Analysis of Pharmacists` Attitudes Toward a Distance

Analysis of Pharmacists’ Attitudes Toward a Distance Learning
Initiative on Health Screening
Jane Whiteman, Eileen M. Scott and James C. McElnay
The Pharmacy Practice Research Group, School of Pharmacy, The Queen’s University of Belfast, 97 Lisburn Road, Belfast BT9
7BL, Northern Ireland
A questionnaire was developed to investigate pharmacists’ attitudes to distance learning (DL) as a vehicle
for continuing education (CE). It was included in each of a two part DL course on Health Screening. Part One
was mailed to all community pharmacists in England (16,400) and returns were received from 1487. The
questionnaire in Part Two was returned by 436 pharmacists. Attitude statements were scored using a fivepoint Likert scale. The mean response to all attitude statements was positive. Participants were significantly
more satisfied than non-participants with DL in general and the DL course studied (P≤0.05). Over 80 percent of
respondents completing the course found DL to be enjoyable and more suitable than other CE methods.
More females and less males than expected (based on registration statistics) requested (P≤0.001) and
completed the course (P≤0.001). Pharmacists of all ages participated, although those recently qualified
showed greater interest.
INTRODUCTION
Continuing post-qualification education and training is required by pharmacists wishing to remain up-to-date within
a changing and evolving profession(1,2). Although continuing education (CE) is not mandatory in the UK at present,
the Royal Pharmaceutical Society of Great Britain (RPSGB)
has recently recognized the need for CE by adopting a
national curriculum and advising pharmacists to participate
in at least 30 hours of CE per year(3). The requirement for
pharmacists in the UK to remain up-to-date has been addressed in the code of ethics(4), which states “a pharmacist
must keep abreast of the progress of pharmaceutical knowledge in order to maintain a high standard of professional
competence relative to his sphere of activity”. The need for
pharmacists to participate in CE has been highlighted by the
fact that even though pharmacists view their advisory function as a major part of their role, some have not always
performed adequately in this area and do not always transform knowledge into practice(5-8).
Pharmacists cite job constraints and lack of time to
attend formal courses as reasons for nonparticipation in
CE(1,9,10). Distance learning (DL) overcomes many of
these problems and specially designed DL courses are becoming increasingly attractive to busy community pharmacists in the UK. Although DL has only recently been introduced as a means of providing pharmaceutical CE in the
UK, historically DL has been utilized more frequently in the
USA. For example, in the years 1981, 1983 and 1985, samples
of pharmacists in Michigan USA were investigated for the
types of CE courses used to fulfil mandatory CE requirements. Correspondence courses were the dominant form of
CE and about 30 percent reported that they obtained all of
the required credits in this way(11).
As well as satisfying the needs of CE in general, DL is
used to educate pharmacists towards certain defined goals
including diplomas and certificates (12,13). A number of
UK universities have recently introduced DL in postgraduate professional courses for both hospital and community
pharmacists.
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The work presented in this paper describes the evaluation of a DL course, Health Screening for Health Promotion, which was written to update pharmacists in this important area of pharmacy practice. The need for such a course
was identified in a joint report of the RPSGB and the
Department of Health on the future of community pharmaceutical services in the UK(14). This latter report suggested
that community pharmacies should consider providing a
number of additional services including diagnostic and
screening services and that completion of additional training or demonstration of appropriate knowledge should be a
prerequisite for pharmacists providing these services.
The aim of this study was to determine community
pharmacists’ attitudes to distance learning in general and to
the Health Screening for Health Promotion DL course in
particular. A further aim was to assess the influence of
certain characteristics upon pharmacist involvement in distance learning. Differences in attitude between participants
and non-participants was also examined.
