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.

Icons made by dDara from www.flaticon.com

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.

The Importance of Financial Management Courses for Professional and Graduate Students

by Heidi Ott, PharmD, PGY1 Pharmacy Practice Resident, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS

It is no surprise that the cost of attending college is expensive. Pursuing professional or graduate degree, such as a PharmD or PhD, is even more costly. The average annual tuition for graduate programs ranges between $30,000-$40,000.¹ These programs typically 4 years, so those annual tuition fees really add up. How are students supposed to afford this? Well, they become very familiar with Sallie Mae, Direct Plus, and numerous other loan programs. Nearly 85% of pharmacy students borrow money to pay for their degree and their average loan debt is $166,528.²



Students must take ownership and accept responsibility for their financial futures. While some things may be out of their control, students have choices that can affect their education-related debt. It can be tempting to use student loans to support a lifestyle that unnecessarily escalates debt burden. Thus, it is important for students to learn how to manage their finances appropriately; otherwise, they could spend a lifetime carrying around student loans.¹

A cross-sectional study assessing graduating pharmacy students’ attitude toward debt revealed that fear of debt was correlated with higher perceived levels of stress and higher student loan amounts.³ Conversely, increased contemplation and knowledge about loans was associated with lower amounts borrowed. The authors concluded that educational programming concerning loans, debt and personal financial management might help reduce student anxiety as well as the amount borrowed.

Financial/debt management courses should be included in the curriculum for all graduate and professional degree programs because the prevalence and amount of debt among these students is so high. These courses should be structured in such a way that students are required to actively design their own financial plans. There are many books available to help with money management and some of these books (i.e. Personal Finance for Dummies) are used in personal finance courses. While these books are great resources, they are not a substitute for a well-designed course led by an experienced instructor.

A report in American Journal of Pharmaceutical Education entitled An Elective Course in Personal Finance for Health Care Professionals provides insight into how to design and implement a financial/debt management course.⁴ The course was offered as a 1.5 credit course to second-year students in an accelerated, 3-year Doctor of Pharmacy (PharmD) program. The course met for 1.5 hours per week for 10 weeks. Educational outcomes of the course were to provide to students the knowledge and skills to:

• Develop a plan to achieve financial goals
• Create and evaluate a personal budget
• Plan insurance strategies for property, health, disability, and life risks
• Analyze credit and loan vehicles
• Understand basic investment concepts regarding stocks, bonds, and mutual funds
• Compare and contrast options involved in deciding whether to rent or purchase a home
• Prepare income taxes
• Facilitate a discussion with financial professionals using appropriate terminology

The course coordinator chose to focus on active learning techniques instead of using examinations to test the mastery of the learning objectives. Student grades were based on participation during lectures and completion of a series of assignments. Students who turned in consistent and thoughtful assignments received full credit; while, an assignment not thoughtfully prepared was given back to the student to redo. The assignments that seemed to have the greatest impact on the students included the personal budgets, credit card comparison assignment, debt reduction worksheet, personal property inventory, and the tax return exercise. Students took the JumpStart Financial Literacy Survey prior to the course and at the end of the course. The students’ mean score prior to receiving any instructions was 60% and improved significantly with the mean post-assessment score reaching nearly 90%.⁴

Students today often prefer to learn using technology and social media platforms. One potential way to provide instruction on financial/debt management would be to use the online program called Your Financial Pharmacist.⁵ This course provides a systematic approach to creating your own financial freedom strategy. A strength of this program is that it offers a private online group for students to interact with one another and get personal help. However, one challenging element is that all the modules/materials are only available online. While some students prefer online instruction, other students will likely require face-to-face guidance. This course offers resources, such as a zero-based budgeting template, the Public Service Loan Forgiveness (PSLF) checklist, and a student loan milestone checklist. In addition to these resources, Your Financial Pharmacist offers benefits exclusively to student members of the American Pharmacists Association (APhA) including member-only webinars, podcast episodes, financial advice articles, and financial consultations with the Your Financial Pharmacist team.⁶

A longitudinal analysis of East Tennessee State University Class of 2014 pharmacy graduates examined the association between completion of a personal finance elective course in pharmacy school and post-graduation personal finance behaviors. Eighteen months following graduation, this analysis revealed that students who took the personal finance elective were significantly more likely to develop monthly budgets and report positive career satisfaction when compared to students who did not.⁷ It is clear that these courses are well-received and students likely used the information from the course to build a more successful financial future.

