Improving advanced pharmacy practice experiences with an intention/reflection practice

The Divergence between Self- and Preceptor-Assessments of Student Performance during Advanced Pharmacy Practice Experiences

(1) Objectives: A divergence in self- and preceptor-evaluations of clinical skills has been noted during Advanced Pharmacy Practice Experiences (APPEs). The goal of this study was to determine the domains of overestimation of clinical skills by students during their APPE rotations. (2) Methods: Preceptor-assigned grades for APPE rotations from 2017-2022 were analyzed to identify instances of letter grade B or lower. The self- and preceptor-evaluations of APPE rotation were compared to determine the domains of divergence in evaluation between students and preceptors. (3) Results: Between 2017 and 2022, 305 student APPE rotations were graded as B or lower (~14%) by the preceptors. A statistically significant difference was noted between self- and preceptor-assigned letter grades across all practice settings including ambulatory patient care, community pharmacy, general medicine patient care, hospital/health system pharmacy, and special population patient care APPE rotations. In addition, examining the self- and preceptor evaluation rubric for these rotations revealed a statistically significant overestimation of clinical skills by students in all 9 domains of APPE evaluation. Finally, the divergence in the rating of clinical skills between student- and preceptor evaluation was found to be highest in the domains of planning and follow-up of patient care, disease knowledge, and communication with patients. (4) Conclusions: Students who fail to exhibit exemplary practice readiness during APPEs tend to overestimate their clinical skills in all domains of APPE evaluation. The results from our study support the need for additional avenues to assist in the identification of deficits in student learning before APPEs to increase their self-awareness (metacognition).

Perspectives of Professionalism, Self-Awareness, Leadership, and Innovation and Entrepreneurship From Experiential Education Preceptors

OBJECTIVE

The objectives of this study were to (1) quantify the perceived importance of and comfort with the Accreditation Council for Pharmacy Education Standard 4 (ACPE-S4) key elements, (2) describe how preceptors promote and assess key elements, and (3) describe preceptor perceptions of student key element skill demonstration.

METHODS

This study used a cross-sectional electronic survey to assess experiential education preceptors' perceptions of ACPE-S4 key elements. The survey consisted of 2 item categories, with 5 and 15 items included to collect information on preceptor demographics and ACPE-S4 key elements, respectively. Surveys were distributed to 451 introductory and advanced rotation preceptors. Frequencies and means were reported for quantitative survey items, open-ended survey responses were analyzed using a general interpretivist approach.

RESULTS

In total, 242 surveys were completed for a response rate of 54%. Most respondents identified as female (54.5%) and precepted community pharmacy rotations (28.5%). ACPE-S4 key elements, in order of most to least important, were professionalism, self-awareness, leadership, and innovation and entrepreneurship. Respondents varied in their conceptualization of key elements, with multiple activities used for skill demonstration and assessments. Qualitative analysis identified 2 themes: "Variation in preceptor fluency with S4 key elements" and "Communication as a means to demonstrate and evaluate ACPE-S4 key element skills."

CONCLUSION

Variation among preceptors in conceptualization, learning activities, and comfort in assessment for ACPE-S4 key elements highlights the need for support and resources to assist preceptors in developing activities and assessments for skills reflective of ACPE-S4 key elements. Preceptors commonly relied on vulnerable communication with students to assess key element skills, identifying a potential target for assessment and preceptor development. Pharmacy programs, in addition to the Academy, could benefit from using assessments already offered by preceptors. Finally, explicit evaluation criteria may help to guide skill acquisition and facilitate consistent assessment of key element skills.

Qualitative analysis of advanced pharmacy practice experience goals

INTRODUCTION

This study identified advanced pharmacy practice experience (APPE) activities students wish to pursue via a qualitative analysis of goal setting. It also aimed to understand student goal setting alignment with core Entrustable Professional Activities (EPAs).

METHODS

SMART (specific, measurable, achievable, realistic/relevant, time-bound) goal data were reviewed, analyzed, and coded to develop an inductive thematic analysis. Overall frequency of SMART goal coding themes was analyzed using descriptive statistics, along with frequency of themes based on rotation type. Relative percentages of each rotation type were compared. A crosswalk between themes and EPA was created post-coding.

RESULTS

Several themes among student SMART APPE goals from one complete academic year were identified (n = 79). A total of 1690 SMART goals were categorized into 22 themes. The top five most frequently utilized themes represent 60.6% of all goals, and included "Assess, Select, Recommend Therapy" (19%); "Patient Communication" (15.4%); "Foundational Knowledge" (12.4%); "Interprofessional Collaboration" (7.9%); and "Workflow, Roles and Responsibilities" (6%). The core EPA Patient Care Provider Domain was most common and accounted for 46.4% of SMART goals. The remainder included Information Master (18.8%); Practice Manager (16.1%); Interprofessional Education Team Member (7.9%); Population Health Promoter (6.6%); and Self-Developer (3.6%).

CONCLUSIONS

Our analysis revealed that students set goals in alignment with the profession's primary focus of providing direct patient care however some EPAs were infrequently citied by students in their goal setting process which may mean there is less focus on these important skills.