METHODOLOGY
The Pharmacy Practice Research Group in the Queen’s
University of Belfast (QUB) was commissioned in 1990 to
produce a written DL course entitled “Health Screening for
Health Promotion”. The course was designed in two parts:
Part One provided a general introduction to the topic and
highlighted opportunities for pharmacists to become involved in health screening; Part Two consisted of six Core
Units which discussed a range of screening and monitoring
services, namely: (i) general aspects of screening; (ii) screening for coronary heart disease; (iii) diabetic screening; (iv)
monitoring of asthma patients; (v) pregnancy and ovulation
tests; and (vi) further screening options. In November 1990
Part One was mailed to all community pharmacists in England (N = 16,400) using address labels provided by the
RSPGB. Part Two was only issued upon written request
from pharmacists. The closing date for requesting Part Two
was three months from receipt of Part One. Both Part One
and Two contained multiple-choice question assessments
American Journal of Pharmaceutical Education Vol. 58, Fall 1994
that participants were invited to complete and return to
QUB for individual assessment. These assessment papers
were marked and returned to participating pharmacists
together with their score, the correct answers to questions
and explanatory notes. This was intended to allow participants to assess their understanding of the course and to
provide a sense of achievement at having completed the
course assessments. Return of these assessments was taken
as an indication of having studied and completed that part of
the course. The project was sponsored by the Department of
Health as part of their remit to provide continuing education
for graduate pharmacists in England. Both parts of the
course and the individualized assessments were provided
free of charge to participating community pharmacists.
A questionnaire on attitudes to DL in general and the
DL course studied was included in both parts of the course.
Pharmacists were requested to return these questionnaires
to QUB for analysis. Sociodemographic data were also
requested in a section of the questionnaire. This paper
reports the results obtained from returned questionnaires.
A cover letter was included in Part One explaining the
purpose of the DL course, emphasizing the importance of
evaluating this new educational method in the UK and
therefore requesting the return of the attitude questionnaire so that pharmacists’ views on the course could help to
improve the provision of future DL material. Pharmacists’
cooperation was requested even if they did not wish to
receive Part Two of the course. It included a promise of
confidentiality and an expression of gratitude. A five-point
Likert scale, ranging from strongly agree (scored as one
point) to strongly disagree (scored as 5 points), was employed in this questionnaire. The following sociodemographic
details and current practice data were requested: sex, employment in community pharmacy (part-time/full-time), year
of registration, type of pharmacy (independent versus multiple/chain), diagnostic services provided in place of work,
diagnostic services planned for place of work, and reasons
for nonprovision of diagnostic services (if applicable).
Attitude responses and sociodemographic details were
entered into a Borland Paradox® database with an identification number that was assigned to each questionnaire as it
arrived back at the study center. A separate database file
linking identification number to name and address details
was also maintained. To maintain confidentiality, this information was password protected. The results presented in
this paper are based upon information obtained from three
separate groups of pharmacists:
Group 1 (not requesting) was those pharmacists who returned the attitude questionnaire contained in Part One but
did not request Part Two.
Group 2 (requesting) was those pharmacists who returned
the attitude questionnaire contained in Part One and requested Part Two.
Group 3 (completing) is a subgroup of group 2 and was those
pharmacists who completed the course. This group also
returned the same attitude questionnaire included in Part
Two of the course, but unless otherwise stated, data from the
first questionnaire were used in the analyses.
Data was analyzed using SPSS/PC® software. For continuous dependent variables f-tests and ANOVA (followed
by Student-Newman-Kiiel’s multiple range test) were employed. Discrete variables were analyzed using chi square
Fig 1. The percentage in each five-year band of the total number
(N=1,485) of communitypharmacistsparticipating in distance
learning compared with the percentage in the same band of
community pharmacists in Great Britain according to RSPGB
register, 1990 (N=20,787).
procedures (with Yate’s correction for any two-by-two analyses).
RESULTS
Response Rates
Part One of the course was sent by post to 16,400
community pharmacists registered in England. Two hundred copies of this did not reach the addressees and were
returned to QUB. The number of pharmacists in each of the
three designated groups were as follows: Group 1 (not
requesting) 117; Group 2 (requesting) 1487 of whom 1485
returned the attitude questionnaire; Group 3 (completing)
520 of whom 436 returned the attitude questionnaire contained in Part Two of the course. This represents a response
rate of nine percent of community pharmacists to whom the
course was mailed and a completion rate of 35 percent (i.e.,
520 of 1487) of those who requested Part Two of the course.
Factors Influencing Participation
The influence of gender and employment profile on
participation in DL was investigated using chi square analysis to compare the details of pharmacists in Group 2 (requesting) and Group 3 (completing) with data for all community pharmacists on the RPSGB register in 1990 for
Great Britain (i.e., England, Scotland and Wales, N = 20787)
(Table I). Results indicated that a higher than expected
percentage of females versus males requested (P≤0.001)
and completed (P≤0.001) the course. Based on the information available, the numbers of part-time and full-time pharmacists requesting the course was not significantly different
(P>0.05) from the number of part-time and full-time community pharmacists on the register, although it was observed that 10 percent of pharmacists failed to identify
whether they were working full- or part-time. Significantly
more part-time pharmacists completed the course (P<0.05).
