Alignment of CanMEDS-based Undergraduate and Postgraduate Pharmacy Curricula in The Netherlands

Fostering moral reflectivity in community pharmacists through moral case deliberation using the dilemma method

BACKGROUND

Moral case deliberation has been successfully implemented in multidisciplinary groups of secondary care professionals to support ethical decision making. It has not yet been reported for community pharmacists.

AIM

This study investigated whether moral case deliberation fosters moral reflectivity in community pharmacists.

METHOD

Two moral case deliberations with 14 community pharmacists were guided by two facilitators. One session was described and illustrated with participants' quotes, detailing each reflection step of the method. An adapted version of the Maastricht evaluation questionnaire was used to understand the effects of the moral case deliberation on participants' moral reflectivity skills both quantitatively and qualitatively.

RESULTS

In a 2-h session, pharmacists reflected on a moral dilemma concerning double anticoagulant therapy of one presenter pharmacist. Participants discussed the pros and cons of two potential actions: dispensing the medication as prescribed without contacting the patient or contacting the patient first. Deliberation highlighted the importance of understanding the patient's perspective, leading the presenter and two others to shift towards the latter action. The evaluation questionnaire revealed that all 14 participants felt supported by the deliberation and the facilitator in recognising the dilemma's moral dimension and understanding their own and others' values behind arguments and how these influenced different perspectives. They all felt encouraged to critically reflect, to ask open questions and to delay judgements. The method helped all to morally justify their final decision, with six participants arriving at a decision different from their initial perspective towards the dilemma's resolution.

CONCLUSION

This study demonstrates that moral case deliberation enables pharmacists to critically examine their reasoning and reach morally sound resolutions, supporting pharmacists' professionalism and ethical decision-making.

Pharmacists and pharmacy students' perceptions on how a new teaching model supports their clinical decision-making

BACKGROUND AND PURPOSE

Clinical decision-making (CDM) is crucial in pharmacy practice, necessitating effective teaching in undergraduate and postgraduate pharmacy education. This study aims to explore undergraduates and postgraduates' perceptions of how a new teaching model supports their CDM when addressing patient cases.

EDUCATIONAL ACTIVITY AND SETTING

Implemented in a full-day CDM course for pharmacy students and a half-day course for pharmacists in the Netherlands, the model, accompanied by a learning guide, facilitated CDM in patient cases. Eight courses were conducted between September 2022 to June 2023, followed by an online survey measuring participants' agreement on how the model supported their CDM, using a 5-point Likert scale. Additionally, three open-ended questions were included to elicit learning outcomes and self-development opportunities.

FINDINGS

Of 175 invited participants, 159 (91%) completed the survey. Most agreed the teaching model supported their CDM, particularly in considering the patient's healthcare needs and context (96%), and exploring all available options (96%). Participants found the model provided a clear structure (97%), and fostered critical thinking (93%). The most frequently mentioned learning outcomes and self-development opportunities included collecting sufficient relevant information, maintaining a broad perspective, and decelerating the process to avoid premature closure.

SUMMARY

Participants agreed that the teaching model helped them to make clinical decisions. Both undergraduate and postgraduate pharmacy education could possibly benefit from the teaching model's implementation in supporting pharmacy students and pharmacists conducting CDM in pharmacy practice.

Curriculum, competency development, and assessment methods of MSc and PhD pharmacy programs: a scoping review

BACKGROUND/OBJECTIVES

We aim to systematically review and evaluate the current landscape of postgraduate pharmacy education to a) identify current evidence, best practices, challenges, recommendations, and solutions; and b) develop a framework to optimize postgraduate pharmacy programs.

METHODS

A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Electronic databases, including PubMed, Scopus, EMBASE, ProQuest, Web of Science, and Google Scholar were utilized. The search covered studies published from January 2011 to September 2023. Following the principles of Arksey and O'Malley's framework, data charting and extraction were performed using a pre-designed data collection tool, followed by the synthesis and grouping of studies based on common themes.

RESULTS

Of the 5542 articles found, the review included 36 eligible ones focusing on pharmacy postgraduate education (PhD and MSc), grouped into three themes: 1) courses and curriculum; 2) training and skills development; 3) assessment and mentorship methods. Utilized methodologies included descriptive analyses, questionnaires, surveys, trials, and focus groups/interviews. The studies underscored the need for competency-based curricula with regular evaluations, career planning, and diverse course offerings. Identified key skills and competencies in the studies included soft skills, communication, research, desperate skills (e.g., leadership and management), and critical thinking. The studies also emphasized the value of comprehensive evaluation and peer review methods. Challenges included balancing academic and real-world requirements, training, limited resources, time constraints, and faculty workload.

