Medication therapy management training using case studies and the MirixaPro platform

Objective

To implement and assess a medication therapy management (MTM) training program for pharmacy students using the MirixaPro (Mirixa Corporation, Reston, VA) platform and case studies.

Design

Students received lectures introducing MTM and were given a demonstration of the MirixaPro platform. They were divided into teams and assigned cases and times to interview patients portrayed by faculty members. Using the MirixaPro system, students performed 2 comprehensive medication reviews during the semester, recording the patient''s current medications, indications, side effects, allergies, health conditions, and laboratory test recommendations and developed a personal medication record and medication action plan.

Assessment

Based on a rubric with a rating scale of 0-10, campus and distance pathway students received mean scores ranging from 6.3-7.4 for their performance on the second MTM exercise, an increase of 47%-54% over the first MTM exercise. In qualitative assessments, the majority of students believed that their confidence in providing MTM was enhanced by the activity, while faculty members recognized the advantage of using MirixaPro, which allowed students to experience what is required in processing a pharmacist led, billable MTM encounter.

Conclusions

Use of the MirixaPro system and patient cases provides students with a “hands-on” experience that may encourage them to promote MTM during their APPEs and provide MTM services as practicing pharmacists.     

Faculty and student expectations and perceptions of e-mail communication in a campus and distance doctor of pharmacy program

Objective

To examine faculty members'' and students'' expectations and perceptions of e-mail communication in a dual pathway pharmacy program.

Methods

Three parallel survey instruments were administered to campus students, distance students, and faculty members, respectively. Focus groups with students and faculty were conducted.

Results

Faculty members perceived themselves as more accessible and approachable by e-mail than either group of students did. Campus students expected a shorter faculty response time to e-mail and for faculty members to be more available than did distance students.

Conclusion

E-mail is an effective means of computer-mediated communication between faculty members and students and can be used to promote a sense of community and inclusiveness (ie, immediacy), especially with distant students.     

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.     

Pharmacy Student Knowledge and Communication of Medication Errors

Objectives

To describe and evaluate pharmacy students'' knowledge of and comfort in communicating, managing, and preventing medication errors.

Methods

Using a cross-sectional design, a survey instrument was administered to fifth-year pharmacy students. The survey instrument included both open- and close-ended questions to describe and examine factors associated with knowledge and comfort in communication of medication errors.

Results

Survey instruments were completed by 93 students (90% response rate). Nearly 80% reported not having received training in communicating medication errors. The perception of having more adequate training was related to greater knowledge in the communication of medication errors (p ≤ 0.001). Knowledge was also associated with students having greater comfort in communicating medication errors (p ≤ 0.05).

Conclusions

The need and value of additional training for pharmacy students in communicating medication errors was demonstrated. Educational interventions should be developed to provide consistent instruction on these communication issues.     

Physician Acceptance of Pharmacotherapy Recommendations Made by Pharmacy Students in a Rural Pharmacy-based Diabetes Care and Education Clinic

Objective

To assess outcomes from a rural, community pharmacy-based diabetes care and education program involving collaboration between local pharmacists and physicians, fourth-year pharmacy students, and University of Colorado Denver School of Pharmacy faculty members.

Design

Fourth-year pharmacy students provided education and testing (hemoglobin A1c, blood glucose, blood pressure, and lipid profiles) to diabetes patients, once a month for 6 months. Clinical notes with medication recommendations were faxed to each patient''s physician following each visit.

Assessment

Twelve pharmacy students made 533 recommendations to 29 physicians for 52 patients over 18 months. Overall, 32% of the recommendations were accepted based on subsequent medication orders and patient reports. Three of the physicians accepted 50%-60% of the recommendations they received while 4 did not accept any recommendations.

Conclusions

Physician acceptance of pharmacy students'' medication recommendations for patients attending a rural community pharmacy-based diabetes management clinic varied. Further study is needed to determine the reasons for this.     

Comparing team-based and mixed active-learning methods in an ambulatory care elective course

Objectives

To assess students'' performance and perceptions of team-based and mixed active-learning methods in 2 ambulatory care elective courses, and to describe faculty members'' perceptions of team-based learning.

Methods

Using the 2 teaching methods, students'' grades were compared. Students'' perceptions were assessed through 2 anonymous course evaluation instruments. Faculty members who taught courses using the team-based learning method were surveyed regarding their impressions of team-based learning.

Results

The ambulatory care course was offered to 64 students using team-based learning (n = 37) and mixed active learning (n = 27) formats. The mean quality points earned were 3.7 (team-based learning) and 3.3 (mixed active learning), p < 0.001. Course evaluations for both courses were favorable. All faculty members who used the team-based learning method reported that they would consider using team-based learning in another course.

Conclusions

Students were satisfied with both teaching methods; however, student grades were significantly higher in the team-based learning course. Faculty members recognized team-based learning as an effective teaching strategy for small-group active learning.     

A systems approach to scaffold communication skills development

Objectives

To implement a communication skills development (CSD) system and evaluate its effectiveness in a clinical communications course.

