Meijo University GP Sponsored Symposium held at the 6th Asian-Pacific Conference on PBL at Tokyo Women's Medical University on May 27, 2006, and attended by over 200 Participants from all over the world

The pharmacy education of Japan was reformed from the four-year education system to six-year system from this year. The purpose of this reconstruction was, in response to a Society's request, to bring up pharmacists who will contribute more to healthcare society. In order to educate diverse clinical issues, Problem based learning (PBL) is extremely suitable clinical education method. Meijo University is affiliated with the medical department since 2003, and we promote the education of clinical pharmacist training in the master course. This education is a skill education specialized in pharmaceutical care.
In this course, the introductory clinical education was constituted from PBL and clinical communication skill as the center of two big pillars of the education. We experienced the PBL being the good "Skill" education.However, Japanese pharmacy faculty members do not show a keen interest in "skill and attitude".
The questionnaire concerning the present state of PBL was sent to Presidents/Deans or affairs in charge of total number of 62 faculties/universities of pharmacy in Japan (17 of national and public, 45 of private institutions), in June 2005. The questionnaire recovery rate was 72.6%. Thirty-four percent of institutions have already now adopted PBL in their education, and PBL-non-adopted institutions were 57%. Seventy-five percent of national/public institutions were indifferent to bring PBL in pharmacy education, compared to 49% of private institutions. In 15 institutions that have experience of PBL, seven institutions performed the PBL for the graduate students, and all of 15 institutions have practiced PBL to the undergraduate students, especially first grade students. The reply to the questionnaire that the most of institutions have practiced for freshmen let us guess a possibility that they answered including kinds of group studying. However, 84% of institutions that have not adopted PBL had the intention to adopt such method from now on. Twenty-eight % of institutions have already had actual plans, and 66% of all institutions suggested adoption of PBL into the six-year education. Especially such tendency was remarkable in the private institutions.
Conventionally, the mainstream of conventional pharmacy education in Japan is the "Knowledge" education, besides Pharmaceutical basic science and research education. Nevertheless, the results of the survey have suggested a tendency that PBL will also spread in the healthcare-directed pharmacy education as well as medical education in Japan from now on.

When this question is applied to an educational context, it could be translated as, for example, "What kind of teaching and learning theories are effective for adult learners engaged in professional education?" The two key phrases in this question are professional education, teaching, and learning theories for adult learners. Neither of these concepts is static; both are in a constant process of development. That being the case, it is no easy task to provide a clear answer to this question. It is necessary to prepare the ground in order to discuss the issue properly, and so I would first like to comment briefly on these concepts. Taking the concept of professional education, the scope of what constitutes a profession is rapidly expanding in line with fundamental developments in society, that is, the spread of knowledge-based-society. As a result, in addition to qualifications in professional fields with a long history such as medicine and law, universities are introducing and systematizing new categories of professional education to provide professional development for adult learners in areas of work requiring highly specialized knowledge. For example, at the author's university, Meijo University, The School of Professional Development for Educational Design and Management has been recognized by national authorities and accepted its first entrants in April this year. The aim of the Master's Degree course in this School is to develop specialists in educational management.
As far as teaching and learning theories for adult learners are concerned, I would like to draw attention to the notion of andragogy developed by Malcolm Knowles in the USA in the 1970s. In its process of development, this notion has been subjected to a great deal of debate and criticism. At present, the strength of the concept of andragogy is considered to be its effective applicability to the various learning situations of the maturing adult learner as a member of society, as a member of an organization and as an individual.
The Figure below shows the six basic principles upon which the notion of andragogy is based. These principles allow for differences in the aims and objectives of the adult learner, as well as individual differences or differences in the learning context.

According to these principles, the characteristics of the adult learner can be portrayed as; 1) learner's need to know, 2) self-concept of the learner, 3) prior experience of the learner, 4) readiness to learn, 5) orientation to learning and 6) motivation to learn. For adult learners with such characteristics, what is required in terms of educational practice is an active and experiential methodology that will develop their ability to apply learning to problem solving in future situations.
However, at present, much of the undergraduate education taking place in universities focuses on transmission of knowledge and skills, premised on the notion of pedagogy and its underlying assumption of educational practice based on a child (and youth) developmental stages model. This is reasonable. Undergraduate courses are structured so as to take students mainly straight from high school and, as such, this environment is weak in terms of its function as a model of adult learners.
In Japan, professional education in medicine and pharmacy is also structured to take students straight from high school, and so it is difficult in reality to apply the function of the adult learner model to it. Nevertheless, it is essential to encourage students' continuous self-development and develop their abilities to apply the knowledge and skills they learn to solving problems in future work situations.
What kind of methods is suitable for putting the new course of professional education into effective practice in a limited amount of time? This question can be answered by focusing attention on the relationship between the factors discussed above, that is, education and learning theories and the model of the learner assumed in such theories. That is to say, it is necessary to shift from a concept of the learner as a passive youth to an active adult, and develop a professional education methodology, which, from an early stage, comprises an educational program to support this concept of the learner. Taking this educational perspective, the methodology of Active Learning Strategies should not be merely limited to encouraging learners to participate more actively. Rather, it should be given meaning within the wider framework of a methodology and practice developed on the premise of different education and learning theories, and a different model of the learner.
The author is actually using the principles of andragogy and the adult learner model in the aforementioned School of Professional Development for Educational Design and Management, in the content and selection procedures of the admissions policy and in developing and putting into practice a problem-based learning (PBL) education program as part of Active Learning Strategies. In-service training for class teachers on teaching and learning theories and adult learner models was also carried out in advance. However, many issues regarding the effective functioning of the establishment and management of a syllabus centered on Active Learning Strategies, the creation of appropriate materials, class evaluation and so on, remain to be ironed out. A period of trial and error is still required in order to raise levels of satisfaction amongst both learners and class teachers.

