Cultural competence knowledge and confidence after classroom activities

Objectives

To determine change in cultural competency knowledge and perceived confidence of second-year pharmacy students to deliver culturally competent care after completing a required cultural competency curriculum.

Design

Cultural competence material was covered in the second-year PharmD curriculum through lectures, laboratories, and an experiential/out-of-class assignment.

Assessment

Eighty-five second-year (P2) pharmacy students completed a survey which assessed influence of classroom activities related to cultural competence. Mean values for knowledge and perceived confidence were significantly higher for posttest compared to pretest (p < 0.01), after cultural competency activities. Focus groups were used to solicit students'' opinions on instructional effectiveness, relevance of activities, and areas for enhancement.

Conclusion

The cultural competency curriculum increased pharmacy students'' awareness of and confidence in addressing cultural diversity issues that affect pharmaceutical care delivery.     

Evaluating the accuracy of pharmacy students' self-assessment skills

Objectives

To evaluate the accuracy of self-assessment skills of senior-level bachelor of science pharmacy students.

Methods

A method proposed by Kruger and Dunning involving comparisons of pharmacy students'' self-assessment with weighted average assessments of peers, standardized patients, and pharmacist-instructors was used.

Results

Eighty students participated in the study. Differences between self-assessment and external assessments were found across all performance quartiles. These differences were particularly large and significant in the third and fourth (lowest) quartiles and particularly marked in the areas of empathy, and logic/focus/coherence of interviewing.

Conclusions

The quality and accuracy of pharmacy students'' self-assessment skills were not as strong as expected, particularly given recent efforts to include self-assessment in the curriculum. Further work is necessary to ensure this important practice competency and life skill is at the level expected for professional practice and continuous professional development.     

A Spanish language and culture initiative for a doctor of pharmacy curriculum

Objective

To implement a Spanish language and culture initiative in a doctor of pharmacy (PharmD) curriculum that would improve students'' Spanish language skills and cultural competence so that graduates could provide competent pharmaceutical care to Spanish-speaking patients.

Design

Five elective courses were created and introduced to the curriculum including 2 medical Spanish courses; a medical Spanish service-learning course; a 2-week Spanish language and cultural immersion trip to Mexico; and an advanced practice pharmacy experience (APPE) at a medical care clinic serving a high percentage of Spanish-speaking patients. Advisors placed increased emphasis on encouraging pharmacy students to complete a major or minor in Spanish.

Assessment

Enrollment in the Spanish language courses and the cultural immersion trip has been strong. Twenty-three students have completed the APPE at a Spanish-speaking clinic. Eleven percent of 2010 Butler University pharmacy graduates completed a major or minor in Spanish compared to approximately 1% in 2004 when the initiative began.

Conclusion

A Spanish language and culture initiative started in 2004 has resulted in increased Spanish language and cultural competence among pharmacy students and recent graduates.     

First-year Pharmacy Students' Self-Assessment of Communication Skills and the Impact of Video Review

Objectives

To determine the ability of first-year students to self-assess communication skills and measure the impact of video review on students'' self-assessment.

Design

Students participated in a digital video-recorded, counseling-simulation exercise and completed self-assessment before and after viewing their video. A faculty member evaluated the students using the same counseling assessment tool.

Assessment

Correlation between the students'' self-assessment scores and the faculty member''s scores were poor (pre-video: r = 0.38, post-video: r = 0.46). The largest portion of the students overestimated their skills in comparison to the faculty member''s evaluations (47.1% pre-video and 67.9% post-video). Those in the lowest quartile overestimated their skills, while those in the upper quartile underestimated their skills (pre-video). Video review brought about an increase in the self-assessment scores for nearly two-thirds (62.1%) of the students.

Conclusion

First-year pharmacy students had difficulty self-assessing, and video review increased their perception of skill achievement. A curriculum should include opportunities for students to develop self-assessment skills early in the program, and this should be reinforced throughout the curriculum.     