Ultimately, access to financial/debt management courses may give students in graduate and professional degree programs greater self-assurance about their financial future. This can result in greater independence, job satisfaction, and, ultimately, better patient care. It is important to make updates/revisions to the instructional design of these courses to keep students engaged. Some revisions that should be considered are adding technology into the course using podcasts, blogs, and online private groups to help students communicate with financial advisors and peers.

References 

1. Cain J, Campbell T, Congdon HB, et al. Complex Issues Affecting Student Pharmacist Debt. American Journal of Pharmaceutical Education. 2014; 78 (7): Article 131. Accessed 29 September 2019.
2. American Association of Colleges of Pharmacy Graduating Student Survey: 2018 National Summary Report. Office of Institutional Research and Effectiveness. Accessed 30 September 2019.
3. Chisholm-Burns MA, Christina SA, Jaeger MC, Williams J. Association between Pharmacy Students’ Attitudes Toward Debt, Stress, and Student Loans. American Journal of Pharmaceutical Education. 2017; 81 (7): Article 5918.
4. Chui MA. An Elective Course in Personal Finance for Health Care Professionals. American Journal of Pharmaceutical Education. 2009; 73 (1): Article 6.
5. Your Financial Pharmacist: Student Resources 2019. Accessed 01 October 2019.
6. American Pharmacists Association: Financial Education 2019. Accessed 01 October 2019.
7. Hagemeier NE, Branham T, Ansari N. Personal Finance Beliefs and Behaviors: A Longitudinal Analysis of Pharmacy Graduates. American Journal of Pharmaceutical Education. 2016; 80 (5): Article S2.

Access to Recorded Lectures and Students’ Performance and Memory

by Alicia Rogers, Pharm.D., PGY-1 Pharmacy Resident, Baptist Memorial Hospital-North Mississippi, Oxford, Mississippi

In recent years, there has been lots of discussion about whether to require students to attend class for lectures and then later allow students access to recordings of the lectures. Until recently, I didn’t quite understand why this was such a hot topic or what all the fuss was about. My thoughts were simple. If students wanted to skip class and watch lectures at a later time, let them. However, as I’ve come to understand, there is bigger picture. It’s not simply about convenience or preferences, it’s about student learning. Does allowing students to have remote and later access to recorded lectures affect students’ long- term memory and performance? I decided to take a deeper look.
 

Recently, investigators at the University of North Carolina Eshelman School of Pharmacy published a study entitled “Exploring the Consequences on Memory of Students Who Know They Have Access to Recorded Lectures.”² I found the results very interesting and contrary to my assumptions. The study included to two parallel groups: students with access to a recording of a lecture after the lecture was delivered and students who did not. The goal of this study was to test immediate recall performance and to gauge performance during delayed recall. Students with access to recorded lectures had the option to repeatedly view the material. Students without access would need to find other means to review the material. This study found that there was increased performance in delayed recall with the group with assess to lectures. However, access to recorded lectures was not beneficial from any other standpoint and there was a suggestion that knowledge of assess to recorded lectures could have negative effects on memory and encoding long-term.² In their discussion, the authors explore two educational theories which may explain this finding: The Efficient Encoding Hypothesis and The Desirable Difficulty Hypothesis. When students have access to recorded lectures, taking fewer notes reduces the quality of brainpower to learn because no real work is required to support the commitment to long-term memory. There was also evidence to support The Efficient Encoding Hypothesis whereby students with no access took fewer notes, but in turn, paid more attention to the initial lecture for greater understanding.² These results were completely different than what I thought would be true.

One major problem I have with this study is the conditions under which it was conducted. It was a simulation. Thus, the study lacked "real life" variables and consequences. This might play a major role in students' behaviors and subsequent performance. Performance and memory are dependent on several intrinsic factors, including motivation.

The authors should be applauded for considering some important instructional design principles to help students learn effectively in their study. Microlearning, spaced learning, and retrieval were all used. Microlearning is providing instruction in short snippets such 5-15 minute videos.³ Spaced learning is the act of repeating information to learners over time instead of relaying all of the information in a single session. Spaced learning substantially improves long-term encoding and may boost learning by as much as 200%.³ Lastly, retrieval involves improving retention and performance by asking questions. All three learning strategies were used in both groups. Research suggests that these strategies help learners refresh their knowledge and strengthen their memory of the content.

