Smartphones and Applications: Teaching Student Pharmacists to Appropriately Use Them

by Dylan B. Ware, PharmD, PGY1 Pharmacy Resident, Baptist Memorial Hospital-North Mississippi

I once heard a classmate say: “I don’t have to know this off the top of my head.” “Just Google it” and “Hey Siri” are other common phrases that I hear quite often from pharmacy students. Honestly, I have been guilty of expressing statements similar to these when I was a student. However, as a pharmacist now, I approach this form of thinking quite differently.

When I was enrolled in pharmacy school, I had the opportunity to hear many professors speak about their educational experiences when they were a student. These conversations helped me understand the differences in the learning methods and examination processes between my professors’ experiences compared to mine. Each of these conversations always seemed to have one commonality; they did not have access to online resources and smartphones like pharmacy students have today. The Internet and smartphones have become a huge part of American culture over the past ten years. The Pew Research Center reports that about 96% of people in the United States own some kind of cellphone and the vast majority of those people own a smartphone.¹

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Healthcare professionals and students use smartphones that are capable of downloading applications to assist with daily functions. Healthcare professionals can use applications for information management, time management, reference and information gathering, and clinical decision making.² Information management incorporates an easy way to write notes, take photographs, and organize information on smartphones.² Smartphones allow healthcare professionals to manage their time by scheduling appointments and meetings.² Most medical textbooks, medical literature sources, and drug reference guides have smartphone applications for health care professionals to download and use.² Clinical decision-making tools such as treatment guidelines, diagnosis aids, medical calculators, and laboratory test interpretations can all be found through applications available on smartphones.²

Pharmacy students should be taught to utilize tertiary resources such as Micromedex^®, Clinical Pharmacology, and Lexicomp^®. Each of these sources has a personalized mobile application that can be readily accessible in the palm of a hand.  But how should we teach student pharmacists to appropriately use these applications? I have found it effective to first explain some purposes of these applications which include: finding dosing recommendations, looking up drug interactions, adjusting medications for renal and hepatic dysfunction, and understanding how to explain adverse effects and counseling points to patients. Once the purpose of these applications is understood, teaching students how to use and apply the information is a vital skill.

The University of Mississippi School of Pharmacy has partnered with my residency site, Baptist Memorial Hospital-North Mississippi, to host second-year student pharmacists as they complete their Introductory Pharmacy Practice Experiences (IPPEs). Some of the educational activities that the student pharmacists complete include: gathering a medication history and performing a medication reconciliation, reviewing medical records for laboratory monitoring data, and participating in discharge counseling. As a preceptor for these student pharmacists, I have taught them how to use Micromedex^®, Clinical Pharmacology, and Lexicomp^® to complete these activities.

1.   Medication history with reconciliation

a.  Using these applications to look up medications that are unfamiliar to the student pharmacists and understanding their indications for use

2.   Chart review with laboratory monitoring

a.  Reviewing a patient’s lab values and using these applications to look up important monitoring parameters of each medication to ensure the medication is safe and effective for each patient

3.   Discharge counseling

a.  Looking up every medication the patient is expected to take after hospital discharge and using the counseling section of these applications to ensure all information is discussed before discharge

However, there will be certain situations in clinical practice where instant drug recall is needed. Examples include: treating cardiac arrest, stabilizing critical care patients, and creating repertoire with other health care professionals when pharmacy specific questions are needed immediately. In these situations, we should teach student pharmacists that using these smartphone applications is not feasible and being able to respond immediately is critical.

When else should students be taught they cannot use smartphone applications? That would be for examinations that prepare students for licensure: the NAPLEX^® and MPJE^®. The NAPLEX^® first-time pass rate was 94.9% in 2014 and dropped to 89.5% in 2017.^3,4 In a recent commentary published in AJPE, the authors discuss possible explanations for the decreasing pass rates, including diminished exam preparation, declining academic ability, and the increasing difficulty of the NAPLEX^®.³ Additionally, the authors speculate that smartphones may be affecting students' ability to apply and recall information.³  In a recent study, the investigators found that  "when people expect to have future access to information, they have lower rates of recall of the information itself and enhanced recall instead for where to access it."⁵ It's true that smartphones are capable of replacing some cognitive functions.⁶ But student pharmacists should be taught early in their pharmacy school curriculum that smartphones are not allowed on the NAPLEX^® and MPJE^®. Therefore, immediate recall of information learned during pharmacy is required to successfully pass the board examinations.

Learning or memorizing all the information about every single drug available is impossible. Smartphone applications obviously have a role. Therefore, student pharmacists should be taught about how to effectively use tertiary resources such as Micromedex^®, Clinical Pharmacology, and Lexicomp^®. However, they should understand the difference between when it is appropriate and not appropriate to use smartphone applications. All student pharmacists should have a strong fund of knowledge that is not dependent on checking a smartphone and should be lifelong learners.

References:

1. Pew Research Center Internet and Technology. Mobile Fact Sheet. 2019 June 12.
2. Ventola CL. Mobile Devices and Apps for Health Care Professionals: Uses and Benefits. PT. 2014 May;39(5):356-364.
3. Fjortoft N, Getting J, Verdone M. Smartphones, Memory, and Pharmacy Education. American Journal of Pharmaceutical Education. 2018;82(3) Article 7054.
4. National Association of Boards of Pharmacy. NAPLEX Pass Rates August 2019.
5. Sparrow B, Liu J, Wegner DM. Google effects on memory: cognitive consequence of having information at ourfingertips. Science. 2011;33396043):776-778
6. Wilmer HH, Sherman LE, Chein JM. Smartphones and Cognition: A Review of ResearchExploring the Links between Mobile Technology Habits and Cognitive Functioning. Front Psychol. 2017;8:605.