Analysis of Group 2 (requesting) by year of registration
indicated interest by pharmacists of all ages. For comparative purposes, these results were grouped into five year
bands and presented as a percentage of the total numbers of
Group 2 pharmacists (N-1485) compared with a similarly
banded age profile of all community pharmacists on the
RPSGB register (N= 20787) (Figure 1). The RPSGB’s data
available for the years 1987-90 was not complete and did not
American Journal of Pharmaceutical Education Vol. 58, Fall 1994
301
Table I. Influence of gender and employment profile on participation in the DL course.
Community
Participants
pharmacists on
(percent)a
register (percent)b
N=1485
N=20,787
Group 2: Requesting
Part Two of DL course
Group 3: Completing Part
Two of DL coursee
Significancee
Male
747
(50)
12257
(59)
P<0.001
Female
733
(49)
8530
(41)
Full-time
927
(62)
14562
(70)
Part-time
410
(28)
6102
(29)
NSd
Male
191
(44)
12257
(59)
P<0.001
Female
228
(52)
8530
(41)
Full-time
271
(62)
14562
(70)
Part-time
143
(33)
6102
(29)
P<0.05
a
where % values do not add up to 100%, this was due to incomplete data available
Data was obtained from RPSGB register, 1990 for Great Britain
c
All comparisons were carried out using chi square analysis
d
NS - not significant
e
return of course assessment form was taken as evidence of completion
b
Fig 2. Attitudes of pharmacists to the statement, distance learning
is more suitable for me than other continuing education methods”
related to whether they did not request, did request, or completed the
course.
include new graduates coming onto the register in 1990.
Other demographic details of participating pharmacists
are shown in Table II. Approximately 74 percent of Group
3 (completing) pharmacists already provided, or intended to
provide, screening services. Pregnancy testing (53 percent),
blood pressure monitoring (13 percent) and cholesterol
measurement (five percent) were the main services provided. In all three groups the main reasons for not providing
diagnostic services were lack of time, no demand, lack of
staff and poor financial return; it can be inferred that the
majority considered that diagnostic tests were of value and
that provision of diagnostic services would improve job
satisfaction.
Attitudes to Distance Learning
The attitude statements presented in the questionnaire are
shown in Table III. The mean response to all statements
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Fig 3. Attitudes of pharmacists to the statement, “this method of
learning was enjoyable” related to whether they did not request, did
request, or completed the course.
was better than “neutral” (mid-point score = 3) whether a
positive response to an individual statement required an
agree or disagree answer. Attitudes to DL in general were
assessed by two statements, namely, “distance learning is
more suitable for me than other continuing education methods” and “this method of learning was enjoyable” and a
detailed breakdown of the responses obtained are shown in
Figures 2 and 3 respectively. Approximately 80 percent of
Group 3 respondents believed that DL was more suitable
for them than other CE methods. The relationships between
demographic details and these statements are summarized
in Table IV for Group 2 (requesting) and Group 3 (completing) participants and were analyzed utilizing a t-test, treating
the data as ordinal. In Group 2, females reported DL to be
more enjoyable than males (P<0.05), and those employed
part-time found DL more enjoyable than those employed
full-time (P<0.05). In this same group DL was also found to
American Journal of Pharmaceutical Education Vol. 58, Fall 1994
Table II. Demographic details of pharmacists not requesting (Group 1), requesting (Group 2) and completing
(Group 3) the DL course.
