Emphasizing Bloom's Affective Domain to Reduce Pharmacy Students' Stigmatizing Attitudes

Impact of teaching, learning, and assessment of medical law on cognitive, affective and psychomotor skills of medical students: a systematic review

BACKGROUND

It is necessary to improve medical students' legal cognitive, affective, and psychomotor skills to prevent further legal issues in the medical profession. Choosing the proper teaching and assessment methods is crucial in this matter. This study aimed to investigate the impact of teaching, learning, and assessment of medical law on the cognitive, affective, and psychomotor skills of medical students.

METHODS

A systematic review was conducted in PubMed, Embass, and Web of Science databases, and Google Scholar search engine using MECIR and PRISMA, AMEE Guide 94 for 1980 to 2022.12.30. Nineteen articles met the inclusion criteria. MERSQI checklist was used to assess the quality of the articles, and URSEC (theoretical underpinning of the development, resources required, setting, educational methods employed, and content) used to assess the risk of educational bias.

RESULTS

Internship courses called Medical Education Humanities and Society (MESH), clinical scenario design, seminars and small group discussions, web-based interactive training, legal training courses, PBL, and mind maps have been used to improve the medico-legal knowledge of medical students. MESH clerkship, simulation of a legal event, medico-legal advocacy program based on interdisciplinary education, group discussion, integration, and court-based learning used to improve student attitudes. Multidisciplinary training, small group discussions after the seminar, mock trial competition, and interdisciplinary education are used to teach psychomotor skills. All studies, except one on knowledge, reported positive effects of legal education on students' knowledge, attitudes, and legal performance. Written assessments were used for cognitive and affective domains, while performance was assessed by OSCE, simulated court, and evaluation of patient referrals.

CONCLUSION

There are few studies to examine the cognitive, affective, and legal psychomotor skills of medical students. The texts have not yet fully explored the high level of affective and psychomotor domains, which is evidence of a gap in this sector. Recognizing that medico-legal problems are prevented through proper education and assessment, it is recommended that this area be considered a research priority and that effective educational policies are adopted.

Impact of a Neuropsychiatric Therapeutics Course and a Case-Based Course on Pharmacy Students' Mental Health Stigma

OBJECTIVE

Mental health education can reduce the stigma held by medical and nursing students; however, findings in this regard are limited in pharmacy academia. This study investigated the impact of a neuropsychiatric therapeutics course followed by a case-based course on the mental health stigma held by pharmacy students.

METHODS

A survey was conducted of second-year pharmacy students (n = 202) on the first and last day of a neuropsychiatric therapeutics course and 4 months later, at the end of a case-based course. The questionnaires included the Opening Minds Stigma Scale for HealthCare Providers (OMS-HC) scale, Recovery scale, Empowerment scale, and Attribution Questionnaire (AQ-9). Omnibus Friedman tests evaluated the main effect of time, followed by Wilcoxon signed-rank post hoc tests to compare baseline and postcourse scores.

RESULTS

Friedman test outcomes showed significant main effects of Time for OMS-HC, Recovery, Empowerment, and AQ-9 scales. Post hoc analysis indicated that compared to the baseline scores, the scores on Recovery and Empowerment scales significantly increased, OMS-HC scores decreased, but AQ-9 scores did not change after the therapeutics course. Compared to the baseline, OMS-HC and AQ-9 scores decreased, Recovery scale score increased, but the Empowerment scale score did not change after the case-based course. The scores did not decrease further after the case-based course compared to those after the therapeutics course.

CONCLUSION

The decreases in OMS-HC and AQ-9 scores and increases in Recovery and Empowerment scores indicate reductions in mental health stigma. Stigma among students was overall reduced after the therapeutics course and this reduction was maintained after the case-based course.

Evaluation of a training program to support the implementation of a community pharmacist-led support service for people living with severe and persistent mental illness

BACKGROUND

With appropriate training, community pharmacists can support people living with severe and persistent mental illness (SPMI) by identifying and managing medication-related issues and physical health concerns. The Bridging the Gap between Physical and Mental Illness in Community Pharmacy (PharMIbridge) randomized controlled trial (RCT) tested the impact of an individualized, pharmacist-led support service for people living with SPMI.

OBJECTIVE(S)

To evaluate the impact of the PharMIbridge training program on pharmacy participants' knowledge and confidence, as well as stigma and attitudes, in relation to supporting, and providing services to, people living with SPMI; compared to Mental Health First Aid (MHFA) training alone.

