Impact of Standardized Simulated Patients on First-Year Pharmacy Students' Knowledge Retention of Insulin Injection Technique and Counseling Skills

Employing Simulated Participants to Develop Communication Skills in Medical Education: A Systematic Review

SUMMARY STATEMENT

Simulated participants (SPs) are often employed to teach communication skills in medical education. Although there is a large number of qualitative and/or noncomparative studies in this field, there is no current evidence for the effectiveness of this teaching method based on quantitative comparative meta-data. The aim of this review was to evaluate the effectiveness of SP-based teaching on patient-centered communication skills in medical education compared with traditional teaching formats such as lecture or peer role play focusing on quantitative and comparative data. According to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we searched MEDLINE, Cochrane Library, PsycINFO, CINAHL, and ERIC databases for relevant studies published through February 2023. We also conducted hand searches and ancestry searches. Of the 8523 publications identified, 21 studies with 2500 participants and a Medical Education Research Study Quality Instrument score of 13.7 (SD = 1.3, N = 21) were included in the synthesis. Ten studies were eligible for meta-analysis. The pooled effect for communication skills outcomes suggests a medium effect preferring SP-based teaching to traditional teaching formats (standardized mean difference = 0.74, 95% confidence interval = 0.37 to 1.11, I2 = 95%, n = 2061). The heterogeneity is high among the analyzed studies. Further analysis reveals great differences among the studies' characteristics (population, objectives, interventions, control group settings, and outcome measurements).

Effectiveness of teaching and evaluation methods of clinical competencies for pharmacy: A systematic review

BACKGROUND

This review aimed to analyze the effectiveness of the teaching and assessment methodologies used to develop fundamental clinical skills in pharmacist who are training in patient care.

METHODS

SCOPUS, EMBASE, ERIC, and PubMed were searched for original studies that featured randomized controlled trials as the study design published until March 2024. The search and extraction process followed PRISMA Guidelines.

RESULTS

The database search resulted in 2954 articles, of which 14 met the inclusion criteria. Four studies developed and tested interactive web-based software as the teaching methodologies. Eight studies applied simulation to their teaching and/or evaluation strategies. Two articles used high fidelity simulation, and the remaining studies used standardized patients associated with other teaching and evaluation techniques. The simulation methodologies were more effective than the conventional ones in three studies. In the other studies, the interventions were as effective or better than the control, albeit there no meaningful differences between the methods. In the studies that focused on the assessment methods, immediate feedback was preferred by students over delayed feedback. Additionally, the tested assessment tool, General Level Framework, proposed a pragmatic assessment from which the individual's training needs were identified.

CONCLUSION

Few studies involved the objective quantification of learning beyond pre- and post-intervention knowledge tests. Proper assessment in pharmaceutical education requires expansion beyond the administration of student satisfaction, self-efficacy research tools, and knowledge assessments, and should encompass an examination of clinical performance and critical thinking.

Transition from in-person to telehealth standardized patient encounters: A retrospective analysis of 18 cases

INTRODUCTION

Due to the COVID-19 pandemic, many pedagogical activities shifted from in-person to virtual modalities, including standardized patient (SP) encounters. While many academic institutions may not have previously been conducting SP encounters virtually, this change provided student pharmacists with new opportunities to learn and practice telehealth techniques, which are important with the continuously evolving healthcare landscape.

METHODS

This retrospective study analyzed pharmacy student performance on and perceptions of SP cases in fall 2019 (in-person) and fall 2020 (telehealth) semesters. The primary objective was to compare average total scores on SP cases from fall 2019 (in-person) and fall 2020 (telehealth) for first-, second-, and third-year pharmacy students (P1, P2, and P3, respectively). Secondary objectives were to compare average scores from case-specific and relationship and communication (R&C) checklists, as well as to describe student perceptions of the pedagogy.

RESULTS

Total scores on SP cases decreased from in-person to telehealth for the average of all P1 SP cases, but not for P2 or P3 cases. Case-specific scores did not change, but R&C scores decreased significantly across all three years. Student survey data revealed difficulty with communicating effectively and building rapport via telehealth.

CONCLUSIONS

Overall, student performance on in-person vs. telehealth SP encounters was similar, though P1 students performed more poorly on SP cases conducted via telehealth compared to P2 or P3 students. Thus, faculty could consider focusing on in-person encounters for early learners before introducing virtual encounters. This study also highlights the difficulty in establishing rapport when communicating with patients via telehealth.