These instructional design strategies are routed in several theories in education psychological including behaviorism, cognitive learning theory, and constructivism. Behavioral psychology advocates repetition and reinforcement in learning material to create a “behavior” in the learner. Cognitive psychology focuses on engaging the learner’s senses to create a learning process, while constructivism emphasizes the learner’s own experience and personal interpretation.1 There are intrinsic factors that play a role in learning including motivation and how individuals encode information. It would be expected that students that re-watch recorded lectures would have increased retention. Although re-watching recorded lectures is not the only means to increase retention, it does provide an opportunity for repetition.

As a former pharmacy student, access to recorded lectures allowed me to reinforce the information that was initially covered during a face-to-face lecture. There are times when students can be distracted during a lecture — after 1 or 2 hours, who wouldn’t get distracted! Having access to recorded lectures allows student access to materials they may have missed during the live session. Some students use recordings in order to fill in gaps in their notes and to help with a better understanding of the course material. When re-watching lectures, students can slow down the speed and this can be helpful to some students who need a bit more time to fully understand what the teacher is saying (e.g. students whose primarily language is not English).

We are in the technology age. Millennials are accustomed to online learning and having information available at their fingertips 24/7. Many people enjoy the convenience of technology and take advantage of learning on-the-go. As a student, I enjoyed being able to re-watch lectures in the comfort of my own home so that I could focus on understanding the information without interruptions. I believe students can get more out of lectures when they do not have a constant stream of distractions. Distractions are a common problem in the classroom. Thus, not having access to recorded lectures after class would be detrimental from some, if not most, students.

So, while this study is intriguing, I do not think denying access to recorded lectures is the best strategy to enhance recall and long-term memory. Indeed, there was no difference in performance when students re-studied using a recorded lecture when compared to when students retrieved information through questioning.⁴ While the overall group performance was similar, there are likely individual differences and some students would undoubtedly perform better using one reinforcement strategy versus another.

In my opinion, this study was flawed. The study was not conducted under “real life” conditions and the subject matter (astronomy) was unrelated to anything that a pharmacy student would ordinarily study. Moreover, students are expected to learn and retain information from multiple courses and subjects simultaneously. In a pharmacy curriculum, knowledge builds on itself. Students often use previously learned material to help bring together their understanding and “just-in-time” access to recorded lectures can be very helpful. So, while access to recorded lectures might not be helpful in simulated learning environments like this study, it doesn’t appear to be harmful. So, if it’s not broken, why fix it?

References

1. Little B. Principles of instructional design. Retrieved from https://www.mindtools.com/blog/corporate/principles-instructional-design/  Accessed on October 6, 2019.
2. Patel B, Yook G, Mislan S, and Persky A. Exploring the consequences of memory of students who know they have access to recorded lectures. American Journal of Pharmaceutical Education 2019; 83(5): Article 6958. Retrieved from https://www.ajpe.org/doi/full/10.5688/ajpe6958 
3. ShifteLearning. Use these 5 instructional design strategies to create an effective e-learning course. Retrieved from https://www.shiftelearning.com/blog/instructional-design-strategies-effective-elearning  Accessed on October 6, 2019.
4. Palmer S, Chu Y, and Persky A. Comparison of re-watching recording and retrieval practice as post-class learning strategies. American Journal of Pharmaceutical Education 2019; Publication Ahead of Print. Retrieved from https://www.ajpe.org/doi/pdf/10.5688/ajpe7217

Incorporating LGBT Instruction into Pharmacy Curricula

by Elizabeth Hearn, Pharm.D., PGY-1 Community Pharmacy Resident, University of Mississippi School of Pharmacy, Jackson, Mississippi

While only 4.5% of adults in the United States identify themselves as lesbian, gay, bisexual, or transgender (LGBT), this population faces some significant health problems.¹ HealthyPeople2020 reports that LGBT youth are more likely to be homeless and are up to 3 times more likely to attempt suicide when compared to heterosexual, cis-gendered youth. They also have significantly higher rates of illicit drug, tobacco, and alcohol use.² Transgender individuals are more likely to suffer from mental health disorders such as depression, post-traumatic stress disorder, and suicidality as well as HIV/AIDS and other sexually transmitted infections.^2,3 Perhaps one of the most shocking data for healthcare providers to digest is that LGBT individuals report feeling isolated and a lack of social support due to culturally incompetent healthcare providers.²

