Geriatric care as an introductory pharmacy practice experience

The role of active learning methods in teaching pharmaceutical care - Scoping review

Background

The pharmacists in a community pharmacies have already provided, or will provide in the near future advanced pharmaceutical care services. This requires modifying the approach to teaching pharmacy students as well as adapting the curriculum to the changing professional realities. It has been proven that in the field of medical and related sciences, learners-centered active teaching methods allow to achieve learning outcomes effectively, especially in the field of practical skills.

Objectives

As the pharmaceutical services are only being introduced in many European countries, the question arises as to what active learning methods to use to prepare pharmacy graduates for this. Thus the review of worldwide literature occurred to be helpful in identifying what active learning methods are being used specifically in teaching aspects of pharmaceutical care.

Methods

Three electronic databases: Pubmed, Scopus and Web of Science were searched using the keywords "active learning" and "pharmaceutical care".

Results

On the basis of the publications included in the review, 7 methods were distinguished. Case-study, role play and simulation exercises turned out to be the most popular. It was also possible to make preliminary conclusions on how to properly match the method to the learning outcomes. Moreover, a weak point of many studies was the lack of structured methods of assessing the skills acquired by the students.

Conclusions

In conclusion, the curriculum renewal in pharmacy is necessary and requires taking many aspects into account, from the types of tasks assigned to pharmacists, through the selection of appropriate teaching methods, to the verification of assessment methods.

Medication review in multi-morbid geriatric patients: A training program for pharmacy students in Germany

INTRODUCTION

Medication reviews can reduce the geriatric risk of experiencing drug-related problems (DRPs), but medication review training programs in pharmacy education are infrequent and inconsistent. Data on education programs that practice DRP management skills and DRP prioritization should be collected as such training requires a tailored student evaluation at the DRP level.

METHODS

A geriatric patient medication review training was developed and implemented for eighth-semester pharmacy students. Students' DRP management skills were evaluated using audiotaped, 15-min simulated patient scenarios before and after the training using a newly developed algorithm (score 1-9, adequate management defined ≥7). The scenarios included 17 DRPs, five of which were identified as a high priority. Students rated their DRP management and knowledge by self-assessment before and after the training and supplied feedback about the training.

RESULTS

Student comprehension and handling of DRPs improved after the training. The median number of adequately managed DRPs increased from 4 to 7 (P = .001) and the median number of high-priority DRPs identified increased from 4 to 5 (P = .007). Students felt they improved their overall competency, DRP management, and knowledge, and 85% rated the training essential to their university education.

CONCLUSIONS

This training provided students with an objective evaluation algorithm for complex patient simulations in elderly patients. The training improved students' DRP prioritization and management, providing a basic template for future geriatric medication review training programs.

Knowledge and Attitude of Pharmacy Students Regarding Geriatric Care: Questionnaire-Based Analysis in Malaysia

INTRODUCTION

There is a predicted growth of up to 17% in an older adult of Malaysian above 60 years of age by 2040. This will increase the workload of almost every healthcare provider to ensure optimal geriatric care.

PURPOSE

This study aimed to assess pharmacy students' knowledge and attitudes towards geriatric pharmacy education and older patients to determine their preparation in delivering appropriate medical care to the geriatric population.

METHODS

Self-administered questionnaires were distributed among pharmacy students in different Malaysian universities. The survey included several sections to assess multiple aspects such as sociodemographic information, assessment of knowledge using a validated 28-item Geriatric Knowledge Assessment Scale (GKAS), and attitudes towards geriatrics education.

RESULTS

The response rate was around 70% of the respondents. The mean (± standard deviation) age of the cohort was 22.28 (±1.12) years. Despite around 78% of pharmacy students claiming that their knowledge of geriatric care is adequate, their GKAS score showed that only around 20% have high geriatric knowledge. Around 80% of them showed a positive attitude on the importance of taking courses focused on geriatric care and demonstrated interest to further knowledge and training in geriatric care. However, more than half of the students were uncertain of their answers towards their attitudes regarding older patients.

CONCLUSION

Given the growing role of pharmacists in the ageing population, this study highlights the importance of geriatric care education among potential pharmacists. Therefore, we urge the need to improve/develop geriatrics education and training into the pharmacy curriculum to ensure sufficient preparation for actual practice after graduation.

implementing Student Pharmacist- Led Health Outreach Events at Long-term Care Facilities in a Medically Underserved Community

OBJECTIVE

To describe the process of creating precepted, student pharmacist-led health outreach events at long-term care facilities and to describe the lessons learned during the implementation process.

