Continuing Education and Performance Evaluation: Essential Elements of Community Pharmacy Success

by Dewansia Sutton, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy

Summary and Analysis of: Grant M, Remines J, Nadpara P, Goode J. Impact of Live Training on Medication Errors in a Community-Based Pharmacy Setting. Innov Pharm. 2020;11(3): Article 11. https://doi.org/10.24926/iip.v11i3.3291

The Academy of Managed Care Pharmacy reports that medication errors affect at least 1.5 million people every year resulting in direct medical costs of at least $3.5 billion and result in significant morbidity and mortality.¹ I know that medication errors are a widespread problem, so I chose this study² because I was curious about the influence of training programs on the practice and whether they would be a beneficial addition to my future practice as a community pharmacist. This study assessed the benefit of live interactive training and also analyzed the impact of pharmacy prescription volume and the ratio of pharmacists to pharmacy technicians on the incidence of medication errors.

The study analyzed the incidence of medication errors at several Kroger pharmacies in one district before and after a live training program that addressed the most common types of medication errors reported in the previous six months. These errors occurred at reception, product dispensing, and during the final verification step. The topics of physical and mental fatigue, workplace cohesiveness, ways in which medication errors occur, strategies for mitigating errors, best practices for pharmacy workflow, and company policies and procedures were also addressed during a series of mini (8-minute) lectures. Following the lectures, teams of four consisting of both pharmacists and pharmacy technicians discussed examples of how they could improve their practice to reduce the occurrence of medication errors. These sessions were led by the same team of pharmacists on six occasions. Eighty pharmacists and 150 technicians from 20 different Kroger pharmacies completed the program. The pharmacies were classified as low, medium, or high volume based on their average number of prescriptions filled per week.

Comparisons of medication error occurrences before and after training and differences between the pharmacy categories were made. The ratios of pharmacists to certified pharmacy technicians and other demographic information was recorded. The results of the study are summarized in the tables below. There was a decrease in the number of errors overall and between the pharmacy classifications from pre and post-training but these differences were not statistically significant. The number of pharmacists and technicians based on pharmacy volume (low, medium, or high volume) was significantly different.  The authors concluded that the implementation of these live training programs helped streamline best practices and reiterate patient safety by focusing on medication error reduction.

Table 1: Pharmacy Characteristics

*Differences between groups p <0.01

Table 2:  Medication Error Rates at Baseline vs. Post-Training

This study is valuable because it highlights the fact that even in the most structured pharmacy practice systems, there is always room for improvement. It is also valuable because it shows the potential benefit of continuing education and analyzing medication error trends. I think more pharmacies should design programs similar to this one where pharmacists educate pharmacy technicians and other pharmacists on methods to decrease workplace fatigue and increase cohesiveness to decrease medication errors. The mean number of full-time pharmacists to certified technicians was 2:1 in low volume pharmacies and 2:2 in medium volume pharmacies. The mean number of errors in the medium volume pharmacies pre-live training was just over double the mean number of errors in the low volume pharmacies pre-training.  These results were interesting to me because they show that the number of pharmacists relative to pharmacy technicians may be an important factor in mitigating medication errors. It would be beneficial to employees and patients if the work environment was less stressful and had a smooth, structured workflow with a balanced workload. It is also valuable because it shows what difference can be made when the focus is put towards fixing systematic problems in the pharmacy instead of placing blame on individual employees.

A limitation of this study is the fact that it relied on the pharmacies to self-report the number of medication errors. Recall bias and underreporting of medication by pharmacies could give false confidence that the pharmacy made fewer errors after the training. It also failed to report a breakdown of the number of reported errors in each category before and after the training. This data would have been helpful to determine if the training is effective in minimizing a specific type of medication error. Another limitation is the fact that the pharmacies included in the study were all Kroger pharmacies and have similar policies and procedures.  Moreover, the pharmacists and technicians may not have had the freedom to make significant changes in the workflow or environment if it violated corporate policies. A sample including multiple chains and independent pharmacies would have provided a more accurate assessment of whether this training program leads to a reduction in medication errors and which kinds of practices benefit the most. A larger sample may have produced statistically significant results and more generalizable data. A longer observation period for data collection before and after the training would have increased the amount of data available to analyze and perhaps draw more precise conclusions. 

A similar study analyzed the impact of pharmacist-led training on the incidence of medication errors in an intensive care unit and post-surgical care unit.³ The educators in that program included a clinical pharmacist and a nurse.  The incidence of medication errors before and after the program, which included a lecture and ward-based hands-on instruction, remained high.  But the authors concluded that the program was effective because it changed the work environment to promote a safety culture. Another study published in the Journal of Pharmacy Technology evaluated the incidence of medication errors in the community pharmacy setting but collected data retrospectively.⁴ It attributed the number of reported medication errors to high prescription volumes and lack of adequate pharmacist coverage.  The authors concluded that increasing the number of pharmacists to accommodate the workload may help to minimize errors. The results of this study lead to a revision of pharmacy technician training requirements and certification in the state of New Hampshire. The results of these studies suggest that more work is needed to minimize medication errors and well-constructed training programs may be part of the solution.

Medication errors are expensive, harmful, and potentially deadly.  Live interactive training programs are a great method for delivering information.  I believe people are more likely to remember things when given the opportunity to interact with other participants and the instructor compared to when participants only hear or read about the material. More studies regarding the impact of live interactive training in community pharmacy are needed but the available data suggests they can make a difference in medication errors in pharmacy. Trial and error will be needed to figure out what elements are needed in the training sessions and whether periodic follow-up training should be implemented. Training sessions will also need to be adapted to fit different types and sizes of community pharmacies. Pharmacists should be aware of this study and similar studies so they can make informed decisions about employee training and different approaches to reduce medication errors. 

References:

1. Medication Errors. AMCP.org. https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/medication-errors. Published 2019.
2. Grant M, Remines J, Nadpara P, Goode J. Impact of Live Training on Medication Errors in a Community-Based Pharmacy Setting. Innov Pharm. 2020;11(3):11. doi:10.24926/iip.v11i3.3291
3. Nguyen H, Pham H, Vo D et al. The effect of a clinical pharmacist-led training programme on intravenous medication errors: a controlled before and after study. BMJ Qual Saf. 2013;23(4):319-324. doi:10.1136/bmjqs-2013-002357
4. Pervanas H, Revell N, Alotaibi A. Evaluation of Medication Errors in Community Pharmacy Settings. Journal of Pharmacy Technology. 2015;32(2):71-74. doi:10.1177/8755122515617199

An Escape Room Activity for Preceptor Development

by Elizabeth Akers, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy

Summary and Analysis of: Richter LM, Frenzel JE. Design and Assessment of a Preceptor Development Escape Room. Am J Pharm Educ. Published online July 28, 2020: ajpe8073. doi:10.5688/ajpe8073

Learning is often informative but boring.  Or it can be entertaining.  But I think the best learning is both informative and fun! When learning is fun, it helps grab my attention and engages me in the topic.  That’s why a recent article published in the American Journal of Pharmaceutical Education got my attention. The investigators created an escape room activity for preceptor development. Escape rooms are a form of amusement where a group of participants works together to actively solve puzzles in order to “escape” confinement from a room. Applying escape room principles to health professions education allows learners to participate in life-like scenarios but in a low-stakes environment. They offer an opportunity to learn and change perspectives based on experience in a practice scenario. While this instructional strategy was initially used to provide instruction to student pharmacists, this study looked at changes in preceptor knowledge following participation in an escape room game.

