Integrating virtual patients into a self-care course

Using a virtual simulation platform for dispensing pediatric prescriptions in a community-based pharmaceutical skills course

BACKGROUND AND PURPOSE

Safe and accurate dispensing of medications is an essential skill. Pharmacy schools must provide students with the knowledge and practice to enhance special population dispensing skills. The objective of this study is to describe a community pharmacy pediatric simulation completed by first-year pharmacy students and to review student perceptions on confidence and knowledge learned after a MyDispense (Monash University) simulation.

EDUCATIONAL ACTIVITY AND SETTING

First-year Pharmaceutical Skills students participated in a MyDispense simulation to identify errors and omissions of prescription orders with a focus on pediatrics. Although students had limited therapeutic knowledge, the activity emphasized federal and Florida law requirements. Retrieval and direct application of these principles along with new experiences in identifying medication errors afforded students to learn in a low-stake, controlled environment.

FINDINGS

Of the 64 students enrolled in the Pharmaceutical Skills I course, 57 completed the pre-simulation survey and 56 students completed the post-simulation survey (87.5% response rate). Increased confidence and knowledge were found for most questions. The pre-simulation survey had students most frequently answer neutral followed by disagree or strongly disagree for ability to complete the listed task. The post-simulation survey responses shifted with many students responding with agree or strongly agree for the listed task and found MyDispense to be a helpful simulation tool.

SUMMARY

Exposing pharmacy students to pediatric virtual simulations early in the curriculum may increase confidence and knowledge. Future pediatric simulation coursework would benefit longitudinally to further build confidence and enhance retention of knowledge.

Community pharmacies and the empowerment of self-care in the United States

Background

As part of self-care, patients prevent diseases or conditions, maintain, or enhance their current health status, and address current health challenges. As a key member of the healthcare team, the role of the pharmacist in relation to self-care is important, given the ease of access to pharmacists in a variety of care settings.

Objectives

To describe the structure and function of self-care within community pharmacies throughout the United States (U.S.).

Methods

The literature within the U.S. was reviewed related to self-care definitions and practice, the role and training of the pharmacist, and challenges and opportunities for pharmacists.

Results

Within the U.S., self-care is broader than simply products found in the "over-the-counter" (OTC) section of pharmacies; it includes pharmacists involvement in disease prevention, evaluation and maintenance of current health status, and assistance in managing health challenges. There is growing recognition of the significance of pharmacists in aiding patients in self-care, due to publication of outcomes related to pharmacist-provided self-care support. Accreditation standards require student pharmacists to develop knowledge and competency related to the broadest definition of self-care; resources exist related to curricular content and student evaluation and assessment support. The evolving role of the pharmacist in relation to self-care has presented challenges in terms of recognition and renumeration for services and workload issues. Efforts are currently underway to address these challenges.

Conclusions

Spiraling health care costs, poor health outcomes, and continued health disparities indicate a need to better support U.S. patients on their health care journey, which often begins with self-care. There is a plethora of opportunities for pharmacists to advocate for expanding roles related to self-care, including participation in national efforts to recognize the outcomes of pharmacists in self-care.

Pharmacy Students’ Experiences with an Interactive Video Platform to Develop Clinical Reasoning

Activities used to evaluate clinical reasoning include the use of standardized patients, role play, and case studies. To provide a standardized student experience at a lower cost than a standardized patient, standardized patients were developed using an interactive video platform. The purpose of this article is to report pharmacy students’ perceptions of the interactive video standardized patients used to practice applying clinical reasoning in a self-care therapeutics course. Students participated in the following five methods to assess clinical reasoning: case studies, interactive patient videos, role play, case creation, and Zoom^® polls. Four of the five methods (case studies, interactive patient videos, role play, and case creation) were used in small breakout groups consisting of two to three students. Upon completion of the small group work, Zoom^® polls assessed the clinical reasoning of the entire class. Students completed a survey that assessed their level of agreement with 17 statements about the course on a five-point Likert scale and 2 questions that asked the students to rank the activities based on their experiences. There were 127 students that took the self-care therapeutics course, and 112 completed the survey (88%). Overall, the students preferred the Zoom^® poll activity; however, of the four different methods utilized within the small breakout groups, the findings of our survey indicated that students preferred to receive fully written-out patient cases followed by the interactive patient videos. Additionally, the students thought that the written-out patient cases and interactive patient videos were most efficient for learning and recall. The interactive patient videos may be an alternative activity that allows students to demonstrate and assess their clinical reasoning for each patient case, in addition to seeing how this impacted their patient’s outcome.

Effects of virtual simulation on student pharmacists' ability to assess self-care patient cases

INTRODUCTION

The use of simulation is recognized as an effective means to teach skills necessary for pharmacy practice. It is essential these educational activities are evaluated. The purpose of this study is to evaluate the effectiveness of virtual simulation on student pharmacists' ability to assess and formulate a plan for patients seeking self-care.

METHODS

In a third-year course, student pharmacists are assessed on their abilities to assist a patient seeking self-care. This assessment is a standardized patient (SP) case graded using a checklist. Previously, students prepared by participating in workshops and lectures only. In 2017, students continued workshops and lecture, but MyDispense virtual exercises were also assigned. Student performance after using MyDispense was compared to the previous year's students. Each student was assigned one of six different cases for the SP assessment. The maximum possible score was 20. Statistics used were chi-square, Fischer's exact, and t-test.