SETTING

Yakima, Washington, a medically underserved area.

PRACTICE DESCRIPTION

Pharmacy students, supervised by pharmacist preceptors, conducted health outreach events at local long-term care facilities on a rotating monthly basis. These students provided comprehensive medication reviews, blood pressure screenings, and blood glucose screenings.

PRACTICE INNOVATION

Pharmacists providing medication reviews at long-term care facilities where residents manage their medications can address polypharmacy by identifying medication discrepancies, determining the effectiveness of treatment, and improving patient outcomes. Conducting health outreach events with pharmacy-student involvement includes the added benefit of providing students with the opportunity to gain hands-on experience before beginning their clinical Advanced Pharmacy Practice Experience (APPE) rotations and practice skills described in the American Society of Consultant Pharmacists Geriatric Pharmacy Curriculum Guide and Pharmacist's Patient Care Process.

RESULTS

Nineteen health outreach events at long-term care facilities were held, and more than 100 residents participated annually. Students coordinated events successfully after developing a standardized set of questions, which was necessary for planning, and identifying someone to act as an event coordinator, recruiting students and ensuring they were appropriately trained, and creating a monitoring form to be filled in and shared with the participant. Students learned key lessons including naming the events appropriately to avoid confusion, understanding that not all long-term care facilities are alike, deciding how many students to recruit from each cohort to participate in events, optimizing the preceptor-to- student ratio, and ensuring preceptors were thorough in their oversight of students.

CONCLUSION

This work described the implementation of health outreach events conducted by supervised student pharmacists at long-term care facilities. Health outreach events could be conducted by other colleges or facilities to provide important medication review and health screening services for long-term care facilities' residents, as well as providing student pharmacists with opportunities to learn and practice patient-care related skills.

Geriatric care curriculum in US PharmD programs: What's happening?

OBJECTIVES

Current Accreditation Council for Pharmacy Education (ACPE) Standards are not explicit regarding geriatrics content. The objective of this review is to describe published examples of how care for older adults is integrated into Doctor of Pharmacy (PharmD) curricula at accredited schools/colleges of pharmacy across the United States.

METHODS

PubMed and Embase databases were searched. Manuscripts addressing care for older adults in pharmacy curriculum in the United States were included in the review.

RESULTS

Thirteen PharmD programs have thirteen published examples of how geriatric care was integrated into their curriculum. The most common way geriatric care is integrated into PharmD programs is through Introductory Pharmacy Practice Experiences (IPPE) followed by existing course content and elective course content.

CONCLUSION

There is a wide variety of curriculum strategies currently being utilized to incorporate geriatric education into PharmD programs in the United States. However, this may not be sufficient to support the care of the growing older adult population.

Student use of health literacy tools to improve patient understanding and medication adherence

OBJECTIVE

Evaluate curricular changes related to health literacy and determine impact on independent-living senior residents as part of an introductory pharmacy practice experience for third-year student pharmacists.

DESIGN

Students were randomly assigned a resident whom they visited multiple times to conduct assessments and provide various services using three methods: Ask Me 3™ Four Habits Model, and Teach-back.

SETTING

The study was conducted at independent-living apartments within a 24-mile radius from the St. Louis College of Pharmacy, St. Louis, Missouri.

PATIENTS, PARTICIPANTS

Participants (n = 147 to 173, across all three years) were volunteer, elderly residents, living at a facility that collaborated with the research.

INTERVENTIONS

Within one academic year, students collected medical and medication histories, conducted household safety checks, performed screening assessments, assessed adherence, and provided general recommendations to a resident.

MAIN OUTCOME MEASURE(S)

Outcomes included resident satisfaction, student satisfaction, and correlations between student use of health literacy tools and resident satisfaction.

RESULTS

Exit surveys indicated resident overall satisfaction with the program, increased understanding of health-related information, increased confidence in asking health care professionals questions about their health, and greater commitment to medication adherence as a result of the experience. Students were highly satisfied with the program. Analyses reveal some correlations between a previously determined performance level of student communication and resident satisfaction.

CONCLUSIONS

Students' use of health literacy communication tools during encounters with independent-living senior residents can result in greater patient understanding and empowerment, which may in turn help improve medication adherence.

Investigating pharmacy students' attitudes toward nursing facility patients after a geriatric rotation

OBJECTIVE

To investigate pharmacy students' attitudes toward nursing facility patients and nursing facilities after completing a geriatric rotation.