Current Events Project in a Pharmacotherapy Course

Objective

To implement and assess a current events project added to the curriculum of a pharmacotherapy course in a doctor of pharmacy (PharmD) program.

Design

Third-year PharmD students researched a current event topic related to infectious diseases and prepared a written and verbal summary that was presented to their classmates.

Assessment

Scores on course examinations and quizzes to assess students'' knowledge of current events material were equal to or better than non-current events material. Based upon a student self-assessment survey, this active-learning activity increased students'' awareness of current events related to pharmacy practice, and their understanding of the process to prepare and present information to a group in a statistically significant manner. There was a positive but not significant improvement in students'' desire to prepare and present information to a group; ability to evaluate, organize, and present information in a written report; and ability to verbally present material to a group.

Conclusion

The addition of a current events presentation as an active-learning activity significantly increased students'' awareness of current events related to pharmacy practice and their understanding of the process to prepare and present information to a group.     

Evaluation of a Train-the-Trainer Program for Cultural Competence

Objectives

To develop, implement, and evaluate the impact of a cultural competence train-the-trainer workshop for pharmacy educators.

Methods

A 2-day train-the-trainer workshop entitled Incorporating Cultural Competency in Pharmacy Education (1.65 CEUs) was provided to pharmacy faculty from schools across the United States. Baseline, posttraining, and 9-month follow-up surveys assessed participants'' (n = 50) characteristics and self-efficacy in developing and teaching content.

Results

At baseline, 94% of faculty members reported no formal training in teaching cultural competence. After completing the workshop, participants'' self-rated confidence for developing and teaching workshop content significantly increased. The number of participants who rated their ability to teach cultural competence as “very good” or “excellent” increased from 13% to 60% posttraining. Participants reported teaching 1 or more aspects of the workshop curriculum to nearly 3,000 students in the 9-months following training.

Conclusions

The workshop significantly increased faculty members'' perceived and documented ability to teach cultural competence. The train-the-trainer model appears to be a viable and promising strategy for meeting the American Council for Pharmacy Education accreditation standards relating to the teaching of diversity, cultural issues, and health literacy.     

Students' Health-Related Quality of Life Across the Preclinical Pharmacy Curriculum

Objectives

To examine health related quality of life (HRQOL), perceived stress, and coping skills in the 3 preclinical years of a doctor of pharmacy (PharmD) curriculum.

Methods

Health-related quality of life, perceived stress, and coping strategies were measured using the Short Form-36, Perceived Stress Scale, and Brief COPE. Average annual scores were compared across curriculum years.

Results

Two hundred thirteen students enrolled in the study. Entering students had physical and mental HRQOL scores that were similar to age-adjusted US norms. Mental HRQOL scores were significantly lower and stress significantly higher during the second year of the PharmD curriculum compared to the first year (p < 0.05). Lower mental HRQOL scores were associated with increased stress and use of maladaptive coping skills in all years of the curriculum.

Conclusion

Increased stress and reduced mental HRQOL were observed across the first 3 years of a PharmD curriculum. Methods to reduce stress and/or use of maladaptive coping skills are needed to improve students'' HRQOL throughout the pharmacy curriculum.     

Peer-Level Patient Presenters Decrease Pharmacy Students' Social Distance From Patients With Schizophrenia and Clinical Depression

Objectives

To create a doctor of pharmacy curricular experience that will decrease students'' social barriers to interaction with and treatment of mentally-ill patients.

Design

We created a survey instrument to measure 4 aspects of students'' conceptions of schizophrenia and clinical depression: (1) understanding of the medical nature of each disease, (2) understanding of patient behavior, (3) belief in the efficacy of treatment, and (4) social distance. We delivered this instrument before and after a neuropsychiatry curriculum including “peer-level patient presenters” in addition to the traditional first-year pharmacy curriculum.

