Assessing student pharmacist communication skills: Development and implementation of a communication rubric

Creating a win-win: A novel layered learning approach for assessing first-year pharmacy students' communication skills

BACKGROUND AND PURPOSE

Individualized assessment of students in skills-based courses is essential for practice readiness, however recruiting evaluators is challenging. Our school of pharmacy offers a teaching certificate program for postgraduate year one pharmacy residents (PGY1 residents; PGY1s) which requires completion of a teaching experience. The longitudinal layered learning assessment experience (LLLAE) was designed to meet instructional needs for individualized assessment of first-year pharmacy students' communication skills and provide a meaningful teaching opportunity for PGY1s. This manuscript describes the implementation and evaluates the impact of the LLLAE.

EDUCATIONAL ACTIVITY AND SETTING

PGY1s were invited to participate in the yearlong LLLAE. Faculty developed PGY1s' skills through training sessions, direct observation, and debrief sessions. PGY1s evaluated students and provided feedback using pre-defined criteria during 3 summative assessments (capstones). Capstones were common pharmacy practice scenarios in which students interact with an actor serving as a standardized patient or provider. PGY1s completed an end-of-year survey to self-rate their improvement in evaluating students, providing feedback, and confidence.

FINDINGS

Twenty-two PGY1s participated in the LLLAE over 2 years. They evaluated 73.2% of total capstone interactions. The end-of-year survey was completed by 20 PGY1s (90.9% response rate). All respondents indicated improvement in their skills to evaluate students, ability to provide feedback, and confidence. Scores were 4 or 5 (scale of 1 to 5) across all measures. Key contributors fostering improvement were the training and debrief sessions, faculty feedback, pre-defined criteria, and multiple practice opportunities.

SUMMARY

This novel layered learning approach was a win-win for faculty and PGY1s. The approach improved feasibility for faculty to continue individualized student assessment while mentoring early career pharmacists. PGY1s gained an opportunity to contribute to student growth, learn from experienced faculty, and develop skills for practice. Additionally, students benefited from individualized feedback.

What's been trending with OSCEs in pharmacy education over the last 20 years? A bibliometric review and content analysis

BACKGROUND

Objective structured clinical examinations (OSCEs) remain an integral part of pharmacy education. This study aimed to characterize key researchers, areas, and themes in pharmacy education OSCEs using a bibliometric review with content analysis.

METHODS

A bibliometric review was conducted on literature from over 23 years from January 2000 to May 2023. Articles focusing on any type of OSCE research in pharmacy education in both undergraduate and postgraduate sectors were included. Articles were excluded if they were not original articles or not published in English. A summative content analysis was also conducted to identify key topics.

RESULTS

A total of 192 articles were included in the analysis. There were 242 institutions that contributed to the OSCE literature in pharmacy education, with the leading country being Canada. Most OSCE research came from developed countries and were descriptive studies based on single institution data. The top themes emerging from content analysis were student perceptions on OSCE station styles (n = 98), staff perception (n = 19), grade assessment of OSCEs (n = 145), interprofessional education (n = 11), standardized patients (n = 12), and rubric development and standard setting (n = 8).

IMPLICATIONS

There has been a growth in virtual OSCEs, interprofessional OSCEs, and artificial intelligence OSCEs. Communication rubrics and minimizing assessor variability are still trending research areas. There is scope to conduct more research on evaluating specific types of OSCEs, when best to hold an OSCE, and comparing OSCEs to other assessments.

Exploring the Impact of a Vicarious Learning Approach on Student Pharmacists' Professional Identity Formation Using a Simulated Pharmacist-Patient Encounter

Purposefully developed professional identity formation (PIF) learning activities within the didactic curriculum provide crucial groundwork to complement PIF within authentic settings. The aim of this didactic exercise was to explore the impact upon student pharmacists' PIF after viewing, analyzing, and reflecting upon a simulated pharmacist-patient encounter (PPE). A 12 min role-play video was created, featuring a pharmacist counseling a standardized patient on a new medication regimen; foundational principles of medication safety, health literacy, social determinants of health, empathic communication, and motivational interviewing were included in the counseling, with some aspects intentionally performed well, others in need of improvement. Also included were the patient's varied reactions to the counseling. Students assumed the observer role and learned vicariously through viewing the PPE. Postactivity debriefs included justifying a foundational principle performed well by the pharmacist, and another in need of improvement, and a self-reflection essay expressing the impact of viewing the PPE on their PIF, from which extracts were thematically analyzed for impact. The main themes of the impact included increased awareness of counseling techniques, patient-friendly medical jargon, patient perspectives/empathy, positive and negative pharmacist role-modeling, and the value of the observer role. This PPE exercise enhanced PIF in terms of students thinking, acting, and feeling like a pharmacist, based on students' self-reflections, which most often referenced effective pharmacist-patient communication and enacting optimal patient care.

Impact of a training program on hospital pharmacists' patient-centered communication attitudes and behaviors

Background

Effective communication that integrates the value of patient-centered care is important in healthcare encounters. Communication skills training (CST) has been indicated as effective in improving patient-centered communication behaviors. However, there is a paucity of studies on the impact of CST among Malaysian hospital pharmacists.

Objective

This study aimed to evaluate the effects of a patient-centered CST program on patient-centered communication scores, communication self-efficacy, and attitudes toward concordance among pharmacists in public hospitals.