Why Self-Assessment and Life-Long Learning Go Hand-in-Hand

By Brie Holmes, PharmD, PGY1 Pharmacy Practice Resident, Magnolia Regional Health Center

 

Healthcare is advancing and expanding at an astounding rate. Now, more than ever, healthcare professionals must take the initiative to learn about new technology, diagnoses, and treatment options to provide the best care to patients.¹ Healthcare practice is rooted in trusting patient/provider relationships, and healthcare professions are expected to continually expand their knowledge. It is simply not adequate to rely on one’s initial education and training or the required continuing education hours to stay well informed about the latest developments.² Instead, healthcare professionals must take responsibility and be self-directed learners to remain competent throughout their career.

Self-assessment methods and the utility of those methods has been well studied. Research has shown that those who regularly engage in a self-assessment process have increased academic achievement and workplace performance.¹ Andrade defines self-assessment as “…a process of formative assessment during which students reflect on and evaluate the quality of their work and learning, judge the degree to which they reflect explicitly stated goals or criteria, identify strengths or weaknesses in their work and revise accordingly.”³ There are other definitions of self-assessment, but all sources agree that it is a process with the goal of continuous improvement involving an intrinsic evaluation of one’s knowledge and performance, recognizing one’s own deficits, and implementing a plan to correct identified deficits. Because there is a clear expectation for healthcare professionals to stay up-to-date on new research, there is also an expectation that healthcare professionals skillfully use self-assessment techniques to accomplish this. Despite what’s known about effective self-assessment methods and their benefits, there are numerous studies showing the general inability of students and healthcare providers alike to accurately assess their knowledge and skills and, therefore, effectively address deficits. In fact, only 45% of the studies included in a systematic review of the physician literature showed a positive relationship between self- and external assessments.³ Not only is this a disservice to oneself as a professional, but it is also a disservice to our patients who have trusted us to provide the best care possible.

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Multiple studies have suggested students and some providers are not able to correctly assess their learning needs.  One possible explanation is that students have grown accustomed to dependent learning. Historically, evaluation of knowledge has largely been done using exams. This external form of evaluation often creates dependent learners who have very little intrinsic consideration or responsibility. Dependent learning can quickly dissolve motivation to gain knowledge outside of what will be on an exam and instead encourages memorization, resulting in a reliance on external motivation and validation.³ This process does not adequately equip students with the necessary skills required for work after graduation as they are not prepared to take the initiative to identify their learning needs or to address perceived deficits. After graduation, there will no longer be someone who will identify the student’s learning needs or direct them to appropriate learning activities.¹ Thus, educators can and should incorporate self-assessments early in the curriculum to teach students this important skill so that they can apply it in the real world.⁵

Developing good self-assessment skills can also improve the learner’s willingness to accept feedback as well as develop their self-confidence.³ It is well-accepted that self-assessment is a learned skill.  It not something that most people “just naturally” know how to do. Because of this, the Accreditation Council on Pharmacy Education has stated that self-assessment should be integrated into the pharmacy curriculum early and continued throughout the curriculum.³ Additionally, the American Medical Association considers self-assessments to be a vital professional skill and has suggested guided self-assessments be incorporated at the earliest possible stage in medical training.⁴ The key to guiding self-assessments is ensuring the student receives quality external feedback. Some examples of activities educators could incorporate that would provide an opportunity for self-assessment coupled with external feedback is an Objective Structured Clinical Examination (OSCE), particularly if they are videotaped and reviewed by the student.  Problem-based learning cases and independent learning projects can also be used, whereby students compare their self-assessment of their performance to external evaluations using rubrics.^1,3

If educators want their students to be competent and successful healthcare professionals who embrace the notion of continuous professional development, they must instill the importance and benefits of self-assessments and stimulate increased motivation to engage in the process.³ As research continues to show the clear benefits of self-assessment, accrediting bodies require health professional programs to include self-assessments.  Self-assessment techniques should be introduced early in curriculums alongside external assessments.  This will help students learn the vital skill of identifying deficits and critically evaluating their work.  In this way, students will be better prepared for post-graduation work and lifelong learning. Furthermore, self-assessments should prompt students to consider their personal and professional goals while equipping them with the tools necessary to achieve those goals. Without effective self-assessment strategies, healthcare professionals will not be adequately prepared for lifelong learning in a field that is constantly expanding and changing.

References

1.    Guglielmino LM. The case of promoting self-directed learning in formal educational institutions. South African Education Journal. 2013;10(2):1-18.

2.    Asadoorian J, Batty, H. An evidence-based model of effective self-assessment for directing professional learning. Journal of Dental Education. 2005;69(12):1315-1322.

3.    Motycka CA, Rose RL, Ried LD, Brazeau G. Self-assessment in pharmacy and health science education and professional practice. Am J Pharm Educ 2010;74(5) Article 85.

4.    Duffy FD, Holmboe ES. Self-assessment in lifelong learning and improving performance in practice. JAMA 2006;296(9):1137-1139. doi: 10.1001/jama.296.9.1137

5.    Adachi C, Tai JH-M, Dawson P. Academics’ perceptions of the benefits and challenges of self and peer assessment in higher education. Assessment & Evaluation in Higher Education. 2017;43(2):294-306. doi:10.1080/02602938.2017.1339775.