METHODS

Pharmacy staff (n = 140) from 55 community pharmacies across four RCT regions attended face-to-face training. Both intervention group (IG) and comparator group (CG) participants received MHFA training while IG participants received additional PharMIbridge training, involving role-plays and mental health consumer educators (MHCEs). A questionnaire including validated instruments was administered at baseline, after training and after 12 months. Comparative analyses included paired t tests and mixed between/within analysis of variance (ANOVA).

RESULTS

Pre and post-training surveys were completed by 136 participants, most of which were pharmacists. Both IG and CG participants had significant reductions in stigma (P < 0.001) post-training. IG participants' confidence and knowledge regarding metabolic monitoring significantly improved compared to CG (P < 0.001). IG participants were significantly more confident and comfortable in providing medication counseling, compared to CG participants (P < 0.05).

CONCLUSION

MHFA training reduced participants' stigma toward mental health. However, the purpose-designed PharMIbridge training program provided pharmacists with additional knowledge and skills to confidently support the physical health care needs of people living with SPMI. The inclusion of role-plays and MHCEs allowed pharmacists to self-reflect and practice skills in safe, supportive environments. Future studies should continue to involve MHCEs in pharmacy training and explore whether these improvements are sustainable.

Medical teachers' affective domain teaching dilemma and path exploration: a cross-sectional study

BACKGROUND

In the student-centered modern teaching environment of higher education, the affective domain was of great value to the overall development of medical students and the sustainable development of medical education. However, in the teaching practice of the medical specialty in Our country, there are still a lot of phenomena that pay attention to knowledge teaching but neglect affective education. Compared with affective domain, teachers tended to focus on the learning of specialized knowledge and skills. This paper investigated the attitudes and evaluations of teachers and students of medical school on affective education, analyzed the current situation and problems of teaching in the affective educauion of medical professions, and explored the path of combining the affective field and medical profession from the perspective of medical teachers.

METHODS

A questionnaire survey was conducted among medical teachers and students across the country. Using the self-appointed teacher scale and the student scale to obtain their ratings of all dimensions of teaching in the affective field through a free online tool called "WenJuanXing". Descriptive statistics and multiple regression analysis methods were used to analyze the data to explore the obstacles in affective education and the factors affecting the outcome of affective education.

RESULTS

A total of 523 medical teachers and 3268 medical students were surveyed, according to the results of questionnaire data analysis, there are differences in the needs of senior and lower grade students in various dimensions of affective education, and the current Chinese medical teachers carrying out affective education are facing unclear positioning and interpretation of affective education goals, lack of affective experience in teaching methods, lack of affective education evaluation norms, lack of continuity and progressivity of affective cultivation, and school organizational mechanisms need to be improved.

CONCLUSIONS

This paper had some suggestions aimed at the above problem. Firstly, It is necessary to strengthen the construction of the organizational mechanism of medical universities, provide them with guarantees and training according to the characteristics of teachers of different teaching ages, and comprehensively improve teachers' affective literacy from the inside out. Secondly, teachers should design clear progressive goals and content systems of affective education, constructing an evaluation system of affective education in the experiential teaching method.

Using Visual Thinking Strategies to Support Development of Pharmacy Student Competency in Person-Centered Care

Objective. To evaluate the introduction of 10 Visual Thinking Strategies (VTS) sessions into year 2 of a Bachelor of Pharmacy (BPharm) program with the aim of assisting students in developing the skills and attitudes required for inclusive practice.Methods. The evaluation used a cross-sectional study design. All members of the first two successive student cohorts to complete multiple VTS sessions completed a 38-item online reflective questionnaire exploring student perceptions of competency development, transference, and session acceptability. Students were asked for their consent to include their responses in a research study. Closed-question responses were analyzed to produce descriptive statistics. Free-text responses were categorized and quantified using an inductive approach and manifest content analysis.Results. Fifty-six percent of the students (98 of 174) allowed their responses to be included in the study. Students generally believed the sessions had supported their development of person-centred communication, cultural competence, and critical thinking skills. The minimum level of agreement that improvement in an area occurred was 74.5%. Free-text responses revealed the perception of additional skill and attitude development. Sixty percent of participants had thought about the VTS questions or used what they had learned in the VTS sessions in other settings. Eighty-six percent of students agreed that content on VTS should remain in the BPharm curriculum.Conclusion. Incorporating regular VTS sessions into the second year of a BPharm program was acceptable to students. Data suggest that inclusion of multiple VTS sessions is a valuable addition to the pharmacy curriculum, offering affective learning experiences which support development and transference of key skills and attitudes relating to the provision of inclusive person-centred care.