Twelve tips to center social accountability in undergraduate medical education

As the intersections of social identities and health become increasingly evident, the need for medical schools to center their education on social accountability becomes critical. Medical schools have a responsibility to direct their curriculum to ensure graduates become competent physicians in identifying and intervening for their community's needs. These topics have historically been taught in a didactic fashion, but there lacks adequate translation of this teaching style to clinical and community health advocacy. Active learning strategies must be used to engage students to critically think and act on the inter-relationships of social issues and health. We provide 12 recommendations to optimize medical education to effectively immerse students in social accountability through the use of experiential learning within a spiral curriculum. These recommendations are based on reviews of the literature and an environmental scan of curricular activities across Canadian medical schools.

Nailed it! Doctor of pharmacy learners' self-awareness of performance on authentic assessments

INTRODUCTION

The primary objective of this pilot study was to determine the reliability and validity of an objective structured clinical examination (OSCE) self-awareness survey. A secondary objective was to assess learner self-awareness in OSCE performance.

METHODS

A retrospective review of OSCE data from a single cohort in a three-year accelerated doctor of pharmacy program occurred. The cohort completed four OSCEs with a total of 23 discrete cases. At the end of each case, before receiving feedback, learners completed an evaluation of their skills, communication, overall performance, and identified if they believed the patient/provider would return ("nailed or failed"). These self-evaluations were then compared with respective learner performance scores for each case. Content validity was assessed for the self-awareness survey via the Lawshe method. Reliability of the OSCE cases and self-awareness survey were conducted utilizing Cronbach's alpha and the Spearman-Brown formula, respectively.

RESULTS

The OSCE self-awareness survey was found to be face valid and reliable for the overall survey. The subsections of return to pharmacist and overall learner performance were also found to be valid and reliable. A statistical relationship was found between learner self-assessment of pass/fail and their actual grade for overall performance and return to pharmacist.

CONCLUSIONS

Results from this study may guide remediation plans related to OSCE performance and development of other self-awareness activities in practice settings. Further studies are needed to evaluate the broader application and use of self-awareness tools.

Utilization of an emotional intelligence workshop to enhance student pharmacists' self-awareness

BACKGROUND AND PURPOSE

This study evaluated the impact of an emotional intelligence (EI) workshop as a tool to improve student pharmacists' self-awareness. The primary objectives were to assess the change in student pharmacists' self-awareness as measured by the Self-Awareness Outcomes Questionnaire (SAOQ) and identify trends in their self-reflection.

EDUCATIONAL ACTIVITY AND SETTING

A four-hour EI workshop was delivered in a first-year required student pharmacist leadership course. The components of the workshop included: an EI assessment via the Emotional Quotient Inventory (EQ-i 2.0) administered to student pharmacists outside of class, active learning class time that applied the principles of EI to leadership and group dynamics, and peer-to-peer discussions. Personal results of the EQ-i 2.0 were reviewed individually and in small groups. Student pharmacists completed a self-reflection and EI action plan outside of class. The SAOQ was completed before and after the workshop and the aggregated Likert scales were analyzed by paired t-tests.

FINDINGS

After two consecutive course offerings of the workshop (N = 100), there was a significant increase in the total SAOQ score as well as a significant increase for the three positive subscales: reflective self-development, acceptance, and proactivity. There was no change in the negative subscale: emotional costs. Student pharmacists positively perceived the workshop and reported that the activities motivated students to improve their interpersonal skills and increase extracurricular involvement.

DISCUSSION

Implementing an EI workshop is an effective curricular method to improve the affective domain of student development, specifically self-awareness.

A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training

BACKGROUND

Effective communication between pharmacists and patients is essential and improves health outcomes. Simulated patients (SPs) are trained to reproduce real-life situations and can help pharmacy students to develop and adapt their communication skills in a safe, learner-centred environment. The aim of this research was to explore how SP and pharmacy student role-play supports communication training.

METHODS

A mixed methods realist evaluation approach was adopted to test an initial theory relating to SP role-play for pharmacy students. The intervention tested involved complex communication cases in a men's and women's health module in year three of a new MPharm programme. This SP session was the first such session, of the programme which exclusively focused on complex communication skills for the students. Data collected comprised video-recordings of both training and mock OSCE sessions, and from student focus groups. Communication videos were scored using the Explanation and Planning Scale (EPSCALE) tool. Scores from SP and mock OSCE sessions were compared using the Wilcoxon-signed rank test. Focus groups were conducted with students about their experience of the training and analysed thematically, through a realist lens. Data was analysed for Context-Mechanism-Outcome configurations to produce modified programme theories.

RESULTS

Forty-six students (n = 46/59, 78 %) consented to their video-recorded interactions to be used. Students identified contextual factors relating to the timing within the course and the setting of the intervention, the debrief and student individual contexts. Mechanisms included authenticity, feedback, reflection, self-awareness and confidence. Negative responses included embarrassment and nervousness. They distinguished outcomes including increased awareness of communication style, more structured communication and increased comfort. However quantitative data showed a decrease (p < 0.001) in communication scores in the mock OSCE compared with scores from training sessions. Modified programme theories relating to SP training for pharmacy students were generated.

CONCLUSIONS

SP role-play is a valuable communication skills training approach. Emphasis should be placed on multiple stakeholder feedback and promotion of reflection. Time limits need to be considered in this context and adjusted to meet student needs, especially for students with lower levels of communication comfort and those communicating in languages different to their first language.