Assessment

Social-distance scores significantly decreased in first-year pharmacy students who attended peer-level patient presentations, indicating increased willingness to interact with persons with schizophrenia and clinical depression. In addition, students'' understanding of the causes of illness, behavior of patients, and most importantly, efficacy of drug counseling for these diseases increased.

Conclusions

Changes to the curriculum including the addition of peer-level patient presentations can quantitatively decrease pharmacy students'' social barriers to the treatment of mentally-ill patients.     

A capstone advanced pharmacy practice experience in research

Objective

To implement a required capstone experience in research for pharmacy students, assess course outcomes, and solicit mentors'' and students'' opinions regarding the structure and efficacy of the course.

Design

Fourth-year pharmacy students chose a research project, selected a mentor, and completed a 5-week capstone advanced pharmacy practice experience (APPE), during which they wrote a research paper and presented their research at a poster session.

Assessment

Eighty students completed the capstone experience in 2008-2009 and 56 faculty and non-faculty pharmacists served as mentors. Based on their responses on a course evaluation, the students'' experience with their mentor and course instructor were positive. Thirty-one mentors completed a survey on which they indicated their overall support of the capstone project, but wanted their role to be better defined and felt the students needed to have additional training in statistics, survey question design, and the IRB process before completing the APPE.

Conclusion

The capstone APPE was perceived by students and mentors as a positive learning experience that allowed the student to take information from the curriculum and apply it to a real-world situation. Additional research is needed to determine whether pharmacy students will use the research skills acquired in their future careers.     

Pharmacy Students' Perceptions of Their Preparedness to Provide Pharmaceutical Care

Objective

To assess students'' perceptions of their preparedness to perform advanced pharmacy practice competencies.

Design

The Preparedness to Provide Pharmaceutical Care (PREP) survey was modified and administered to each class at a Midwestern university from 2005-2008. Factor analysis and 1-way ANOVA with multiple comparisons were applied to assess the effectiveness of changes made in the pharmacy curriculum.

Assessment

Factor analysis yielded patterns similar to those reported in the literature. Students rated themselves highest on the psychological aspects and lowest on the administrative aspects of care. Perceived pharmaceutical care skills grew as students progressed through the curriculum, and changes in coursework were reflected in the competencies.

Conclusion

Students’ perceived competencies (ie, communication, psychological, technical, administrative) were similar to those at other institutions and perceptions of competencies increased in a manner consistent with actual program outcomes.     

Assessment of pharmacy students' communication competence using the Roter Interaction Analysis System during objective structured clinical examinations

Objective

To determine the value of using the Roter Interaction Analysis System during objective structured clinical examinations (OSCEs) to assess pharmacy students'' communication competence.

Methods

As pharmacy students completed a clinical OSCE involving an interview with a simulated patient, 3 experts used a global rating scale to assess students'' overall performance in the interview, and both the student''s and patient''s languages were coded using the Roter Interaction Analysis System (RIAS). The coders recorded the number of utterances (ie, units of spoken language) in each RIAS category. Correlations between the raters'' scores and the number and types of utterances were examined.

Results

There was a significant correlation between students'' global rating scores on the OSCE and the number of utterances in the RIAS socio-emotional category but not the RIAS business category.

Conclusions

The RIAS proved to be a useful tool for assessing the socio-emotional aspect of students'' interview skills.     

Multiple rubric-based assessments of student case presentations

Objectives

To evaluate a rubric-based method of assessing pharmacy students'' case presentations in the recitation component of a therapeutics course.

Methods

A rubric was developed to assess knowledge, skills, and professional behavior. The rubric was used for instructor, student peer, and student self-assessment of case presentations. Rubric-based composite scores were compared to the previous dichotomous checklist-based scores.

Results

Rubric-based instructor scores were significantly lower and had a broader score distribution than those resulting from the checklist method. Spring 2007 rubric-based composite scores from instructors and peers were significantly lower than those from the pilot study results, but self-assessment composite scores were not significantly different.

