Pharmacy faculty and students' perceptions of standardized patients for objective structured clinical examinations

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.

An Exploration of Diversity, Equity, Inclusion, and Antiracism in Standardized Patient Simulations

A trending topic in pharmacy education is the importance of educating and exposing student pharmacists to topics of diversity, equity, inclusion, and antiracism (DEIA). Incorporation of diverse patient populations is one emerging learning opportunity for students in the DEIA space. This commentary presents the findings of seven pharmacy programs reporting similarities and differences in standardized patient (SP) recruitment and training, and their use in DEIA simulation learning activities. Common barriers of DEIA-centric SP activities in pharmacy programs were also identified and included recruitment of diverse SPs, lack of faculty knowledge for implementation of DEIA-focused simulations, and emotional protection of SPs involved. While no best practices or standardized processes exist, the authors provide suggestions for addressing barriers, and make a call to action for further research to determine best practices related to recruitment, training, and utilization of diverse SPs in simulation activities in pharmacy education.

Shifting to Authentic Assessments? A Systematic Review of Student Perceptions of High-Fidelity Assessments in Pharmacy

OBJECTIVE

Despite becoming increasingly popular, there is no comprehensive review on high-fidelity assessments in pharmacy education that has a focus on the perceptions and experiences of students. This systematic review investigates the student acceptability of high-fidelity simulation for summative assessments in pharmacy education and provides recommendations regarding high-fidelity simulation practices.

FINDINGS

The search yielded 37 studies in total. The articles fell into 3 distinct categories: objective structured clinical examinations (N = 25); face-to-face simulation assessments (N = 9), and augmented reality assessments (N = 3). Most high-fidelity assessments were well received with most students agreeing they had a vital role in assessing the application of clinical knowledge, even though they are stressful. Students prefer high-fidelity assessments to be face-to-face rather than online and also prefer when simulated patients whom they are unfamiliar with are used. Students also expressed a need to be well-prepared for the assessment regarding the logistics of the exam and technology use.

SUMMARY

High-fidelity simulation is likely to be increasingly important in the assessment of the knowledge and skills of pharmacy students and student perception is an important factor to consider when developing such assessments. Reducing stress associated with high-fidelity assessments could include familiarizing students with task logistics or technology used prior to the assessment, using external simulated patients, and having face-to-face assessments and practice sessions.

Comparison of Students' Self-Assessment and Simulated Patient Assessment in a Patient Counseling Evaluation and Perceived Importance of Communication Skills

The primary objective of this study was to compare students' self-assessment ratings with simulated patient (SP) assessment ratings of communication skills in a patient counseling Objective Structured Clinical Exam (OSCE). The secondary objective was to evaluate student perceptions of the importance of communication skills in the practice of pharmacy as well as the impact of a virtual OSCE format. First-year pharmacy students completed an OSCE focused on self-care product counseling. The evaluation was graded using a rubric covering both verbal and non-verbal communication. Students who completed the course were provided a 15-question, post-evaluation survey with questions related to self-assessment of communication skills and perceptions of the importance of communication skills. Of the 138 students in the course, 68 completed the optional post-assessment survey (49% response rate). There were no statistically significant differences between the ratings by students and SPs for the four communication elements included in the self-assessment. Most of the students recognized the importance of communication skills, including developing rapport and trust. Recognition of the importance of communication skills to future practice as a pharmacist positively correlated with performance on the evaluation (r² = 0.5409, p-value = 0.0007). Student self-assessment is an effective and cost-effective mode of feedback for practice experiences as an alternative to the use of SPs.

Transition from in-person to telehealth standardized patient encounters: A retrospective analysis of 18 cases

INTRODUCTION

Due to the COVID-19 pandemic, many pedagogical activities shifted from in-person to virtual modalities, including standardized patient (SP) encounters. While many academic institutions may not have previously been conducting SP encounters virtually, this change provided student pharmacists with new opportunities to learn and practice telehealth techniques, which are important with the continuously evolving healthcare landscape.

METHODS

This retrospective study analyzed pharmacy student performance on and perceptions of SP cases in fall 2019 (in-person) and fall 2020 (telehealth) semesters. The primary objective was to compare average total scores on SP cases from fall 2019 (in-person) and fall 2020 (telehealth) for first-, second-, and third-year pharmacy students (P1, P2, and P3, respectively). Secondary objectives were to compare average scores from case-specific and relationship and communication (R&C) checklists, as well as to describe student perceptions of the pedagogy.

RESULTS

Total scores on SP cases decreased from in-person to telehealth for the average of all P1 SP cases, but not for P2 or P3 cases. Case-specific scores did not change, but R&C scores decreased significantly across all three years. Student survey data revealed difficulty with communicating effectively and building rapport via telehealth.