Numbersa and (percent) of pharmacists
Demographic variable
Type of pharmacy
Independent
Multiple/Chain
Diagnostic services provided
Type of services
pregnancy testing
blood pressure
cholesteroi
other
Intending to provide services
Reason for not providing services
Lack of time
Poor financial return
Tests of no value
Does not improve job satisfaction
Lack of Staff
No demand
Other
a
Group 1
N = 117
Not requesting
60 (51.3)
39 (33.3)
Group 2
N=1485
Requesting
Group 3
N=436
Completing
582 (39.2)
705 (47.5)
763 (51.4)
177 (40.6)
227 (52.1)
241 (55.3)
49 (41.9)
49 (41.9)
17 (14.5)
6 (5.1)
5 (4.3)
22 (18.8)
750 (50.5)
179 (12.1)
72 (4.8)
47 (3.2)
343 (23.1)
232 (53.2)
58 (13.3)
22 (5.0)
17 (3.9)
81 (18.6)
34 (29.1)
319 (21.5)
98 (22.5)
20 (17.1)
4 (3.4)
8 (6.8)
15 (12.8)
35 (29.9)
42 (35.9)
161 (10.8)
7 (0.5)
12 (0.8)
174 (11.7)
255 (17.2)
546 (36.8)
64 (14.7)
1 (0.2)
0 (0)
79 (18.1)
86 (19.7)
152 (34.9)
Missing values (i.e. no response) are not presented
Table III. Attitudes of pharmacists not requesting (Group 1), requesting (Group 2) and completing (Group 3) the DL
course on Health Screening for Health Promotion
Attitudesa (mean score ± SD)
of pharmacists participating in DL course
Group 1
Group 2
Group 3
N = 117
N = 1485
N = 436
Attitude statement
Not requesting
Requesting
Completing
The material was easy to read
1.7 ±0.9
1.6 ±0.7
1.7 ± 0.7
The material was difficult to understand
4.1 ±1.1
4.3 ± 0.8
3.9 ± 0.9
The standard of presentation was good
1.8 ±0.7
1.8+0.7
1.7 ± 0.7
The in-text questions were not helpful
3.3 ±1.1
3.7 ± 0.9
3.7 ± 1.0
The self-assessment questions were useful
2.4 ±1.0
2.0 ± 0.8
1.9 ±0.7
The information in the unit was not new to me
2.6 ±0.9
2.9 ±1.0
3.4 ±0.8
This method of learning was enjoyable
2.5 ± 1.0
2.1 ±0.8
1.9 ±0.7
The material was relevant
2.2 ± 0.9
1.9 ±0.7
1.9 ±0.8
Distance learning is more suitable for me than
2.2± 1.2
1.8 ±0.9
1.7 ± 0.9
other continuing education methods
a
Based on a Likert 5 point scale; strongly agree, 1; strongly disagree, 5.
be more suitable by pharmacists working in independent
pharmacies than those working in multiple pharmacies
(P<0.05). However, these factors were not significantly
different in Group 3 participants. As expected the material
was found to be significantly more relevant by both groups
when they provided diagnostic services in their pharmacy
(P<0.05). In all cases the differences in the scores were small
and followed similar trends. When dealing with such large
numbers of participants, it is possible to achieve significance
with small changes in attitude. Also differences may be
influenced by response variability.
American Journal of Pharmaceutical Education Vol. 58, Fall 1994
Differences in Attitudes Between Participants and
Nonparticipants
A one-way analysis of variance was used to investigate
differences in attitudes between participants who completed
(Group 3), participants who ordered but did not show
evidence of completing (Group 2 minus Group 3, i.e., Group
2*) and nonparticipants who did not request Part Two of the
DL course (Group 1). All groups agreed with the statement.
“The standard of presentation was good”. The responses to
all other statements showed significant differences (P<0.05).
A multiple-range test was then used to evaluate which
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Table IV. The relationship of demographic variables and attitudes by those requesting (Group 2) and completing
(Group 3) the DL course.
Attitude scoresa (mean ± SD) of pharmacists
Requesting (Group 2)
Completing (Group 3)
b
Pb
N
P
N
This method of learning was enjoyable
Male
2.1 ± 0.8
694
1.8 ± 0.7
186
1.9 ± 0.7
1.8 ± 0.7
255
140
1.9 ± 0.7
1.8 ± 0.7
270
176
1.9 ± 0.8
224
1.7 ± 0.8
186
1.7 ± 0.9
1.7 ± 1.0
226
141
1.7 ± 0.8
1.7 ± 0.9
270
176
1.7 ± 0.9
225
1.8 ± 0.7
238
2.0 ± 0.8
168
0.026
Female
Part-time
2.0 ± 0.7
2.0 ± 0.7
699
399
Full-time
Independent
2.1 ± 0.8
2.0 ± 0.8
901
565
0.33
0.013
0.30
0.05
0.08
694
Multiple
2.1 ± 0.8
Distance learning is more suitable for me than other methods
695
Male
1.8 ± 0.9
Female
Part-time
1.7 ± 0.9
1.7 ± 0.9
698
398
Full-time
Independent
1.8 ±0.9
1.7 ± 0.9
911
564
1.8 ± 0.9
695
1.9 ± 0.7
741
0.147
0.06
0.44
0.02
Multiple
The material was relevant
Services provided
0.46
0.015
Services not provided
2.0 ± 0.7
559
0.48
0.02
a
Based on a Likert five-point scale: strongly agree, 1; strongly disagree, 5
All comparisons were carried out using unpaired Student r-tests.