RESULTS

Data from 135 students in the intervention group were compared to 178 students in the control group. No differences were detected between the mean total scores of all cases when the intervention group was compared to the control group (16.89 vs. 17.22, respectively). A significant difference was only detected for Case 4 (15.91 vs. 18.02, intervention vs. control respectively, P < .001). Significant differences on the grading checklist were identified for six items.

CONCLUSIONS

Virtual simulation may impact student pharmacists' ability to assist patients seeking self-care recommendations. However, not all changes identified were positive.

Development of a web-based virtual simulated learning environment for pharmacy practice education

Objective:

In the present study, we aimed to develop a virtual simulation that allows pharmacy students to play through actual prescriptions and pharmacy practice scenarios productively and on a personal computer. If designed properly, this program may serve as a supplementary educational tool without the need for an existing human tutor that could provide learning outcomes as good as those resulting from traditional paper-based pharmacy practice tutorials.

Methods:

A computer-based simulation of a community pharmacy was developed. This program mainly targeted three basic learning needs of pharmacy students: drug dispensing, patient counseling, and dealing with clinical situations related to the patients’ prescription or demand for over-the-counter (OTC) recommendations. Fundamental design decisions were based on breaking down the dispensing process into logical components to provide discrete development elements. For teaching patient counseling and clinical skills, instructors wrote scenarios covering the most prevalent pharmacy practice issues, mainly focused on medication use during pregnancy or lactation, OTC recommendations, information related to drug interactions and adverse drug reactions, and interactions between prescription drugs and patient's underlying disease.

Findings:

Based on the primary curriculum topics, the development team designed exercises for pharmacy practice units presented to year 5 pharmacy students. Accordingly, exercises were developed to authentically reflect tasks and challenges a community pharmacist would regularly face in the workplace. To fulfill this part, over 2000 real prescriptions were scanned and categorized based on the main drugs included. These prescriptions were used for both activities, namely medication dispensing and clinical scenarios. Furthermore, five senior pharmacy students wrote more than 200 clinical scenarios under a clinical pharmacist's supervision. The main objectives of pharmacy practice courses were followed to cover the most important must-to-know clinical tips, whether related to giving relevant advice as an OTC recommendation, referring the patient to a primary care physician, or just providing a piece of general health advice, which is expected to be comprehensively learned by pharmacy students.

Conclusion:

This program was designed as a simulated learning environment to help students develop prescription dispensing and clinical skills. To be considered a success, this simulation needed to provide equivalent or better learning outcomes than the current practice approach, which should be assessed in the future evaluation of the software, and then be promoted accordingly.

Development of a Structured Communication and Counseling Skills Course for Pharmacy Students: A Simulation-based Approach

Objectives

We aimed to develop a structured communication and counseling education program to improve pharmacy students' skills. Then, we objectively assessed this program by using simulated patients. The program aims to improve pharmacy students' communication and counseling skills by using a patient-centered approach.

Materials and Methods

The study was conducted in three stages. First, a "Pharmacist-Patient Communication and Counseling Skills" education program was developed. Second, this program was implemented for pharmacy students. Third, the program was tested on volunteer students and evaluated for its effectiveness.

Results

The education program had a very large effect (Cohen's d_z: 6.074) on improving students' communication and counseling skills, especially their empathy skills.

Conclusion

The education program achieved its goals. After demonstrating the program's success, a course was added to the pharmacy curriculum, and a communication skills laboratory was established in the school.

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.

Interactive Clinical Avatar Use in Pharmacist Preregistration Training: Design and Review

BACKGROUND

Virtual patients are interactive computer-based simulations that are being increasingly used in modern health care education. They have been identified as tools that can provide experiential learning and assessment in a standardized and safe environment. However, the study of high-fidelity virtual patients such as interactive clinical avatars within pharmacy is limited.

OBJECTIVE

The aim of this paper is to describe the design and review of three interactive clinical avatar simulations as part of pharmacist preregistration training.

METHODS

A multistep design approach was taken to create interactive clinical avatar simulations on the topics of emergency hormonal contraception (EHC), calculation of renal function, and childhood illnesses. All case studies were reviewed by registered pharmacists to establish content and face validity. The EHC case study and data collection questionnaire were also reviewed by a purposive sample of preregistration trainees and newly qualified pharmacists. The questionnaire used Likert ranking statements and open-ended questions to obtain users' feedback on the design, usability, and usefulness of the interactive clinical avatars as learning tools. Descriptive statistics and content analysis were undertaken on the data.

RESULTS

Ten preregistration trainees and newly qualified pharmacists reviewed the EHC interactive clinical avatars and data collection questionnaire. The data collection questionnaire was associated with a Cronbach alpha=.95, demonstrating good reliability. All three interactive clinical avatar simulations were reported as usable and appropriately designed for preregistration training. Users perceived they were developing skills and knowledge from the simulations. The high-fidelity nature of the avatars and relevance of the simulations to real-life practice were reported as aspects that encouraged the application of theory to practice. Improvements were suggested to ensure the simulations were more user-friendly.

CONCLUSIONS

The design and creation of the interactive clinical avatar simulations was successful. The multistep review process ensured validity and reliability of the simulations and data collection questionnaire. The in-depth explanation of the design process and provision of a questionnaire may help widen the use and evaluation of interactive clinical avatars or other simulation tools in pharmacy education. The interactive clinical avatars were reported as novel learning tools that promoted experiential learning and allowed users to feel like they were engaging in real-life scenarios, thus developing transferable knowledge and skills. This may be potentially beneficial for many health care training courses as a way to provide standardized experiences promoting active learning and reflection.

