Improving medical and pharmacy student confidence in medication management and attitudes about interprofessional collaboration by utilizing an interprofessional module

Geriatric education for pharmacy students: A scoping review

BACKGROUND

Comprehensive medication management for older adults requires specific knowledge and skills. Therefore, pharmacy curricula should include appropriate strategies to prepare students for care of this population. This scoping review aimed to identify how geriatric concepts, such as geriatric topics and competencies, are included in pharmacy curricula, and to map current literature on preferred teaching and assessment methods related to geriatric pharmacy education.

METHODS

Four databases were searched to identify papers involving pharmacy learners, education, and geriatrics. Selection process was a two-step approach, involving independent title/abstract screening by two reviewers, then full-text retrieval for eligibility assessment. All types of articles were considered except opinion papers. Data extraction included details on methodology, participants, setting, educational activity, teaching method, and outcomes assessed.

RESULTS

A total of 2537 articles were identified from which 189 met the inclusion criteria: 221 documents after citation and gray literature searching. Articles were grouped for analysis as education-related intervention articles (studies, n = 100 or descriptive articles/case reports, n = 49), studies not including an education-related intervention (n = 49), and others (e.g., reviews, position papers/statements, n = 23). Various teaching methods were reported including experiential, didactic, interprofessional, or simulation. Most articles reported positive outcomes on skills, knowledge, or attitudes, but few articles used a validated assessment tool. Curricula and student's surveys were consistent with suboptimal geriatric education, with few programs offering mandatory dedicated geriatric courses or rotations.

CONCLUSIONS

Gaps remain regarding geriatric inclusion in pharmacy curricula despite decades of evidence, advocacy, and frameworks to guide its development. A wide diversity of teaching methods has been described and their combination may be considered for skills and competency development. There is a need for the scholarship of teaching and learning to be applied to pharmacy programs in order to prepare future pharmacists for an aging society.

Educational Interventions for Medical Students to Improve Pharmacological Knowledge and Prescribing Skills: A Scoping Review

Introduction

Medication-related errors place a heavy financial burden on healthcare systems worldwide, and mistakes are most likely to occur at the stage of prescribing. Junior doctors are more likely to make prescribing errors, and medical graduates also lack confidence and preparedness towards prescribing. Thus, this review aimed to evaluate the existing educational approaches to improve pharmacological knowledge and prescribing skills among medical students.

Methods

CENTRAL, CINAHL, ERIC, Ovid Embase, Ovid MEDLINE, Ovid PsycINFO, and Scopus were searched with keywords related to "pharmacological knowledge", "prescribing skills", "educational interventions" for articles published since 2016.

Results

3595 records were identified, and 115 full-text articles were assessed for eligibility. Eighty full-text articles were eligible and included in this review. Thirty-seven studies focused on improving prescribing skills, whilst 43 targeted pharmacological knowledge. A broad range of interventions was implemented, including e-learning, case-based, interprofessional, and experiential learning. Pharmacological knowledge and prescribing skills were measured in various ways, and all studies reported one or more positive findings at Kirkpatrick level 1 or 2. No study reported outcomes at Kirkpatrick levels 3 and 4.

Discussion

The World Health Organisation's Good Guide to Prescribing was the foundation of the development of prescribing educational interventions. Emerging interventions such as experiential and interprofessional learning should be incorporated into the prescribing curriculum. Innovative approaches such as game-based learning can be considered for clinical pharmacology teaching. However, there was a lack of outcomes at Kirkpatrick levels 3 and 4. Robust methodology and reliable outcome measures are also needed in future studies.

Interprofessional education for shared decision making in drug therapy: a scoping review

The current complex scenario of medication use calls for the implementation of interprofessional education (IPE) initiatives focused on shared decision making (SDM) in drug therapy. A scoping review was conducted to collate, summarize, and report the evidence available on IPE teaching and learning approaches in this context, involving pre-licensure healthcare students. Searches were conducted in seven electronic databases, with 21 articles meeting the inclusion criteria. This review examines educational strategies employed for interprofessional SDM as well as characteristics of students, teachers, and tutors involved in IPE interventions. The reviewed studies lack detailed description of the students' decision-making process, and none addresses aspects related to patient preferences as a part of learning outcomes. We identified shortcomings in how IPE interventions are assessed and reported. Only a few of the studies explicitly describe the use of competency-based frameworks proposed by national and international organizations, and less than 60% describe learning outcomes. The absence of experiences focused on interprofessional SDM in drug therapy suggests a gap that needs to be addressed with future studies evaluated in a robust way. We argue that such experiences enable students, as a team, to learn to share decisions with the patient as an effective team member.