CONCLUSION

Evidence-based suggestions to improve postgraduate pharmacy education include the implementation of practice-oriented courses, value of tailored/or comprehensive assessments, focus on real-world skills, effectiveness of advanced teaching methods, and mentorship role. The proposed framework can guide program enhancement and highlight the need to improve programs holistically, entailing the three themes.

Development of the entrustable professional activity 'medication reconciliation' for clinical pharmacy

BACKGROUND

Entrustable professional activities (EPAs) are observable process descriptions of clinical work units. EPAs support learners and tutors in assessment within healthcare settings. For use amongst our pharmacy students as well as pre-registration pharmacists we wanted to develop and validate an EPA for use in a clinical pharmacy setting at LMU University Hospital.

METHODS

The development of the clinical pharmacy EPA followed a set pathway. A rapid literature review informed the first draft, an interprofessional consensus group consisting of pharmacists, nurses, and medical doctors refined this draft. The refined version was then validated via online survey utilising clinical pharmacists from Germany.

RESULTS

We designed, refined and validated an EPA regarding medication reconciliation for assessment of pharmacy students and trainees within the pharmacy department at LMU University Hospital in Munich. Along with the EPA description an associated checklist to support the entrustment decision was created. For validation an online survey with 27 clinical pharmacists from all over Germany was conducted. Quality testing with the EQual rubric showed a good EPA quality.

CONCLUSIONS

We developed the first clinical pharmacy EPA for use in a German context. Medication reconciliation is a suitable EPA candidate as it describes a clinical activity performed by pharmacists in many clinical settings. The newly developed and validated EPA 'Medication Reconciliation' will be used to assess pharmacy students and trainees.

An undergraduate course on pain: Its impact on students' empathy

INTRODUCTION

Empathy towards patients in pain involves an internal process in which both affective and cognitive processes in the observer are responsible for a final behavioral reaction. This study investigated the impact of an undergraduate elective course on pain on students' empathy in a mixed-method design.

METHODS

Undergraduate students of the elective course on pain (intervention group) as well as undergraduate students of a compulsory course on neuropharmacology (control group) completed the Dutch version of the Interpersonal Reactivity Index (IRI) questionnaire at the beginning and the end of the course. In addition, students' empathy in the intervention group was explored by content analysis of students' reflective writing assignments related to documentary films that were part of the course activities.

RESULTS

Twenty students (intervention group) and seven students (control group) completed both IRI questionnaires. IRI scores for subscales perspective taking, fantasy, and personal distress significantly increased over time more in the intervention group than in the control group (intervention x time interaction). Effect sizes (generalized eta squared) for these effects were 0.084, 0.041, and 0.139 for perspective taking, fantasy, and personal distress, respectively. The qualitative data revealed information on cognitive and affective responses, and to some extent behavioral responses.

CONCLUSIONS

Both IRI outcomes and analysis of the reflective assignments demonstrate that students' empathy increased during the course on pain. Further research should explore in-depth the effects of different documentaries in the course on students' empathy development and the long-term effect of the course on students' empathy.

Emerging concepts in the CanMEDS physician competency framework

Background

The CanMEDS physician competency framework will be updated in 2025. The revision occurs during a time of disruption and transformation to society, healthcare, and medical education caused by the COVID-19 pandemic and growing acknowledgement of the impacts of colonialism, systemic discrimination, climate change, and emerging technologies on healthcare and training. To inform this revision, we sought to identify emerging concepts in the literature related to physician competencies.

Methods

Emerging concepts were defined as ideas discussed in the literature related to the roles and competencies of physicians that are absent or underrepresented in the 2015 CanMEDS framework. We conducted a literature scan, title and abstract review, and thematic analysis to identify emerging concepts. Metadata for all articles published in five medical education journals between October 1, 2018 and October 1, 2021 were extracted. Fifteen authors performed a title and abstract review to identify and label underrepresented concepts. Two authors thematically analyzed the results to identify emerging concepts. A member check was conducted.

Results

1017 of 4973 (20.5%) of the included articles discussed an emerging concept. The thematic analysis identified ten themes: Equity, Diversity, Inclusion, and Social Justice; Anti-racism; Physician Humanism; Data-Informed Medicine; Complex Adaptive Systems; Clinical Learning Environment; Virtual Care; Clinical Reasoning; Adaptive Expertise; and Planetary Health. All themes were endorsed by the authorship team as emerging concepts.

Conclusion

This literature scan identified ten emerging concepts to inform the 2025 revision of the CanMEDS physician competency framework. Open publication of this work will promote greater transparency in the revision process and support an ongoing dialogue on physician competence. Writing groups have been recruited to elaborate on each of the emerging concepts and how they could be further incorporated into CanMEDS 2025.