Pharmacy Students' Perceptions and Performance on the Use of an Online Virtual Experience Tool for Practicing Objective Structured Clinical Examinations

Objective. To examine pharmacy students' performance on and perceptions regarding the use of an interactive online tool for practicing to take objective structured clinical examinations (OSCEs).Methods. The Monash OSCE Virtual Experience (MOVE), an online module consisting of 20 pharmacy case scenarios with virtual patients, was piloted with final-year pharmacy students at Monash University campuses in Australia and Malaysia. A mixed methods approach that included reviewing user attempts and comparing grades, collecting student-administered questionnaires, and holding focus groups was used to examine students' perception and performance.Results. More than 99% of all students attempted at least one online case scenario in preparation for their final in-person OSCE, and 81% attempted all 20 scenarios two or more times. Ninety percent of students at the Malaysia campus and 70% of students at the Australia campus reported that MOVE was a helpful study tool for their OSCE preparation. However, a raw comparison of user attempts and OSCE grades did not find a direct correlation between online module attempts and assessment grades. Self-administered questionnaire and focus group results indicated that MOVE prepared students for targeted and time-restricted history-taking and problem-solving skills. Overall, students perceived MOVE to be a useful learning tool and a less overwhelming learning experience than were face-to-face sessions. Nevertheless, students still preferred face-to-face OSCE practice with simulated patients over online practice with virtual patients.Conclusion. The Monash OSCE Virtual Experience was perceived by our students as a flexible and useful online learning aid in preparing for their final-year OSCE However, there was no direct correlation between online practice attempts and students' exam grades.

Use of a virtual patient simulation program to enhance the physical assessment and medical history taking skills of doctor of pharmacy students

INTRODUCTION

To evaluate if utilizing a virtual simulated patient program in a required pharmacy course improves the health history taking and physical assessment skills of first-year professional pharmacy students.

METHODS

During a 14-week course students registered for a web-based virtual patient simulation program. Students were assigned a virtual patient case to complete during weeks one and 13 of the course. Scores from the pre- and post-interventions were compared focusing on the students' ability to perform a physical exam, take a medical history, provide patient education, and display empathy. Students were also asked to self-assess their skills after having been exposed to the virtual simulation program throughout the semester.

RESULTS

The total number of paired observations used in the final analysis of the pre- and post-virtual patient test case was 171 students. The overall student performance index, which includes the scoring of subjective/objective data and patient education/empathy, improved from 52% at week one to 78.42% at week 14. The individual scoring of subjective/objective data and patient education/empathy significantly improved from week one to week 13. Approximately 76.54% of the class strongly agreed or agreed that the virtual simulation program made them feel more confident in their ability to obtain a medical history from patients.

CONCLUSIONS

Virtual patient simulation programs are effective teaching methods for students to develop and improve upon their medical history taking and physical assessment skills.

Evaluation of an interactive simulated patient educational tool on course performance among current pharmacy students

BACKGROUND AND PURPOSE

In an accelerated doctor of pharmacy program, student examination performance on a key knowledge concept, the Cockcroft-Gault equation (CGE) for creatinine clearance estimation, was suboptimal. A scenario-based online tutorial using a virtual patient activity was developed to provide just-in-time access to an active-learning opportunity, consistent with Millennial learning styles. The purposes of this study were to assess the association between tutorial use and CGE examination performance and to explore learner characteristics that may affect this association, including student age group.

EDUCATIONAL ACTIVITY AND SETTING

CGE calculation is a required component of Renal and Cardiovascular System I, the fourth of a five-quarter intensive integrated course sequence. The tutorial used pretest-based branching, learner personalization, and virtual-patient scenarios in a realistic environment. Statistical analyses estimated the association of voluntary tutorial usage with CGE-calculation performance using Spearman's Rho correlations and linear regression analysis. Covariates included age group and course grade, excluding CGE points.

FINDINGS

Over a three-year study period (2015 to 2017), students (n = 436) accessed the tutorial a mean (median) of 5.64 (5.0) times. Tutorial access varied significantly, but not consistently, across age categories. In both bivariate and linear regression analyses, tutorial access was significantly associated with CGE grade only among students with non-CGE grades in the top 25% (i.e. top quartile).

SUMMARY

The majority of learners took advantage of an interactive educational tool designed for active learner engagement. Frequency of tutorial access was associated with improvements in CGE calculation performance only among top-quartile students.

Impact of virtual simulation in self-care therapeutics course on introductory pharmacy practice experience self-care encounters

BACKGROUND AND PURPOSE

Pharmacy education programs use simulation to provide a realistic and safe environment for student learning. We studied whether incorporation of virtual simulation into a required first year self-care therapeutics course impacted frequency of interactions, self-reported student confidence, and preceptor-reported student performance during second-year community pharmacy introductory pharmacy practice experiences (IPPEs).

EDUCATIONAL ACTIVITY AND SETTING

Virtual simulation cases using MyDispense were incorporated into a self-care therapeutics course in winter 2017. Students and preceptors were surveyed at the end of the fall semester community pharmacy IPPE. Data from IPPE experiences was compared with students who took the self-care therapeutics course in winter 2016 (control).