Methods

A communication skills training (CST) program was conducted among hospital pharmacists. This training intervention was developed based on patient-centered communication frameworks and techniques, namely the Four Habits Model and motivational interviewing. A pre-test/post-test quasi-experimental design was implemented for the evaluation. Pharmacists underwent pre-test/post-test audiotaped simulated consultations and completed questionnaires, including the Revised United States-Leeds Attitudes Toward Concordance scale (RUS-LATCon) and Communication Self-Efficacy scale. The Four Habits Coding Scheme (FHCS) was used to evaluate patient-centered communication scores from the audiotapes, and the Wilcoxon signed-rank test was used to analyze for differences in the pre- and post-intervention scores.

Results

A total of 38 pharmacists from four tertiary hospitals participated in this study and completed the pre-test. However, due to the impact of COVID-19, only 23 pharmacists completed the post-test data collection. Improvements were noted in the FHCS scores post-training, including items related to exploring patients' concerns, acceptability, and barriers to treatment. Based on the questionnaire, there was an improvement in recognizing patients' needs and potential medication uncertainty and an increase in the overall communication self-efficacy scores after the training.

Conclusions

CST may help improve the adoption of patient-centered communication in pharmacists' consultations with patients.

An initial reliability analysis of a patient counseling rubric to objectively measure student pharmacist performance

Current literature outlines the documented need for improved communication during patient medication counseling. Although many tools exist, there needs to be a national standardized tool that complies with federal and state law, to objectively measure student pharmacist performance during patient counseling in the community pharmacy setting. The primary objective of this study is to perform an initial analysis of the internal consistency reliability of a patient medication counseling rubric designed with an Indian Health Services theoretical framework. Secondary objectives include measuring changes in student performance over the time of the study. The 18-item rubric was developed to objectively measure student pharmacist performance during patient medication counseling sessions in a 21-h Introductory Pharmacy Practice Experience (IPPE) course. The community-pharmacy-based IPPE patient counseling course evaluates students' communication skills and patient-centered counseling techniques in live and simulated patient counseling sessions. Three pharmacist evaluators assessed a total of 247 student counseling sessions. The rubric's internal consistency reliability was analyzed, and student performance improvement was observed within the course. Students' performance was evaluated as "meets expectations" in most live and simulated sessions. However, an independent groups t-test showed that the mean performance score for the live counseling sessions (2.59, SD = 0.29) was higher (p < 0.001) than that for the simulated counseling sessions (2.35, SD = 0.35). Students' performance in the course improved over three weeks [Week 1: mean (SD) = 2.29 (0.32), Week 2: mean (SD) = 2.44 (0.33), Week 3: mean (SD) = 2.62 (0.29); p < 0.001]. A Tukey-Kramer comparison post hoc test found a significant increase in the mean performance scores between weeks (p < 0.05). The overall internal consistency reliability of the counseling rubric was determined acceptable, with a Cronbach's alpha of 0.75. Further study is required, including the assessment of inter-rater reliability, factor analysis, variable analysis, and use in other states with patient confirmation testing necessary to validate the rubric for use with student pharmacists in the community pharmacy setting.

Evaluation of a New Home Patient Services Practicum for Community Pharmacy Students in Japan

This study aimed to evaluate the usefulness of the practicum as well as assess the knowledge, skills, and various specific realizations that the students gained from it. A total of 244 students role-played a scenario in which a pharmacist visited a patient at home and provided pharmaceutical management services. After completing the practicum, the students completed (i) a questionnaire survey consisting of six questions that assessed their level of understanding of the role of pharmacists in home medical care and (ii) a rubric survey that evaluated their learning achievement. In addition, they submitted practicum portfolios describing the patients' living conditions, physical conditions, and background as well as the services that required consideration of said variables. Their responses to the portfolio item "What were noticed through the practicum" were analyzed using the grounded theory approach. After the practicum, 45% and 53% of the students reported having a full and partial understanding of a pharmacists' role in home medical care. The students' mean ± standard deviation rubric score was 3.0 ± 0.4. They classified monitoring drug use, support for improving medication adherence, and observation to identify side effects early as major service categories in home medical care. The practicum led the students to perceive the need for communication with patients and various healthcare professionals to improve their readiness for practical training.

Exploring standardized persons' expectations for practice-readiness among student pharmacists

INTRODUCTION

Although patient expectations and preferences for healthcare selection have been described in the literature, there are no studies exploring what qualities and behaviors standardized persons (SPs) identify for the practice-ready pharmacist. This manuscript explores those qualities and behaviors within an objective structured clinical examination (OSCE) to determine SP interest in having the student as their pharmacy provider.

METHODS

Using open-ended questions via a Qualtrics survey, SPs were asked to provide qualities and behaviors they associated with each of three practice-readiness rating levels. Using a constant comparative approach, the researchers coded the collected data over multiple stages to allow for authentic reflection and interpretation of the data. Coders used both inductive and deductive processes prior to establishing a unified understanding and corresponding codebook.

RESULTS

A total of 55 SPs (61.1% response rate) participated in the survey, with the majority of participants working for the organization no more than two years (58.2%). Through the coding process, several major themes emerged across each of the three ratings including professionalism, patient-centered skills, communication, and preparation. Findings indicated the differences in ratings were influenced by the degree that students demonstrated each theme.

CONCLUSIONS

Overall, these findings provide a better understanding of the qualities and behaviors SPs associate with student pharmacists completing OSCEs acting as practicing pharmacists. However, additional research is needed to determine if the same qualities and behaviors would be viewed as essential with SPs at other academic institutions.