Validity evidence for summative performance evaluations in postgraduate community pharmacy education

INTRODUCTION

Workplace-based assessment of competencies is complex. In this study, the validity of summative performance evaluations (SPEs) made by supervisors in a two-year longitudinal supervisor-trainee relationship was investigated in a postgraduate community pharmacy specialization program in the Netherlands. The construct of competence was based on an adapted version of the 2005 Canadian Medical Education Directive for Specialists (CanMEDS) framework.

METHODS

The study had a case study design. Both quantitative and qualitative data were collected. The year 1 and year 2 SPE scores of 342 trainees were analyzed using confirmatory factor analysis and generalizability theory. Semi-structured interviews were held with 15 supervisors and the program director to analyze the inferences they made and the impact of SPE scores on the decision-making process.

RESULTS

A good model fit was found for the adapted CanMEDS based seven-factor construct. The reliability/precision of the SPE measurements could not be completely isolated, as every trainee was trained in one pharmacy and evaluated by one supervisor. Qualitative analysis revealed that supervisors varied in their standards for scoring competencies. Some supervisors were reluctant to fail trainees. The competency scores had little impact on the high-stakes decision made by the program director.

CONCLUSIONS

The adapted CanMEDS competency framework provided a valid structure to measure competence. The reliability/precision of SPE measurements could not be established and the SPE measurements provided limited input for the decision-making process. Indications of a shadow assessment system in the pharmacies need further investigation.

An online Delphi study to investigate the completeness of the CanMEDS Roles and the relevance, formulation, and measurability of their key competencies within eight healthcare disciplines in Flanders

BACKGROUND

Several competency frameworks are being developed to support competency-based education (CBE). In medical education, extensive literature exists about validated competency frameworks for example, the CanMEDS competency framework. In contrast, comparable literature is limited in nursing, midwifery, and allied health disciplines. Therefore, this study aims to investigate (1) the completeness of the CanMEDS Roles, and (2) the relevance, formulation, and measurability of the CanMEDS key competencies in nursing, midwifery, and allied health disciplines. If the competency framework is validated in different educational programs, opportunities to support CBE and interprofessional education/collaboration can be created.

METHODS

A three-round online Delphi study was conducted with respectively 42, 37, and 35 experts rating the Roles (n = 7) and key competencies (n = 27). These experts came from non-university healthcare disciplines in Flanders (Belgium): audiology, dental hygiene, midwifery, nursing, occupational therapy, podiatry, and speech therapy. Experts answered with yes/no (Roles) or on a Likert-type scale (key competencies). Agreement percentages were analyzed quantitatively whereby consensus was attained when 70% or more of the experts scored positively. In round one, experts could also add remarks which were qualitatively analyzed using inductive content analysis.

RESULTS

After round one, there was consensus about the completeness of all the Roles, the relevance of 25, the formulation of 24, and the measurability of eight key competencies. Afterwards, key competencies were clarified or modified based on experts' remarks by adding context-specific information and acknowledging the developmental aspect of key competencies. After round two, no additional key competencies were validated for the relevance criterion, two additional key competencies were validated for the formulation criterion, and 16 additional key competencies were validated for the measurability criterion. After adding enabling competencies in round three, consensus was reached about the measurability of one additional key competency resulting in the validation of the complete CanMEDS competency framework except for the measurability of two key competencies.

CONCLUSIONS

The CanMEDS competency framework can be seen as a grounding for competency-based healthcare education. Future research could build on the findings and focus on validating the enabling competencies in nursing, midwifery, and allied health disciplines possibly improving the measurability of key competencies.

The International Pharmacy Game: A Comparison of Implementation in Seven Universities World-Wide

The utilization of serious games and simulations in health professional education has increased. The Pharmacy Game is one such concept that intersects gamification and simulation, in which pharmacy student teams competitively manage simulated pharmacies; a concept included in the pharmacy curricula of seven international universities. This study aimed to compare the implementation and conduct of the Pharmacy Game of participant universities and their students’ performance in the same educational task. Data were collected via a questionnaire completed by academic staff in April 2020, and the collation of results of the same patient case was conducted at each university (April 2020 to March 2021). The main results reflected differences in the game frequencies and the curricular approach (standalone or integrated course) and in the learning outcomes for the Pharmacy Game. Other differences were identified in the extent to which students of other professions were part of the game such as medical students or pharmacy assistants. Student case outcomes revealed similar strengths across the universities in patient communication and focus on safety, with variations identified as areas for improvement. Collation of the international utilization of the Pharmacy Game identified a broad spectrum of similar learning outcomes, inspiring a model of international core and aspirational learning outcomes. While the Pharmacy Game has been implemented with flexibility regarding the numbers of teams (4–10) and the duration of activity (12–36 days), all universities reported positive experiences and student outcomes, suggesting that the intervention represents a potential tool to deliver capstone learning experiences, promote interprofessional education, reinforce patient safety, and prepare pharmacy graduates for future practice.