FINDINGS

Students completed 30 virtual simulation cases and three cases as part of the final examination (n = 33). Students in the intervention group reported more patient care interactions during their IPPEs than students who did not complete virtual simulation cases, but there was no difference in self-reported confidence. Preceptors did not report any differences in the ability of students to complete over-the-counter medication interactions during IPPEs.

SUMMARY

Cases were well received by students although they took longer to complete than initially anticipated. Students in the intervention group reported significantly more patient care interactions during IPPEs than those in the control group; however, there were no differences in self-reported confidence. Incorporation of virtual simulation was a sustainable change as the cases were able to be re-used the following year with minimal edits.

Virtual simulation to personalize student learning in a required pharmacy course

BACKGROUND AND PURPOSE

Virtual simulation is used to provide a realistic and safe environment for student pharmacists to learn and practice a variety of skills in the didactic and experiential settings.

EDUCATION ACTIVITY AND SETTING

The simulation program, MyDispense, that is used to teach medication dispensing in the outpatient setting was incorporated into a 2-credit hour required first-year pharmacy practice skills course. A total of 30 optional and 16 required exercises were completed by students.

FINDINGS

There was a total of 2,457 attempts (mean = 28.9 attempts per student) at optional practice exercises and students completed an average of 16.6 ± 7.9 (range 1-30). While variation in the number of optional practice exercises completed was observed between students with varying levels of pharmacy experience, the difference was not statistically significant. A component of the final exam utilized the virtual simulation program and all students passed this portion of the exam based on a minimum requirement of 70.0% (mean 92.9%, range 74.5-100%).

DISCUSSION

Students generally identified that the use of virtual simulation was an effective tool to learn medication dispensing skills in a classroom setting. Furthermore, this created an opportunity for pharmacy practice residents to develop teaching skills. The biggest barrier to implementation was the amount of time required to create and test each exercise.

SUMMARY

The virtual simulation program allowed students to self-identify the amount of practice they thought was necessary in order to gain specific skills related to medication dispensing.

Utilization of a virtual patient for advanced assessment of student performance in pain management

BACKGROUND AND PURPOSE

To assess student performance and achievement of course objectives following the integration of a virtual patient case designed to promote active, patient-centered learning in a required pharmacy course.

EDUCATIONAL ACTIVITY AND SETTING

DecisionSim™ (Kynectiv, Inc., Chadsford, PA), a dynamic virtual patient platform, was used to implement an interactive patient case to augment pain management material presented during a didactic session in a pharmacotherapy course. Simulation performance data were collected and analyzed. Student exam performance on pain management questions was compared to student exam performance on nearly identical questions from a prior year when a paper-based case was used instead of virtual patient technology.

FINDINGS

Students who performed well on the virtual patient case performed better on exam questions related to patient assessment (p = 0.0244), primary pharmacological therapy (p = 0.0001), and additional pharmacological therapy (p = 0.0001). Overall exam performance did not differ between the two groups. However, students with exposure to the virtual patient case demonstrated significantly better performance on higher level Bloom's Taxonomy questions that required them to create pharmacotherapy regimens (p=0.0005). Students in the previous year (exposed only to a paper patient case) performed better in calculating conversions of opioids for patients (p = 0.0001).

SUMMARY

Virtual patient technology may enhance student performance on high-level Bloom's Taxonomy examination questions. This study adds to the current literature demonstrating the value of virtual patient technology as an active-learning strategy.

Implementation of a virtual dispensing simulator to support US pharmacy education

INTRODUCTION

A key element for pharmacy practice defined by the Accreditation Council for Pharmacy Education (ACPE) is medication use systems management. A web-based community pharmacy simulation originally created for Australian pharmacy students was adapted for pharmacy students in the United States (US). The objective of this study was to collaboratively adapt an existing international simulation program for utility in the US and measure student perceptions of a web-based community pharmacy simulation program in three US schools of pharmacy.

METHODS

An Australian development team in collaboration with US pharmacy school faculty modified the existing MyDispense software to create a virtual environment that accurately represented US community pharmacy practice. Students at three US schools of pharmacy used the newly adapted version of MyDispense and were surveyed on their prior experience in community pharmacy and their perceptions of MyDispense as a learning tool.

RESULTS

Overall 241 (44%) students completed the satisfaction survey. Approximately 40% of these students worked in a community pharmacy before starting pharmacy school. Most students agreed or strongly agreed that MyDispense was straightforward to learn (76%), was more realistic than addressing similar paper cases (73%), and offered a learning opportunity to safely make errors (84%). Qualitative thematic analysis revealed that MyDispense allowed students to practice how to gather patient information and ask appropriate questions, counsel patients, and practice the dispensing process.

DISCUSSION AND CONCLUSIONS

Response to the US version of My Dispense is positive and proves to be a viable option for introducing and reinforcing community pharmacy practice skills to students during in their pharmacy education.

Community pharmacists' perceptions about pharmaceutical service of over-the-counter traditional Chinese medicine: a survey study in Harbin of China

BACKGROUND

This study aims to investigate community pharmacist's perception on the provision of over-the-counter (OTC) traditional Chinese medicine (TCM) pharmaceutical services; focusing on the areas of their attitude, general practice, perceived barriers and suggested improvements.

