle, PharmD, BCPS
Pacific University – School of Pharmacy
222 SE 8th Ave, Suite 451
Hillsboro, Oregon 97123
503.352.7371(p) | 503.352.7270 (f)
[email protected]