The implementation of the CPD simulation course resulted in higher mean scores on the SPLLL scale compared to their classmates and their self-rating before implementation. The course provided students with opportunities to practice and develop skills in self-assessment and awareness, SMART planning, evaluation and proper documentation of their learning, which are all desirable for LLL. Most students performed very well (78%) in their assignments and got high scores on their portfolio evaluation. Students perceived that the course matched its aim and that they had achieved most of the course objectives. Students perceived themselves currently more committed and oriented to LLL and professionalism.
CPD and LLL in pharmacy education is challenging, inconsistent, and usually not assessed or even required in many pharmacy programs in Cyprus, Turkey and across the globe. In this study, grounded theoretical features were employed within a longitudinal CPD course to enable students to develop themselves as independent lifelong learners beyond graduation.
Within the different learning modes, educators identified varying advantages and disadvantages associated with each mode of learning. In the current course, a wide range of teaching methods were adopted involving exposition, discussion, enquiry, activity and collaboration .
A small group learning method was used to enable enhanced knowledge exchange and discussion among students and with their instructors. Small group learning is well established in the literature as an effective setting for learning  and a method preferred by pharmacy students suitable for enhancing LLL skills [29, 30].
The CPD cycle derived from Kolb’s learning cycle was adopted as a main framework for students’ assignments and portfolios. In the literature, students’ completion of a minimum of two CPD cycles was reported as an effective utilization of the mode in leadership and professional development . In the current study, a minimum of three completed CPD cycles was required to assure students’ competence in utilizing the CPD cycle.
Other features possibly contributing to program outcomes include a lengthy course duration in contrast to short courses or workshops shown by many educators to be less effective and having an effect that may last a week or a few hours [33, 34]. Active learning methods known to improve the problem-solving and critical thinking skills of students along reflective portfolios that provide evidence of professional development and the achievement of the desired competencies were all adopted during the course [35, 12, 36]. Both subjective and objective assessment methods were utilized. based on Donald Kirkpatrick’s developed model to evaluate the overall effectiveness of training programs .
Several students stated that they found the SMART learning objective exercise to be useful and beneficial. One of the students stated that “I guess I learned especially from the SMART objective and personal SWOT analysis, I even used it in my scientific presentation course. I was able to talk about how to be specific and to be smart in planning everything that you do in pharmacy, achieving your aims and everything”. This perception toward the SMART learning objective was similarly reported in US schools .
CV development is an important ability closely linked to CPD, as also emphasized by Dyke JE et al.’s study. Students were suggested to design and update their CVs during the course so to grasp how CPD may contribute toward improving their CVs fast with time .
Students found portfolio development to be one of the more challenging activities in the course. A student said that “it was stressful and needed concentration, but it’s beneficial”. A similar study reported that 40% of the surveyed students found the portfolio to be a challenge while 54% of them reported that it was effective in supporting their learning . The use of online training modules and electronic portfolio submissions made the CPD program much more convenient. A student commented that “using online portfolio and incorporating technology was pleasant and unexpected”.
CPD is not learning for the sake of learning; it helps to move students toward their career goals . As a student expressed in the focus group session, that now they can improve themselves in all fields: “now we also might improve ourselves not only in a community pharmacy, we could work also in other sectors”. CPD allows students to individualize aspects of their education since being a self-directed lifelong learner requires skills for determining individual learning needs. The students reflected on how they liked that the course was based on individual learning needs: “in university things are not based on our weakness or need we are never asked this. But in CPD the activities were based on our needs and then we improved that was good” as a student in FG1 emphasized.
O’Brocta et al suggested that incorporating the CPD process early in the 1st year will familiarize the students with the CPD method and permit them to become more proficient in applying it. Continuing the CPD process during advanced experiential years mimics its integration into actual pharmacy practice . Students in the current study supported these opinions, where most of them preferred to have orientation in the early years while the practice of CPD should be required in the advanced years of the program: “there are basic information we could have even from first classes, such as why CPD, why we need it, and some online courses, while maybe some advance things as portfolios and conferences are suitable for 5th-year students, but at least basics can be delivered earlier” as a student commented.
Improving the knowledge of students’ learning preferences, behaviors, and strategies can benefit and guide CPD. Applying Austin’s Pharmacist’s Inventory of Learning Styles tool can contribute to defining, describing, and measuring learning styles among pharmacists . The dominant learning style of the students in current study was assimilator (40.7%), followed by diverger (33.3%), accommodator (14.8%) and converger (11%). A similar distribution was reported in a study done at the University of Malaysia involving pharmacy students in which the dominant learning style of the students was assimilator .
A few limitations of the current study are mentioned. To start with, the small sample size for the students limits the generalization of the study findings over the study population. Additionally, the response rate of the 5th year students used as a control was not high enough, although the current responses are considered acceptable for generating hypotheses . Further, the subjective nature of the self-evaluation, as in the case of SPLLL scale used in this study, may be considered as a limitation, although an objective assessment of assignments and portfolios by instructors was done. Additionally, it is important to mention that pre-post assessments could be subject to recall bias, though the duration between the two assessments in the current study was relatively long (9 months). Also the multifaceted nature of CPD processes utilized in different countries may arise challenges in replicating this course, yet the process adopted in this course is universal and promoted by the world FIP .
Despite the presence of these limitations, the findings of this study contribute to the prior literature on LLL and CPD in pharmacy education. To date, no researcher reported the successful implementation of an LLL targeted program utilizing the CPD model in programs outside the US. Dyke JE et al reported poor outcomes of the program at a UK based university. In addition, in an Australian university, although an improvement of students’ skills was noticed, poor student acceptance of the TLR was reported [19, 18] contrary to the current study findings. The introduction of the CPD simulation in an advance year coupled with experiential practices is contrary to Dyke JE et al’s course, which was administered to first year students, and this may explain the success of the program in North Cyprus. Additionally, the small group learning strategy adopted and the lower complexity of the program introduced in the current study may justify higher student satisfaction and acceptance compared to the TLR study. Other features supporting the validity of the findings of the current study include the mixed method design adopted to generate both quantitative and qualitative data. In regard to the course assessment, both objective and subjective approaches were used to evaluate student performance and all components of the program. The course features were mainly supported by grounded theories and evidence. This study is the first to report an attempt to implement longitudinal courses targeting and developing CPD and LLL in resource-limited settings or developing countries.
Future research must assess the implementation and impact of similar programs using a larger sample of students, especially for the early introduction of the program in the second and third years of M.pharm programs coupled with introductory pharmacy practice experiences. Practicing CPD within experiential courses is important since it simulates the required setting of pharmacy practice as the students graduate. Assessing the impact of similar programs following student’s graduation and registration as practitioners would be useful too.
The implementation of a CPD course may also provide more flexible opportunities or a window for learning newly evolving concepts or practices not addressed in pharmacy curriculum since curricula needs years to be revised and updated in many countries. Students in the current study have reported that their self-development in both areas were not sufficiently addressed during their studies and in new areas previously unfamiliar to them (e.g., sports medicine and vaccinations). Thus, assessing such an impact of a CPD course in contrast to other courses provided within curricula may further enrich the current literature.