Comparison of Student Pharmacists' Knowledge Retention Utilizing Electronic Health Records Versus Simultaneously Completing Simulated Experiences

Objective. The purpose of this study was to determine whether the addition of standardized patients or the addition of interprofessional student teams with standardized patients to the use of a simulated electronic health record improved student knowledge retention and perceptions.Methods. This was a prospective cohort study assessing three cohorts of first-year student pharmacists in pharmacy skills laboratory activities that occurred in 2018, 2019, and 2021. The primary objective of the study was to compare knowledge retention of the case material between groups at one month. Each year, an element of simulated experience was added onto the previous year's case. In 2018, students completed the case using only the electronic health record web application. In 2019, the previous year's experience was combined with an objective structured clinical examination (OSCE) with standardized patients. In 2021, the 2019 experience was supplemented with student physician assistants. Case scores and student perceptions were also compared between groups.Results. Of the 260 potential participants, 238 students were included in the primary analysis. Results showed that with the addition of interprofessional team-based care and standardized patients, significant improvement was demonstrated in knowledge retention assessments at one month. Mean knowledge retention assessment scores for the 2018, 2019, and 2021 groups were 63.8%, 71.7%, and 76.1%, respectively. Significant improvement was also found in student perceptions.Conclusion. Adding standardized patients and interprofessional team-based care to a pharmacy skills laboratory that uses a simulated electronic health record significantly improved student knowledge retention and perceptions.

Investigating the influence of interaction modality on the communication patterns of spinal cord injury peer mentors

OBJECTIVES

To examine how the quality of spinal cord injury peer mentorship relationships and mentor-mentee behaviors are impacted by interaction modality.

METHODS

Using a within-subjects, repeated measures, experimental design, peer mentors (n = 8) completed two mentoring sessions with a standardized mentee in a telephone and a video chat condition. Measures of therapeutic alliance and autonomy supportiveness were administered following each session. Mentors' leadership behaviors, motivational interviewing skills, and behavior change techniques were compared across conditions. Mentors' and mentees' use of motivational interviewing skills and behavior change techniques were further analyzed using state space grids.

RESULTS

Mentors' therapeutic alliance, autonomy supportiveness, use of leadership behaviors, motivational interviewing skills, and behavior change techniques did not significantly differ across the two conditions (ps > 0.123; Cohen's d range = 0.218-0.619). State space grids analyses revealed that the dynamic structure of mentoring conversations was similar when interactions occurred through the telephone versus video chat.

CONCLUSIONS

Mentors were effective at forming positive, autonomy supportive relationships with mentees in telephone and video chat interaction conditions. Mentors also used leadership/counselling behaviors to a similar extent when interacting through these two modalities.

PRACTICE IMPLICATIONS

Organizations that provide peer mentorship can have confidence in using both telephone and video chat modalitites.

The Effects of Sequencing Strategies in Teaching Methods on Nursing Students’ Knowledge Acquisition and Knowledge Retention

Background: No existing research has determined which teaching sequence strategy is the best for nursing students. Purpose: To find out which sequence is most effective in knowledge acquisition and knowledge retention and to further verify knowledge acquisition between problem-based learning (PBL) and lecture-based learning (LBL). Methods: This was a quasi-experimental design with a comparison of two nursing student groups selected from students in their final program year who were invited to participate. Generalized estimating equation was used to compare Group I (LBL-PBL-clinical practicum) and Group II (PBL-LBL-clinical practicum) by using knowledge acquisition and knowledge retention as outcome variables. Findings: Fifty-six senior students joined this study. Group I was significantly better than Group II on both knowledge acquisition (β = 7.05, p = 0.04) and knowledge retention (β = 9.40, p = 0.03). Discussion: The sequence of LBL-PBL-clinical practicum or policy of allowing practicum and courses in the same semester might be the best strategy to enhance knowledge retention.

A "Virtual Pharmacy Shelf" to Enhance the Rigor and Efficiency of Standardized-Patient OSCEs for Over-the-Counter Medication Advice

BACKGROUND

Realistic simulation in health professional education can be costly or cumbersome.

ACTIVITY

A low-cost, tablet-based simulated "virtual shelf" of over-the-counter (OTC) medications, hyperlinked to Drug Facts labels, eliminated use of physical product boxes or printed drug lists in objective structured clinical examinations (OSCE) for Doctor of Pharmacy students learning to provide OTC advice.

RESULTS AND DISCUSSION

The application reduced instructor preparation and OSCE administration time by allowing students to tap product options instead of thumbing through medication lists. The shelf is realistic, easily updated, and transferable to other OSCEs when visual recognition is important or treatment options change frequently.

