An instrument to evaluate pharmacists' patient counseling on herbal and dietary supplements

Objective

To develop a measure of pharmacists’ patient counseling on herbal and dietary supplements.

Methods

A systematic process was used for item generation, testing, and validation of a measure of pharmacists counseling on herbal and dietary supplements. Because a pharmacist-patient encounter may or may not identify an indication for taking an herb or dietary supplement, the instrument was bifurcated into 2 distinct components: (1) patient counseling in general; and (2) patient counseling related to herbal and dietary supplements.

Results

The instrument demonstrated high reliability and desirable construct validity. After adjusting for item difficulty, we found that pharmacists tended to provide more general patient counseling than counseling related to herbal and dietary supplements.

Conclusion

This instrument can be applied to assess the quality of counseling provided by pharmacists and pharmacy students, and the outcomes of pharmacist and pharmacy student education on herbal and dietary supplements.     

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.     

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.     

Improvisational Exercises to Improve Pharmacy Students' Professional Communication Skills

Objective

To create and implement improvisational exercises to improve first-year pharmacy students'' communication skills.

Design

Twelve 1-hour improvisational sessions were developed and added to an existing/established patient communication course to improve 3 basic skills: listening, observing and responding. Standardized patient examinations were used to evaluate student communication skills, and course evaluations and reflective journaling were used to evaluate students'' perceptions of the improvisational exercises.

Assessment

The improvisational exercises markedly improved the students'' performance in several aspects of standardized patient examination. Additionally, course evaluations and student comments reflected their perception that the improvisational exercises significantly improved their communication skills.

Summary

Improvisational exercises are an effective way to teach communication skills to pharmacy students.     

Elective course in acute care using online learning and patient simulation

Objective

To enhance students’ knowledge of and critical-thinking skills in the management of acutely ill patients using online independent learning partnered with high-fidelity patient simulation sessions.

Design

Students enrolled in the Acute Care Simulation watched 10 weekly Web-based video presentations on various critical care and advanced cardiovascular pharmacotherapy topics. After completing each online module, all students participated in groups in patient-care simulation exercises in which they prepared a pharmacotherapeutic plan for the patient, recommended this plan to the patient''s physician, and completed a debriefing session with the facilitator.

Assessment

Students completed a pretest and posttest before and after each simulation exercise, as well as midterm and final evaluations and a satisfaction survey. Pharmacy students significantly improved their scores on 9 of the 10 tests (p ≤ 0.05). Students’ performance on the final evaluation improved compared with performance on the midterm evaluation. Overall, students were satisfied with the unique dual approach to learning and enjoyed the realistic patient-care environment that the simulation laboratory provided.

Conclusion

Participation in an elective course that combined self-directed Web-based learning and hands-on patient simulation exercises increased pharmacy students’ knowledge and critical-thinking skills in acute care.     

Clinical pharmacy consultations provided by American and Kenyan pharmacy students during an acute care advanced pharmacy practice experience

Objective

To compare the clinical consultations provided by American and Kenyan pharmacy students in an acute care setting in a developing country.

Methods

The documented pharmacy consultation recommendations made by American and Kenyan pharmacy students during patient care rounds on an advanced pharmacy practice experience at a referral hospital in Kenya were reviewed and classified according to type of intervention and therapeutic area.

Results

The Kenyan students documented more interventions than American students (16.7 vs. 12.0 interventions/day) and provided significantly more consultations regarding human immunodeficiency virus (HIV) and antibiotics. The top area of consultations provided by American students was cardiovascular diseases.

Conclusions

American and Kenyan pharmacy students successfully providing clinical pharmacy consultations in a resource-constrained, acute-care practice setting suggests an important role for pharmacy students in the reconciliation of prescriber orders with medication administration records and in providing drug information.     

A Genotyping Exercise for Pharmacogenetics in Pharmacy Practice

Objective

To develop a genotype exercise to improve pharmacy students’ comprehension of pharmacogenetic principles that apply to patient care.