METHODS

Questionnaire survey targeting community pharmacists in Harbin of China was applied in this study. Questionnaires were distributed and collected at community pharmacies. Data was analyzed by combining descriptive analysis and Chi-test.

RESULTS

280 valid questionnaires were collected, giving a response rate of 78%. Respondents generally showed positive attitude towards OTC TCM pharmaceutical services. However, they were uncertain about whether such pharmaceutical services should be considered as their primary responsibility. Respondents indicated that they acted proactively to find out all the medicines taken by their patients and to remind consumers of possible OTC TCM adverse reactions. However, they were less keen on recommending or re-directing consumers to suitable OTC TCM. The three main barriers hindering the provision of OTC TCM pharmaceutical service identified in this study were "insufficient professional knowledge" (54.6%), "ambiguity of the professional role of pharmacists" (54.6%) and "lack of scientific evidence of OTC TCM" (45.4%). The three main actions considered most relevant to improving pharmaceutical service of OTC TCM were "formulating or refining legislation to clarify the legal and professional role of pharmacists with respect to TCM" (60.7%), "strengthening training of pharmacists with respect to TCM" (57.9%), and "promoting public awareness of the pharmacist's role" (53.6%). According to the results of Chi-test, respondents' perceptions about the attitude, practice, perceived barriers, and improvement suggestions were significantly different depending on the education levels, certificate types and workloads of western medicine.

CONCLUSIONS

The community pharmacists in Harbin, China were positive about the provision of OTC TCM pharmaceutical services. However, they were less certain about taking this duty as their primary responsibility. Insufficient knowledge and lack of role definition in the area of OTC TCM were found to be the major factors discouraging the provision of pharmaceutical service on OTC TCM by community pharmacists.

Virtual Patient Case Sharing Across Two Schools of Pharmacy

Objective. To expand the use of virtual patients at 2 schools of pharmacy through virtual patient case sharing. Design. Faculty members at two schools of pharmacy collaborated to expand the use of virtual patients. Two simulation programs, vpSim and DecisionSim (Decision Simulation, LLC, Chadsford, PA), were used to create interactive patient cases for a required course and an elective course at the different schools. Each school developed cases for their own use and then shared the cases with the other school. Assessment. The development, sharing, and subsequent modification of cases were examined using a standardized data collection form completed by both schools. Survey instruments were used to gather data regarding faculty perception and student satisfaction. Pre- and post-tests were administered to assess student learning. Five cases were developed and shared between the institutions. The time spent constructing new cases (22 hours/case) was significantly longer than the time spent modifying the shared cases (1.2 hours/case). Faculty members and students were largely satisfied with case sharing and the use of virtual patient cases, respectively. Virtual patients significantly enhanced student learning of material (mean score: 3.2 vs 3.6 on a 5-point scale). Conclusions. The sharing of virtual patient cases may allow institutions to overcome barriers to implementation of virtual patient programs, namely faculty resources, while improving student learning and satisfaction.

Use of a fictitious community-based virtual teaching platform to aid in the teaching of pharmacy practice skills: Student perspectives after initial implementation

Background

Providing patient-centred care requires pharmacy students to learn how to interact effectively and understand individual differences that can influence patients’ health. The School of Pharmacy at The University of Auckland, New Zealand (NZ), developed a virtual teaching platform, called NZ Pharmville, which consisted of twenty-one community-based patients who are members of six families; each family had a video vignette associated with it. Bachelor of Pharmacy (BPharm) students, enrolled in the third year pharmacy practice course, were able to view these recorded vignettes as part of their weekly pre-laboratory work for the course. All the clinical cases within the course were based on this community, with the aim of increasing the realism in the practical sessions and increasing patient-centred learning. This study aimed to explore the perspectives of pharmacy students regarding the integration of this virtual community into a third year undergraduate pharmacy practice course.

Methods

An anonymous, voluntary survey which consisted of twenty-one items, 13 requiring a Likert scale response and 8 requiring free text responses, was distributed to all students who had completed the third year pharmacy practice course. The responses to the questions were collated and analysed. Responses to questions one to thirteen were recorded in Excel, and results were presented as the combination of strongly agree and agree, strongly disagree and disagree and neutral. Responses to free text questions were read multiple times before being coded by two members of the research team into broad themes aligned to the overall aims of the evaluation.

Results

Eighty-six (80.4 %) of the eligible students completed the survey and the majority of responses were positive towards the benefits of using the virtual community in the course. Responses indicated that many of the students found the integration of the virtual community to be useful preparation for their practical sessions and the majority of students felt that the vignettes made it easier to develop empathy for the patients rather than reading about them.

Conclusion

The use of virtual communities, for example, NZ Pharmville, show promise as a platform to aid in teaching and learning. The resources in NZ Pharmville allow students ongoing access to patient video clips that attempt to depict a real life situation, and enable students to engage with the fictional characters. The virtual community provided an educational experience which was well received by students. This teaching method appeared to promote active patient-centered learning and allowed students to reflect on and revisit these skills on a weekly basis.