When structuring this game, the investigator wanted to create an interactive, fast-paced, hands-on preceptor development program.¹ The intent of this hands-on experience was for participants to use the school’s preceptor handbook, locate and understand the School of Pharmacy’s mission and vision statement, use the pharmacist's patient care process (PPCP), and problem-solve a patient case. The escape room activity was offered on two separate occasions, one to preceptors at a district meeting of the North Dakota (ND) Pharmacists Association and at the ND annual pharmacy convention. Facilitators created a virtual escape room which consisted of five rooms, each with a puzzle.  The participants were given a total of 45 minutes to escape. To move from one puzzle to the next, the participants had to submit their answers using a Google Form. The Google Form would “unlock” the next puzzle when the correct answer was submitted and this directed them to move on to the next station in the room. Teams also received a PPCP passport to document their progression through the PPCP wheel. If a puzzle was solved incorrectly or the team ran into a roadblock, teams could write a preceptor pearl in exchange for a hint. Teams were instructed to be efficient.  The team that solved all of the puzzles in the shortest amount of time was considered the “winner.” After all of the teams had completed the game, the faculty facilitators debriefed to enforce the core concepts that were encountered during the experience.

To document the impact of the escape room method, the investigators asked participants to complete an electronic survey via Qualtrics immediately before and after the experience.  They collected demographic information about the preceptor’s practice experiences and administered a knowledge-based multiple-choice test about the PPCP and the school’s mission, and asked questions about the preceptor’s perceptions of the game. They analyzed the perception and knowledge questions using a paired t-test to determine if participation in the escape room lead to statistically significant improvements when compared to the baseline responses.

Preceptors (n=15) who participated in the escape room experience had statistically significant increases in their perceived abilities to locate and access the preceptor handbook and to describe and use the PPCP. Before the experience, only nine preceptors could correctly order the 5 steps of the PPCP.  Following the escape room activity, 13 preceptors were able to do so. On the other hand, preceptors were less likely to correctly answer the type of approach the PPCP uses. Of the preceptors participating, ten had previously participated in an escape room and all 15 participants stated they would recommend the experience to another preceptor. Preceptors indicated they were open to the gaming format and their preference for using various resources remained unchanged.¹

The methods used to perform and evaluate this study were appropriate. A strength of the study was the diverse group of preceptors (from different practice environments) and it was offered on two different occasions in different locations. The weaknesses of this study included a very small sample size and previous exposure to escape rooms. Some participants felt less inclined to contribute compared to others. This could be due to the size of the team or their attitudes towards other team members. The time constraint and pace of the game could have caused participants to miss information needed to answer the post-game questions. The post-survey was also completed with a limited amount of time; therefore, they could have rushed through and not provided errant responses. Participants who had no experience with escape rooms would likely be less efficient at solving the puzzles and this may have reduced their motivation to participate in gameplay. Based on previous work, the investigators also discovered many preceptors prefer online preceptor development programs over face-to-face programs.² This led researchers to believe an online escape room may be more appealing and draw in a larger number of participants.

Previous studies have examined the impact of escape rooms on educating student pharmacists.^3-5  The previous studies showed mixed effects on learning but participants generally had positive perceptions of the escape room format.^3-5 In one study, students performed poorly on the post-assessment test but reported a positive perception of the game.⁴ Another study found that while the escape room was an effective method for reinforcing course content, knowledge retention was poor.⁶ Similarly, the participants stated they had positive experiences and believed they would use institution-specific tools more often.

This study demonstrates that an escape room is an interesting and fun way to learn. An escape room might not be the most efficient way to learn and didactic instruction might still be needed.  Moreover, learners might miss some of the key concepts if the activity isn’t reinforced by debriefing afterward with the facilitator. Using game-like scenarios in an escape room provides an opportunity for learners to practice teamwork which is an important skill in health care today. 

References

1. Richter LM, Frenzel JE. Design and Assessment of a Preceptor Development Escape Room. Am J Pharm Educ. Published online July 28, 2020: ajpe8073. doi:10.5688/ajpe8073
2. Davison M, Medina MS, Ray NE. Preceptor preferences for participating in electronic preceptor development. Pharm Pract 2009;7(1):47-53.
3. Eukel HN, Frenzel JE, Cernusca D. Educational gaming for pharmacy students – design and evaluation of a diabetes- themed escape room. Am J Pharm Educ. 2017;81(7):6265.
4. Clauson A, Hahn L, Frame T, et al. An innovative escape room activity to assess student readiness for advanced pharmacy practice experiences (APPEs). Curr Pharm Teach Learn. 2019;11(7):723-728.
5. Kavanaugh R, George S, Lamberton N, Frenzel JE, Cernusca D, Eukel HN. Transferability of a diabetes escape room into an accelerated pharmacy program. Curr Pharm Teach Learn. 2020;12(6):709-715.
6. Nybo SE, Klepser SA, Klepser M. Design of a disaster preparedness escape room for first and second-year pharmacy students. Curr Pharm Teach Learn. 2020;12(6):716-723.

The Positive Effects of Promoting Mental Illness Stigma Awareness

by Amber Forsman, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy

Summary and Analysis of: Bamgbade BA, Ford KH, Barner JC. Impact of a Mental Illness Stigma Awareness Intervention on Pharmacy Student Attitudes and Knowledge. Am J Pharm Educ. 2016; 80(5): Article 80.

