Simulation-Based Education Implementation in Pharmacy Curriculum: A Review of the Current Status

A systematic review of the impact of simulation on students' confidence in performing clinical pharmacy activities

BACKGROUND

Although confidence does not automatically imply competence, it does provide pharmacy students with a sense of empowerment to manage a pharmacotherapeutic problem independently. Among the methods used in higher education, there is growing interest in simulation.

AIM

To evaluate the impact of simulation on pharmacy students' confidence in performing clinical pharmacy activities.

METHOD

Articles that reported the use of simulation among pharmacy students with fully described outcomes about confidence were included. Studies for which it was impossible to extract data specific to pharmacy students or simulation were excluded. The search was carried out in Medline, Embase, Lissa and PsycInfo from inception to August the 31th, 2022. The results were synthesized into 4 parts: confidence in collecting information, being an expert in a procedure/pathology, counselling and communicating, and other results. The quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool "MMAT" tool.

RESULTS

Among the 39 included articles, the majority were published in the last 5 years and conducted in the United States. The majority included pharmacy students in years 1 through 3 (69.2%). The most common study design was the pre-post uncontrolled design (66.7%). Studies measuring the effects of human and/or virtual simulation were mainly focused on confidence to counsel and/or communicate with patients and colleagues (n = 20). Evaluations of the effects of these types of simulation on confidence in information gathering by health professionals were also well represented (n = 16).

CONCLUSION

Simulation-based training generally yielded positive impact on improving pharmacy students' confidence in performing clinical pharmacy activities. Rigorous assessment methods and validated confidence questionnaires should be developed for future studies.

Pharmacy students' process of learning of real patients in a simple first-person perspective patient simulation exercise - A qualitative analysis

INTRODUCTION

Pharmacists need more insight into patients' perspectives on medicine to target their counseling and improve patient outcomes. Patient simulation exercises, where pharmacy students are asked to consume medicine-like products, have been shown to foster such understandings, although the specifics of how this occurs, in particularly, how students turn their first-person perspectives toward generalizations about real patients' lives with medicines, are not well documented. The aim was to identify central aspects of the learning process by introducing reflection questions about real patients and follow students' development during a study period.

METHODS

The study was conducted with students in their 4th semester in the second year of Pharmacy Education at the University of Copenhagen who were asked to respond to free text questions in a survey instrument about their daily experiences of taking a licorice product for one week as well as answering patient reflection questions. Qualitative deductive analysis was performed by coding students' experiences according to concepts of 'experiential learning'. Pattern identification within each concept was then inferred, as were their interrelationships.

RESULTS

Patient reflection questions enabled students to turn their first-person perspectives toward relevant generalizations about real patients' lives with medicines, including involved psychological mechanisms and how real patient groups differ in their ability to take medicine regularly. Students who during the week faced challenges with following the required dosing scheme came to more nuanced realizations that medicine adherence requires special efforts and restricts one's daily life; hence, negative emotions were involved in the learning process.

CONCLUSIONS

The design of the simple patient simulation exercise gave rise to new types of insights into real patients' lives with medicines. Negative emotions due to interference between the requirements of the exercise and students' normal social lives, as well as commitment to the exercise, were important aspects of this process.

Innovation and evaluation of vocational pharmaceutical education system under the 1 + X certificate system in China

BACKGROUND AND OBJECTIVES

The 1 + X certificate system, introduced in China in 2019, integrates academic credentials with vocational skill certificates to meet the heightened demand for skilled talents in the growing economy. This study aims to innovate and evaluate the vocational pharmaceutical education system under the 1 + X certificate framework, specifically addressing the gap between theoretical education and workplace requirements.

MATERIALS AND METHODS

A retrospective observational approach analyzed 490 pharmacy students over two academic years. The 2021 cohort underwent 1 + X integrated education, while the 2020 cohort followed conventional education. We collaborated closely with industry partners to identify and compile typical job competencies, formulating work projects aligned with industry demands. Combining the skill level standards and assessment content of "1+X Pharmaceutical Purchasing and Sales" and "1+X Pharmaceutical Preparation", we revised the course standards, incorporating typical work projects into the 2021 pharmacy professional teaching curriculum. This constituted the fundamental content of the 1 + X education reform. Statistical analysis compared course scores and 1 + X certificate examination performance.

RESULTS

The 2021 cohort, under the 1 + X educational model, demonstrated higher average scores in pharmacy courses, with significant improvements in pharmacology (1 + X vs. Traditional education: 58.40 ± 14.20 vs. 53.44 ± 14.67), clinical pharmacotherapy (72.74 ± 10.28 vs. 63.15 ± 11.03), and pharmaceutical distribution and marketing (79.34 ± 10.96 vs. 67.50 ± 15.82). 1 + X certificate pass rates and satisfaction with the model were also higher than the 2020 cohort.

