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 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.