HealthyPeople2020 set nationwide goals for improving the health, safety, and well-being of the LGBT community. One of the metrics is to provide, “medical students with training to increase provision of culturally competent care.”² However, healthcare providers across multiple healthcare disciplines – not just physicians – have reported limited knowledge and confidence in treating transgender patients.³ Are we doing enough to equip pharmacy students with the knowledge and confidence needed to address the healthcare disparities experienced by the LGBT community? Or are we leaving them ill-prepared?

A recent cross-sectional survey of 142 schools of pharmacy in the United States found a wide variety of transgender-related instructional activities. However, only 53% (35, n=66) of surveyed schools reported purposely implementing instruction regarding transgender care in their curriculum. Of those schools who have transgender-related care coursework, only 14 of 35 provided 2 hours or less of student experience with this patient population. Moreover, only 15 schools had plans to further develop or implement transgender-related care in their curricula within the next 3 years. When schools were asked to rate graduating pharmacy students’ confidence level for providing competent care to transgender patients, only 2 schools felt students would have a high level of confidence.³ With these data in mind, there is room for improvement with regard to transgender-related care in American pharmacy schools.

Instruction regarding LGBT health-related issues can be taught in several ways. In a 2017 study, didactic instruction about transgender-related care improved pharmacy students’ scores on knowledge-based assessments and self-reported confidence in decision making. Third-year Doctor of Pharmacy students received a 2-hour lecture about transgender-related care. When compared to 4th-year students who did not receive the lecture, 3rd-year students scored significantly higher on both a knowledge-based assessment (63.4% vs. 72.5%) and a self-confidence assessment (60.6% vs. 76.8%).⁴

In another study, lecture-based instruction about LGBT healthcare was shown to improve students’ understanding of the role of a pharmacist in transgender care. Pre- and post-lecture surveys showed a marked increase in student pharmacists’ understanding of their role in caring for transgender patients (30.6% vs. 96.5%).⁵ Amongst the schools of pharmacy who have already incorporated instruction about transgender-related care into their curricula, didactic lectures and discussions are by far the most prevalent instructional methods.³

Some schools of pharmacy report offering Introductory and Advanced Pharmacy Practice Experience (IPPE and APPE) opportunities for students to interact with LGBT patients. Utilizing IPPEs and APPEs for this purpose may seem ideal, as educators have reported they perceive that there is not enough time in the didactic curricula to include additional lectures, discussions, or care-based activities. Designated IPPE and APPE sites could be LGBT-specific clinics or locations that have a higher-than-average percent of their patient population who identifies as LGBT (such as an HIV clinic). However, these IPPE and APPE experiences are uncommon, with only 12 (out of 63) schools providing an experience where students can interact with LGBT patients. Due to limited availability and potential site-to-site variability, these types of IPPEs and APPEs may be best suited as elective experiences.³

Researchers at two schools of pharmacy in Washington and New Mexico took a creative approach to their instructional methods. Students were exposed to 3 hours of content about cultural, empathetic, and medical considerations for patients with diverse gender identities. Interestingly, the educators used a variety of mediums, namely: a pre-recorded video lecture; a list of frequently-asked-questions and answers; a game-show-style game; a patient video; a gender identity exploration exercise; role-playing scenarios; and a panel discussion with gender-diverse patients. The gender-exploration activity, which was adapted from Lavender Health’s Gender Role Socialization activity, was rated least helpful by students in the post-class surveys. However, more than half of the students found the remaining exercises to be very informative — the panel discussion with gender-diverse patients was considered by students to be most helpful. A panel session with individuals who identify as LGBT appears to be an effective way to include LGBT instruction in pharmacy curricula.⁶

We should use these examples to establish or update curricula at schools of pharmacy. When developing LGBT-related care education, consider the following learning opportunities for student pharmacists:

