Assessing students' knowledge regarding the roles and responsibilities of a pharmacist with focus on care transitions through simulation

A transitions of care (TOC) PharmD elective and its impact on students' perceptions on their TOC knowledge, skills, and attitudes

INTRODUCTION

Transitions of care (TOC) continue to evolve as a problem within our health care system and is a direct driver to worsened patient outcomes. Currently information of in-depth instruction and application of TOC content within health care education, especially pharmacy, is limited. In 2012, a small team of faculty members created a specialized TOC pharmacy elective for third year doctor of pharmacy students. The purpose of this paper is to describe the impact of this TOC course on students' perceptions on their TOC knowledge, skills, and attitudes over the four years course span.

METHODS

A pre-/post-paper anonymous survey was distributed to the students. Descriptive statistics captured the analyzed survey questions into four main themes. Within each respective theme, quantitative data were provided for pre- and post-survey responses to illustrate the difference in the scores with corresponding P values to showcase if significance was present.

RESULTS

The response rate of the survey was 100%. Within all of the respective themes, all of the survey questions, pre- to post-responses, had a significant shift toward a higher degree of agreement.

CONCLUSIONS

This study illustrates the impact a course dedicated to TOC has on student's learning.

Transitions of care education in US colleges and schools of pharmacy

INTRODUCTION

Pharmacist-led transitions of care (TOC) services have demonstrated a positive impact on patient care and professional pharmacy organizations recommend integration of TOC-related education into doctor of pharmacy (PharmD) curricula. The objective of this study is to determine the extent to which TOC is taught in United States (US) colleges and schools of pharmacy and to characterize the educational content and the instructional methods used.

METHODS

An 18-question electronic survey about TOC education was sent to US school of pharmacy faculty. One survey response per school was requested. Schools with an accredited or candidate-status PharmD program were included and duplicate responses from schools were adjudicated and combined.

RESULTS

The survey response rate was 54.6% (n = 77). Of the responding schools, 92.2% reported incorporating TOC content into their required didactic curriculum and 43.1% reported incorporating TOC content in their elective didactic curriculum. Of the 11 TOC-related topics included in the survey, 3 were covered universally in the required or elective didactic curricula of responding schools. Both lecture and active-learning pedagogies were used to teach TOC. Introductory pharmacy practice experiences and advanced pharmacy practice experiences that incorporate TOC were offered at 85.3% and 98.5% of schools, respectively.

CONCLUSION

Most schools of pharmacy who responded to this survey included TOC-related content in their curricula. Research into best practices for educating students on this topic is needed to help ensure graduates are prepared to contribute to this area of practice.

A qualitative dual-site analysis of the pharmacist discharge care (PHARM-DC) intervention using the CFIR framework

Introduction

Older adults face several challenges when transitioning from acute hospitals to community-based care. The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits at two large hospitals. This study used the Consolidated Framework for Implementation Research (CFIR) framework to evaluate pharmacist perceptions of the PHARM-DC intervention.

Methods

Intervention pharmacists and pharmacy administrators were purposively recruited by study team members located within each participating institution. Study team members located within each institution coordinated with two study authors unaffiliated with the institutions implementing the intervention to conduct interviews and focus groups remotely via telecommunication software. Interviews were recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Qualitative analysis was performed using an iterative process to identify “a priori” constructs based on CFIR domains (intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation) and to create overarching themes as identified during coding.

Results

In total, ten semi-structured interviews and one focus group were completed across both hospitals. At Site A, six interviews were conducted with intervention pharmacists and pharmacists in administrative roles. Also at Site A, one focus group comprised of five intervention pharmacists was conducted. At Site B, interviews were conducted with four intervention pharmacists and pharmacists in administrative roles. Three overarching themes were identified: PHARM-DC and Institutional Context, Importance of PHARM-DC Adaptability, and Recommendations for PHARM-DC Improvement and Sustainability. Increasing pharmacist support for technical tasks and navigating pharmacist-patient language barriers were important to intervention implementation and delivery. Identifying cost-savings and quantifying outcomes as a result of the intervention were particularly important when considering how to sustain and expand the PHARM-DC intervention.