A Scenario-Based Virtual Patient Program to Support Substance Misuse Education

Objective. To evaluate virtual patient (VP) programs for injecting equipment provision (IEP) and opiate substitution therapy (OST) services with respect to confidence and knowledge among preregistration pharmacist trainees. Methods. Preregistration trainee pharmacists pilot-tested the VP programs and were invited to complete pre/post and 6-month assessments of knowledge and perceived confidence. Results. One hundred six trainees participated and completed the pre/postassessments. Forty-six (43.4%) participants repeated the assessments at six months. Scores in perceived confidence increased in all domains at both time points postprogram. Knowledge scores were greater posteducation than preeducation. Knowledge scores were also greater six months after education than preeducation. Knowledge scores at six months were lower than posteducation for both programs. Conclusion. Virtual patients programs increased preregistration pharmacists' knowledge and confidence with regard to IEP and OST immediately after use and at six months postprogram. There was a loss of clinical knowledge over time but confidence change was sustained.

Impact of a Paper vs Virtual Simulated Patient Case on Student-Perceived Confidence and Engagement

OBJECTIVE

To evaluate online case simulation vs a paper case on student confidence and engagement.

DESIGN

Students enrolled in a pharmacotherapy laboratory course completed a patient case scenario as a component of an osteoarthritis laboratory module. Two laboratory sections used a paper case (n=53); three sections used an online virtual case simulation (n=81). Student module performance was assessed through a submitted subjective objective assessment plan (SOAP) note. Students completed pre/post surveys to measure self-perceived confidence in providing medication management. The simulation group completed postmodule questions related to realism and engagement of the online virtual case simulation. Group assessments were performed using chi-square and Mann Whitney tests.

ASSESSMENT

A significant increase in all 13 confidence items was seen in both student groups following completion of the laboratory module. The simulation group had an increased change of confidence compared to the paper group in assessing medication efficacy and documenting a thorough assessment. Comparing the online virtual simulation to a paper case, students agreed the learning experience increased interest, enjoyment, relevance, and realism. The simulation group performed better on the subjective SOAP note domain though no differences in total SOAP note scores was found between the two groups.

CONCLUSION

Virtual case simulations result in increased student engagement and may lead to improved documentation performance in the subjective domain of SOAP notes. However, virtual patient cases may offer limited benefit over paper cases in improving overall student self-confidence to provide medication management.

Effectiveness of educational technology to improve patient care in pharmacy curricula

A review of the literature on the effectiveness of educational technologies to teach patient care skills to pharmacy students was conducted. Nineteen articles met inclusion criteria for the review. Seven of the articles included computer-aided instruction, 4 utilized human-patient simulation, 1 used both computer-aided instruction and human-patient simulation, and 7 utilized virtual patients. Educational technology was employed with more than 2700 students at 12 colleges and schools of pharmacy in courses including pharmacotherapeutics, skills and patient care laboratories, drug diversion, and advanced pharmacy practice experience (APPE) orientation. Students who learned by means of human-patient simulation and virtual patients reported enjoying the learning activity, whereas the results with computer-aided instruction were mixed. Moreover, the effect on learning was significant in the human-patient simulation and virtual patient studies, while conflicting data emerged on the effectiveness of computer-aided instruction.

Use of virtual patients in an advanced therapeutics pharmacy course to promote active, patient-centered learning

OBJECTIVE

To assess student satisfaction and learning of course objectives following the integration of virtual patient cases designed to promote active, patient-centered learning in an advanced therapeutics pharmacy course.

DESIGN

A dynamic virtual patient platform that incorporated a branched-narrative, decision-making teaching model was used in an advanced therapeutics course to supplement lecture content.

ASSESSMENT

Presimulation and postsimulation tests were used to assess student learning. The use of virtual patients significantly enhanced student learning for both higher- and lower-level test questions (p<0.001 and p=0.01, respectively). Students agreed or strongly agreed that the virtual patient cases provided an effective way to learn (72%), were enjoyable (69%), and were appropriate in content (80%), and that more should be incorporated (59%).

CONCLUSION

The use of virtual patients in an advanced therapeutics practicum effectively promoted active, patient-centered learning; engaged students in an interactive and dynamic educational technology; encouraged teamwork; enhanced higher-level student learning; and improved student satisfaction in the course.

Evolution of self-care education

During the past 15 years, the curriculum content for nonprescription medication and self-care therapeutics has expanded significantly. Self-care courses ranging from stand-alone, required courses to therapeutic content and skills laboratories, have evolved in colleges and schools of pharmacy to accommodate rapid changes related to nonprescription medications and to meet the needs of students. The design of and content delivery methods used in self-care courses vary among institutions. Teaching innovations such as team-based learning, role playing/vignettes, videos, and social media, as well as interdisciplinary learning have enhanced delivery of this content. Given that faculty members train future pharmacists, they should be familiar with the new paradigms of Nonprescription Safe Use Regulatory Expansion (NSURE) Initiative, nonprescription medications for chronic diseases, and the growing trends of health and wellness in advancing patient-care initiatives. This paper reviews the significant changes that may be impacting self-care curriculums in the United States.

A virtual patient software program to improve pharmacy student learning in a comprehensive disease management course

OBJECTIVE

To implement and assess the impact of a virtual patient pilot program on pharmacy students' clinical competence skills.

DESIGN

Pharmacy students completed interactive software-based patient case scenarios embedded with drug-therapy problems as part of a course requirement at the end of their third year.

ASSESSMENT

Assessments included drug-therapy problem competency achievement, performance on a pretest and posttest, and pilot evaluation survey instrument. Significant improvements in students' posttest scores demonstrated advancement of clinical skills involving drug-therapy problem solving. Students agreed that completing the pilot program improved their chronic disease management skills and the program summarized the course series well.