Conclusions

Successful development and implementation of a grading rubric facilitated evaluation of knowledge, skills, and professional behavior from the viewpoints of instructor, peer, and self in a didactic course.Key words: rubric, pharmacy, peer assessment, self-assessment, assessment     

Concept mapping to evaluate an undergraduate pharmacy curriculum

Objectives

To explore a pharmacy school curriculum for opportunities for student engagement and to determine how these might shape student identity as pharmacists.

Methods

The learning aims and objectives and methods of assessment from the curriculum of a bachelor of pharmacy (BPharm) program were collected and a concept map was generated. The concept map was interpreted using Barnett and Coates'' curricular domains of knowing, acting and being.

Results

The key concepts within the intended curriculum that were identified from the concept map were drugs, pharmacy, understanding, practice, and skills. Concepts such as patient and consumer, which would indicate a patient-centered approach to the curriculum, were limited. The main form of assessment used in the curriculum was multiple-choice and short-answer examinations.

Conclusion

There was an emphasis in the curriculum on student acquisition of knowledge and this was reinforced by the use of theoretical examinations. The content of the curriculum was drug-centered rather than patient-centered and the emergence of students'' identity as pharmacists may be fragmented as a result.     

Factors affecting prepharmacy students' perceptions of the professional role of pharmacists

Objective

To assess prepharmacy students'' perceptions of the professional role of pharmacists prior to enrollment in pharmacy school, and the association between perceptions and student demographics.

Methods

A 58-question survey instrument regarding pharmacists'' roles, work experiences, and demographics was developed and administered to students (N = 127) enrolled in an organic chemistry laboratory experience at Purdue University.

Results

Theory of planned behavior subscales (attitude, subjective norm, perceived behavioral control) were influenced by students'' grade point average, gender, and application to pharmacy school, while unpaid work experience affected professional commitment. Students evaluated work experience related to their pharmacy studies more positively than non-pharmacy-related areas in the theory of planned behavior subscales.

Conclusions

Evaluating students'' perceptions may be beneficial in helping pharmacy educators design their curricula, as well as allowing admissions committees to select the most qualified students to promote the development of positive perceptions toward the professional role of pharmacists. Grade point average (GPA) and application to pharmacy school were associated with significant differences for the theory of planned behavior and professional commitment subscales.     

Active-learning strategies to develop health literacy knowledge and skills

Objective

To implement active-learning exercises in a required pharmacy course and assess their impact on students'' knowledge and confidence in identifying and communicating with patients with low health literacy, as part of a required course in cultural competency, health literacy, and health beliefs.

Design

Active-learning activities including administering health literacy assessments, identifying informal signs of low health literacy, conducting mock patient counseling sessions, rating the readability of drug information, analyzing information in drug advertisements, and writing patient education materials were incorporated into the 6-sesssion health literacy portion of the course.

Assessment

A pretest and posttest showed that students'' knowledge of health literacy increased, and a retrospective pretest found improvement in students'' confidence in their ability to care for patients with low health literacy. In-class discussions provided informal evidence that students gained new knowledge from the active-learning activities.

Conclusion

The addition of active-learning activities was effective in teaching health literacy concepts to pharmacy students.     

Development and evaluation of a required patient safety course

Objectives

To develop, implement, and assess a required patient safety course for second-year doctor of pharmacy students.

Design

A patient safety course was developed that included didactic lectures, case studies, in-class activities, and reading assignments. Written examinations and essays were used to evaluate student learning. In addition, a modified minute paper and a pre- and post-intervention student self-assessment survey were used to assess course outcomes.

Assessment

Results examining the utility of the course teaching format and the relevance of the material in meeting the course outcomes are presented and discussed. The self-assessment course survey indicated major improvements in the students'' knowledge and skills, readiness for knowledge application, and commitment to improve patient safety.

Conclusion

The course provided pharmacy students with an increased level of understanding of the principles and concepts of patient safety.     