Interprofessional education focused on medication safety: a systematic review

Safe medication use necessitates interprofessional working, with calls to enhance interprofessional education (IPE) focusing on medication safety (MS) in healthcare professional (HCP) curricula. Little is known about the design, delivery or evaluation of such activities. This systematic literature review describes MS-focused IPE activities in pre-qualification HCP programmes. MedLine, EMBASE, CINAHL and ERIC were searched, relevant studies identified and data extracted. The McGill Mixed Methods Appraisal Tool was employed. The 3P (presage-process-product) theory structured deductive analysis. Thirty-one studies were included, reporting on 30 activities, mostly undertaken in North America or United Kingdom. Presage/Design: Most reported activities involved pharmacy, nursing, medical or physician assistant students learning with one or more other HCP group. Few studies matched student groups' skills or experiences. Few studies reported theoretical underpinnings. Process/Delivery: Multiple pedagogical approaches were employed, mostly social construction, and low- and high-fidelity simulation-based learning. Few studies reported learning outcomes or summative assessment, more reported formative assessment. Product/evaluation: Outcomes measured were learners' opinions, satisfaction or attitudes toward interprofessional working and findings were generally positive. Few studies reported on student development or outcomes specific to medication safety. Lack of integration of qualitative/quantitative components of mixed methods studies and limited outcome measurements' validity or reliability weakened study quality. MS-focused IPE for pre-qualification HCPs is well received by students. Design of future activities could be enhanced by employing theory and ensuring matching of students' and groups' skills, professional identity and learner attributes to enhance learning in an interprofessional setting. Future delivery should embed MS-focused IPE into the standard curricula to optimize constructive alignment, learner engagement, quality and drive development. The required skillset in pre-qualification HCP programmes to facilitate future safe medication practice, together with the associated learning outcomes and assessment approaches, should be defined. The quality of scholarly studies examining these activities needs improvement.

Enablers and challenges to pharmacy practice change in Kuwait hospitals: a qualitative exploration of pharmacists' perceptions

RATIONALE, AIMS, AND OBJECTIVES

The practice of hospital pharmacists in many developing countries has been changing to include the delivery of direct patient care services, but practice change can be a challenging process. This article explores the perceptions of hospital pharmacists in Kuwait about the enablers and challenges to expanding their scope of practice to include direct patient care.

METHODS

A phenomenological qualitative approach was employed to conduct focus group interviews to explore pharmacists' perceptions about their professional practice at different hospitals across Kuwait. Data were collected from 110 pharmacists using 11 focus group interviews. The interviews were audio-recorded, transcribed verbatim, and analysed using framework analysis.

RESULTS

The practice of most hospital pharmacists includes limited direct patient care role. However, a growing number of pharmacists have been introducing clinical pharmacy services at hospitals. Three themes about enablers to practice change emerged from data: (a) increasing physicians' acceptance to pharmacists' role in patient care, (b) patients' trust in pharmacists' knowledge about medications, and (c) pharmacists' perceived benefits of providing direct patient care. These benefits includes enhancing patients' safety and adherence to therapy and improving the professional identity of pharmacists. Participants' perceived challenges to practice change include professional, individual, and organizational challenges. Most participants welcomed assuming direct patient care role. They agreed that pharmacists need to receive adequate education and training and to be equipped with a clinical degree to responsibly provide direct patient care services at hospitals.

CONCLUSIONS

Pharmacists have been increasingly attempting to provide clinical pharmacy services in Kuwait hospitals. This qualitative data revealed breadth of challenges hindering pharmacists' attempts to expand their professional practice to include direct patient care role. It also outlines facets of improvement and enablers to practice change. The collaboration between different stakeholders in the profession is essential to support pharmacists' efforts in achieving the change in the scope of pharmacy practice to improve patient care services.

Medicine, pharmacy and nursing trainees' perceptions of curriculum preparation to deprescribe and interprofessional roles in the deprescribing process

With increasing rates of polypharmacy among older adults, preparedness of current and future health care professionals to identify and deprescribe potentially inappropriate medications (PIMs) is critical. Medicine (n = 28), pharmacy (n = 35) and nursing (n = 11) trainees enrolled in an interprofessional course completed a survey assessing preparedness, confidence and attitudes toward deprescribing, and perception of interprofessional roles in the process. Pharmacy (p = .001) and nursing (p = .007) felt that their curriculum prepared them better to identify and deprescribe PIMs compared to medicine trainees. Pharmacy trainees perceived significantly more barriers to deprescribing compared to medicine (p = .003), but not nursing trainees. Physicians and pharmacists were perceived as the main drivers of the deprescribing process. Current curricular content should be modified to address lack of preparedness to deprescribe in clinical practice. Addressing such gaps as part of an interprofessional team may increase interprofessional role recognition and translate into changes in clinical practice as trainees move into the workforce.