Development of Affective Learning in Dietetics Graduates: A Qualitative Longitudinal Study

Background

Methods

Results

Conclusions

Simulation can enhance affective learning among dietetic students.

The simulation developed affective learning in four of the six participants, specifically in relation to their view of themselves as practitioners and their understanding of their future responsibilities to patient care.

Three key themes were identified in the participants: (1) feeling of workforce readiness, (2) valuing lifelong learning and (3) attitudes towards interprofessional teamwork.

Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review

BACKGROUND

Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders.

METHODS

We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo.

RESULTS

A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions.

CONCLUSIONS

The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.

Arts and Humanities to Teach Civility in Health Professions

Incivility is defined as rude or disruptive behavior which may result in psychological or physiological distress for the people involved. These behaviors, which appear to be more pervasive than ever in today's society, both in academia and in the health-care system, negatively affect professionals' well-being and the workplace environment. Nurses have an obligation to practice with compassion and respect, and to develop creative solutions for addressing incivility. Education about incivility should begin in prelicensure programs for all health professions, so that students understand the behavior expected of them as professionals. When health-care professionals embody the ideals of respect and civility, they set an example for others to follow. The arts and humanities can be used as a pedagogical tool to provide innovative learning opportunities to teach these values through the affective domain of learning. This article discusses one of the creative avenues for facilitating such opportunity, the use of the arts and humanities to teach civility in health professions education.

Simulation Design, Findings, and Call to Action for Managing Difficult Patient Encounters

Objective. To implement and evaluate a laboratory simulation for teaching difficult patient encounter skills to pharmacy students to improve their self-assessed communication abilities and skills in the affective domain.Methods. Twelve simulation scenarios that represented difficult patient encounters in a variety of practice settings were developed. All students completed a self-assessment of their ability to communicate during difficult patient encounters before and after the simulations, and wrote a guided reflection afterward. The impact of the simulation was evaluated using quantitative and qualitative methodology. Three student cohorts were analyzed to determine whether significant change occurred in students' self-perceived communication abilities. Thematic analysis of the qualitative reflection responses was performed.Results. Over three years, three student cohorts of third-year professional students participated in the simulations (n=236). Students self-rated their ability to communicate on a 0-100 scale. Mean self-rating of ability prior to the simulation was 57.7 (SD=15.9) and after was 79.2 (SD=15.2). This mean difference of 21.5 points equates to an approximate 20% increase in self-rated ability. Variability in self-ratings between the cohorts was not significant. Qualitative analysis revealed that the simulation identified for student areas needing further development which in turn promoted self-awareness. Students expressed that learning in the safe, formative environment provided by the simulation contributed to their professional growth and was relevant to their future practice of pharmacy.Conclusion. This simulation fills a gap in skills-based education, addresses the affective domain of the Accreditation Council for Pharmacy Education (ACPE) Standards, transfers easily to schools and colleges of pharmacy. This supports a call to action for pharmacy educators to provide purposeful opportunities for students to practice communicating with patients during difficult encounters.

Evaluation of the impact of a social media-focused intervention on reducing mental health stigma among pharmacy students

Introduction

Stigma may negatively affect the treatment of people with mental illness, and pharmacists have the opportunity to play a key role in reducing mental health stigma. The purpose of this study was to determine whether a pharmacy student-focused educational intervention impacts stigma toward people with mental illness.

Methods

A 90-minute interactive learning module, which used social media and fictional case scenarios, was developed and administered to third-year pharmacy students (n = 145) during small group class sessions. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC), a validated tool to measure stigma, was administered immediately before and after the intervention. Pre-post OMS-HC scores were analyzed using related samples t tests.

Results

A total of 93 presurvey and postsurvey OMS-HC scores were paired and analyzed. Based on the 15-item version of the scale, stigma was significantly reduced, consistent with a score reduction of 4.6%, from 36.8 (95% confidence interval, 35.4-38.1) to 35.1 (95% confidence interval, 33.8-36.3), P < .0001.

Discussion

Educational interventions for pharmacy students that use social media applications might reduce mental health stigma. After the intervention, most participants believed that stigma impacts the treatment of mental illness, and that pharmacists may play a role in changing mental health stigma.

Stigma in health facilities: why it matters and how we can change it

Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.