(100) No Pain, No Gain: Embedding Desirable Difficulties into Pharmacy Skills Laboratories to Strengthen Student Learning

Objective : To describe the implementation and assessment of desirable difficulties, including spaced-repeated testing, interleaving, and other cognitive psychology strategies, into a pharmacy skills laboratory series.

Methods: Faculty developed a vertically integrated curricular approach to desirable difficulties by intentionally connecting laboratory activities based on cognitive psychology principles. Longitudinal activities incorporated spaced-repeated testing to enhance the retrieval of information from memory; interleaving to switch between different topics rather than focusing on a single topic; thinking out loud to verbalize thought processes and problem-solving strategies; real-life scenarios and practical applications to bridge the gap between theory and practice; and formative assessment as learning to address weaknesses. Activity scores were utilized to quantitatively assess the impact of each of these interventions on students' learning. Post-activity evaluations were used to gather qualitative data on students' perceptions and experiences and were thematically coded by faculty.

Results: There was a significant improvement in scores on drug utilization reviews and patient counseling simulations despite the increasing difficulty and complexity of the medication problems presented (p < 0.001). Students expressed that interleaved activities helped to make connections to prior learning and move beyond memorizing facts to application of content. Compared to traditional teaching methods, students exposed to desirable difficulties exhibited higher scores and retention rates of course material. Students reported positive experiences with embedded desirable difficulties, noting these techniques encouraged active engagement with course material, increased motivation to study, and enhanced problem-solving skills.

Conclusions: While traditional teaching may prioritize ease of learning, study findings suggest that some level of cognitive effort, when strategically applied, can enhance learning outcomes. Implementing desirable difficulties led to improved retention of course material and enhanced critical thinking and problem-solving skills.