Impact of Curricular Integration Between Patient Care Laboratory and Introductory Pharmacy Practice Experience on Documentation

Advancing Pharmacy Education by Moving From Sequenced "Integration" to True Curricular Integration

OBJECTIVES

Traditional pharmacy education focuses on teaching content, which is affectionately known as "silos". Each topic area or discipline includes a course or an individual class session designed to impart knowledge, skills, or abilities needed for the student pharmacist to become a practice-ready, team-ready pharmacist. With expanding content and educational standards, there have been calls to simplify and streamline content. Truly "integrated" curricula (sequenced, coordinated, and collaboratively taught) where silos are removed to foster student integrative learning and build connections across disciplines (foundational, clinical, and social or administrative sciences) could be one such approach. Thus, the objectives of this integrative review are to provide recommendations for decreasing curriculum overload by moving to truly integrated curricula, explore integrated approaches, discuss challenges and barriers, and propose next steps for creating integrated curricula that decrease content overload.

FINDINGS

Although there are different approaches to curricular integration, most curricular integration occurs through sequenced courses or integrated cases. In order to truly streamline content and foster connections across disciplines, integration must move beyond simply sequencing of content to content that includes all the disciplines taught seamlessly. When taught together, curricular integration offers the opportunity to cover medication classes quickly and efficiently with multiple opportunities for reinforcement.

SUMMARY

There remains limited data and examples of these types of true integration approaches. Thus, it is important for the Academy to determine if the integration of content improves curricular outcomes, positively affects students' learning, and addresses curriculum overload by increasing efficiency and streamlining curricula.

Community pharmacy-based SOAP notes documentation

There is still scarce and sparse evidence regarding documentation of the subjective, objective, assessment and plan (SOAP) note in community pharmacies despite its long implementation history in clinical and academia settings. Hence, we aimed to document and maintain SOAP notes for individual patients visiting community pharmacies for their health problems. We conducted a community-based cross-sectional study at 2 community pharmacies in Nepal from July to December 2019. We recruited 400 patients from all age groups suffering from any health problem using simple random sampling. Patients' subjective complaints were retrieved from their respective prescriptions and verified by interviewing them. Data were collected on the standard format of the SOAP notes and all data related to patients' subjective and objective evaluations, and assessments and plans were descriptively analyzed with R programming 4.0.3. Drug interaction profile was checked with the Medscape Drug Interaction Checker. A total of 87 (21.8%) patients aged 42 to 51 years participated in the research, out of whom 235 (58.8%) were female, 208 (52%) illiterate, 359 (89.8%) were facing mild polypharmacy, and 40 (9.9%) were suffering from joint, leg, ankle, and knee pain. There were 41 minor (11.4%), 130 major (32.7%), and 3 severe (0.9%) drug interaction cases (i.e., medication-related problems), with 11 (2.8%) occurring between amlodipine and metformin, which required close monitoring. There were 226 (56.5%) cases with follow-up planned for the patients when necessary. This novel approach in documenting SOAP notes at community pharmacies during dispensing would be an extended form of the same being applied in clinical settings. Hence, this would open a new arena for the community pharmacists to expand their professionalism beyond the clinical and academia by documenting patients' complex disease and medication profiles in their documentation.

Methods for Optimizing Student Pharmacist Learning of Clinical Note Writing

Objective. To investigate the effectiveness of using problem-solving and worked examples in teaching clinical note writing to Doctor of Pharmacy students.Methods. First year student pharmacists who were recruited to participate in the study first studied a worked example on generating a clinical note from a written patient case. Participants were then randomized either to study another worked example or to practice writing a clinical note from a written patient case. Embedded in each condition was problem variability (ie, participants encountered either a similar disease state as that in the initial worked example or a different disease state). The primary outcome was the combined performance on writing two clinical notes. Secondary outcomes included quiz performance on knowledge of the components of a clinical note and ability to transfer writing skills to a novel disease state.Results. Seventy-nine students completed the study. Participants who studied a worked example followed by problem-solving (WE-PS) practice performed better than participants who studied two worked examples (WE-WE) on clinical note writing. However, there was no difference in their respective knowledge as determined by quiz performance.Conclusion. Both worked examples and problem-solving facilitated students' learning of the basic knowledge of clinical note writing. However, only problem-solving improved student pharmacists' ability to apply that knowledge. While there were significant improvements in student pharmacists' knowledge of the basics of clinical note writing, it is unclear how worked examples or problem-solving influence the clinical decision-making skills needed to write a clinical note.