b
Table V. Differences in attitudes to distance learning in
participants who completed (Group 3), participants
who ordered but did not show evidence of completing
(Group 2*, i.e. Group 2 minus Group 3) and nonparticipants (Group 1) who did not request Part Two of
the DL course
Attitude statement
Group scoresa
The material was easy to read
The material was difficult to understand
The standard of presentation was good
The in-text questions were not helpful
The self-assessment questions were useful
The information in the unit was not new to me
This method of learning was enjoyable
The material was relevant
Distance learning is more suitable for me than
other continuing education methods
a
3 < 2* = 1
1 < 2* = 3
not significant
1 < 2* = 3
3 = 2* < 1
1 < 2* = 3
3 = 2* < 1
3 = 2* < 1
3 = 2* < 1
the mean score for each group was calculated for each statement based on a
Likert 5 point scale and the means compared using one-way analysis of
variance (P ≤ 0.05) followed by a Student-Newman-Keuls procedure.
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groups had significantly different means (Table V). Responses indicate that participants were more satisfied than
nonparticipants with DL in general and the present DL
course in particular.
Attitudes Before and After the Course
The changes in attitudes of the group of pharmacists
who completed the course (Group 3) were examined by
comparing their responses to statements in the first attitude
questionnaire, i.e., before receiving Part Two of the course
and the second attitude questionnaire, i.e., after completing
Part Two of the course. Two statements were investigated.
No significant difference was found for the statement “distance learning is more suitable for me” (mean score: before,
1.72; after, 1.66). There was a significant improvement (P
≤0.001) in the score awarded for the statement “this method
of learning was enjoyable” after completion of the course
(mean score, 1.86) compared with before (mean score, 2.02)
studying Part Two.
DISCUSSION
This study indicated that more females and less males than
expected from the Register’s statistics requested and completed the course (P≤0.001). When employment profiles
American Journal of Pharmaceutical Education Vol. 58, Fall 1994
were examined it was found that those requesting the course
had similar employment profiles to the total number of
pharmacists in community pharmacy. Past research into
attendances at CE courses in a region of the UK had
identified certain demographic trends(16) in that the percentage of female and part-time pharmacists attending
courses was much higher than the actual percentages of
these groups residing in the region. In contrast, a recent
paper evaluating two DL courses for pharmacists in England remarked upon the fact that two-thirds of participants
were male and that over 90 percent of respondents were in
full-time employment(17). Major reasons given for this
finding were the facts that financial incentives were provided and the courses were focused towards pharmacists
who were pharmacy owners with National Health Service
contracts. No financial incentives were provided in the DL
course evaluated in this study and although significantly
more females than males did participate in this DL course,
large differences were not found and it would appear that
interest from male pharmacists was also comparatively high.
However, our study does support the view that DL is a more
suitable form of CE for pharmacists in full-time employment. Also, while pharmacists of all ages participated in the
DL course, more recently qualified pharmacists showed
greater interest and this may also reflect the increasing
numbers of females coming on the register.
Responses were favorable to the concept of DL, especially in those who completed the course, with approximately 80 percent of this group finding DL more suitable
than other CE methods and 90 percent finding DL an
enjoyable method of CE. Although Group 1 pharmacists,
i.e., those who did not request Part Two of the DL course,
were significantly less enthusiastic (P<0.05) about the merits of DL than the two groups of participants, this group still
agreed that DL was more suitable for them than other
methods of CE. However, it must be borne in mind that
fewer than 10 percent of all community pharmacists in
England requested Part 2 of the DL course and only one
third of those who requested the course showed evidence of
completing it by returning the multiple choice questionnaires for assessment. Encouragingly, pharmacists found
the DL method of learning more enjoyable after completion
of Part Two of the course than before studying it. Past
research has identified DL as a preferred method for pharmacists to participate in CE(10,18,19). Experience in Australia. USA and the UK has also shown DL to be an
effective, convenient way to educate pharmacists(20-27).