PBL Education at Samford University, USA.The Problem-Based Learning (PBL) Initiative at Samford University began in 1998 in conjunction with two grants from the Pew Charitable Trusts. Since that time, Samford University has incorporated PBL into various academic programs within the Schools of Arts and Sciences, Business, Education, Nursing and Pharmacy.The purpose of the Samford PBL Initiative was to enhance student learning through the training, implementation and documentation of PBL and other methods of active, student-centered, collaborative, inquiry-based learning and to share these practices with other educators. Samford University strives to be a learner-centered community that nurtures the intellectual, emotional, physical, social and spiritual development of students and teachers.In the Samford University McWhorter School of Pharmacy, PBL was first implemented in the fall of 1998. Several courses were converted from the traditional lecture format to a PBL format including clinical pharmacokinetics and therapeutics. For the therapeutics course, PBL cases for acute and chronic renal disease, congestive heart failure, and acid-base problems were designed and implemented.Today in the therapeutics course, PBL is used in the form of Evidence Based Medicine Cases and Real World Cases. These cases are taught with a facilitator in the traditional small group PBL format with the problem being presented first to the students. These cases follow the educational objectives of PBL identified by Dr. Howard Barrows in 1986: (1) Structuring of knowledge for use in clinical contexts; (2) Development of an effective clinical reasoning process; (3) Development of effective self-directed learning skills; (4) Increased motivation for learning. Student assessment reveals that the educational objectives are being met and that students are learning content and the clinical reasoning process. Student evaluations indicate that most like and learn from the PBL format.

Pharmacy education in Australia has undergone significant changes in the past 10 years. The 'standard' training degree, formerly a 3-year undergraduate program was extended to a four-year degree (B.Pharm) and a number of graduate entry programs have been established. The number of institutions offering pharmacy degrees has increased from six to 18 within 8 years. PBL, in different forms, has been introduced into many of these programs. However, PBL techniques are mostly integrated into the later years of the degree, and primarily only in clinical or therapeutics-based topic areas. The approach to assessment of PBL-based courses varies. There is active discussion among academic groups about the role of case-based teaching or patient-centered learning as compared to PBL. The role of PBL-based teaching and application in the acute care clinical (hospital) setting is seen as challenging. The challenge relates to several factors including, the timeliness of case discussions and PBL group work; training of practitioners to be able to utilise PBL to facilitate learning in the workplace (hospital or community pharmacy); and the increasing numbers of students in training (increases in the number of pharmacy schools has also been accompanied by increased student numbers overall). The intensive nature of small group work in PBL classes requires a higher number of staff to be involved in the training of these students (when compared to didactic programs). The shortage of pharmacists in the workforce has been highlighted as new student programs have been introduced, and the availability of practitioners to be involved in student education- although desirable- is limited. The use of PBL approaches in clinical training is as yet undeveloped- although it is of interest, particularly given self-directed models of student learning have been broadly accepted.

Clinical Pharmacist Training in Meijo University, Master Course Program -Role of PBL as Clinical Simulation Study to Bedside Education -
Meijo University and Fujita Health University School of Medicine started the joint master course program for clinical training of pharmacists in the university hospital in 2003. The curriculum consists of 6 months of preclinical and 18 months of clinical education: the former includes basic pharmacy sciences and Problem based Learning (PBL), the latter includes hospital training. PBL is performed as simulation to clinical case study to serve as a bridge to bed side case analysis. PBL is carried out on seven case scenarios each year on diseases such as diabetes, hyperlipidemia, asthma, nephrotic syndrome, malignant lymphoma, hypertension, and type C virus chronic hepatitis. After each PBL case study students are assessed by self, by peer and by faculty, and PBL students also assess scenario. Assessment results are feed backed. After 6 months of "preparatory" learning at pharmacy school students come to the hospital. They first participate in the pharmacy practice (6 wks), nursing care training (1 wk), and then onsite patient care training for 13 months. Patient care training is carried out on several internal medicine subspecialty services, GI tract surgery, and emergency room service. During clinical training students are required to learn basic pathophysiology of typical diseases of each subspecialty and to monitor efficacy and toxicities of pharmaceutical therapy of patients. Both physician instructors and pharmacy school faculties assess students' activities. A thesis is required to complete the two-year course. By the time of the symposium, two classes will have completed the entire two-year program.
PBL session seems to be playing a significant role as a preparatory education; students appear to be partially prepared for case study and patient care when they come to on site clinical training. The entire master course program is to be assessed: however, it should be admitted now that pharmacy students should learn more about diseases and their drug therapy at pharmacy school, and pharmacist preceptors to teach them on site are indispensable to improve training quality.
Our master course program will serve as a role model for clinical pharmacy training in Japan, where pharmacy education has been reorganized as a six-year system to provide clinical education required for pharmacists to be active participants in the patient care as drug therapy specialists.