Design

Deoxyribonucleic acid (DNA) was collected during class from 10 student volunteers and subjected to genotype analysis. The results were presented to the class and discussed in the context of a patient genetic counseling session. Students completed a survey instrument regarding their attitudes toward this learning experience.

Assessment

Students indicated that the exercise engaged them with the course content and would positively influence their ability to apply pharmacogenetic principles to patient care.

Conclusion

An applied genotype exercise enhanced learning of pharmacogenetic principles. Based on these findings, conducting a genotype exercise in a large classroom setting is feasible in terms of time and expense, and meaningful in terms of student satisfaction.     

A Motivational Interviewing Course for Pharmacy Students

Objective

To create, implement, and evaluate a pharmacy course on motivational interviewing.

Design

A 3-hour elective course was created to train doctor of pharmacy (PharmD) students in brief patient-centered motivational interviewing counseling strategies that have proven effective with the types of health issues most commonly addressed in pharmacy settings. Students were assisted in developing their skills through required readings, interactive lectures, in-class demonstrations and practice sessions, out of class skills practice, one-on-one supervision provided by doctoral level clinical health psychology students, and written reflections on each class session.

Assessment

Students demonstrated significant improvement in motivational interviewing skills and a high level of motivation for and confidence in using these skills in their future practice. Students overall assessment of the course and supervision process was highly positive.

Conclusion

This patient-centered counseling skills course was feasible and produced improvements in PharmD students'' counseling skills and increased their motivation and confidence to use motivational interviewing skills in their future communications with patients.     

A Nutrition Journal and Diabetes Shopping Experience to Improve Pharmacy Students' Empathy and Cultural Competence

Objectives

To implement and assess the effectiveness of an exercise designed to develop pharmacy students'' empathy toward patients regarding diabetes and obesity and encourage cultural and “economic” competence.

Design

Students in the Nutrition Journal and Diabetes Shopping Experience attended a nutrition and weight management lecture, monitored their own nutritional intake by maintaining an online nutrition and exercise journal, and grocery shopped based on an assigned patient scenario. Scenarios varied in terms of income, ethnicity, insurance coverage, family size, grocery store, and medication lists. Students completed written reflections and group discussions and completed pre- and post-assignment survey instruments.

Assessment

The activities improved student confidence levels regarding nutrition and weight-related patient counseling, and knowledge about general nutrition and weight management. The majority of students agreed that the activities improved their ability to empathize with overweight patients regarding the challenges of nutrition and lifestyle changes and enhanced their awareness of the impact that cultural and financial situations have on nutrition and lifestyle.

Conclusion

The Nutrition Journal and Diabetes Shopping Experience positively impacted the way pharmacy students view the challenges surrounding nutrition and healthy eating in patients with culturally and socioeconomically diverse backgrounds.     

Impact of Patient Empathy Modeling on pharmacy students caring for the underserved

Objective

To determine the impact of the Patient Empathy Modeling pedagogy on students'' empathy towards caring for the underserved during an advanced pharmacy practice experience (APPE).

Design

Pharmacy students completing an APPE at 2 primary care clinics participated in a Patient Empathy Modeling assignment for 10 days. Each student “became the patient,” simulating the life of an actual patient with multiple chronic diseases who was coping with an economic, cultural, or communication barrier to optimal healthcare. Students completed the Jefferson Scale of Physician Empathy (JSPE) before and after completing the assignment, and wrote daily journal entries and a reflection paper.

Assessment

Twenty-six students completed the PEM exercises from 2005-2006. Scores on the JSPE improved. Students'' comments in journals and reflection papers revealed 3 major themes: greater appreciation of the difficulty patients have with adherence to medication and treatment regimens, increased empathy for patients from different backgrounds and patients with medical and psychosocial challenges, and improved ability to apply the lessons learned in the course to their patient care roles.

Conclusion

A Patient Empathy Modeling assignment improved pharmacy students'' empathy toward underserved populations. Integrating the assignment within an APPE allowed students to immediately begin applying the knowledge and insight gained from the exercise.     