CONCLUSION

The 1 + X certificate system is useful for developing talent in Chinese vocational education, effectively integrating assessments with industry standards. Future research should aim at evaluating long-term outcomes and improving quantitative skills assessments for enhanced effectiveness.

A meta-narrative review of choose-your-own-adventure style patient case activities in pharmacy education

BACKGROUND

The objective of this review was to characterize the methods of delivery and assessment of Choose Your Own Adventure (CYOA)-style activities in pharmacy education. A secondary objective was to utilize available data to determine best practices for educators interested in developing similar activities.

METHODS

A meta-narrative approach according to the guidance of the RAMESES standards was used for this review. A broad literature search was conducted using PubMed and Embase. Studies published on the use of a CYOA-style patient case format in pharmacy education were identified and appraised individually for their relevance.

RESULTS

Thirteen studies from the pharmacy education literature were included in the review. Activities were delivered for 25 unique topics, largely in small groups during class via patient simulation or interactive data collection software. Overall, students have a positive perception of CYOA-style activities, with positive results regarding knowledge development and student engagement. The most commonly reported challenge to implementing CYOA-style patient case activities was the up-front time commitment to develop activities.

IMPLICATIONS

This review provides a snapshot of the small but expanding body of literature on CYOA-style patient case activities in pharmacy education. CYOA-style activities are recommended for expanded use in pharmacy education as the preponderance of studies that assessed knowledge development showed significant improvement in knowledge after participation in CYOA-style activities. Additionally, students have a positive perception of CYOA-style activities and reported that they were enjoyable, improved their confidence, and helped them learn course material.

What Happened to Simulation-Based Education in Outpatient Setting in The 21st Century: A Scoping Review

Introduction

Simulation-based education (SBE) is an instructional approach that aims to accurately recreate real-life scenarios and engage learners in the practical application of lesson content. By replicating critical elements of clinical situations, SBE facilitates a deeper understanding and better preparation for managing such conditions in actual clinical practice. SBE offers promising prospects for improving medical education and patient care in various settings, such as outpatient clinics. Therefore, this scoping review aims to determine to what extent the most effective components and standards of the simulation have been considered in outpatient education.

Methods

The present scoping review adheres to the guidelines outlined in the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist" and the "Joanna Briggs Institute (JBI) Reviewers' Manual". This review focused on articles that specifically focused on the use of simulation in outpatient education. Google Scholar, PubMed, Scopus, Embase, and ERIC were searched for keywords related to simulation, ambulatory care, outpatient clinics, and medical education from January 1, 2001, to August 12, 2023.

Results

The search indicated 513 articles, which were narrowed down by title and abstract relatedness. Twenty-nine articles entered the study's second phase, and after reviewing their full text, nine articles that explicitly reported simulation use in outpatient education remained. Based on the findings of eligible articles, the ten most frequent components of SBE that should be considered and followed discussed. These features were training facilitators, pre-briefing sessions, the type of simulation techniques, the site of simulation participation, the simulation duration, unit of participation, extent of direct participation, Simulation fidelity, feedback, and debriefing and reflection.

Conclusion

SBE is a contemporary method of practical training for medical students that involves realistic modeling or simulation of clinical situations. It enhances learning effectiveness and provides a safe, educational atmosphere for teaching and learning. Designing simulations adhering to established standards and carefully considering essential components improves efficiency and effectiveness.

Vaccination Training for Pharmacy Undergraduates as a Compulsory Part of the Curriculum?-A Multicentric Observation

In order to increase vaccination rates, the Government of Germany introduced vaccination against influenza and COVID-19 into the regular care administered by pharmacists. However, vaccination training is yet not integrated into the German pharmacy curriculum. Therefore, the Institute for Clinical Pharmacy and Pharmacotherapy in Duesseldorf had developed an innovative vaccination course using high-fidelity simulation for students. To investigate the acceptance further, the course was carried out at three different German universities (Bonn, Duesseldorf, Greifswald). Students were asked to give their self-assessment before and after and satisfaction only after the training course. Responses from 33 participants from the University of Bonn, 42 from the University of Duesseldorf and 49 from the University of Greifswald were analyzed. Every participant at the respective universities showed a significant increase in their self-assessment and indicated a high level of satisfaction with the course. The results also did not differ significantly between the respective universities. Consequently, the results lead to the hypothesis that the satisfaction of pharmacy students with this kind of training using high-fidelity simulation is very high and attractive, and can be recommended for other German universities. The integration of such vaccination training into the German pharmacy curriculum might be a future step.