Design

Students conducted baseline interviews and wrote SOAP notes, and based on faculty, patient, self- and peer assessments, set goals for improvement of their communication skills. Students participated in various activities to scaffold their learning, several of which took place in a web-based environment to enhance access and function for both students and faculty members. Quantitative and qualitative analyses were performed.

Assessment

Students'' communication skills improved as evidenced by assessment scores. Student and faculty comments offered additional evidence of the effectiveness of standardized patient interviews, learning strategies, and assessment methods.

Conclusion

The CSD system effectively integrated various types of learning activities and feedback processes. The use of scaffolding strategies appeared to enhance the development of students'' communication skills.     

A Diabetes Camp as the Service-Learning Capstone Experience in a Diabetes Concentration

Objectives

To assess the effectiveness of a service-learning advanced pharmacy practice experience (APPE) in a diabetes camp to improve student confidence in diabetes knowledge and related skills

Design

Pharmacy students assisted medical staff during a week-long diabetes camp for children. Students participated in all aspects of diabetes care, as well as wrote pre- and post-camp reflection papers, completed online quizzes, presented an educational training session, and completed pre- and post-camp survey instruments.

Assessment

Students'' confidence in their diabetes knowledge and patient care skills increased as a result of participating in the camp.

Conclusion

A diabetes camp APPE improved students'' confidence in their knowledge and ability to manage diabetes, and allowed them to gain experience working with an interdisciplinary team in a unique real-world environment.     

Best Practices Assessment to Guide Curricular Change in a Bachelor of Pharmacy Program

Objectives

To identify best practices in global pharmacy education and curriculum design as the basis for decisions about major curriculum change in an existing 4-year bachelor of pharmacy curriculum.

Design

We investigated international best-practice standards, conducted semi-structured interviews with faculty members, and used standardized instruments to investigate student perceptions of the existing curriculum and how they approached their learning.

Assessment

Faculty recommendations included horizontal and vertical integration of curriculum content to replace the previous discipline-based approach; and a theme-based structure underpinned by a detailed statement of learning outcomes that describe the knowledge, skills, and attitudinal milestones to be achieved each year and by the time of graduation. The triangulation of student survey data highlighted issues that needed to be addressed at the individual course unit level, with a particular focus on feedback, assessment, and workload.

Conclusions

The results of the curriculum review provided clear guidance for decisions relating to major curriculum change. An ongoing program of staff development will address the wide range of learning and teaching issues identified by both staff members and students. The results of our investigation of students'' approaches to learning will also be used to guide staff development workshops, focusing on strategies to promote “meaningful learning.”     

Avoiding Potential Medication Errors Associated with Non-intuitive Medication Abbreviations

Background:

Pharmaceutical companies use a variety of abbreviations to denote short- and long-acting medications. Errors involving the administration of these medications are frequently reported.

Objectives:

To evaluate comprehension rates for abbreviations used to denote short- and long-acting medications and to evaluate whether changes to medication labels could reduce potential errors in the selection and administration of medications.

Methods:

In phase 1 of the study, nursing staff were asked to define 4 abbreviations and then to categorize them by release rate. In phase 2, a simulation exercise, nursing staff were asked if it would be appropriate to administer a medication illustrated in a photograph (oxycodone CR 5-mg blister pack) on the basis of information highlighted in a screen shot of an electronic medication administration record (order for oxycodone 5 mg). Three different presentations were used to identify the medication in the medication administration record and on the drug label.

Results:

In phase 1, 10 (28%) of 36 nursing staff members knew what all 4 abbreviations meant, and 14 (39%) correctly classified all 4 abbreviations as indicating a short- or a long-acting medication. In the simulation exercise (phase 2), labelling changes reduced the likelihood of a potential medication administration error.

Conclusions:

Most abbreviations used to indicate short- versus long-acting medications were not correctly understood by study participants. Of more concern was the incorrect interpretation of some abbreviations as indicating the opposite release rate (e.g., “ER” interpreted as meaning “emergency release”, rather than “extended release”, with incorrect classification as a short-acting medication). This evaluation highlighted the potential consequences of using non-intuitive abbreviations to differentiate high-risk medications having different release rates.     

An Advanced Pharmacy Practice Experience in Inpatient Medication Education

Objective

To describe a unique advanced pharmacy practice experience (APPE) in which pharmacy students provided medication education to hospitalized patients.

Design

Students were trained to independently assess patients'' needs for education and identify drug-related problems. Students then provided medication education and performed medication therapy management under the supervision of clinical staff pharmacists. To assess the impact of the APPE, the number of hospitalized patients assessed and educated during the 3-month time period prior to student involvement was compared to the first 3 months of the APPE.

Assessment

Student participation increased the number of patients receiving medication education and medication therapy management from the hospital pharmacy. At the end of the APPE, students reported that the experience positively affected their ability to impact patients'' care and to critique their own learning and skills.

Conclusion

The inpatient medication education APPE provided students the opportunity to be responsible and accountable for the provision of direct patient care. In addition, the APPE benefitted the hospital, the school of pharmacy, and, most importantly, the patients.     