Mental illness has been part of recorded history dating back to 400 B.C. in Ancient Greece and described by the physician Hippocrates.¹  The societal stigma that frames the diagnosis of mental illness has varied over time and culture. Pharmacy students, just like other members of society, have been exposed to and influenced by such stigmas. But unlike other members of society, pharmacy students (indeed, all health professions in general) have a special obligation to provide patient-centered care to all individuals, including those with mental illness. Thus, programs that are intended to address misconceptions about and stigma related to mental illness are a critical component of health professions education.  The Impact of a Mental Illness Stigma Awareness Intervention on Pharmacy Student Attitudes and Knowledge is a study conducted at the University of Texas at Austin that provides evidence that a course on mental illness stigma awareness can make a difference by reducing mental health stigma and increasing mental health knowledge.²

In this pre-post study, a stigma awareness program was provided to Doctor of Pharmacy students on select mental illnesses — specifically depression and schizophrenia —over two class periods (2.5 hours total). Participants (n=120) were third-year student pharmacists who had previously completed the mental health pharmacotherapy module in the school’s curriculum.² The mental illness stigma awareness program was provided as part of a required pharmacoeconomics course, but the activity did not count toward the students’ grades in the course.² The stigma awareness program included videos on schizophrenia stereotypes, patient and provider testimony on the impact of stigma in healthcare practices, patient testimony on experiencing depression and schizophrenia, and a documentary of a patient refusing to be treated for schizophrenia.² After students watch each video, the instructors facilitated reflective discussions.² In addition, there were active learning exercises such as schizophrenic hallucination simulations and “Fact or Fiction” exercises. The videos, discussions, and active learning exercises were designed to target specific domains of mental health stigma (MHS): safety, social distance, separation, comfort, disclosure, and recovery. Participants completed anonymous surveys immediately before and after the program using identical instruments.² The pre and post-surveys included questions related to MHS subdomains: recovery, safety, disclosure, separation, and comfort.² Responses to most survey questions were based on a 5-point Likert scale [strongly disagree (1) to strongly agree (5)].² However, the MHS separation subdomain was measured using an 8-item Social Distance Scale and two additional questions derived from the primary literature.^2,3-5 The pre and post-survey also included ten true/false questions to determine the students’ mental health knowledge (MHK).² The MHS data were analyzed using paired t-tests to compare mean scores before and after the program.² The MHK true/false question data (based on answer correctness) was analyzed using McNemar’s tests to compare the accuracy of student’s answers before and after the program.² 

The pre-program survey revealed significant knowledge deficits among students who had already taken a pharmacotherapy module regarding the treatment of various mental illnesses (pre-test MHK mean score = 5.9/10).  Moreover, the MHS subdomain mean scores range of 1.8 to 3.4 suggested that many students have some level of stigma toward individuals with mental illness.²  After completing the program, post-program survey results found the MHK improved significantly and there was diminished stigma towards mental illness.²  See a summary of the study results in Table 1.

Table 1:  Summary of Study Results²

MHS	Overall stigma toward depression and schizophrenia decreased after the mental illness stigma awareness program
	Significant improvements in the (p<0.01) mental illness stigma occurred in the following subdomains: recovery, safety, separation, and comfort stigma.
	There was a significantly greater decrease in stigma subdomains: recovery and separation for schizophrenia when compared to the changes in the recovery and separate subdomains for depression
MHK	MHK significantly increased after the program, with the mean score improving from 5.9 to 6.8 (<0.01).
	Improvements in student knowledge related to pharmacy counseling, outcomes associated with mental illness, and symptomology of mental illness significantly increased (P<0.05)

One strength of this study was the data collection about the students’ personal (including family members) experience with mental illness. This data was valuable because personal experience could impact a student’s responses to the survey. Conversely, a weakness is the limited diversity of the population.  The intervention was conducted and assessed in only one group of students at a single pharmacy school, with only 88 participants completing both the pre and post-survey. In order to get a more precise picture of the benefits of this intervention, it will be necessary to repeat the program in multiple groups of pharmacy students at several schools across the nation, or even internationally. I believe that the methods used in this study were appropriate, especially because the program included several elements (videos, reflective discussion, and active learning exercises), and the survey instruments included validated questions that measure the intended constructs related to MHS.

Similar studies have been conducted at other pharmacy schools.   Consumer- led Mental Health Educations for Pharmacy Student⁶, A Mental Health Elective to Improve Pharmacy Students’ Perspectives on Mental Illness ⁷, and An Elective Psychiatric Course to Reduce Pharmacy Student’s Social Distance Toward People with Severe Mental Illness⁸ all came to a similar conclusion -  that stigma toward individuals with mental illness can be reduced when student pharmacists interact with patients with mental illness and provided instruction regarding mental health.^2,6-8

The fact that student’s biases and knowledge can be positively impacted through an educational program seems like common sense. However, instruction can take many forms and some strategies may be more effective than others.  What I have found in the components of this study and the comparable studies is that the instructional materials used attempt to humanize mental illness in contrast to the textbook-type (detached and unemotional) way pharmacy students most often learn about diseases. Additionally, this study provides evidence that using diverse and engaging materials such as videos, discussions, and active learning exercises can have a positive impact. Moreover, this study provides some helpful insight into how programs intended to address highly stigmatized disease states could be designed and implemented. I sincerely hope that the positive effects observed in this short intervention will positively impact the way these students communicate with and care for their future patients with mental illness.

References

1. WGBH Educational Foundation. Treatments for Mental Illness [Internet]. PBS. Public Broadcasting Service; [cited 2020Sep29].
2. Bamgbade BA, Ford KH, Barner JC. Impact of a Mental Illness Stigma Awareness Intervention on Pharmacy Student Attitudes and Knowledge. Am J Pharm Educ. 2016; 80(5):Article 80.
3. Corrigan PW, Green A, Lundin R, Kubiak MA, Penn DL. Familiarity With and Social Distance From People Who Have Serious Mental Illness. Psychiatric Services. 2001; 52(7): Pages 953–8. [Pub Med]
4. Penn DL, Guynan K, Daily T, Spaulding WD, Garbin CP, Sullivan M. Dispelling the Stigma of Schizophrenia: What Sort of Information Is Best? Schizophrenia Bulletin. 1994; 20(3): Pages 567–78.
5. Link BG, Cullen FT, Frank J, Wozniak JF. The Social Rejection of Former Mental Patients: Understanding Why Labels Matter. American Journal of Sociology. 1987; 92(6): Pages 1461–500.
6. O'Reilly CL, Bell JS, Chen TF. Consumer-led Mental Health Education for Pharmacy Students. Am J Pharm Educ. 2010; 74(9): Article 167.
7. Gable KN, Muhlstadt KL, Celio MA. A Mental Health Elective to Improve Pharmacy Students' Perspectives on Mental Illness. Am J Pharm Educ. 2011;75(2): Article 34.
8. Di Paula BA, Qian J, Mehdizadegan N, Simoni-Wastila L. An Elective Psychiatric Course to Reduce Pharmacy Students’ Social Distance Toward People With Severe Mental Illness. Am J Pharm Educ 2011;75(4): Article 72.