CONCLUSIONS

Overall, student performance on in-person vs. telehealth SP encounters was similar, though P1 students performed more poorly on SP cases conducted via telehealth compared to P2 or P3 students. Thus, faculty could consider focusing on in-person encounters for early learners before introducing virtual encounters. This study also highlights the difficulty in establishing rapport when communicating with patients via telehealth.

Communication training for pharmacy students with standard patients using artificial intelligence

INTRODUCTION

The objective structured clinical examination (OSCE) is among validated approaches used to assess clinical competence through structured and practical evaluation. Most studies of OSCE have used standardized patients (SPs). However, to our knowledge, there is limited information regarding the specific communication skills enhanced by providing communication training (CT) with SPs. Recently, an artificial intelligence (AI) technology was developed. The aim of this study was to evaluate the experience and outcomes of CT with SPs and impact of using AI for this training.

METHODS

This study targeted fourth-year students participating in a pre-learning course for pharmacy practice experience offered at a Japanese university in 2020. The ENcode, Decode, Control, and REgulate model, which evaluates 24 communication skills, was utilized as a questionnaire-based survey. The survey was conducted prior to CT, following CT, and after a second CT session six weeks later with AI.

RESULTS

Seven skills, namely "desire suppression," "expectation acceptance," "facial expression," "emotional communication," "dominance," "maintaining relationships," and "dealing with disagreements," were enhanced by the CT with SPs. These skills were included in the broad categories of "management" and "expression" skills. They were not significantly enhanced by following AI training. However, differences observed between the students who underwent AI training and those who did not demonstrated a positive effect in almost all skills, suggesting that AI training can enhance certain skills.

CONCLUSIONS

CT with SPs enhances students' "management" and "expression" skills. Additionally, AI shows potential for improving the effect of CT.

The utilization of simulated patients for teaching and learning in the pharmacy curriculum: exploring pharmacy students' and recent alumni's perceptions using mixed-methods approach

BACKGROUND

The use of simulated patients (SPs) is considered a significant resource for teaching and assessing clinical and communication skills in health professional education. We conducted this study to explore pharmacy students' perspective towards the utilization of SPs in Qatar and to identify areas that require improvement.

METHODS

An explanatory sequential mixed-methods design was used among students and recent graduates of the College of Pharmacy at Qatar University (QU-CPH). First, their perspectives toward the current utilization of SPs at QU-CPH was explored using a quantitative cross-sectional study design. Following this, we conducted six focus group discussions based on the analysis of the questionnaire results. The findings of the two phases were interpreted through integration of the quantitative and qualitative phases.

RESULTS

The majority of the participants (> 90%) reported that interactions with SPs are important in building good communication and counseling skills during professional skills course activities. Similarly, most of the respondents (80%) indicated that interactions with SPs prepared them to apply the clinical skills gained during professional skills and patient assessment sessions in real-life. In addition, they reported that interactions with SPs during competency-based assessments were good experiences. The participants disagreed with the notion that interaction with SPs of opposite gender was uncomfortable for them. Themes identified from the focus groups include: interactions with trained SPs compared to faculty SPs, standardization and consistency of SPs' roles, communication and language barriers, simulations of real-life case scenarios, SPs' competence and preparedness, psychological impact associated with interaction with SPs, proposed strategies for improving the SP program. Identified areas for improvement include the need for strengthening the SP training and orientation program as well as the SP selection criteria.

CONCLUSION

This study showed a positive impact of the utilization of SPs in this pharmacy curriculum as perceived by students and alumni. However, the SP program needs to be optimized in terms of the training and orientation of SPs.

Transitioning Competency-Based Communication Assessments to the Online Platform: Examples and Student Outcomes

In light of the COVID-19 pandemic, pharmacy education has shifted from in-person teaching and assessments to the virtual environment. Many education programs had previously adopted objective structured clinical examinations (OSCEs) to assess communication abilities in-person with standardized patients (SPs). However, comparative student outcome data between virtual and in-person methods as well as guidance on how to conduct communication-based OSCEs in the virtual environment is lacking. The University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) describes its methods of conducting two types of communication-based OSCEs (patient counseling and gathering a medical history). Student performance data from the two virtual OSCEs in 2020 was compared to results from two 2019 in-person OSCEs using Mann Whitney U Tests. The 2020 cohort scored significantly higher than the 2019 cohort in all variables (i.e., using effective verbal and non-verbal communication, using patient friendly education, organizing the encounter, demonstrating empathy, establishing trust, professionalism) and in overall score. However, the effect size for these findings indicate the differences between performances are generally small and more likely due to changes in grading patterns due to the pandemic.