A mental health elective to improve pharmacy students' perspectives on mental illness

Objective

To evaluate the impact of a mental health elective on pharmacy students'' perceptions and stigmatizing views of mental illness.

Design

An elective was designed that featured an advanced overview of psychopharmacology; student training in motivational interviewing; a presentation by the National Alliance on Mental Illness (NAMI) local chapter; introduction to pharmacy collaborations with peer support specialists, social workers, and psychiatrists; mock patient counseling sessions; and a required psychiatric patient interview at a local community mental health center.

Assessment

A survey instrument with 17 Likert-scale items was constructed to measure 2 distinct areas: social distance and stigmatizing views. The survey instrument was administered at the beginning and end of the spring 2010 semester to pharmacy students enrolled in the mental health elective course and to a control group of pharmacy students enrolled in an unrelated clinical elective. The course had a positive impact on pharmacy students'' perceptions of mental illnesses. Students'' social distance and stigmatizing views of mental illnesses improved, while no significant change in views occurred among students in the control group.

Conclusion

Advanced training in psychiatric medicine and exposure to mental health care are vital to prepare pharmacy students to provide unbiased, patient-centered care to this population.     

Pharmacists’ and Pharmacy Students’ Ability to Identify Drug-related Problems Using TIMER (Tool to Improve Medications in the Elderly via Review)

Objective

Determine the effectiveness of TIMER (Tool to Improve Medications in the Elderly via Review) in helping pharmacists and pharmacy students identify drug-related problems during patient medication reviews.

Methods

In a randomized, controlled study design, geriatric patient cases were sent to 136 pharmacists and 108 third-year pharmacy students who were asked to identify drug related-problems (DRPs) with and without using TIMER.

Results

Pharmacists identified more tool-related DRPs using TIMER (p = 0.027). Pharmacy students identified more tool-related DRPs using TIMER in the first case (p = 0.02), but not in the second.

Conclusion

TIMER increased the number of DRPs identified by practicing pharmacists and pharmacy students during medication reviews of hypothetical patient cases.     

Health Promotion Integrated Into a Thai PharmD Curriculum to Improve Pharmacy Practice Skills

Objective

To implement and evaluate 5 integrated teaching modules in the fifth-year doctor of pharmacy (PharmD) curriculum to increase students'' ability to promote patients'' health as part of their pharmacy practice.

Design

Activity-based learning was added to each module: (1) a practice experience in which students provided health information and counseling to the public; (2) academic debates on current issues in pharmacy (3) journal clubs on articles from the pharmacy literature; and (4) research projects relating to ongoing faculty research on diabetes. Students on 12-week practice experiences had visits to patients in inpatient wards, outpatient clinics, and either primary care units or community pharmacies.

Assessment

Practice examinations at the end of the first semester, the average student score was above 80% as determined by preceptors in experience sites and from faculty members. Group interviews found that students were positive about the benefits of integrated teaching.

Conclusion

The integration of the teaching between modules in the same semester is possible and greatly benefits student learning.     

Readiness for self-directed learning and academic performance in an abilities laboratory course

Objective

To assess the relationship between readiness for self-directed learning, academic performance on self-directed learning activities, and resources used to prepare for an abilities laboratory course.

Methods

The Self-directed Learning Readiness Scale (SDLRS) was administered to first-year (P1) doctor of pharmacy (PharmD) candidates at the University of Maryland. Additional data collected included final course grades, quiz scores, resources used to prepare for laboratory activities, and demographics.

Results

The mean SDLRS score was 148.6 ± 13.8. Sixty-eight students (44%) scored > 150, indicating a high readiness for self-directed learning. These students were more likely to complete assignments before the laboratory, meet in study groups, and report postgraduation plans to enter noncommunity pharmacy. No significant association was found between academic performance and the SDLRS.

Conclusions

Readiness for self-directed learning is associated with self-directed learning habits, but may not be necessary for learning foundational knowledge, provided students are given specific instructions on what to study. Whether high readiness for self-directed learning is necessary for more complex learning or for self-identification of learning needs is unknown.