Experiential Learning in a Gamified Pharmacy Simulation: A Qualitative Exploration Guided by Semantic Analysis

Experiential learning is an important component of pharmacist education and is primarily achieved through supervised placement or simulation. This study explored senior pharmacy students' experiential learning in an extended, immersive, gamified simulation, conducted as a capstone learning activity toward the end of their final year of study, consolidating all prior learning and preparing students for intern practice. The simulation aimed to enhance student confidence, competence and collaboration. The three-week activity involved student teams competitively managing simulated pharmacies, assuming the role of pharmacists to complete all scaffolded assessments, including dispensing prescriptions, clinical cases, verbal counselling, simulated patient cases, interprofessional collaboration, and assignments. Assessments were marked continuously, with consequences of practice acknowledged through gain or loss of 'patients' for the pharmacy. From 2016 to 2018, 123 students completed multiple individual reflective journals (n = 733). Reflective journals were analyzed to explore the student experience, using a mixed methods approach. Initial Leximancer® 4.51 semantic analysis guided thematic analysis, conducted in NVivo® 12. The major themes that emerged were teamwork, patient-centeredness, medicines provision, future practice, and the learning experience. Student participants reported an intense and emotional experience in the gamified simulation, with many students revealing transformation in their skills, behaviors and attitudes over its duration.

Design of a Pharmacy Curriculum on Patient Centered Communication Skills

For delivering high quality pharmaceutical care pharmacy students need to develop the competences for patient centered communication. The aim of the article is to describe how a curriculum on patient centered communication can be designed for a pharmacy program. General educational principles for curriculum design are based on the theories of constructive alignment, self-directed learning and the self-determination theory. Other principles are paying systematic and explicit attention to skills development, learning skills in the context of the pharmacy practice and using a well-balanced system for the assessment of students' performance. Effective educational methods for teaching communication skills are small group training sessions preferably with (simulation) patients, preceded by lectures or e-learning modules. For (formative or summative) assessment different methods can be used. The Objective Structured Clinical Exam (OSCE) is preferred for summative assessment of communication competence. The principles and educational methods are illustrated with examples from the curriculum of the master Pharmacy program of Utrecht University (The Netherlands). The topics 'pharmaceutical consultations on prescription medicine,' 'pharmaceutical consultations on self-care medication' and 'clinical medication reviews' are described in detail. Finally, lessons learned are shared.

Longitudinal Changes of Deep and Surface Learning in a Constructivist Pharmacy Curriculum

In the undergraduate Pharmacy program at the department of Pharmaceutical Sciences, Utrecht University, an educational model is used that is aimed at the development of deep and self-regulating learning. It is, however, unknown whether these objectives are realized. The aim of this study was to assess longitudinal changes in processing and regulation strategies of student learning during their progression in the curriculum, that is explicitly based on constructivist principles. Processing strategies (deep vs. stepwise), regulation strategies (self- vs. external), conceptions of learning and orientations to learning were measured with the Inventory of Learning patterns of Students (ILS). Longitudinal data are reported here for students, of which data are available for year 1/2 and year 4/5 (n = 90). The results demonstrate that the use of deep processing (critical thinking in particular, effect size = 0.94), stepwise processing (analyzing in particular, effect size = 0.55) and concrete processing strategies (effect size = 0.78) increases between the bachelor phase (year 1/2) and the master phase (year 4/5). This change is based on the students having a constructivist view about the nature of learning and is mediated through a relatively large increase in the use of self-regulating strategies (effect size = 0.75). We conclude that this six-year undergraduate Pharmacy program effectively stimulates the development of deep and self-regulated learning strategies in pharmacy students.

The Pharmacy Game-GIMMICS® a Simulation Game for Competency-Based Education

The profile of the profession of pharmacists has profoundly changed over the last decades. Pharmacy education has moved towards competency-based education. The pharmacy game, called GIMMICS^®, developed at the University of Groningen, is unique in combining simulation with serious gaming to teach a wide range of competencies. In this article, we describe the learning goals, the assessment methods, the teaching tools, and the students’ view of the pharmacy game. The learning goals are to train the competencies of collaboration, leadership, communication, and pharmaceutical expertise. The core of the game is the simulation of community pharmacy practice activities, such as patient counseling, processing of prescriptions, and collaboration with other health professionals. Students are assessed individually and as a pharmacy team. The pharmacy team, with the largest number of patients wins the game. Student evaluations show that they value the course. Currently, seven universities from around the globe have adopted the pharmacy game in their curriculum, adjusting the course to their country’s pharmacy practice and educational system.