1. Understanding sexual and gender development
2. Discussing gender identity and how to document sexual preferences and gender identity in medical records⁴
3. Identifying barriers to access to care by LGBT people
4. Outlining drug and health-related resources for LGBT patients who are uninsured or underinsured
5. Motivational interviewing for smoking, alcohol, or drug cessation in the LGBT community⁷
6. Managing pharmacotherapy in LGBT people experiencing:
1. Mental health disorders
2. HIV and AIDS
3. Sexually transmitted infections
4. Chronic diseases
5. Gender transition ^4,7

Student pharmacists have expressed the desire to learn about this topic.⁵ Multiple exposures to LGBT-care-related issues would result in greater sensitivity, confidence, and competence.⁵ Given that health disparities for the LGBT community clearly exists and pharmacy students are willing to learn how to minimize them, it is our responsibility to step up and provide the opportunity. Incorporating LGBT instruction in our classrooms can transform a pharmacy student from a culturally incompetent healthcare provider to a well-informed, self-confident practitioner.

References

1. Williams Institute: Adult LGBT Population in the U.S. March 2019. Accessed 15 August 2019. Available from: https://bit.ly/2W2AxHB
2. HealthyPeople2020: Lesbian, Gay, Bisexual, and Transgender Health. Accessed 15 August 2019. Available from: https://bit.ly/2H939tF
3. Eckstein MA, Newsome CC, Borrego ME, et al. A Cross-sectional Survey Evaluating Transgender-Related Care Education in United States Pharmacy School Curricula. Currents in Pharmacy Teaching and Learning. 2019; 11(2019): 782-792. DOI: 10.1016/j.cptl.2019.04.005
4. Ostroff JL, Ostroff ML, Billings S, Nemec EC. Integration of Transgender Care into a Pharmacy Therapeutics Curriculum. Currents in Pharmacy Teaching and Learning. 2018; 10(2018): 463-468. DOI:10.1016/j.cptl.2017.12.016
5. Knockel LE, Ray ME, Miller ML. Incorporating LGBTQ Health Into the Curriculum: Assessment of Student Pharmacists’ Knowledge and Comfort Level in Caring for Transgender Patients. Currents in Pharmacy Teaching and Learning. 2019; DOI:10.1016/j.cptl.2019.07.001
6. Newsome C, Chen LW, Conklin J. Addition of Care for Transgender-Related Patient Care into Doctorate of Pharmacy Curriculum Implementation and Preliminary Evaluation. Pharmacy. 2018; 6(4): 107. DOI: 10.3390/pharmacy6040107
7. Mandap M, Carillo S, Youmans SL. An Evaluation of Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Education in Pharmacy School Curricula. Currents in Pharmacy Teaching and Learning. 2014; 6(2014): 752-758.  DOI:10.1016/j.cptl.2014.08.001

Patient Simulation and the Benefits to Student Pharmacists

Darby Pullen, Pharm.D., PGY1 Pharmacy Practice Resident, Baptist Memorial Hospital, North Mississippi

Pharmacy education is continually changing and faculty should be familiar with a variety of models to teach students. During my time in Pharmacy School, patient simulation mannequins were used to demonstrate and practice hands-on techniques that I might later use in practice, such as how to give glucagon when a patient with diabetes is hypoglycemic and not responsive.

Students today are exposed to more stimuli and expect more than a typical PowerPoint presentation. Mannequins can mimic several disease states such as cardiac arrest and allergic reactions. Students can gather a variety of clinical information from a mannequin including a pulse, heartbeat, lung sounds, and other hemodynamic parameters.¹ Virtual patients are another form of simulation that can enhance student learning. Virtual patients are created in digital, computer-based environments.

Simulation is a way to bridge the foundational knowledge that is taught in the classroom to hands-on experience. Moreover, some students prefer hands-on activities in order to fully understand different disease states. Mannequins can benefit the students who are visual, kinesthetic, or auditory learners.¹ This would, in turn, enhance the pharmacy student’s knowledge, confidence, and clinical skills.¹

Simulation can enhance students’ learning process.¹ Using patient simulation requires more active student participation in a low-risk environment.¹ Students are able to have more hands-on activities that simulates real-life scenarios but without risking actual patient harm. Facilitators are usually available to correct student behavior when they are interacting with the mannequins and computer simulators can provide ongoing feedback.¹

According to the ACPE accreditation standards for pharmacy schools, “graduates must possess basic knowledge, skills, and abilities to practice pharmacy independently, at the time of graduation."² ACPE allows up to 20% of the students’ required hours of practice experience to be fulfilled using simulation.² By including more patient simulation in the classroom, it would be a win-win situation. Students would have greater access to semi-authentic learning exercises and would fulfill requirements for ACPE.

