Teaching Student Pharmacists to Be Patient-Centered

by Jenna Klempay, Pharm.D., PGY1 Community Pharmacy Practice Resident, University of Maryland School of Pharmacy

When teaching students how to provide pharmaceutical care, pharmacy educators have emphasized providing personalized, patient-centered care.  It is no longer acceptable to paternalistically tell patients how to take their medications and manage their disease states.  Student pharmacists are being taught to listen to the patient and tailor therapy to suit the patient’s lifestyle.  Evidence shows there is a positive correlation between patient-centered communication and improvement in health outcomes.¹  But given the subjective nature of the topic, it can be challenging to teach “patient centeredness.”  I believe pharmacy schools need to do a better job teaching this concept and emphasizing it throughout the curriculum.

Explaining terms to students like “empathy”, “compassionate care”, and “active listening” and role-playing how to provide patient-centered care is a good start.  But it’s not enough.  In order to really open the eyes of the student to the humanism of pharmaceutical care, the curriculum needs to include reflective learning activities.  One pharmacy school has developed a course that utilizes reflective and discovery learning to explore how pharmacists can improve interpersonal connections with their patients and facilitate healing, both physically and mentally.¹

The University of California-San Francisco (UCSF) School of Pharmacy offers a one credit elective course titled, The Healer’s Art.  It is modeled after a course developed for medical students taught by Dr. Rachel Remen of the UCSF School of Medicine.  The course is offered at medical schools across the nation, but UCSF is the first pharmacy school to offer it to student pharmacists.²  

The course includes three major instructional methods:

• Case studies shared by guest health care practitioners
• Student/faculty reflection in small groups
• Journaling between sessions

The course includes five sessions covering different topics intended to meet the course goal: understanding the “value of being ‘fully’ present and attending with heart” to patients:²

• Session 1:  “Tending to Our Patients” focuses on being fully present and attentive to patients in an appreciative and non-judgmental way.²
• Session 2: “Tending to Ourselves” challenges the students to reflect on the importance of caring for oneself and having a balance in life in order to offer “mindful, heart-based work”.² 
• Session 3:  “Tending to Life Changes” reflects on physical, mental, and emotional effects of life and how being present and listening with heart can be meaningful in healing.²
• Session 4:  “Tending to Appreciation and Alignment” offers an opportunity to recognize the joy of the profession in giving to others and also serves as a reminder of the impact pharmacists can have on the well-being of their patients.²
• Session 5:  “Translating Heart Matters into Practice” allows students to reflect on their experience and recognize the value of creating “safe places” for patients when developing a pharmacist-patient connection.²

Students are evaluated on their competency based on faculty observations during small group sessions, a review of each student’s reflective journal, and a questionnaire at the end of the course.

Students indicated that the course was a positive experience, they learned how to listen ‘with heart’, and they felt more comfortable dealing with emotional situations.  In addition, this class enriched their view of professional practice.²  Students felt empowered to “address the emotional needs of patients and their families” and understood that emotional needs can contribute to and complicate a patient’s condition.²  This class is an excellent example of how to teach students to be more patient centered and facilitate their growth as professionals.

The key to providing patient-centered care is not merely recognizing the illness, but also understanding the attitude or perception the patient and creating a way to provide care in a manner that is conducive to healing.³  By teaching students from the beginning how to provide this type of care, we can stop them from developing poor patient care habits.  All too often, students are taught by preceptors who have become cynical, burnt out, and accustomed to suppressing their emotions and treating patients more like disease states than humans.  It is important for educators to teach students how to keep their hearts alive in settings where many lose heart.  When students begin experiential learning, they will encounter patients suffering and dying.  Students need to be prepared to face these realities and help patients, families, and caregivers.  The pharmacy curriculum should teach humanism just as much as it prepares students to be knowledgeable about pharmacotherapy.

Effectively teaching students to practice with their hearts requires a different approach.   Typical didactic teaching won’t work.  Patient centeredness cannot be taught through a series of lectures.  It requires reflection.  Reflection is more likely to lead to deeper learning and meaningful change.  Reflection can be prompted through stories about one’s experiences, journaling, and small groups discussions.  Students should be encouraged to express their feelings.  This can only be fostered by creating a safe classroom environment where students feel comfortable opening up and sharing personal thoughts.  The classroom environment should emulate the type of environment the student should one day create for his or her patients.  Finally, an affirmation activity during the last class session will facilitate the transfer of the classroom experience to the clinical setting.  An affirmation activity consists of each individual sharing positive remarks about how the student can make a difference in the lives of patients.  This activity will give students confidence in their ability to care compassionately for patients and encourage them to take what they have learned into practice.

UCSF provides a great model for how to teach a topic that is not easy to teach.  While this class is a great start, a one-credit course is not enough.  If we want to mold our students into patient-centered practitioners, this kind of reflective learning should occur during all four years of pharmacy school.  Yes, the curriculum is already crammed full, but one potential solution is to hold a yearly class retreat for students to revisit important concepts of humanism.  Clinical faculty and preceptors should be invited to this retreat to renew their hearts and reaffirm the qualities that make them caring practitioners.  Since these pharmacists are mentors and role models for students, it is important that they model for students patient centeredness in their words and actions.

Dan Pink, keynote speaker of the 2007 AACP Annual Meeting, advised pharmacy educators to “challenge students to mature into holistically oriented healers, knowledgeable about the whole person with whom they soon will be establishing healing relationships.”⁴  Students need to be taught that the pharmacist-patient interaction is just as important as the technical services and the medications we provide.  Medications are not enough.  By providing compassionate care, we have the ability to heal with our hearts as well.

References

1.  Stewart M. Towards a global definition of patient centered care. BMJ 2001;322:444-5. 

2.  Vogt EM and Finley PR. Heart of pharmacy: Acourse exploring the psychosocial issues of patient care. Am J Pharm Educ. 2009; 73(8): Article 149.  

3.  Sánchez AM. Teaching patient-centered careto pharmacy students. Int J Clin Pharm. 2011;33:55-57.  

4.  Maine L. and Vogt E. The courage to teach caring. Am J Pharm Educ. 2009;73(8) Article 138.