Conclusion

The PHARM-DC intervention can successfully be implemented at two institutions with considerable variations in TOC initiatives, resources, and staffing. Future implementation of PHARM-DC interventions should consider the themes identified, including an examination of institution-specific contextual factors such as the roles that pharmacy technicians may play in TOC interventions, the importance of intervention adaptability to account for patient needs and institutional resources, and pharmacist recommendations for intervention improvement and sustainability.

Trial registration

NCT04071951.

Usability assessment of an open-source simulated electronic medical record in pharmacy education

BACKGROUND AND PURPOSE

The growth of electronic medical records (EMRs) has been a critical component of evolving pharmacy practice, catalyzed by foundational initiatives such as the HITECH Act in 2009. The objective of this study was to evaluate the usability and student perceptions of a novel, open-source, educational EMR (EdEMR) for integration in the PharmD program at the University of British Columbia (UBC).

EDUCATIONAL ACTIVITY AND SETTING

Participants were PharmD students at UBC and had to complete a series of survey questions and EdEMR tasks including a Systems Usability Scale (SUS) evaluation. Task completion time, mouse clicks, SUS score, and 5-point Likert scale rankings of student opinions on the use of the EdEMR were collected.

FINDINGS

Seven students successfully completed the study. Participants self-ranked themselves as novice EMR users who used EMRs a few times a week. The mean time to complete the tasks was 6 min, 42 seconds and was approximately double that of benchmark times (mean benchmark = 2 min, 20 seconds). The EdEMR scored within the upper quartile of SUS scores (mean = 83), indicating good usability. Participants identified that the EMR would most optimally be used for distance learning and case-based learning.

SUMMARY

The EdEMR showed good usability as demonstrated by the successfully completed tasks and SUS score. Participants were receptive to the EdEMR's application as an online learning tool and for case-based learning. The EdEMR is an enticing, open-source tool currently available to all pharmacy programs and could further support online and remote teaching.

Student pharmacists' perspectives on training, readiness, and confidence to provide transition of care services

INTRODUCTION

Previous research has shown that pharmacists can have an essential role in improving patient care transitions. However, the extent of student pharmacists' training, readiness, and confidence in ability to provide transitions of care (TOC) remains unclear. Our goal was to examine student pharmacist preparation, readiness, and confidence for engaging in TOC.

METHODS

Second-year student pharmacists at two schools/colleges of pharmacy in the United States were asked questions about their training, readiness, and confidence for providing TOC services. Descriptive statistics were used to analyze data.

RESULTS

In all, 113 (59 Western New England University [WNE] and 54 University of Wyoming [UWYO]) second-year pharmacy students received the survey request and 78 (50 WNE and 28 UWYO) completed the survey, resulting in an overall response rate of 69%. Participants reported that pharmacy coursework provided the highest level of preparedness to offer TOC services (37%), followed by introductory pharmacy practice experiences (31%). Most participants reported having the highest level of confidence for activities related to gathering patient medication histories during TOC (46.1%), and similarly, this category of activity showed the highest population of participants who indicated a positive level of readiness (41.3%).

CONCLUSIONS

Applicable training and experiences with TOC increase the likelihood of greater confidence and readiness for student pharmacists to provide TOC at their future practice sites. These results provide a framework for additional quantitative research in TOC engagement among student pharmacists.

Pharmacy students' perspectives on the initial implementation of a teaching electronic medical record: results from a mixed-methods assessment

BACKGROUND

Electronic medical records (EMRs) have been used for nearly three decades. Pharmacists use EMRs on a daily basis, but EMRs have only recently been incorporated into pharmacy education. Some pharmacy programs have implemented teaching electronic medical records (tEMRs), but best practices for incorporating tEMRs into pharmacy education remain unknown. The objectives of this study were to 1) assess pharmacy students' views and experiences with a tEMR; and 2) identify current learning activities and future priorities for tEMR use in pharmacy education.

METHODS

We used a mixed-methods approach, including three, two-hour student focus groups and a 42-item web-based survey to examine student perspectives of the tEMR. All first, second, and third year professional pharmacy students were eligible to participate in the survey and a focus group. Web-based survey items were measured on a 7-point Likert scale, and quantitative analyses included descriptive statistics. Two researchers independently coded transcripts using both deductive and inductive approaches to identify emergent themes. These analysts met and resolved any coding discrepancies via consensus.

