Course context and curriculum delivery

At our institution, there is a strong educational culture of interprofessional learning within the health sciences that abide by the general principles of interprofessional education [24]. Because the pharmacy and physical therapy instructor teams had successfully collaborated on an earlier PAL activity [16], this inhaler single PAL activity was a logical follow-up. More importantly, these PAL activities ensured that students from both pharmacy and physical therapy had the opportunity to be in a teaching role.

The success of the PAL activity was also contingent upon logistical concerns such as developing the schedules/curriculum, finding common schedule times, and accommodating physical space [3]. Instructors from the pharmacy and physical therapy programs met to discuss the inaugural PAL activity a year before the actual activity so that changes could be made to the schedules/curriculum and booking of physical space. An initial step was to determine which courses this activity was to be housed in and then include the activity as a mandatory requirement in the respective course schedules. The pharmacy instructor team selected the inhaler teaching skills course to conduct the PAL activity, whereas the cardiorespiratory course was selected by the physical therapy team to learn this skill. Within the four-year undergraduate pharmacy program, second year students were taught therapeutic knowledge within their pulmonary course, and skills/simulation laboratory, of which students learned about inhaler device types, technique, maintenance of inhalers, and communication with patients in the academic terms prior to the PAL activity. The learning objective of the pharmacy PAL activity was to practice educating another healthcare profession, physical therapy about inhaler devices. Within the 28 months Master’s program, physical therapy students learned about inhalers in their first-year cardiorespiratory course. A small subset of physical therapy students (n = 18) who were at a satellite centre located in another city, received all of their courses including the cardiorespiratory course via video-conferencing. Physical therapy instructors were also located at this satellite site to help with coordination and organization of their courses. For the physical therapy students, the objectives of the PAL activity were to learn the correct method to deliver inhaled drugs using various devices and to gain experience learning with and from students from another healthcare profession. The preparation for both pharmacy and physical therapy students prior to the activity included a discussion in their respective courses to gain an understanding of each other’s role and how to work together across disciplines in clinical health teams [25, 26] with respect to management of inhalers.

An essential feature of the PAL activity was that standardized information be taught. In preparation of the activity, pharmacy students were assigned to a teaching group of 3 students. Each pharmacy group prepared handouts on inhaler devices that were to be given to the physical therapy students. These handouts were submitted to the instructor for review and the best designed handout, as evaluated by the course coordinator (RB), was used by all pharmacy groups. The standardized handout included images of the common inhalers used for chronic airway diseases, types of medications and their mechanism of action, medication side effects, basic techniques for all inhaler types currently available on the Canadian market cleaning/storage, cost and coverage, red flags, common administration challenges, and resources. After completing this activity, pharmacy students individually completed a written reflection exercise regarding their experiences. The instructor reviewed the teaching plans for accuracy and compiled a standardized plan for all pharmacy groups to use for this PAL activity. Pharmacy students were marked on their teaching plan assignment and their reflective journal entry, while physical therapy students were examined on their final written cardiorespiratory course exam about inhaler knowledge taught in the PAL activity.

A key logistical issue concerned accommodation of the large number of students given the availability of physical space. The 238 students were assigned to small groups (3 pharmacy:2 or 3 physical therapy students) and the PAL activity was divided into two 1-hour sessions of 21 groups each. Physical therapy students learning at the satellite location were also assigned to groups and the instruction occurred over video conference. They received the same equipment as the other student groups.

Study assessment

To address any implementation issues, we piloted the inhaler PAL activity the year before with a different cohort of pharmacy and physical therapy students. Because no issues arose, a formal evaluation for the current cohort was implemented. A pre-post study design was executed for this evaluation. Pharmacy and physical therapy students were invited to participate based on announcements in their courses prior to the scheduled activity. Students were informed that the course activities were mandatory and part of the curriculum; however, as per ethics requirements, pre/post surveys could be completed if they consented to participate in this study. Students were provided with information sheets regarding the study and written consents were obtained. Ethics approval was secured from the Health Research Ethics Review Board of the University of Alberta (PRO00036759).

Study procedures

Immediately before and after the PAL activity, consenting physical therapy students individually completed a paper-format survey which included demographics, 10 knowledge-based multiple-choice questions, a question regarding students’ confidence if they were to assist clients with inhaler devices, and perception of physical therapists’ role in assisting clients with inhalers. The knowledge questions for physical therapy students were grouped into three categories: storage and cleaning of inhalers (3 questions), technique of using inhalers (4 questions), and therapeutic knowledge of drugs given by inhalation (3 questions). All 10 questions were scenario-based (applied knowledge). The post-survey, which was completed immediately after the PAL activity, consisted of all the questions asked before the activity except the demographic information. Although the pre-post knowledge-based questions were the same, the order of questions varied.

Pharmacy students who provided consent, individually completed eight questions before the PAL activity, including demographics, past experience with use of different types of inhalers, confidence if they were to assist clients with inhaler devices, confidence in teaching and perception of physical therapists’ role in assisting clients with inhalers. The post-survey consisted of questions about the pharmacy students’ confidence if they were to assist clients with inhaler devices, confidence in teaching other healthcare professional students, and three open ended questions about the effectiveness of the PAL activity. All of the confidence ratings for pharmacy and physical therapy surveys used a 7 point Likert scale ranging from ‘very uncertain’ (1) to ‘very certain’ (7).


Descriptive statistics were calculated for all variables. Scoring for the correct pre and post activity answers were completed for the 10 physical therapy knowledge-based questions. Using paired t-tests, total test scores were compared between pre- and post-test questions to assess improvement of physical therapy students. Statistical analyses were performed using SPSS Statistics version 24 software.

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