Engaging Students in a Videoconference Classroom

by Kassidy Voinche, PharmD, PGY-1 Community Pharmacy Resident, University of Mississippi School of Pharmacy

Teaching and learning have looked different over the past six months. Due to the need for social distancing during the COVID-19 pandemic, many schools have turned to virtual classrooms. Using video teleconferencing for live educational seminars is a great solution to keep everyone safe and to keep learning on track. Indeed, there are many technologies available that can help bridge the distance between students and teachers. However, teaching at a distance, either synchronously or asynchronously, presents several challenges for both the instructor and the learner. It can be difficult to engage students in discussions, group work, and in-class assignments when they are home with lots of potential distractions. Although there are inherent obstacles, with some extra tools, creative thinking, and problem-solving, the online classroom can become a place for engaged learning.

According to an article in Teach for America (TFA), creativity, clarity, and self-reflection are key to being a great teacher in the virtual classroom.¹ It’s essential, particularly in an online environment, to establish clear learning goals and objectives. With so much digital communication to keep up with, expectations need to be well-defined to ensure everyone is on the same page. Instructor feedback on assignments should be more thorough. It's helpful to reflect on student engagement, both in and out of class-time, using these questions from the TFA article, 7 Tips for Being a Great Virtual Teacher:

• What trends do I see in student participation? Possible causes?
• What am I learning about my students as participants in my virtual classroom?
• What could I do to make learning more accessible, inclusive, and meaningful?
• How are we, as a class, doing physically, mentally, and emotionally? ¹

Checking in with yourself and the students allows for adaptation. Investigate what works and what does not, listening to and recognizing what the students seem to be responding to well.

Combining offline, asynchronous activities with synchronous videoconferencing can improve participation.²  Create brief recorded videos or other learning activities for students to complete before class. Then, use class-time to summarize this content. Students can divide into breakout rooms for problem-based learning.  Ask students to create a Google doc to keep them accountable. Allow students some autonomy over assignments and encourage them to experiment.  This can lead to richer discussions. ² Asynchronous participation could include allowing students to view other students’ work and asking them to give feedback with guiding questions. This method promotes peer-to-peer accountability. 

Incorporating personality with a little humor and fun goes a long way when capturing student’s attention. The article Don't Turn into a Bot Online: Three Easy Strategies to Let Your Personality Shine in Your Online Course provides several tips on how to add a personal touch to your virtual classroom.³ Let some of your personality shine through! This can be done using humor or relatable stories. Humor can be tricky, but in small doses, effective. Searching online for a popular meme or gif to throw into a PowerPoint presentation can provide a light-hearted visual. ³ An Inside Higher Ed article suggests allowing students to create various fun content in the forms of memes or tweets to summarize the discoveries made in the session. Instructors can then open the next class meeting with some of their favorites to recap.⁴

Teaching to a virtual classroom where no student has their camera on can seem like talking to a wall. However, students with their camera off could be more engaged than you think.⁵ Indeed, engagement may even be enhanced when the teacher allows students to turn off cameras. Students can record their break-out group sessions with cameras off and turn in the recording.⁵ Providing a choice of camera usage enhances student agency. Another option is to build in ‘camera-off’ time during a class session for students to reflect independently. Without the camera’s constant gaze, students are not rushing to the next step to prevent the awkward silence.⁵ This method provides a specified amount of time for students to work and develop an answer, then share when everyone regroups.  It is always a good idea to check in with students to assess their personal needs and preferences, asking them how they can most effectively interact with the class and material.

The impact of widely used virtual classrooms on student progression and success is unknown at this time, but a study done in 2019 found that the impact may be minimal. Based on eight years’ worth of data from Wingate University School of Pharmacy, investigators found that distance learning via synchronous videoconferencing did not impact performance in a basic biological sciences course among professional degree pharmacy students.⁶ These findings are consistent with several similar studies conducted with various student populations. While using video conferencing for a majority of classes may seem daunting, with the right mindset, support, and tools, students can perform as well as when classes are conducted in-person.

There a few tools built into many videoconferencing applications to improve student engagement, like polls and whiteboards.  But you can combine these tools with countless other online tools. Kahoot, Flipgrid, and Poll Everywhere are a few examples of other applications that can be used to increase student participation. When choosing a platform or method, always consider accessibility. Reach out to students to determine which technologies they’ve had previous experience using and are most accessible. Inviting students to provide input about technologies that will be used in a course can build a connection between teacher and learner. Periodic reflection, by teachers and students, can improve the virtual classroom and generate new ideas on ways to engage. With some thought and resourcefulness, teaching can work just as well and, in some cases, even better in the virtual environment.

In summary, here are six tips for enhancing student engagement through distance learning:

1. Communicate clear, detailed learning objectives and expectations.
2. Combine asynchronous and synchronous learning methods.
3. Allow students to create fun content to summarize what they learned.
4. Survey students about how they best engage with the content and their preferences.
5. Reflect on which strategies are working and how to continue improving.
6. Use tools such as polling and collaboration platforms.

 

References:

1. The TFA Editorial Team. 7 Tips for Being a Great Virtual Teacher. Teach For America [Internet]. 2020 Mar 24.
2. Minero E. 8 Strategies to Improve Participation in Your Virtual Classroom. Edutopia [Internet]. 2020 Aug 21.
3. Evans J. Don't Turn into a Bot Online: Three Easy Strategies to Let Your Personality Shine in Your Online Course. Faculty Focus [Internet]. 2020 Sep 08.
4. Crook A, Crook T. 6 Tips for Teaching Online and In Person Simultaneously. Inside Higher Ed [Internet]. 2020 August 26.
5. Seltzer K. Engaging Students in Virtual Instruction With the Camera Off. Edutopia [Internet]. 2020 Sep 14.
6. Dirks-Naylor AJ, Baucom E. Impact of distance learning via synchronous videoconferencing on pharmacy student performance in a biological science course sequence: an 8-yr analysis. Adv Physiol Educ. 2019;43(4):534-536.

Practice Reinforces Knowledge and Builds Confidence

by Shannon Buehler, Doctor of Pharmacy student, University of Mississippi School of Pharmacy

Summary and Analysis of: Manigault KR, Augustine JM, and Thurston MM. Impact of Student Pharmacists Teaching a Diabetes Self-Management Education and Support Class. Am J Pharm Educ 2020; 84 (3): Article 7621.

This article caught my attention because it involved student pharmacists implementing a diabetes self-management class for patients.¹ As a student pharmacist, diabetes is an interest of mine – something I think that will be important in my future career. This study attempted to demonstrate that students learn best by practicing in a real-life, authentic setting. The authors of this study compared two groups, one group received traditional instruction and experiences working with people with diabetes, the control group, and the other group, the intervention group, had an opportunity to apply what they learned by teaching a diabetes management class to patients. A study like this is needed to help determine what ways are most effective in teaching health professional students.

