Factors Associated With Reflection Among Students After an Advanced Pharmacy Practice Experience (APPE) in Sweden

Objective

To identify individual and social factors associated with pharmacy students'' level of reflection in an advanced pharmacy practice experience (APPE).

Methods

A postal questionnaire, including a reflective assignment, was sent to all pharmacy interns (n=262) at Uppsala University, Sweden, for 4 semesters in 2005-2007.

Results

In a univariate analysis, 7 factors were found to be associated with students'' level of reflection. After controlling for covariates, 3 social factors were found to be independently associated with reflection: having a formal preceptor (OR=5.3), being at a small pharmacy (OR=19.8), and students'' perception of the importance of discussing critical thinking with the preceptor (OR=1.2). No correlation could be observed between level of reflection and critical thinking, nor learning style.

Conclusion

Social components seem to be of higher importance than individual components in students'' reflective levels after pharmacy internship experience. Trained preceptors are important to foster reflection skills.     

Electronic Reflective Student Portfolios to Demonstrate Achievement of Ability-based Outcomes During Advanced Pharmacy Practice Experiences

Objectives

To demonstrate achievement of ability-based outcomes through a structured review of electronic student portfolios in an advanced pharmacy practice experience (APPE) program.

Design

One hundred thirty-eight students produced electronic portfolios containing select work products from APPEs, including a self-assessment reflective essay that demonstrated achievement of course manual-specified ability-based outcomes.

Assessment

Through portfolio submissions, all students demonstrated the achievement of ability-based outcomes for providing pharmaceutical care, evaluating the literature, and managing the medication use system with patient case reports most frequently submitted. The rubric review of self-reflective essays addressed student learning through APPEs and continuing professional development plans.

Conclusion

The electronic portfolio with reflective essay proved to be a useful vehicle to demonstrate achievement of ability-based outcomes.     

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.     

Canadian Pharmacy Students' Knowledge of Herbal Medicine

Objective

To determine fourth-year Canadian pharmacy students'' knowledge of herbal medicine and whether that knowledge is associated with mandatory instruction in herbal medicine.

Methods

Standardized multiple-choice tests assessing students'' herbal knowledge were distributed to all fourth-year BSc pharmacy students at 5 pharmacy schools in Canada.

Results

The Quebec response rate was too low to include in the analysis. Herbal knowledge test scores were positively associated with having previously taken an herbal medicine class and completion of a pharmacy practicum. However, postsecondary education, age, and gender were not associated with herbal knowledge test scores. Students at the University of British Columbia had the highest score, followed by Alberta, Nova Scotia, and Ontario.

Conclusion

Pharmacy students'' knowledge of herbal medicine varies depending on the school attended and higher herbal knowledge test scores appear to be most closely related to mandatory herbal instruction.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Pharmacy students' approaches to learning in undergraduate and graduate entry programs

Objectives

To compare longitudinal data with previous cross-sectional data regarding Australian undergraduate pharmacy students'' approaches to learning, and explore the differences in approaches to learning between undergraduate and postgraduate cohorts.

Methods

Longitudinal, repeated measures design using a validated self-report survey instrument were used to gather data.

Results

Undergraduate students'' preferences for meaning directed, undirected, and reproduction-directed approaches to learning displayed the same pattern across the 2 studies; however, application-directed scores increased significantly in the second half of the undergraduate degree program. Commencing postgraduate students'' approaches to learning were similar to finishing undergraduate students, and this group was significantly more oriented towards meaning-directed learning compared to undergraduate students.

Conclusions

Pharmacy students'' maturation in approach to their learning was evident and this bodes well for pharmacists'' engaging in life-long learning and capacity to work in increasingly complex health settings.     

Guest speakers in a professional development seminar series

Objective

To evaluate the impact guest speakers have on student development in a professional development seminar series.

Design

Over a 5-semester period, presentations were given by 18 guest speakers as part of a professional development seminar series.

Assessment

A 28-item survey instrument was constructed and administered to 68 students to assess the impact of the guest speakers on the students'' professional development. Forty-six (68%) students completed the survey instrument, and the results demonstrated the value of the guest speakers, most notably in the areas of career development and professional responsibility.

Conclusion

Exposing pharmacy students to guest speakers from varied pharmacy career paths positively impacted students'' knowledge of career options and professional development.     

A clinical nutrition course to improve pharmacy students' skills and confidence in counseling patients

Objective

To create, implement, and evaluate a PharmD course on primary care nutrition.

Design

A 2-credit hour elective course was offered to second- and third-year pharmacy students. It was informed by the Socratic method using a minimum number of formal lecture presentations and featured problem-based learning exercises, case-based scenarios, and scientific literature to fuel informed debate. A single group posttest design with a retrospective pretest was used to assess students'' self-efficacy.

Assessment

There was a significant overall improvement in students'' self-efficacy in their ability to practice primary care nutrition.

Conclusion

Completion of a nutrition course improved students'' confidence in providing primary care nutrition and empowered them to speak more comfortably about the role of nutrition in the prevention of chronic diseases.