Faculty at the Universiti Teknologi MARA in Selangor, Malaysia evaluated the difference in students’ performance when they were taught using a human patient simulator compared to a problem-based learning activity.³ The investigators were teaching students about diabetic ketoacidosis and thyroid storm. This was a crossover study. Students were randomized to receive instruction using either a human patient simulator or a problem-based learning activity for one of the disease states and then crossed-over to receive instruction using the alternative instructional method for the second disease state. After each case, students were assessed using a posttest immediately after the lesson followed by a knowledge retention test 10 weeks later. The knowledge retention test included recall and application questions.

On follow-up surveys, students indicated they were more satisfied learning using the patient simulation rather than problem-based learning.³ The posttest and knowledge retention scores were significantly higher (p < 0.05) in the mannequin group (mean scores: posttest 78.5; knowledge retention 58.5) for the thyroid storm case when compared to problem-based learning group (mean scores: posttest 75.1; knowledge retention 53.5).1 This study suggests that human patient simulation may be more effective for long-term knowledge retention than problem-based learning.

In another study, investigators at Griffith University in Queensland Australia assessed the role of virtual (simulated) patients in pharmacy education. Specifically, they examined how students feel about the experience as well as how well they performance on knowledge tests and assessments of clinical skills.⁴ They performed a meta-analysis and found nine studies that compared virtual patients to traditional teaching methods. Their findings showed that the use of virtual patient to teach about therapeutic topics was not superior to traditional teaching in terms of student performance, but does improve the students’ reaction to the learning experience.⁴

Simulator mannequins are expensive. They can run anywhere from 16 to 90 thousand dollars.³ Plus there are additional costs for maintaining the mannequins and hiring qualified operators. This is a high cost for pharmacy schools to add to their budgets. However, schools can consider collaborating with other health professional schools. Nursing and medical programs often use patient mannequins. By using them for interprofessional activities, this not only improves pharmacy student knowledge but also teaches them about team member roles. By having more interprofessional interactions, medical and nursing student benefit as well.

Using mannequins and virtual patients, students must use critical thinking skills in addition to their baseline pharmacotherapy knowledge.⁴ Students can be placed into a high-stress environment but the stakes are low. You don’t want students having their first interaction with a real patient while still trying to learn about a new disease state. Students can be prepared for the experience by completing an orientation exercise and continue to repeatedly practice with the mannequins. Using virtual patients and mannequins, pharmacy students would have greater confidence when advancing into their advanced practice experiences.

There is some evidence that simulator mannequins improve students’ learning, particularly long-term knowledge retention.^4,5 Students respond favorably to learning activities involving mannequins and virtual patients because they are low risk. Traditional learning methods are still needed but simulator mannequins and virtual patients can help students build their confidence. Simulator mannequins should be considered when there is a hands-on technique that students need to master, such as working as an interprofessional team during a code or administering medications. Virtual patients can further pharmacy student’s knowledge and clinical decision-making skills.

References

1. Vyas D, Wombwell E, Russell E, et. al. High-Fidelity Patient Simulation Series to Supplement Introductory Pharmacy Practice Experiences. American Journal of Pharmaceutical Education. 2010; 74 (9) 169. DOI:10.5688/aj7409169
2. Accreditation Council for Pharmacy Education: Policies and Procedures for ACPE Accreditation of Professional Degree Programs – January 2010. Accessed 30 April 2019.
3. Chin KL, Yap YL, Lee WL, et. al. Comparing Effectiveness of High-Fidelity Human Patient Simulation vs Case-Based Learning in Pharmacy Education. Am J Pharm Educ 2014; 78 (8) Article 153. DOI:10.5688/ajpe788153 
4. Baumann-Birkbeck L, Florentina F, Karatas O, et. al. Appraising the Role of the Virtual Patient for Therapeutics Health Education. Currents in Pharmacy Teaching and Learning. 2017; 9 (5): 934-944. DOI:10.1016/j.cptl.2017.05.012
5. Seybert, AL. Patient Simulation in Pharmacy Education. Am J Pharm Educ 2011; 75 (9) Article 187. DOI:10.5688/ajpe759187