This study took place at Wellstar Atlanta Medical Center outpatient clinic. The investigators precept Doctor of Pharmacy students from the Mercer University College of Pharmacy during their fourth-year ambulatory care advanced pharmacy practice experience (APPE). This investigation took place from June 2016 to April 2018 and there were one to two student pharmacists participating in the experience each month. The control and intervention alternated each month so that there was an equal distribution of participants in the two groups. During the first week of the APPE, both groups completed two assessments: one on knowledge of diabetes and the other about their perceived aptitude and confidence. Both groups engaged in traditional patient care activities throughout the five-week APPE. The intervention group conducted a single diabetes self-management education and support (DSMES) class during their fourth or fifth week. Students in the control group did not.  During this investigation period, a total of 15 DSMES classes were taught. The DSMES classes typically had three to five patients participate.  The patients had been previously seen in the clinic by the student. These classes were in-person and lasted approximately two hours.  The students used the US Diabetes Conversations Map Kit provided by the American Diabetes Association (ADA) to help guide the class.² Immediately after conducting the class, the intervention group completed two post-intervention assessments – the same assessments that were administered during the first week of the APPE. Similarly, the control group received the post-intervention assessments in the 4^th or 5^th week.

The results showed that the intervention group substantially increased their level of knowledge and confidence. The intervention group students had a significant improvement in their knowledge (increased from 68.4% at baseline to 81.8%) while the control group did not (increased from 70.0% to 74.1%). Both groups showed significant improvement in aptitude and confidence from baseline. However, the change in mean aptitude/confidence scores was greater in the intervention group (11.9 point increase) when compared to the control group (6.7 point increase, p=.0026).

Measuring knowledge and confidence are two important constructs to assess. Both contribute to what makes a good healthcare provider, thus making this study relevant to APPE preceptors for student pharmacists. It is important to note that students in the intervention group put forth more time and effort and this likely explains why their knowledge gains were greater. Although the post-assessment confidence levels improved in both groups, a confidence boost might come from simply getting real-world experience when completing an APPE rotation. Both groups provided one-on-one counseling about diabetes to patients. This might explain the increased confidence in both groups. The intervention group had greater improvement in confidence which can be explained by their additional experience leading the DSMES class. 

The strengths of this study include using alternating months to enroll participants in the control vs. intervention groups and using consistent pre- and post-assessments. Although they were not randomly assigned by the investigators, students were not “selected” to participate in the intervention or control groups. However, there are some weaknesses including the fact that all participants (students, patients, and preceptors) were from the same clinic and the same school of pharmacy. Moreover, we don’t know if all students had similar experiences and patients may have had different issues or complications. Lastly, some students (20%) had previously participated in a diabetes management elective course offered during their curriculum.  Slightly more students in the control group had taken the elective course but it is unclear if this difference impacted the study results.

A similar study was previously conducted by Shrader and colleagues. Similarly, student pharmacists were engaged in teaching DSMES, but the study did not include a control group. Moreover, the investigators did not perform a comprehensive assessment – they only measured changes in student confidence.³ Another small study evaluated student pharmacists who participated in an interprofessional elective.  Again, the investigators only measured improvements in student confidence when providing DSMES to patients.⁴ In both of these studies, there were positive effects on student confidence levels.  It is perhaps not surprising that student confidence consistently improved in all of these studies as one would hope an educational intervention would improve how students perceive their ability to perform these tasks.

I believe this study provides solid evidence that practice, applying one’s knowledge, improves both knowledge and confidence. From my own experience, I know that putting my knowledge into action in “real” life truly solidifies my knowledge. Every preceptor should provide opportunities for hands-on, authentic practice. This article is a good example that could be applied during any ambulatory care APPE but it can be modified for experiences in other settings too. The key is to provide students with opportunities for more practice.  And this will increase their knowledge and confidence as they transition to independent practitioners. 

References:

1. Manigault K, Augustine J, Thurston M. Impact of Student Pharmacists Teaching a Diabetes Self-Management Education and Support Class. Am J Pharm Educ. 2020;84(3): Article 7621.
2. Diabetes Care. American Diabetes Association Standards of Medical Care in Diabetes – 2020 [Internet]. Diabetes Care 2020;43(1): S1-S212
3. Shrader S, Kavanagh K, Thompson A. A Diabetes Self-Management Education Class Taught by Pharmacy Students. Am J Pharm Educ 2012 Feb 10;76(1): Article 13.
4. Fazel M, Cooley J, Kurdi S, Fazel M. A co-curricular diabetes-specific elective with interprofessional students and faculty. Curr Pharm Teach Learn 2019 Feb;11(2):172-177.

Forming One’s Professional Identity

by Alex Craig, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Making the transition from pharmacy student to practicing pharmacist is challenging.¹ New pharmacists are tasked with actively applying learned materials in their everyday practice as well as problem-solving when areas of practice are often more gray than black and white. During this transition, a pharmacist’s professional identity plays a crucial role. Professional identity has been defined as “a representation of self, achieved in stages over time during which the characteristics, values, and norms” of the profession are “internalized, resulting in an individual thinking, acting, and feeling” like a health professional.² Those with strong professional identities tend to be confident, driven, and adaptive when faced with uncertainty.³ I believe professional identity can and must be actively developed through thoughtfully designed student experiences.

Over the last two decades, there has been an explicit effort to teach “professionalism” in health professions education. In recent years this has evolved and helping students form their “professional identity” during their journey to become healthcare professionals has become the educational objective.⁴ In 2014, the American College of Clinical Pharmacy formed a task force on how to help foster professional identity formation. The task force made recommendations for best practices, created a framework for educational methods to support the formation of professional identity within interprofessional contexts, and generated recommendations to support faculty in helping students develop their professional identities.⁵

Facilitating professional identity formation requires consideration of many factors: What kind of pharmacist (generalist, specialist, practice setting) does the student pharmacist want to become? What are the hallmark characteristics society needs in a pharmacist now and into the foreseeable future? What processes are in place to support and promote identity formation?¹ Forming a professional identity is a dynamic process with many influences.  It is influenced not only by the student’s personal identity, but also factors such as clinical/non-clinical experiences, role models/mentors, formal instruction, self-assessment, reflection, and socialization. Among these, role models/mentors and experiences appear to have the biggest impact. In professional identity formation, a positive mentor/mentee relationship is facilitated by constructive feedback. Feedback serves as a reinforcement of learning and it assists in the confirmation of the learner’s self-perception.⁴ Preceptors and mentors can aid in identity development by sharing personal experiences and encouraging the student to shift into an independent mindset. For example, when encountering a situation where the best decision is unclear, the preceptor should encourage the student to express their thoughts and suggest potential solutions. Encouraging students to combine foundational knowledge with recent literature and applying that to a patient case or practice management scenario can facilitate this independent thinking.  Indeed, students should be encouraged to be responsible for making choices and this should align with who they want to become as a healthcare professional. Exposure to increasing complex scenarios can also help prepare students for their future practice. There also needs to be opportunities for students to share and reflect on their experiences and what was gained or learned. This may be facilitated through debriefing sessions that are student-led.⁴