Learning Across the Curriculum: Connecting the Pharmaceutical Sciences to Practice in the First Professional Year

Objectives

To facilitate the student''s ability to make the connection of the core foundational basic science courses to the practice of pharmacy.

Design

In 2000, 10 faculty members from basic science and practice courses created and implemented an integrated Patient Care Project for which students chose a volunteer patient and completed 15 different assignments

Assessment

Evidence of student learning, such as grades and reflective comments along with collected evaluative data, indicated an enhancement in students'' perceived understanding of the connection between basic science and patient care.

Conclusion

The Patient Care Project provided students an opportunity to use knowledge gained in their first-year foundational courses to the care of a patient, solidifying their understanding of the connection between basic science and patient care.     

Pharmacy Students' Facebook Activity and Opinions Regarding Accountability and E-Professionalism

Objective

To assess pharmacy students'' Facebook activity and opinions regarding accountability and e-professionalism and determine effects of an e-professionalism education session on pharmacy students'' posting behavior.

Methods

A 21-item questionnaire was developed, pilot-tested, revised, and administered to 299 pharmacy students at 3 colleges of pharmacy. Following a presentation regarding potential e-professionalism issues with Facebook, pharmacy students with existing profiles answered an additional question concerning changes in online posting behavior.

Results

Incoming first-year pharmacy students'' Facebook usage is consistent with that of the general college student population. Male students are opposed to authority figures'' use of Facebook for character and professionalism judgments and are more likely to present information they would not want faculty members, future employers, or patients to see. More than half of the pharmacy students planned to make changes to their online posting behavior as a result of the e-professionalism presentation.

Conclusions

There is high social media usage among pharmacy students and many do not fully comprehend the issues that arise from being overly transparent in online settings. Attitudes toward accountability for information supplied via social networking emphasize the need for e-professionalism training of incoming pharmacy students.     

A Computer-based Module for Prescribing Error Instruction

Objective

To evaluate an instructional module''s effectiveness at changing third-year doctor of pharmacy (PharmD) students'' ability to identify and correct prescribing errors.

Design

Students were randomized into 2 groups. Using a computer-based module, group 1 completed worksheet A, watched a presentation on medication errors, and then completed worksheets B and C. Group 2 completed worksheets A and B, watched the presentation, and then completed worksheet C.

Assessment

Both groups scored a median 50% on worksheet A and 66.7% on worksheet C (p < 0.001). Median scores on worksheet B differed between groups (p = 0.0014). Group 1 viewed the presentation before completing worksheet B and scored 62.5%, while group 2 viewed the presentation after scoring 50% on worksheet B.

Conclusion

The module effectively taught pharmacy students to identify and correct prescribing errors.     

An elective course in information mastery

Objective

To design and implement an elective course in information mastery and assess its impact on students'' ability to identify information needs and formulate clinically relevant, evidence-based answers.

Design

A semester-long (15-week) elective course was offered to third-year (P3) doctor of pharmacy (PharmD) students that outlined the necessary knowledge and skills for using information mastery in evidence-based practice.

Assessment

Results of a pre- and postcourse survey instrument demonstrated an increase in students'' knowledge of information mastery and confidence in and familiarity with the practice of evidence-based medicine in pharmacy. Students who had completed the elective were able to provide higher quality search strategies and evidence-based answers to a clinical question than other P3 students, and P4 students who did not participate in the elective.

Conclusion

An elective course in information mastery improved students'' knowledge and understanding of information mastery as it pertains to practicing evidence-based medicine.     

Reinforcing cultural competency concepts during introductory pharmacy practice experiences

Objectives

To incorporate cultural competency concepts into various introductory pharmacy practice experiences (IPPE) at the University of Missouri - Kansas City, School of Pharmacy.

Design

A 6-week series, titled “Becoming a Culturally Competent Provider” was developed to provide IPPE students with the opportunity to apply theory regarding cultural competency in a clinical context.

Assessment

Pre- and post-intervention attitude survey instruments were administered to 25 students in the spring semester of 2009. Several activities within the series were associated with reflection exercises. Student presentations were evaluated and formal feedback was provided by faculty members. A course evaluation was administered to evaluate the series and determine areas of improvement.

Conclusion

A special series on cultural competency resulted in positive changes in students'' attitudes, highlighting the importance of reinforcing cultural competency concepts during IPPEs.     

A Week-Long Diabetes Simulation for Pharmacy Students

Objective

To assess students'' attitudes and confidence about type 2 diabetes mellitus and diabetes self-management education before and after participation in Living With Diabetes Week simulation.

Design

Third-year pharmacy students took part in diabetes lectures, interactive laboratory sessions, and a week-long simulation of life as a patient with diabetes in the Clinical Assessment course. Pre-/postintervention survey instruments and experimental and control group comparisons were completed assessing attitudes and confidence relating to knowledge about diabetes.

Assessment

The understanding that diabetes has a psychosocial impact, patient autonomy is necessary, and the seriousness of the disease increased. Students'' confidence in their diabetes self-management education skills also increased.

Conclusion

The Living With Diabetes Week simulation changed pharmacy students'' attitudes toward patients with diabetes and increased confidence in diabetes education skills.