RESULTS

Focus groups were conducted with 22 total students, with 6-8 students represented from each year of pharmacy training. The survey was completed by 156 students: 47 first year, 55 second year, and 54 third year. Overall, 48.7% of survey respondents altogether agreed or strongly agreed that using the tEMR enhanced their learning in pharmacy classes and laboratories. Qualitative data were organized into four major themes regarding tEMR adoption: current priorities for use within the pharmacy curriculum; tEMR benefits; tEMR barriers; and future priorities for tEMR use to prepare students for pharmacy practice.

CONCLUSIONS

This study reveals pharmacy students' perspectives and attitudes towards using a tEMR, the types of classroom activities that incorporate the tEMR, and students' future suggestions to enhance the design or application of the tEMR for their learning. Our research findings may aid other pharmacy programs and promote more effective use of tEMRs in pharmacy education. In the long-term, this study may strengthen pharmacy education on EMRs and thus increase the efficacy and safety of pharmacists' EMR use for patients' medication management.

Description of a transitions of care and telemedicine simulation lab activity

BACKGROUND AND PURPOSE

Transitions of Care (ToC) is an important clinical practice area requiring trained health care professionals, but there is limited literature describing ToC in the didactic curriculum. The purpose of this study was to describe and evaluate a ToC telemedicine simulation activity in a doctor of pharmacy curriculum.

EDUCATIONAL ACTIVITY AND SETTING

A one-hour lecture and simulation activity was incorporated into a second-year course. Student teams participated in discharge and telemedicine encounters with standardized patients (SPs). Six medication-related problems (MRPs) were incorporated into the activity. Activity documents were collected to identify student competency.

FINDINGS

Fifty-nine student pharmacists in 16 teams participated. All teams accurately identified five of the six MRPs. Fourteen teams (87.5%) accurately identified the sixth MRP after completion of the telemedicine encounter. Six teams (62.5%) completed the discharge medication list accurately and completely. All teams provided medication education, and 93.8% (n = 15) of teams identified follow-up was needed. Ten teams utilized effective interview sequence and structure during both encounters. Activity challenges included resources, financial support and SP training.

SUMMARY

Case-based learning and the use of simulation has good evidence supporting its use in education. Utilizing these techniques to reinforce concepts may be a beneficial way for students to be trained effectively to deliver impactful ToC services.

Pharmacy Student Performance in a Capstone Course Utilizing the Pharmacists' Patient Care Process

Objective. To develop, implement, and assess student performance and confidence in a pharmacy capstone course that used case-based instruction and the Pharmacist's Patient Care Process (PPCP) to develop patient work-up skills in third-year Doctor of Pharmacy (PharmD) students. Methods. A skills-based capstone course was developed by a team of faculty members and instructional designers that focused on patient evaluation skills and applying the steps of the PPCP to complex patient cases housed in a simulated electronic health record (SEHR). The acuity of the cases increased over the course of the semester. For each patient case, students were expected to identify drug-related problems and develop an assessment and plan based on the information provided in the SEHR. Results. Students (n=134) were assessed through weekly quizzes and two practical examinations. The average score for all quizzes was 81%. A significant correlation was found between average quiz scores and performance on the end-of-course practical examination. Student scores significantly improved from the first to the second practical examination (10.4 vs 12.9, respectively), and student confidence with regard to all course objectives significantly improved from the beginning to the end of the semester. Conclusion. A capstone course that applied the PPCP framework successfully taught third-year PharmD students the patient care skills they would need in advanced pharmacy practice experiences.

Evaluation of a sepsis teaching rounds simulation for pharmacy students

BACKGROUND AND PURPOSE

The goal of this prospective, observational cohort study was to determine if simulated interdisciplinary teaching rounds improved student perceptions of confidence and attitudes towards working as part of a team. The secondary objective of this study was to investigate changes in student knowledge of the management of sepsis.