A 2019 scoping review investigated pharmacy student professional identity formation.¹ The paper pointed out important aspects to be considered when developing curricula to foster professional identity formation. First, it's important to examine how pharmacy students see themselves. Pharmacy students often lack an understanding of their professional selves and are unable to articulate what it means to be a pharmacist. Pharmacy students tended to focus on traditional pharmacist roles (dispensing and counseling) and this understanding was reinforced by experiential learning and part-time work experiences. Pharmacy students also found it challenging when engaging with patients when they were met with disinterest or anger. Experiences gained within the pharmacy curriculum often led to unresolved identity dissonance because students’ practice experiences did not align with the idealist view taught in the classroom about the pharmacist role.¹ This includes ambiguity about the definition of “clinical” pharmacy. For example, the definition of “clinical” often vary by practice setting, and students perceive big differences in the role and responsibilities of pharmacists in community, ambulatory care, and hospital settings. Some educators suggest that role-play activities can help encourage students to merge the gap between the “ideal” professional role and their lived experiences. Students should be given opportunities to discuss their experiences with a trust role model and re-enact how they responded to the experience.  This enables students to envision their professional identity but also critically examine their personal identity.⁶

To facilitate professional identity formation, faculty will likely need to be educated about the construct. It is important that faculty understand that students must participate in developing their own professional identities and maintaining a welcoming environment for open dialog is critical.  The curriculum should address known factors that affect identity formation and there should be a mechanism to assess student progress. Some schools engage students in the development of professional identity by using reflective strategies.³ This strategy can consist of some foundational instruction about professional identity formation and periodically asking student pharmacists to reflect on their stage of development. These reflections can help gauge the student’s understanding, track their progress, and identify gaps. A tiered approach is needed and activities should be appropriate for the learner’s stage of development.

I challenge you to think about your own transition into practice and your understanding of your role. What experiences did you have that fostered the development of your professional identity? What experiences or role models do you wish you could have had during your training?

The aim is not to homogenize all personal identities into a standard; rather, the student maintains his or her ‘self-identity’ while building a professional identity through exposure to diverse experiences while upholding the key virtues of a … professional including competence, kindness, honesty, and integrity.⁷

References:

1. Noble C, McKauge L, Clavarino A. Pharmacy student professional identity formation: a scoping review. Integr Pharm Res Pract. 2019; 8: 15-34.
2. Cruess R, Cruess S, Boudreau J, et al. Reframing medical education to support professional identity formation. Acad Med. 2014;89(11):1446–1451.
3. Scanlon L. “Becoming” a professional. Dordrecht: Springer; 2011. 
4. Cruess S, Cruess R, Steinhert Y. Supporting the development of a professional identity: General principles. Medical Teacher. 2019; 41(6): 641-649.
5. American Association of Colleges of Pharmacy. Taskforce on professional identity formation – final report. 
6. Monrouxe LV, Rees CE, Endacott R, et al. “Even now it makes me angry”: health care students’ professionalism dilemma narratives. Med Educ. 2014; 48(5): 502–517.
7. Forouzadeh M, Kiani M, Bazmi S. Professionalism and its role in the formation of medical professional identity. Med J Islam Repub Iran. 2018; 32: 130.

Using Twitter to Augment Student Learning

by Emily Ware, PharmD, PGY1 Pharmacy Practice Resident, St. Dominic Hospital 

The use of social media across the educational landscape has considerably increased over the past few years and especially in the past few months during the COVID-19 pandemic. Social media was not designed for the purpose of education and other learning activities; however, the ease of networking and sharing content has allowed social media platforms to gain popularity in higher education.¹ Twitter has been used as a communication tool for formal and informal learning by allowing students and scholars to engage with their peers and discuss emerging information.¹

In one study that investigated the use of Twitter as part of a face-to-face class, undergraduate students taking a teacher education course reported that Twitter enabled communication and interaction between classmates as well as with the broader educational community.² Students stated that Twitter also facilitated connectedness and resource sharing. This encouraged a more collaborative approach to learning.² Another study looked at the perceptions of first-year biomedical students who completed a course in which Twitter-related activities were incorporated into the course design.³ The study found that the students who most actively engaging in the Twitter activities had higher end-of-semester grades compared with those who did not.³ The authors also reported that the use of Twitter was a useful method of promoting public health, along with facilitating collaboration among peers.³

While there are potential benefits using Twitter for educational purposes, there are some drawbacks that should be mentioned.  One study that explored the perceptions of high school students found that students were overwhelmed with the volume of information on Twitter.⁴ Moreover, first-time users had difficulty using the platform and questioned the appropriateness of using Twitter in the educational setting.⁴ In another study conducted at a school of pharmacy, students who completed an optional survey about the use of Twitter in a management course, 71% stated Twitter was distracting and 69% believed it prevented note-taking.⁵ Although these are valid points, these are issues that could be solved if students are taught how to use Twitter effectively as a tool to support their educational endeavors.

There are many ways to use Twitter as an instructional tool. Since some students will not be familiar with Twitter, it’s important to start out small with a brief activity that intended to get students accustomed to the platform.  For example, an instructor could tweet a poll for students to respond to during class. Next, teachers could create an assignment requiring students to formulate a tweet. As students become more comfortable with the tool, the instructor could ask students to create concise writing exercises (like a tweetorial), take Twitter quizzes, use it to research a topic, and engage “backchannel” discussions.  Backchannel discussions are digital conversations that run concurrently with a face-to-face activity and they enable more students to participate and ask questions.  Twitter can also be used for professional development. For example, there are many health professionals across the world who regularly use Twitter to discuss interesting cases they have seen, analyze recently published research manuscripts, or share experiences during their day-to-day work.  Students may find it beneficial to follow a few people on Twitter who work in a potential career path to get a glimpse of what that field or specialty might be like.  Students could then be asked to complete an assignment summarizing their findings and opinions about their potential career choice.

During my third year of my doctor of pharmacy curriculum, we had days in which we completed a “Twitter consult” and were “on call”. During these simulated on call activities (similar to being on call in real life), it was imperative to be readily available and not engage in any activities during the day that required us to be away from our phone.  The consult request was delivered in the form of a tweet, and we never knew when the consult request was going to arrive.  It was the student’s responsibility to respond to the consult within an hour and formulate a verbal response. Typically, the verbal response could not be longer than two minutes. The concept of Twitter consults was to provide a very interactive way for us to glimpse what our future careers may look like – concisely answering difficult questions from health professionals (and patients) in a timely manner. 