Engaging Pharmacy Students with Diverse Patient Populations to Improve Cultural Competence

Objective

To develop and implement learning activities within an advanced pharmacy practice experience (APPE) to improve students'' cultural competence.

Design

During their AAPE at Community Access Pharmacy, students participated in topic discussions with faculty members, used interpreters to interview Hispanic patients, visited a Mexican grocery store, evaluated nontraditional medicine practices in the Hispanic community, and served as part of a patient care team at a homeless shelter and an HIV/AIDS clinic. The students reflected on these activities in daily logs and completed a final evaluation of their experiences.

Assessment

Forty-three students completed the rotation from 2004-2007. Almost all learned something new about counseling patients with cultural/language differences (98%) and became more aware of financial barriers to health care and potential solutions to overcome them (93%). Students'' reflections were positive and showed progression toward cultural competence.

Conclusion

A culturally diverse patient population provided opportunities for APPE students to develop the skills necessary to become culturally competent pharmacists. Future work should focus on potential evaluation tools to assess curricular cultural competency outcomes in APPE''s.     

Anonymous Peer Assessment of Medication Management Reviews

Objectives

To investigate whether pharmacy students'' anonymous peer assessment of a medication management review (MMR) was constructive, consistent with the feedback provided by an expert tutor, and enhanced the students'' learning experience.

Design

Fourth-year undergraduate pharmacy students were randomly and anonymously assigned to a partner and participated in an online peer assessment of their partner''s MMR.

Assessment

An independent expert graded a randomly selected sample of the MMR''s using a schedule developed for the study. A second expert evaluated the quality of the peer and expert feedback. Students also completed a questionnaire and participated in a focus group interview. Student peers gave significantly higher marks than an expert for the same MMR; however, no significant difference between the quality of written feedback between the students and expert was detected. The majority of students agreed that this activity was a useful learning experience.

Conclusions

Anonymous peer assessment is an effective means of providing additional constructive feedback on student performance on the medication review process. Exposure to other students'' work and the giving and receiving of peer feedback were perceived as valuable by students.     

An Advanced Pharmacy Practice Experience in Public Health

Objectives

To develop and implement an advanced pharmacy practice experience (APPE) that would increase students'' awareness of, acceptance of, and ability to apply public health concepts in pharmaceutical care.

Design

A 6-week APPE was developed that utilized a wide variety of activities including written assignments, role-play, direct patient care, reflective writing, and community outreach to explore various public health issues and their relation to the practice of pharmacy. To determine the students'' perception of learning, a 5-question survey instrument was sent to students upon completion of the experience

Assessment

The results of the survey indicated high satisfaction with the APPE in a variety of different domains including provision of pharmaceutical care, providing patient education, exercising cultural competency, referring to community resources, and utilizing medication assistance programs.

Conclusion

The advanced pharmacy practice experience (APPE) provides students a unique opportunity to develop skills important to the practice of public health and expand understanding of the role of pharmacist in the public health setting.     

Impact of an Introductory Pharmacy Practice Experience on Students' Performance in an Advanced Practice Experience

Objective

To determine the impact of an introductory pharmacy practice experience (IPPE) on students'' clinical skills during their initial advanced pharmacy practice experience (APPE).

Design

A 4-week First Steps course that focused on students developing pharmacy practice skills, clinical communications skills, and effective use of reference materials was introduced in 2006 at the end of the third-year curriculum, prior to students beginning their APPEs.

Assessment

During the third week of the first APPE, faculty members rated students'' demonstration of 9 clinical skills on a 5-point Likert scale (1 being always and 5 being never). The evaluation was performed in 2005 prior to implementation of the course (control group) and again in 2006 after implementation of the course. Students who completed the First Steps course scored better on all 9 skills and had a better average clinical skills value (2.3) compared to the control group (2.6, p < 0.01).

Conclusion

Completion of an IPPE course that focused on critical pharmacy practice aspects, clinical communication skills, and use of reference materials resulted in increased frequency of desired clinical behaviors on a subsequent APPE.