Clinical decision-making by fourth-year pharmacy students: Towards an understanding of their uncertainty

INTRODUCTION

Clinical decision-making is a critical process underpinning much of a pharmacist's daily activities. While it is known that pharmacists hesitate to make decisions, it remains unclear whether pharmacy students experience similar hesitancy. The objective of this study was to better understand the phenomenon of decision-making in pharmacy students.

METHODS

This study was designed from a social constructivist paradigm using qualitative case study methodology. The purpose was to investigate issues related to hesitancy in clinical decision-making by fourth-year pharmacy students. Data were collected through observation of students engaging in simulations, post-simulation interviews, and written reflections. Data analysis included multiple stages of coding, followed by pattern identification and discovery of interrelationships.

RESULTS

The primary themes relating to issues in pharmacy student clinical decision-making were relational factors, teaching and learning, degree of certainty, and personal characteristics. Relational factors include elements of relationships with patients and physicians as well as a sense of autonomy. The theme of teaching and learning included the sub-themes of formal education and learning in the real world. Degree of certainty included patient complexity, weighing risks and benefits, comfort in ambiguity, and a lack of information. Finally, personal characteristics associated with decision-making include personal experiences, leadership skills, and confidence.

CONCLUSIONS

Pharmacy education needs to focus on ensuring preceptors can help model comfort in ambiguity, that assessments include the reality of practice, and ensuring ample practice of decision-making in a simulated environment.

Reflective writing: Implementation and learning perception from students and teachers of French nursing schools

To support reflective skills development, French nursing students write analyses of professional situations (Situation Analysis) experienced during their practice. Sixteen nursing schools in Paris have developed a common framework to support and evaluate students on these skills. The aims of the study were to assess and understand the implementation of the Situation Analysis in French nursing schools as well as their effects on students' learning. A quantitative approach was based on two questionnaires: students (n = 1525, 27.6% of participation) and teachers (n = 131, 49.2%). The results showed that there were variations in teaching of situation analysis. There were correlations between the perception of learning and the modalities of implementation. Not always easy to choose, the situations described were authentic for 97.8% of students, concerned mainly their own practice and relationship with patients. Emotional situations were less frequent. Feedback was generally present and encouraging, but not enough on the students' self-evaluation skills. Slightly more than half of students and teachers were satisfied of the situation analysis. Both of them made positive and negative comments. The study highlights what can be improved in teaching to increase student's learning through situation analysis, for example teamdefined objectives.

Reflective writing in undergraduate clinical nursing education: A literature review

The aim of this review was to explore the evidence of learning from reflective writing in undergraduate clinical nursing education. A combination of 17 quantitative and qualitative studies were included and three main categories emerged Development of clinical reasoning skills, Professional self-development and Facilitators and barriers for learning. The results revealed that reflective writing enhanced the students' reasoning skills and awareness in clinical situations. However, most students reflected primarily at a descriptive level, showing only limited and varied development of reflective skills. They focused on self-assessment; on their own emotional reactions and ability to cope in clinical situations, but had difficulties reflecting on the process of thinking and learning. Learning was promoted through instructive guidelines, scaffolding and detailed feedback from a trusted, available and qualified faculty teacher. Factors that facilitated learning included student maturity, individual cognitive skills, student collaboration and mixed tools for learning. Time constraints, conflicting values, lack of feedback and support, and lack of trust acted as barriers for learning. Reflective writing is a tool for students' professional learning, but above all for the students' personal development in becoming a professional nurse.

A review of the non-equivalent control group post-test-only design

BACKGROUND

Quantitative research designs are broadly classified as either experimental or quasi-experimental. The main distinguishing feature of the quasi-experiment is the manipulation of the independent variable without randomisation. When randomisation or use of a control group is unfeasible, a researcher can choose from a range of quasi-experimental designs.

AIM

To present the features of the quasi-experimental 'non-equivalent control group post-test-only' design, which aims to demonstrate causality between an intervention and an outcome.

DISCUSSION

This paper provides an overview of the non-equivalent control group post-test-only design in terms of its design features, applications and statistical analysis, as well as its advantages and disadvantages.

CONCLUSION

The non-equivalent control group post-test-only design can be used in natural settings, where randomisation cannot be conducted for ethical or practical reasons. Although the design is less complex than some other designs, with low error propagation, it is vulnerable to threats to internal validity.

Analyzing the effectiveness of teaching and factors in clinical decision-making

Objective

The aim of this study is to prepare junior physicians, clinical education should focus on the teaching of clinical decision-making. This research is designed to explore teaching of clinical decision-making and to analyze the benefits of an "Analogy guide clinical decision-making" as a learning intervention for junior doctors.

Materials and Methods

This study had a "quasi-experimental design" and was conducted in a medical center in eastern Taiwan. Participants and Program Description: Thirty junior doctors and three clinical teachers were involved in the study. The experimental group (15) received 1 h of instruction from the "Analogy guide for teaching clinical decision-making" every day for 3 months. Program Evaluation: A "Clinical decision-making self-evaluation form" was used as the assessment tool to evaluate participant learning efficiency before and after the teaching program. Semi-structured qualitative research interviews were also conducted.

Results

We found using the analogy guide for teaching clinical decision-making could help enhance junior doctors' self-confidence. Important factors influencing clinical decision-making included workload, decision-making, and past experience.

Conclusion

Clinical teaching using the analogy guide for clinical decision-making may be a helpful tool for training and can contribute to a more comprehensive understanding of decision-making.

Decision-Making and Problem-Solving Approaches in Pharmacy Education

Domain 3 of the Center for the Advancement of Pharmacy Education (CAPE) 2013 Educational Outcomes recommends that pharmacy school curricula prepare students to be better problem solvers, but are silent on the type of problems they should be prepared to solve. We identified five basic approaches to problem solving in the curriculum at a pharmacy school: clinical, ethical, managerial, economic, and legal. These approaches were compared to determine a generic process that could be applied to all pharmacy decisions. Although there were similarities in the approaches, generic problem solving processes may not work for all problems. Successful problem solving requires identification of the problems faced and application of the right approach to the situation. We also advocate that the CAPE Outcomes make explicit the importance of different approaches to problem solving. Future pharmacists will need multiple approaches to problem solving to adapt to the complexity of health care.