Now, as a pharmacy resident, Twitter has helped me to stay current on the latest research and therapeutic recommendations. I have found it to be a great networking tool. I “follow” other pharmacy residents and practitioners who are located all around the US. It is insightful to learn from other pharmacists about their ideas and perspectives on pharmacy and medication-related issues.

I believe that there are many benefits to using Twitter as a teaching tool and I hope it is used more frequently in the classroom and experiential learning settings.  Students need to develop the skills to collaborate and network with their peers and Twitter (and similar social media platforms) go beyond what could be achieved in face-to-face settings.  Twitter can also help build a student’s confidence by encouraging them to formulate their own ideas and opinions. I believe Twitter can augment learning and can be used by teachers and students to facilitate collaboration, networking, and interaction.

References:

1. Malik A, Heyman-Schrum C, Johri A. Use of Twitter Across Educational Settings: A Review of the Literature. Int J Educ Technol High Educ. 2019;16:1-22.
2. Carpenter JP. Twitter’s Capacity to Support Collaborative Learning. Int. J. of Social Media and Interactive Learning Environments. 2014;2:103
3. Diug B, Kendal E, Ilic D. Evaluating the Use of Twitter as a Tool to Increase Engagement in Medical Education. Educ Health (Abingdon). 2016;29(3):223-230.
4. Bull P, Adams S, et al. Learning Technologies: Tweeting in a High School Social Studies Class. Journal of Educational Technology. 2012;8:26–33.
5. Fox BI, Varadarajan R. Use of Twitter to Encourage Interaction in a Multi-Campus Pharmacy Management Course. Am J Pharm Educ. 2011;75:Article 88.

The Role of Education in Increasing Social Justice

By Bianca Lascano, PharmD, PGY2 Ambulatory Care Pharmacy Practice Resident, University of Mississippi School of Pharmacy

As healthcare professionals, we understand that social determinants of health have profound effects on health outcomes. Awareness of the health disparities they generate underscores the significance of emphasizing social justice principles in health professions education. It is important that educators help students develop the critical thinking, collaboration, and self-reflection skills necessary to foster a better society.¹ There are several courses embedded in the curriculum that must be taught as students matriculate through the didactic portion of their professional degree program. There are many opportunities to discuss social determinants of health throughout the curriculum and help students understand their implications through the lens of social justice.

Image from: https://www.promotionswest.com/health---social-equity.html

In A Practical Strategy for Infusing Multicultural Content into Any Lesson posted on the Faculty Focus website, Dr. St Germain discusses a method to integrate multicultural content into each lesson he teaches in a business communications course. Dr. St. Germain gives specific directions to guide his students to think about marginalized groups. For example, if students are developing a website for the city’s recreation department, the directions would state, “evaluate how well the website ensures people of color and how welcoming the content may be to the LGBTQ community.” Having students work at the evaluation level of Bloom’s taxonomy, greatly increases the chances that the activity will allow the students to construct new knowledge as it pertains to cultural competence and social justice.²

Professors in the health professions can emulate Dr. St. Germain by including diverse patient populations when designing patient cases within each clinical module. Including social aspects of a patient’s life that might impact health outcomes and having students explore how that could affect treatment and healthcare delivery will prompt students to create individualized plans through the lens that is different than their own. Thus social justice issues can be woven into course material that, on the surface, appears unrelated to social justice.

It is surprising that even though issues related to social justice are central to healthcare services provided to patients, they have received inadequate scholarly attention. A lot of the course material taught within the health professions curriculum can be viewed from a social justice perspective. For example, we understand the treatment of hypertension can adversely affect certain patient populations more than others. Access to treatment and follow up care is more difficult for some populations. Food insecurity and lack of transportation can be significant barriers. It is important that students begin to recognize their assumptions and implicit biases as they explore and discuss case studies.

Unfortunately, implicit bias, by definition, influences health professionals without their knowledge and despite their best intentions.⁴ A process described as implicit bias recognition and management (IBRM) is required to mitigate the negative impact of bias. Research on IBRM suggests that as health professionals begin to accept that they can never eliminate all their biases, they also confront that they are learning within an environment that reinforces and contributes to these biases.⁵  Even well-intentioned learners may find the process of discussing and reflecting on biases challenging.  Moreover, faculty may be reticent to facilitate such discussions.⁴

Sukhera, Watling, and Gonzalez propose transformative learning theory (TLT) as a guide for implementing implicit bias training in health professions education. TLT suggests that learning is a process triggered by disruption, followed by a revised interpretation of experiences that guide an individual’s actions.⁴ The process requires critical reflection, dialogue, and action. An illustrative example would be placing a health professional learner in a challenging rural or remote setting for service learning. This would facilitate cross-cultural interactions that produce dissonance, promote skill development, and require dialogue.⁴ This most certainly would be more transformative than a lecture about diabetes. Professors can assess engagement in these activities by inviting students to reflect on how their actions perpetuate the status quo. The goals of transformative learning are to increase awareness of how to construct reality and to break free of limiting structures that shape our understanding.⁴

In a recent article posted on The Edvocate website entitled Teaching Social Justice in Your Classroom, Mathew Lynch provides some activities that can be used to develop the skills necessary to advance social justice.³

These skills include:

·       Differentiating between fact and opinion to determine what is true

·       Examining diverse points of view to look at an issue from all sides

·       Developing a personal perspective based on accurate comprehension

Given that the majority of health professions students come from diverse backgrounds, these skills are not only relevant when treating patients, but also when interacting and working with classmates. Even more reason to explore social justice! Students should be able to have a healthy dialogue with persons of different ethnicities, gender, age, and religious beliefs.

In a recent article posted on the Resilient Educator website entitled Teaching Social Justice in Theory and Practice by Caitrin Blake, the author suggests using these questions  to explore potential systemic inequality in public policy … or healthcare delivery:¹

·       Who makes decisions and who is left out?

·       Who benefits and who suffers?

·       Why is a given practice fair or unfair?

·       What is required to create change?

·       What alternatives can we imagine?

Blake suggests, in order to foster social justice in the classroom, educators must first build a safe, encouraging place where students can speak about their experiences and beliefs.¹ Thought-provoking conversations can be created by encouraging students to share their ideas and respectfully respond to others without shutting the discussion down.

Social justice cannot be taught and fully understood overnight. Starting the dialogue in the classroom affords students the opportunity to engage in an authentic examination of their world and to work toward positive changes that make healthcare delivery more equitable. Providing a safe environment for students to share personal stories and opinions on different aspects of social justice is just the start. Consider how you might discuss social justice topics with your colleagues and introduce these concepts to your students.