DESIGN

A cross-sectional post-test 20-item survey.

SETTING

An academic institution and two nursing facilities.

PARTICIPANTS

Nursing facility patients and second-year Appalachian College of Pharmacy students.

INTERVENTIONS

Students in Early Pharmacy Practice Experience 2 geriatric course.

OUTCOME MEASURES

Students' attitudes toward nursing facility patients and nursing facilities (14 items).

RESULTS

Of 138 students, 91.4% completed the survey following their geriatric rotation. Most students had positive attitudes toward nursing facility patients and nursing facilities on all 14 items. For example, students thought, "most older people are pleasant to be with" (mean = 3.88 ± 1.1). About 98% of students had adequate knowledge of geriatrics. Age, gender, marital status, and relationship with grandparents were not associated with students' attitudes (P ≯ 0.05).

CONCLUSION

Pharmacy students had positive attitudes toward elderly patients and nursing facilities and adequate knowledge of geriatrics after completing the geriatric rotation.

Effect of an introductory pharmacy practice experience geriatric rotation on pharmacy students' learning outcomes: a qualitative study

OBJECTIVE

All second-year pharmacy students at Appalachian College of Pharmacy (ACP) undertake the early pharmacy practice experiences (EPPE) II. EPPE II is an introductory pharmacy practice experience (IPPE) geriatric course/rotation that occurs over two semesters during the second year. During the course, students are introduced to long-term care/geriatric patients through visits with their assigned patient for an hour each week for 24 weeks. The aim of this study is to evaluate the effect of the EPPE II rotation on students' attitudes toward nursing facility patients (mostly geriatric) and long-term care.

STUDY DESIGN

Cross-sectional study.

SETTING

Academic site.

PARTICIPANTS

Fifty-five second-year Doctor of Pharmacy students at ACP.

INTERVENTIONS

All ACP students enrolled in the EPPE II course are required to write a one- to two-page reflective essay during the spring term in which they describe the development of their relationship with their patient over time. Students were asked to submit their essays to faculty investigators for use in this study after completing the course. These essays were independently analyzed for content and categorized into themes by two faculty raters.

MAIN OUTCOME MEASURES

Student learning outcomes.

RESULTS

A total of 55 students voluntarily submitted their reflective essays for inclusion in the study. Most students had positive opinions about the rotation. Overall, students felt that the rotation was rewarding, valuable, worthwhile, and life-changing. Students cited many aspects that they learned from the course: life lessons, what real patient care involves, how to build patient relationships, and disease states and drugs, among others. Most students indicated that they developed a close relationship with their patients and enjoyed visiting with them in the nursing facility.

CONCLUSION

Many students enjoyed visiting with their nursing facility patients and developed a personal relationship with them. Students also learned many aspects as individuals and as future pharmacists.

Pharmacy students' attitudes toward geriatric nursing home patients

OBJECTIVE

To determine the attitudes of second-year pharmacy students toward older people in general and geriatric patients in particular after attending an Early Pharmacy Practice Experiences 2 course.

METHODS

One hundred forty-four second-year pharmacy students completed the Geriatrics Knowledge Test and Attitudes Survey between 2008 and 2010.

RESULTS

On 11 of 14 items, most students had a favorable opinion of older people and providing geriatric care (mean > 3.0 on a 5-point scale). For example, students believed that treatment of chronically ill elderly patients is not hopeless ( 4.2 ± 1.0) and that most older people are pleasant to be with ( 3.8 ± 1.0). Gender, age, race/ethnicity, marital status, having children, and rural or non-rural upbringing were not related to the students' attitudes for most items.

CONCLUSION

Although the majority of second-year pharmacy students had favorable attitudes toward older people and geriatric care, the lack of research in this area suggests that further studies are needed.

A model for curricular quality assessment and improvement

The article describes a systematic assessment model and its potential application to a college's ongoing curricular assessment activities. Each component of the continuous quality improvement model is discussed, including (1) the definition of a competent practitioner, (2) development of the core curricular competencies and course objectives, (3) students' baseline characteristics and educational attainment, (4) implementation of the curriculum, (5) data collection about the students' actual performance on the curriculum, and (6) reassessment of the model and curricular outcomes. Over time, faculty members involved in curricular assessment should routinely reassess the rationale for selecting outcomes; continually explore reliable and valid methods of assessing whether students have reached their learning goals; get legitimate support for assessment activities from faculty members and administration; routinely review curricular content related to attitudinal, behavioral, and knowledge-learning outcomes; and determine what to do with the collected assessment data.