Students' experiences and attitudes toward a newly developed simulation-based pharmaceutical care clinical rotation: A pre-post study design

Purpose

This study aims to evaluate Doctor of Pharmacy (PharmD) students' experience with the newly developed simulation-based pharmaceutical care (PC) rotation by evaluating their knowledge and attitudes towards PC before and after the rotation.

Methods

A self-administered questionnaire was distributed to sixth year PharmD students enrolled in the clinical training rotation "Comprehensive Pharmaceutical Care" during the 2020/2021 academic semesters at Jordan University of Science and Technology's (JUST) Faculty of Pharmacy. Questionnaires were distributed before and after completing four experiential training weeks and consisted of three sections. The first section collected students' demographic details while the second and third sections evaluated students' knowledge about, and attitudes toward PC, respectively. Descriptive statistics were used to describe and compare changes in students' knowledge and attitudes pre-and post-rotation.

Results

A total of 106 valid questionnaires were completed with a response rate of 99.07%. The rates of correct answers increased after the rotation with median total knowledge score increasing from 8 to 10 (out of 13, P value < 0.001). Significant improvements in students' understanding of aspects relating to the concept and process of PC, and the role of clinical pharmacist in PC provision, were shown post the simulation-based clinical rotation. Similarly, their attitudes toward performing PC were either improved or emphasized. In contrast results also revealed that specific aspects of the rotation require further refinement, such as the comprehensiveness of the PC process and responsibilities in providing PC.

Conclusions

PharmD students' understanding and attitudes toward PC were either improved or emphasized after the simulation-based PC rotation. This study highlights the value of simulation as a unique instructional technique that can assist educators to develop PC competencies for pharmacy students.

Potential Barriers to the Implementation of Computer-Based Simulation in Pharmacy Education: A Systematic Review

Computer-based simulation (CBS) is an interactive pedagogical training method that has seen increased interest, especially in recent years. There is some evidence that CBS in pharmacy education is not as widely adopted compared to other healthcare disciplines. Pharmacy education literature to date has not specifically discussed the potential barriers which may cause this uptake challenge. In this systematic narrative review, we attempted to explore and discuss potential barriers that may impact the integration of CBS in pharmacy practice education and provide our suggestions to overcome them. We searched five major databases and used the AACODS checklist for grey literature assessment. We identified 42 studies and four grey literature reports, published between 1 January 2000 and 31 August 2022, which met the inclusion criteria. Then, the specific approach of Braun and Clarke for thematic analysis was followed. The majority of the included articles were from Europe, North America, and Australasia. Although none of the included articles had a specific focus on barriers to implementation, thematic analysis was used to extract and discuss several potential barriers, such as resistance to change, cost, time, usability of software, meeting accreditation standards, motivating and engaging students, faculty experience, and curriculum constraints. Ad- dressing academic, process, and cultural barriers can be considered the first step in providing guidance for future implementation research for CBS in pharmacy education. The analysis suggests that to effectively overcome any possible barriers to implementing CBS, different stakeholders must engage in careful planning, collaboration, and investment in resources and training. The review indicates that additional research is required to offer evidence-based approach and strategies to prevent overwhelming or disengaging users from either learning or teaching process. It also guides further research into exploring potential barriers in different institutional cultures and regions.

Development and Assessment of Innovative High-Fidelity Simulation Vaccination Course Integrating Emergency Cases for Pharmacy Undergraduates-A Randomized Controlled Study

Recently, pharmacists in Germany were allowed to administer influenza and COVID-19 vaccines for people aged 12 years and older in order to increase vaccination coverage rates. In order to adapt the pharmacy curriculum for clinical practice, an innovative, vaccination training course using a high-fidelity simulator (HFS) was developed, implementing clinical scenarios to manage adverse events. In a randomized controlled trial using a pre and post design with pharmacy undergraduates, the intervention group interacted with an HFS, while the control group was trained with low-fidelity injection pads. Before and after the respective training, each participant went through an objective structured clinical examination (OSCE) and completed a self-assessment questionnaire and knowledge quiz. Both training methods showed a significant increase in skills, but there was also a significant greater increase in the intervention group when compared to the control group, particularly with respect to the vaccination process. Furthermore, every individual in the intervention group improved from the pre- to post-training OSCEs. Therefore, HFS has been proven to be an appropriate tool to train pharmacy students for the purposes of vaccine administration and to prepare for future challenges. Particularly, recognizing and managing adverse reactions can be addressed in a very effective way.