Digital Tools in Behavior Change Support Education in Health and Other Students: A Systematic Review

Due to the increased prevalence of chronic diseases, behavior changes are integral to self-management. Healthcare and other professionals are expected to support these behavior changes, and therefore, undergraduate students should receive up-to-date and evidence-based training in this respect. Our work aims to review the outcomes of digital tools in behavior change support education. A secondary aim was to examine existing instruments to assess the effectiveness of these tools. A PIO (population/problem, intervention, outcome) research question led our literature search. The population was limited to students in nursing, sports sciences, and pharmacy; the interventions were limited to digital teaching tools; and the outcomes consisted of knowledge, motivation, and competencies. A systematic literature review was performed in the PubMed, CINAHL, MEDLINE, Web of Science, SAGE, Scopus, and Cochrane Library databases and by backward citation searching. We used PRISMA guidelines 2020 to depict the search process for relevant literature. Two authors evaluated included studies using the Mixed Methods Appraisal Tool (MMAT) independently. Using inclusion and exclusion criteria, we included 15 studies in the final analysis: six quantitative descriptive studies, two randomized studies, six mixed methods studies, and one qualitative study. According to the MMAT, all studies were suitable for further analysis in terms of quality. The studies resorted to various digital tools to improve students’ knowledge of behavior change techniques in individuals with chronic disease, leading to greater self-confidence, better cooperation, and practical experience and skills. The most common limitations that have been perceived for using these tools are time and space constraints.

Preceptor tips for navigating generational differences with introductory and advanced pharmacy practice experience students

Ideally, precepting during introductory and advanced pharmacy practice experiences should be tailored to meet the individualized needs of learners. Understanding generational similarities and differences that exist between both learners and educators will facilitate meaningful interaction and improve learning outcomes. A common pitfall among preceptors is to judge the values of their pharmacy learners based on the stereotypes of the generations. This tends to be more evident when the preceptor’s generation differs from the generation of the learner. The following article describes generational attributes that influence experiential learning with general tips for how preceptors can use this information to enhance their interactions with learners. By comparing and contrasting the predominant generations in the current pharmacy education landscape (Baby Boomers, Generation X, and Millennials), the article will demonstrate how multi-generational interactions impact pharmacy education. As Millennials are the majority of experiential learners, the focus will be on their learning preferences and how preceptors can help engage these learners. Practical advice and tools on engaging Millennial learners will be reviewed. Case vignettes will demonstrate how to identify ways to tailor precepting to meet the needs of the learner, avoid common pitfalls, facilitate meaningful interaction, and, ultimately, improve learning outcomes.

The Role of a Simulation-Based Activity on Student Perceptions of Parenteral Nutrition Education

Introduction: Parenteral nutrition (PN) education in pharmacy schools and postgraduate programs may not sufficiently prepare future pharmacists for clinical practice. Limited data exist regarding innovative teaching strategies in the area of PN. The purpose of this study was to identify students’ perceptions of a simulated PN activity in a pharmacotherapeutics course. Methods: Second-year Doctor of Pharmacy (PharmD) students from two cohorts (N = 84 for both cohorts) completed a PN assignment using simulated PN materials, which resembled those seen in clinical practice. Before and after the activity, students completed identical surveys about their perceived competence and interest in PN, which were analyzed using Wilcoxon signed-rank tests. Results: Following the simulation, the percentage of students affirming their perceived competence (selecting strongly agree or agree in the survey) in their ability to describe the process of combining ingredients to make a PN admixture (45.2% vs. 83.3%, p < 0.001) and calculate PN-related problems (58.3% vs. 83.3%, p < 0.001) improved. The proportion of students expressing interest in PN increased after the simulation (78.6% vs. 86.9%, p < 0.001). Conclusion: A simulated practicum experience in PN was viewed positively by PharmD students at this university, and may be a valuable active learning experience to incorporate in a PharmD curriculum.

Use of active learning and simulation to teach pharmacy students order verification and patient education best practices with oral oncolytic therapies

INTRODUCTION

The primary objective of this study was to describe the incorporation of the flipped classroom model and use of real-life oncology patients to facilitate student learning of oral oncolytic best safety practices and patient counseling. The secondary objective was to assess the impact of the flipped classroom learning activity on students' perceived confidence.

METHODS

This study was a prospective, single center, flipped classroom learning activity and pre/post assessment survey administered to third year doctor of pharmacy students enrolled in the Oncology Pharmacotherapy didactic elective in 2016 and 2017. A pre/post survey was used to assess student's perceived confidence with oral oncolytic best practice competencies.

RESULTS

Ten students participated in the flipped classroom learning activity and survey. Five students completed both the pre- and postsurvey. The overall change in student's mean scores for their confidence of oral oncolytic competencies improved significantly from 3 to 4.1 on a 6-point Likert Scale (p = 0.03) following the learning activity. Students perceived confidence in performing oral oncolytic order verification increased following the implementation of a flipped classroom learning activity and use of real-life cancer oncology patients.