CONCLUSION

Using virtual patient technology allowed for assessment of student competencies and improved learning outcomes.

Promotion of self-directed learning using virtual patient cases

OBJECTIVE

To assess the effectiveness of virtual patient cases to promote self-directed learning (SDL) in a required advanced therapeutics course.

DESIGN

Virtual patient software based on a branched-narrative decision-making model was used to create complex patient case simulations to replace lecture-based instruction. Within each simulation, students used SDL principles to learn course objectives, apply their knowledge through clinical recommendations, and assess their progress through patient outcomes and faculty feedback linked to their individual decisions. Group discussions followed each virtual patient case to provide further interpretation, clarification, and clinical perspective.

ASSESSMENTS

Students found the simulated patient cases to be organized (90%), enjoyable (82%), intellectually challenging (97%), and valuable to their understanding of course content (91%). Students further indicated that completion of the virtual patient cases prior to class permitted better use of class time (78%) and promoted SDL (84%). When assessment questions regarding material on postoperative nausea and vomiting were compared, no difference in scores were found between the students who attended the lecture on the material in 2011 (control group) and those who completed the virtual patient case on the material in 2012 (intervention group).

CONCLUSION

Completion of virtual patient cases, designed to replace lectures and promote SDL, was overwhelmingly supported by students and proved to be as effective as traditional teaching methods.

Communications training in pharmacy education, 1995-2010

The role of the pharmacist as a "communicator" of information and advice between patients, other healthcare practitioners, and the community is recognized as a vital component of the responsibilities of a practicing pharmacist. Pharmacy education is changing to reflect this, although the difficulty is in designing a curriculum that is capable of equipping students with the necessary knowledge and skills, using activities that are effective in promoting communication competency. The objective of this review was to identify published, peer-reviewed articles concerning communication training in pharmacy education programs, and describe which communication skills the structured learning activities aimed to improve and how these learning activities were assessed. A systematic literature search was conducted and the articles found were analyzed and divided into categories based on specific communication skills taught and type of learning activity used. Oral interpersonal communication skills targeted at patients were the most common skill-type described, followed by clinical writing skills. Common teaching methods included simulated and standardized patient interactions and pharmacy practice experience courses. Most educational interventions were assessed by subjective measures. Many interventions were described as fragments, in isolation of other learning activities that took place in a course, which impedes complete analysis of study results. To succeed in communication training, integration between different learning activities and progression within pharmacy educations are important.

Understanding pharmacists' experiences with advice-giving in the community pharmacy setting: a focus group study

OBJECTIVE

To examine the experiences of community pharmacists providing advice about symptoms and complementary and alternative medicines (CAM).

METHODS

Ten licensed pharmacists and 21 student pharmacists working in community settings participated in 4 focus groups to discuss: patients' questions about symptoms and CAM, comfort level providing advice, and factors prompting physician referrals. Focus group recordings were transcribed verbatim and interpreted using thematic text analysis.

RESULTS

Pharmacists' dual role as advisors and medical liaisons emerged as primary themes. Participants reported that patients often seek their advice about self-care of symptoms to delay physician visits. Participants were comfortable giving advice; lack of medical history decreased their comfort level. Most were uncomfortable recommending CAM because of the lack of regulation and evidence. Participants suggested that pharmacy curricula expand training on symptom triage, pharmacist-patient communication, and CAM to prepare graduates for employment in community settings.

CONCLUSION

Student and licensed pharmacists of this study voiced that they are often asked for advice on symptom management, but reported needing training to help provide appropriate advice to patients.

PRACTICE IMPLICATIONS

The findings suggest that training strategies could help pharmacists appropriately triage and advise patients seeking self-care advice for their symptoms in the community setting.

An online virtual-patient program to teach pharmacists and pharmacy students how to provide diabetes-specific medication therapy management

OBJECTIVE

To develop, implement, and assess the effectiveness of an online medication therapy management (MTM) program to train pharmacists and pharmacy students in providing MTM services for patients with diabetes and to increase their intent to perform these services.

DESIGN

An online program was created using an Internet-based learning platform to simulate 4 MTM meetings between a pharmacist and a virtual patient diagnosed with diabetes.

ASSESSMENT

Eighty students and 42 pharmacists completed the program. After completing the program, scores on post-intervention assessments showed significant improvement in 2 areas: control over performing MTM, and knowledge of how to perform MTM. Students had a significantly less-positive attitude about MTM and a decline in their perception of the social expectation that MTM is part of the practice of pharmacy, while pharmacists' attitudes did not change significantly in these areas.

CONCLUSION

This online program using a virtual patient improved both participants' belief that they have control over performing MTM, and their knowledge of how to perform MTM for diabetic patients, which may increase the likelihood that pharmacists and pharmacy students will perform MTM in the future.

European pharmacy students' experience with virtual patient technology

OBJECTIVE

To describe how virtual patients are being used to simulate real-life clinical scenarios in undergraduate pharmacy education in Europe.

METHODS

One hundred ninety-four participants at the 2011 Congress of the European Pharmaceutical Students Association (EPSA) completed an exploratory cross-sectional survey instrument.

RESULTS

Of the 46 universities and 23 countries represented at the EPSA Congress, only 12 students from 6 universities in 6 different countries reported having experience with virtual patient technology. The students were satisfied with the virtual patient technology and considered it more useful as a teaching and learning tool than an assessment tool. Respondents who had not used virtual patient technology expressed support regarding its potential benefits in pharmacy education. French and Dutch students were significantly less interested in virtual patient technology than were their counterparts from other European countries.