The mean Likert scale scores obtained to the attitude
questions for all three groups studied were similar (Table
III). The possibility of central tendency bias, when respondents avoid the extreme categories of a scale, has to be taken
into consideration. The scale does, however, show a tendency for those requesting (Group 2) and completing (Group
3) the course to be more positive towards the course than
those who did not request it (Group 1). The questionnaire
was designed so that a positive response to some statements
required a “strongly agree’’ and others required a “strongly
disagree”‘ response. In this way the full range of Likert scale
responses were required.
The content of any CE course must reflect the needs of
the participants. This DL course dealt with health screening
services and health promotion activities which are developing areas of community pharmacy practice. Approximately
74 percent of pharmacists completing the course already
American Journal of Pharmaceutical Education Vol. 58, Fall 1994
provided or intended to provide screening services. This
may simply mean that pharmacists will choose to do courses
on topics of particular interest to them. It was also encouraging that the majority of all respondents through inference
considered that the diagnostic tests were of value and that
provision of diagnostic services would improve job satisfaction. In the absence of a mandatory requirement for practising pharmacists to participate in CE, considerable attention
must be given by course providers to make their course
attractive and relevant to likely participants. Monetary incentives have not been a feature of CE for pharmacists in the
UK but are given to medical practitioners for CE participation. In a study of the response to two separate DL courses
where nominal remuneration was given to those who returned completed assessment forms, request rates of 49
percent and 43 percent were obtained, although the completion rate was fewer than 50 percent of those requesting the
course (17). In a similar study where no incentives were
offered to pharmacists to participate in a DL course, a
response rate of 12 percent was obtained(18). One further
method of improving motivation is to provide certificates
when assessment questions have been completed and returned(17). The DL course in this study was mailed to
pharmacists at the beginning of November and the proximity of Christmas may have been a disincentive. Support for
this hypothesis is given by the observation that no assessments were returned during Christmas week.
The main reasons for not providing diagnostic services
were lack of time, no demand, lack of staff and poor financial
return. These results are similar to those obtained in the UK
National Audit Office’s (NAO) investigation of community
pharmacy(28). It was found that 67 percent of pharmacists
in England wished to offer more services to the public and
the reasons given for non-provision of such services included the need for a second pharmacist (59 percent),
insufficient remuneration (56 percent), and inadequate time
and resources for further training (50 percent). The Joint
Working Party report on the future of community pharmacy
in the UK has encouraged the provision of diagnostic services by community pharmacists and the NAO has agreed in
its report that the pharmacist’s role should be developed as
quickly as possible(14). Against this background it appears
that pharmacists would welcome the provision of diagnostic
services as part of an extended role but at present feel they
are restrained by time and financial considerations.
This DL course was prepared using a two-color printing
process and a varied page layout to provide an attractive
easily read training package. The course was interactive in
style and self-assessment questions were included throughout the text so that the participants could evaluate their
understanding of the material and measure their progress.
Case reports were also used to provide illustrations of points
made in the text and to maintain the interactive style. An
important aspect of course design is to ensure that having
requested the course, participants will be encouraged to
study it. The completion rate for this course was 35 percent
suggesting that the attention given to presentation was
worthwhile.
The decision to mail Part One to all community pharmacists
was intended to give pharmacists an opportunity to
“sample” the course and decide if they wished to continue
with the full package. It contained general information on
the importance of health screening and health promotion
which was of benefit to all pharmacists. However, such wide
305
distribution was a costly exercise in terms of printing and
mailing costs. Provided a course is well advertised and the
method of requesting the course is kept simple, costs of
providing such DL courses can be reduced by keeping the
print run and postage costs low. However, it could be argued
that the unsolicited approach will capture those pharmacists
who are not motivated to apply for DL courses or attend
other CE events.
In conclusion, the present study demonstrates that distance learning is a suitable and enjoyable method of CE.
Acknowledgement. The authors wish to acknowledge the
Pharmaceutical Contractors” Committee (Northern Ireland)
for their sponsorship and support.
Am. J. Pharm. Educ., 58, 300-306 (1994); received 3/31/94, accepted 7/11/94.
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American Journal of Pharmaceutical Education Vol. 58, Fail 1994