Objectives. To implement a team-based learning (TBL) format in an endocrine module to promote students' active learning in a course delivered to 2 campuses. Methods. Course lectures were transformed into 13 TBL sessions consisting of content pre-assignments (self-directed learning), in-class readiness assurance tests (accountability), and team problem solving of patient cases and faculty-led class discussion (knowledge application). Student performance was evaluated through multiple assessments during the TBL sessions and on unit examinations. Students evaluated each individual TBL session and the course as a whole. Results. Course grades were higher using the TBL method compared to the traditional lecture-based method that was used previously. Individual readiness assurance tests and team contribution scores significantly predicted overall course grades (p,0.001). Students accepted the change in course format as indicated by course evaluation results. Conclusions. TBL is an effective active-learning, instructional strategy for courses with large student-tofaculty ratios and distance education environments.

Objectives. To implement an audience response system in a dual-campus classroom that aggregated data during graded (attendance and quizzes) and non-graded classroom activities (formative quizzes, case discussions, examination reviews, and team activities) and explore its strengths, weaknesses, and impact on active learning. Design. After extensive research, an appropriate audience response system was selected and implemented in a dual-classroom setting for a third-year required PharmD course. Students were assigned a clicker and training and policies regarding clicker use were reviewed. Activities involving clicker use were carefully planned to simultaneously engage students in both classrooms in real time. Focus groups were conducted with students to gather outcomes data. Assessment. Students and faculty members felt that the immediate feedback the automated response system (ARS) provided was most beneficial during non-graded activities. Student anxiety increased with use of ARS during graded activities due to fears regarding technology failure, user error, and academic integrity. Summary. ARS is a viable tool for increasing active learning in a doctor of pharmacy (PharmD) program, especially when used for non-graded class activities. Faculty members should proceed cautiously with using ARS for graded classroom activities and develop detailed and documented policies for ARS use.

ObjectiveTo identify barriers to appropriate dietary behavior in an urban, low-income population of patients with type 2 diabetes and to examine a new instrument in the identification of these barriers in this population.MethodsA cross-sectional survey was developed, validated, and anonymously administered to low-income adults with type 2 diabetes in an academic family medicine physician group practice with a pharmacist-operated diabetes education and comanagement service. The survey consisted of three key subscales: determinants of food selection, importance of life challenges, and barriers to appropriate eating.ResultsThe survey was administered to 98 patients with a mean age of 51.98 years, a mean duration of diabetes of 9.76 years, and a mean hemoglobin A1c of 7.99%. When asked to rate factors most important in food selection, the highest mean responses were taste (3.97 out of 5) and cost (score of 3.94 out of 5). Barriers that the majority of respondents agreed or strongly agreed were important included: stress causing over-eating or unhealthy food choices, difficulty resisting the temptation to eat unhealthy food, and healthy food being too expensive. The Cronbach’s Alpha for the subscales of food selection, importance of life challenges, and barrier were 0.673, 0.853, and 0.786, respectively.ConclusionsIn a low-income, urban, predominantly African American and Caucasian diabetic population, cost of healthy food, stress-related inappropriate eating, and the temptation to eat unhealthy food were the most frequently reported barriers to healthy eating. Diabetes education programs serving similar populations should evaluate the presence of these barriers. The survey instrument was a reliable measure of the constructs it purported to measure.

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Although the timeline and extent of liver enzyme elevation in this case are unclear, the Naranjo probability scale suggests that a causal relationship between pioglitazone and liver disease is probable. Patients with previous TZD-induced hepatotoxicity should not be rechallenged. Cases of hepatotoxicity with second generation TZDs, although clearly linked, have been few in number and less severe in consequence when compared to troglitazone. We agree with current package labeling that requires baseline and then periodic measurement of liver enzymes in patients taking pioglitazone or rosiglitazone.