January 26, 2012

Teaching Pharmacy Students to be Excellent Communicators

By Allison Lardieri, PharmD, PGY1 Pharmacy Practice Resident, University of Maryland Medical Center

After completing four years of undergraduate education, four years of pharmacy school and now six months of PGY1 pharmacy residency training, I’ve come to the realization that communication skills are perhaps the most important skill I need – and I continue to work on them!  Being a skillful communicator does not require one to know the mechanism of action of a specific drug, disease pathophysiology, or the most recent CHEST guidelines – not that these concepts aren’t extremely important.  But, I have found that the importance of effective, clear, and assertive communication by pharmacists surpasses drug knowledge.
Communication skills are vital to pharmacists every day, regardless of whether they work in a community or hospital setting.  As pharmacists move from a medication-dispensing role to a patient-centered role, they must communicate regularly with other health care practitioners and patients.  In the hospital setting, a clinical pharmacist participating on interdisciplinary rounds needs to feel confident speaking up at the appropriate time and needs to know how to make recommendations in a manner that is well-received by the team.  I believe this is a skill that does not come naturally, but rather can be practiced and refined.  Whether in the hospital setting or community pharmacy, pharmacists have opportunities to counsel patients and need to master the best way to illicit pertinent medical information from patients.  Pharmacists in the community are often pressed for time, and it is important to convey the critical counseling points to patients in a caring and knowledgeable way.  Lastly, communication between pharmacists is another area where being open and assertive allows workflow to go smoothly.  Pharmacists and technicians working together should be constantly communicating about tasks that need to be completed and patient care issues that require resolution.

There are countless times where communication is critical, and as future pharmacy educators we need ensure we train students to become excellent communicator.   In the article, “A Tool to Teach Communication Skills to Pharmacy Students” by Susan Hasan, students developed scripts to illustrate interactions between physicians and pharmacists.1  Three different scripts were developed based on three communication styles:  assertive, aggressive, and passive.  One of the scripts was turned into a multimedia CD and used for future students.  This activity allowed pharmacy students to explore different communication techniques and improve their communication skills. 

For a majority of pharmacy students, clinical rotations are where they refine their professsional communication skills.  Optimally students should model the behaviors and communication style of their preceptors.  McDonough and Bennett describe several effective strategies for preceptors to improve pharmacy students communication skills.  This includes a thorough orientation to the practice site, establishing pharmacist-patient relationships, and using a counseling model.2  They emphasize that students cannot improve communication skills by just observing, but rather must participate in communication encounters.  The authors point out that feedback immediately after the student-patient encounter is critical as this will help students to improve.  The authors recommend that preceptors think of students as an extension of themselves and train them to be an active participant in the workflow of the practice.

During my advanced practice experiences as a student and now as a resident, I have noticed that medical students are taught about communication skills and case presentations very early in their education.  Beginning in their third year, medical students are required to do a patient presentation daily to the interdisciplinary team and to work throughout the day on patient care issues.  I think pharmacy students would benefit from earlier exposure to inter-professional interactions.  Even as first or second year students, I think activities requiring students to discuss patients with each other and present their pharmaceutical plans to preceptors would help them to improve their communication skills.  This could also be accomplished by having students practice counseling patients in front of other students, where feedback is provided at the end of the session.  By incorporating these informal activities earlier in pharmacy students’ education, it will help students gain confidence. 

One interesting and creative communication activity involves the use of simulated patients and video review.  In a study conducted at the South Dakota State University College of Pharmacy, video review increased first year pharmacy students’ counseling skill achievement scores and helped to develop their self-assessment skills.3  Video review really helps when giving feedback to students.  I think it is important to have informal opportunities for students to learn from video review prior to using video recording for assessment purposes. 

Communication skills must be taught and students can only improve their communication skills through practice.  I recommend a mix of formal assessment activities and informal opportunities to practice communication beginning early in pharmacy students’ education.  Informal activities can include having students present a patient to a faculty member or counseling a simulated patient as part of a group activity.  The formal and informal use of video review is also helpful.  Feedback by the faculty member and peers can be provided to each student following the activity. I think we teach pharmacy student to be excellent communicators, but only if we start early!
1. Hasan S. A tool toteach communication skills to pharmacy students. Am J Pharm Educ. 2008;72(3): Article 67.
2. McDonough RP, Bennett MS. Improving communication skills of pharmacy students through effectiveprecepting. Am J Pharm Educ. 2006;70(3): Article 58.

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