CONCLUSION

The limited use of virtual patients in pharmacy education in Europe suggests the need for initiatives to increase the use of virtual patient technology and the benefits of computer-assisted learning in pharmacy education.

Virtual patients in pharmacy education

A review of the literature relating to the use of virtual patients in teaching pharmaceutical care to pharmacy students was conducted. Only 7 articles met the inclusion criteria for the review and 4 of the studies were conducted in North America. Few articles identified by the review used virtual patient technology that was true-to-life and/or validated.

Transitioning knowledge gained from simulation to pharmacy practice

Using simulation to teach pharmacy practice skills may result in knowledge that is transferable to patient care. Key areas in which simulation is being used in pharmacy education include therapeutics, communication, physical assessment, patient safety, and populations to which students may have infrequent exposure. Enhancing interprofessional healthcare team dynamics and the skills of practicing healthcare professionals are other practical applications for simulation education. Educators should continue to be creative in the incorporation of simulation into pharmacy education and conduct more studies on the impact of simulation education on patient care to demonstrate the efficacy of this teaching modality.

Computer-based simulation training to improve learning outcomes in mannequin-based simulation exercises

OBJECTIVE

To assess the impact of computer-based simulation on the achievement of student learning outcomes during mannequin-based simulation.

DESIGN

Participants were randomly assigned to rapid response teams of 5-6 students and then teams were randomly assigned to either a group that completed either computer-based or mannequin-based simulation cases first. In both simulations, students used their critical thinking skills and selected interventions independent of facilitator input.

ASSESSMENT

A predetermined rubric was used to record and assess students' performance in the mannequin-based simulations. Feedback and student performance scores were generated by the software in the computer-based simulations. More of the teams in the group that completed the computer-based simulation before completing the mannequin-based simulation achieved the primary outcome for the exercise, which was survival of the simulated patient (41.2% vs. 5.6%). The majority of students (>90%) recommended the continuation of simulation exercises in the course. Students in both groups felt the computer-based simulation should be completed prior to the mannequin-based simulation.

CONCLUSION

The use of computer-based simulation prior to mannequin-based simulation improved the achievement of learning goals and outcomes. In addition to improving participants' skills, completing the computer-based simulation first may improve participants' confidence during the more real-life setting achieved in the mannequin-based simulation.

Professional competencies learned through working on a medication education project

OBJECTIVES

To implement a medication education project and assess the competencies students learned and implemented in professional practice after graduation.

DESIGN

Fourth-year pharmacy students planned, carried out, and reported on a real-life project during 1 study year. Outside experts and 2 faculty members facilitated the work. The aim of the medication education project was to create material that schoolteachers could use to teach children about rational use of medicines.

ASSESSMENT

All students who had participated in the medication education program during its 3 years were contacted (n = 31). A questionnaire was sent to the 21 students who had graduated (18 responded), and a focus group was conducted with the 10 students completing their final year of pharmacy school (9 participants). The competencies that the students reported learning most were teamwork and social interaction skills. They considered the project motivating but also found it challenging and the deadlines frustrating.

CONCLUSIONS

Through participation in a medication education project, students learned interpersonal skills, time management, conflict resolution, and other skills that many of them already were finding valuable in their professional practice.

Developing communication skills in pharmacy: a systematic review of the use of simulated patient methods

OBJECTIVE

To review the literature relating to the use of simulated patient methods to enhance communication skills of pharmacists.

METHODOLOGY

We searched Embase, Lilacs, Medline, Scielo, and Scopus databases between 1980 and 2008, using "communication skills", "patient counseling" and "pharmacist" as keywords. This search was then further refined by using "simulated patients", "pseudo-customer", "standardized patients", and "mystery shoppers" as additional keywords.

RESULTS

The initial search identified 241 published studies. Once further refined, 15 studies met inclusion criteria.

CONCLUSION

The majority of studies had an assessment focus aimed at documenting counseling behavior of practicing pharmacists, rather than an educational focus aimed at equipping pharmacists with effective communication skills. In instances where simulated patient methods were used for educational purposes, little regard was given to the role of performance and corrective feedback in shaping communication behavior of pharmacists. The majority of studies failed to describe the competencies and skills being investigated in relation to communication in the practice of pharmacy.

PRACTICE IMPLICATIONS

Simulated patient methods provide pharmacy educators with a tool for implementing communication skills in the practice of pharmacy and will serve as a basis for implementing communication skills development programs at the College of Pharmacy of the Federal University of Sergipe in Brazil.

Preparing pharmacy graduates for traditional and emerging career opportunities

Educational programs in pharmacy must focus on educating pharmacists of the future who are prepared to serve as competent and confident health care "providers" whose "practice" can occur in any number of current and future settings; and whose expertise is essential to an interprofessional health care team. Graduates must be able to incorporate a scholarly approach to their practice in identifying patient care problems; practicing in an evidence-based manner; and ensuring safe, effective, and appropriate use of medications. It is time for colleges and schools of pharmacy to implement contemporary teaching and assessment strategies that facilitate effective and efficient student learning that is focused at the graduate professional level, to evolve the content around which the curriculum is organized, and clearly articulate the abilities graduates must have to function effectively in the myriad professional roles in which they may find themselves.