CONCLUSION

This study describes the development and implementation of a flipped classroom learning activity and use of real-life patients with cancer that can be implemented at other institutions of higher education in a didactic or experiential learning environment. Additionally, this study demonstrated a potential benefit in student learning.

The Effect of Interactive Educational Workshops With or Without Standardized Patients on the Clinical Skills of Midwifery Students in Providing Sexual Health Counseling

BACKGROUND AND OBJECTIVES

Insufficient skills among health personnel, including midwives, can lead to failure in evaluating and providing sexual health counseling services to clients. Thus, the purpose of this study was to compare the effect of 2 interactive educational workshops with or without standardized patients (SPs) on midwifery students' clinical skills in providing sexual health counseling at Mashhad University of Medical Sciences, Mashhad, Iran, in 2014 to 2015.

RESEARCH METHODS

In this randomized controlled trial, 62 midwifery students were selected through convenient sampling method and then randomly divided into 2 groups who received 1 of 2 interactive educational workshops, with or without SPs in 10-hour educational programs. The students' skills in providing sexual health counseling were evaluated before and 2 weeks after the education through an Objective Structured Clinical Examination composed of 5 stations using validated checklists. The data were then analyzed using the SPSS Software (Version 16) through descriptive statistics as well as independent t test, paired t test, Mann-Whitney U, χ, and Fisher exact tests. The level of significance was considered by P < 0.05.

RESULTS

There was no significant difference between the mean scores of students' clinical skills in providing sexual health counseling services in the group educated with or without SPs (22.4 ± 7.0 and 23.0 ± 9.4, P = 0.77). However, 2 weeks after the interventions, the mean scores were 75.8 ± 11.2 and 47.0 ± 8.9, respectively, meaning a significant difference between the study groups (P < 0.0001).

CONCLUSIONS

Although both teaching methods could promote clinical skills among the midwifery students, the effect of interactive workshop with SPs was much significantly stronger.

Pharmacy faculty and students' perceptions of standardized patients for objective structured clinical examinations

BACKGROUND AND PURPOSE

Objective structured clinical examinations (OSCEs) are one method of assessing clinical competency and communication in doctor of pharmacy programs. The purpose of this study was to capture student and faculty perceptions regarding the use of standardized patients (SPs) in administering OSCEs.

EDUCATIONAL ACTIVITY AND SETTING

Pharmacy students in our program initially participated in OSCEs using internal-SPs (I-SPs) that consisted of faculty and staff acting as patients. One year later, we piloted use of trained actor-based SPs and surveyed students and faculty about the experience.

FINDINGS

Fifty-four (80.6%) students and 12 (92.3%) faculty members completed the survey. When asked about their interactions with SPs, 42 (77.8%) students either agreed or strongly agreed that SPs portrayed patients more realistically and 41 (75.9%) students perceived SPs created a more comfortable environment for patient communication than I-SPs. Thirty-six (66.7%) students either agreed or strongly agreed to feeling more confident when communicating with patients, and 33 (61.1%) felt more confident making recommendations. Ten (83.3%) faculty members either agreed or strongly agreed that SPs portrayed patient interactions more realistically, and 7 (58.3%) felt SPs were more consistent in their simulated patient portrayal for the duration of the OSCE.

SUMMARY

Pharmacy students felt more confident in their ability to communicate and interact with the patient during their OSCEs when actor-based SPs were used. Both students and faculty members perceived this SP portrayal of patient interactions as more realistic than I-SPs and recommended the continued use of actor-based SPs for OSCEs.

The longitudinal learning outcomes of using different teaching sequences in a nursing administration project

AIM

To examine the effects of using different teaching sequences on knowledge acquisition, knowledge retention, self-directed learning and teamwork in a nursing administration project.

BACKGROUND

Compared to other professional courses, nursing administration is relatively difficult, and it is important for nursing administration students to spend long hours working in hospitals. As such, better teaching strategies utilizing proper sequencing may yield better learning outcomes for students.

METHODS

A longitudinal quasi-experimental design was used. A total of 129 students were assigned to two groups with which different teaching sequences were used. The investigated learning outcomes were knowledge acquisition, knowledge retention, self-directed learning and teamwork. Generalized estimating equations were used to measure the learning outcomes.

RESULTS

There was no significant difference between the two teaching sequences in terms of learning effects. One teaching strategy, problem-based learning (PBL), yielded effective student learning outcomes.

CONCLUSION

PBL increased the students' self-directed learning and teamwork. This strategy can be applied to side-by-side co-teaching and post-graduate year training programmes.

IMPLICATIONS FOR NURSING MANAGEMENT

The results from this study may help hospitals retain nurses and find potential nursing leaders. Instructors and nurse managers should discuss learning goals with students in advance to enhance the students' learning outcomes.