References

1. Blake C. Teaching social justice in theory and practice. Resilient Educator [Internet]. 2015 May 13. Available from https://education.cu-portland.edu/blog/classroom-resources/teaching-social-justice/
2. Germain D St. Practical Strategy for Infusing Multicultural Content into Any Lesson. Faculty Focus [Internet]. 2019 Nov 11. Available from:  https://www.facultyfocus.com/articles/effective-teaching-strategies/infusing-multicultural-content-into-any-lesson/
3. Lynch M. Teaching Social Justice in Your Classroom. The Edvocate [Internet]. 2019 Jan 9. Available from: https://www.theedadvocate.org/teaching-social-justice-in-your-classroom/ 
4. Sukhera J, Watling CJ, Gonzalez CM. Implicit Bias in Health Professions: From Recognition to Transformation. Acad Med. 2020;95:717‐723. 
5. Van Ryn M, Hardeman R, Phelan SM, et al. Medical school experiences associated with change in implicit racial bias among 3547 students: A medical student CHANGES study report. J Gen Intern Med. 2015; 30:17

Teaching Stress Management and Coping Strategies to Students in the Health Professions

by Ganiat Animashawun, PharmD, PGY1 Pharmacy Resident G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS

Stress can be perceived in different ways. Stress is a complex bio-behavioral, psycho-social response to a stressor.¹ Stress can be both negative and positive.² Negative stress is labeled as distress, whereas positive stress is called eustress.³ People may assume that all stress is bad, but stress can actually be a positive thing. A stressor can be real or perceived prompted by something in the external environment or internally generated.¹ A “real” stressor is produced from an actual event. For example, if a student fails an exam that is a real stressor. A perceived stressor would be when the student thinks “I did horrible. I failed my exam.”  It hasn’t actually happened (yet). External or environmental stressors are things that are out of one’s control. For example, “there are tornado warnings so I will not be able to drive to the school to take my exam.” Internal stressors are based on the way you evaluate yourself or based on your beliefs.  A panic attack before an exam due to negative self-talk is an example of an internal stressor.² Seeking an advanced degree can stressful – and these stressors are both real and perceived, external and internal. Wanting to be successful in school and making sure that one has a job post-graduation adds more pressure. While some stress can positively drive performance, excessive stress can negatively impact a student’s learning.⁴ Therefore, stress management and coping strategies should routinely be taught in health professions educational programs.

The correlation between stress and learning is multifaceted. There are different factors that influence or cause a person to be more susceptible to feelings of stress. Coping style, personality type, genetic vulnerability, and social support are all factors.² When a student is confronted with a problem, the first step is to identify the source of the problem and then determine what resources are available to address the problem.² If a student is unable to find the resources necessary to cope with the problem, it often results in stress.³

A cohort study entitled Patterns of Stress, Coping and Health-Related Quality of Life in Doctor of Pharmacy Students: A Five Year Cohort Study focused on evaluating perceived stress, coping strategies, and health-related quality of life (HRQOL) in pharmacy students. One hundred forty-five pharmacy students at the University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) participated in the study. The researchers measured stress and HRQOL using 3 tools: the Perceived Stress Scale (PSS), Brief COPE, and Short Form-36. Surveys were administered to the students three times a year over five years. The study found that there was a significant increase (worsening) PSS scores and an increase in students’ maladaptive coping behaviors over time. This corresponded, not surprisingly, with worsening scores on the mental health domain of the health-related quality of life instrument. Thus, the research found a significant increase in perceived stress, increased maladaptive coping, and worsening in mental health across the three pre-clinical curriculum years.⁴  To address this problem, the school implemented strategies for reducing stress and provided coping skills training sessions for the students as well as a peer-to-peer tutoring program.  Moreover, they initiated a curricular review.⁴

To better cope with stress, a student must learn how to take control of the triggers that may cause stress. At the University of Massachusetts Medical School, they have a Mindfulness-Based Stress Reduction (MBSR) curriculum that has been extensively studied and replicated around the world. MBSR guides the students on how to practice, integrate, and apply mindfulness every day.⁶ The primary purpose of the MBSR is to create a structured pathway to increase well-being and alleviate stressors. MBSR can be added and incorporated during early course work in the first year of the curriculum. MBSR is typically taught over 8-weeks with 10 sessions training students to engage in mindfulness meditation and mindful yoga. Even if MBSR course isn’t practical, all students should be introduced to mindfulness. It seems simple but developing mindful habits is actually very difficult. To be truly mindful, students must be able to reflect on all of their actions and be aware of how everything internally and externally can affect their minds and lead to stress.

In a MBSR program, students learn about stress, habitual, automatic behavioral, physical, emotional, and cognitive patterns. In addition the students learn to analyze how they approach and tackle the demands in their everyday life.⁶  Students learn how to recognize their perceptions of a potentially stressful event and then how to creatively respond. Students learn how they can control the way they react or respond. Once the students learn how to condition and focus on the way they respond to stress then they can use the strategies they’ve learned to address future stressful events and thoughts. The MBSR program provides many examples of how to complete each task.⁶ Studies have shown that participants who have completed a MBSR program experience a 35% reduction in the number of somatic symptoms and a 40% reduction in psychological symptoms.⁷ Furthermore, MBSR has been shown to significantly improve health-related quality of life⁷.

Mindfulness-Based Stress Reduction (MBSR) should be routinely taught to first-year health professions students. The earlier the students are exposed to mindfulness practices, the sooner they will able to use those tools to manage stress. Teaching students how to productively managing stressors might vary well lead to improved learning outcomes and reduce drop-out rates.

References

1. Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants Ann Rev Clin Psych 2005; 1: 607-28.
2. Salleh MR. Life event, stress and illness. Malays J Med Sci 2008; 15: 9-18.
3. Votta J and Benau E. Predictors of stress in Doctor of Pharmacy students: Results from a nationwide survey. Curr Pharm Teach Learn 2013; 5: 365-72.
4. Hirsch JD, Nemlekar P, Phuong P, Hollenbach KA, Lee KC, Adler DS, and Morello CM. Patterns of Stress, Coping and Health-Related Quality of Life in Doctor of Pharmacy Students: A Five Year Cohort Study. Am J Pharm Educ [Internet]. (2019).
5. Silvester JA, Cosme S, Brigham TP. Adverse impact of pharmacy resident stress during training. Am J Health-Syst Pharm 2017; 74: 553–554.
6. Kabat-Zinn J, Saki F. Santorelli, Florence Meleo-Meyer, Lynn Koerbel, Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide. [Internet]. (2007).
7. Kabat-Zinn J. Mindfulness-Based Stress Reduction Research Summary.[Internet]. Waterloo, Ontario, Canada; 1992 Dec.