EDUCATIONAL ACTIVITY AND SETTING

Students participated in a traditional sepsis lecture followed by a simulated interdisciplinary rounding experience. Confidence and collaborative attitudes were assessed using a 5-point Likert scale (1=strongly disagree, 5=strongly agree). Changes in knowledge were measured using multiple choice questions. Students completed these tools at three points in time: pre-lecture, post-lecture, and post-simulation.

FINDINGS

Student confidence and attitudes related to interdisciplinary rounds improved following the simulation (2 of 4 items, p=0.003; 2 of 5 items, p<0.05). Also, most students agreed or strongly-agreed that the simulation reinforced knowledge gained from lecture (94.7%), that lecture followed by a simulation was the most effective way to learn about sepsis (94.7%), and that the simulation helped reinforce critical-thinking skills (94.7%). Knowledge improved between the didactic lecture and the simulation, but these differences were not found to be statistically significant.

SUMMARY

A simulated interdisciplinary rounding experience may increase student confidence during teaching rounds and improve attitudes towards working alongside other healthcare professionals. Incorporating rounding simulations into pharmacy curricula may be beneficial towards student success on rounds.

The Impact of Phone Interruptions on the Quality of Simulated Medication Order Validation Using Eye Tracking: A Pilot Study

INTRODUCTION

Order validation is an important component of pharmacy services, where pharmacists review orders with a focus on error prevention. Interruptions are frequent and may contribute to a reduction in error detection, thus potential medication errors. However, studying such errors in practice is difficult. Simulation has potential to study these events.

METHODS

This was a pilot, simulation study. The primary objective was to determine the rate of medication error detection and the effect of interruptions on error detection during simulated validation. Secondary objectives included determining time to complete each prescription page. The scenario consisted of validating three handwritten medication order pages containing 12 orders and 17 errors, interrupted by three phone calls timed during one order for each page. Participants were categorized in groups: seniors and juniors (including residents). Simulation sessions were videotaped and eye tracking was used to assist in analysis.

RESULTS

Eight senior and five junior pharmacists were included in the analysis. There was a significant association between interruption and error detection (odds ratio = 0.149, 95% confidence interval = 0.042-0.525, P = 0.005). This association did not vary significantly between groups (P = 0.832). Juniors took more time to validate the first page (10 minutes 56 seconds vs. 6 minutes 42 seconds) but detected more errors (95% vs. 69%). However, all major errors were detected by all participants.

CONCLUSIONS

We observed an association between phone interruptions and a decrease in error detection during simulated validation. Simulation provides an opportunity to study order validation by pharmacists and may be a valuable teaching tool for pharmacists and pharmacy residents learning order validation.

Allocation of faculty and curricular time to the teaching of transitions of care concepts by colleges of pharmacy

INTRODUCTION

To determine the allocation of faculty and curricular time to the teaching of transitions of care (ToC) concepts by colleges of pharmacy (COPs) to equip students with the necessary skills for the provision of these services.

METHODS

A novel 15-question anonymous electronic survey was sent to 136 pharmacy practice chairpersons.

RESULTS

Response rate was 26.5% (n = 36). Of these, 47% employed ToC faculty while 44% are not actively recruiting for that position in the foreseeable future. Median total curriculum hours dedicated to teaching ToC was four (interquartile range two to 10 hours). Medication reconciliation skills were taught didactically and via interactive lab sessions by 53% of respondents. Only 11% offered an interdisciplinary ToC program. A significant association between not having ToC faculty and lack of implementation of ToC concepts within a pharmacy curriculum (p = 0.02, Fisher's Exact) and practice site (p = 0.045, Pearson's) was observed. Barriers to adopting ToC within the curriculum (e.g., uncertainty of placement within curriculum, resistance by faculty and administrators) and at a practice site (e.g., inadequate infrastructure to accommodate ToC delivery, ToC faculty unavailability and resistance by other health care providers) were reported.

DISCUSSION AND CONCLUSIONS

This study demonstrated that COPs devote curricular time to ToC activities and involve dedicated faculty in the provision of these services. Several barriers to employing ToC faculty and planning additional time in the curriculum for teaching these skills were identified. Future research should determine the best methods for training students to ensure competence in performing ToC tasks.