Effectiveness of educational technology to improve patient care in pharmacy curricula

Virtual reality in experiential pharmacy education: A quasi-experimental study

Introduction

Extended reality (XR) technologies are an umbrella term for simulated-based learning tools that cover 3-dimensional technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR). At King Saud University, first-year pharmacy students are required to experience hospital observational training during the Introductory Pharmacy Practice Experience (IPPE). We aimed to measure the effectiveness and satisfaction of the VR learning experience among IPPE students.

Methods

A Quasi-Experimental study was conducted. The experimental arm included first-year PharmD students. VR headset was used to watch three narrated videos capturing 360° views of the outpatient, inpatient pharmacy, and counseling clinic. A test measuring students' general knowledge was required prior to and post the experience, followed by a satisfaction survey. The control arm included second-year PharmD students who had traditional hospital visits and were administered a knowledge test and satisfaction survey.

Results

A total of 336 students were enrolled, 174 in the experimental arm and 162 in the control arm. The results showed improvement in the knowledge scores average among the experimental arm, 1.9 vs 3.5 in the pre-test and post-test. The control arm had a comparable score with an average of 3.7. Regarding self-assessment using four 5-likert scales assessing pharmacist role, skills, and responsibilities, 31.8 % and 42 % in the experimental arm compared to 28.9 % and 28.9 % in the control group answered strongly agree and agree, respectively. Regarding satisfaction, using five 5-Likert scales assessing the experience time, quality, and content, 53 % and 25 % in the experimental group compared to 34 % and 23 % in the control group answered strongly agree and agree, respectively.

Conclusion

VR provides pharmacy students with a standardized and effective learning and training experience. The experimental arm reported higher satisfaction rates and self-reported outcomes. Thus, implementing VR experiences within the pharmacy curriculum will provide students with an advanced educational advantage.

Implementation of Virtual Interactive Cases for Pharmacy Education: A Single-Center Experience

Patient case simulation software are described in pharmacy education literature as useful tools to improve skills in patient assessment (including medication history-taking and physical assessment), clinical reasoning and communication, and are typically well-received by students and instructors. The virtual interactive case (VIC) system is a web-based software developed to deliver deliberate practice opportunities in simulated patient encounters across a spectrum of clinical topics. This article describes the implementation and utilization of VIC in the undergraduate curriculum at one Canadian pharmacy school. Methods: At our facility, the use of VIC was integrated across the training spectrum in the curriculum, including core and elective didactic courses and practice labs, experiential learning, interprofessional education, and continuing education. Its use was evaluated through student and instructor surveys and qualitative student interviews). VIC is easy to navigate and created a positive and realistic learning environment. Students identified that it enhanced their ability to identify relevant patient information, accurately simulated hospital pharmacy practice and thereby helped them to prepare for their upcoming experiential courses. The use of VIC has expanded beyond its original intended purpose for individual student practice to become a valuable addition to pharmacy undergraduate education. Future plans include ongoing development of cases and exploration of further uses of VIC within the didactic curriculum, for remediation in experiential courses, and for pharmacist continuing education.

Development and Pilot Testing of the OTC Coach Software to Support Student Pharmacist Learning

Description of the problem: Pharmacy students are expected to learn how condition and patient-specific factors influence medication decision-making. Our objective was to create an interactive learning tool that would support students as they learn how individual factors change over-the-counter (OTC) medication recommendations. Description of the innovation: OTC Coach was created to allow student pharmacists to practice making recommendations about OTC medications. First year student pharmacists enrolled in a required self-care therapeutics course were given access to the optional OTC Coach, which included electronic decision algorithms for 10 topics. Student perceptions were collected via an online survey. Critical analysis: Two-thirds of the first-year students enrolled in the self-care therapeutics course activated their OTC Coach account (n=53/79, 67%). Among the students who completed the survey and reported using the tool (n=60/75, 80%), there was agreement that it help them learn the course material (78%), increased their confidence in making appropriate therapeutic recommendations (78%), increased their confidence when answering examination questions (63%), and improved their examination performance (61%). Next steps: Implementing an electronic tool positively supported student learning about OTC medication recommendations, according to student self-report. The tool is being expanded to include an option for students to generate a series of scenarios with randomized patient and condition factors to further allow students to efficiently practice making repeated patient-centered recommendations.

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.

Digital pharmacists: the new wave in pharmacy practice and education

Pharmacists now face the biggest challenges in the history of the profession: the use of digital technologies in pharmacy practice and education and the outbreak of coronavirus disease 2019. Worldwide, pharmaceutical care and pharmacy education via digital technologies have significantly increased and will be incorporated into patient care and the teaching–learning process, respectively. Thus, in this new era of pharmacy practice and education, curricula should promote the development of specific competencies for the cognitive, conscious, and effective use of digital tools. This requires the training of “disruptive” educators, who are capable of using teaching–learning methods adapted to the digital environment and educational processes suitable for stimulating the use of effective disruptive technologies. This commentary argues that the pharmacy profession can no longer wait for the slow integration of digital technologies into pharmacy practice and education.

Expanding naloxone education in the doctor of pharmacy curriculum

INTRODUCTION

Pharmacists are well-positioned to provide patients with access to the opioid-induced breathing emergency reversal agent naloxone, but many do not feel they have received adequate training to do so. The purpose of this project was to develop, implement, and evaluate an enhanced teaching approach to naloxone education in the doctor of pharmacy (PharmD) curriculum.

METHODS

The educational intervention incorporated active learning, technology, and interprofessional education components. Surveys were developed and administered pre-intervention and at one-week, six-month, and one-year post-intervention to evaluate changes in knowledge, perceptions, and confidence in clinical skills related to opioid-induced breathing emergencies and naloxone.

RESULTS

After participating, students' confidence (rated 0 to 5) in their ability to administer both intranasal (2.54 vs. 4.37, P < .001) and intramuscular (IM) (2.8 vs. 4.02, P < .001) naloxone increased, which was reflected in their improved performance on an opioid-induced breathing emergency simulation activity. Students ≤25 years old and females experienced significantly greater increases in their confidence to administer IM naloxone than those >25 years old and male. Most of these effects persisted at six months and one-year post-intervention.

CONCLUSIONS

The educational intervention increased pharmacy students' skills and confidence related to opioid-induced breathing emergency and naloxone. Improvements observed were in line with results of similar pedagogical studies. Age and gender differences in self-reported confidence levels also reflected previously reported findings. Materials and methods have been made available for other PharmD programs to utilize in expanding their curricula in these areas.

Experiencing a virtual patient to practice patient counselling skills

INTRODUCTION

Virtual patients (VPs) are a safe and standardised method of simulating clinical environments but few studies have explored health care professional's experiences of learning via a VP. This study explored how users experienced and used a VP that aimed to teach the user to deliver non-vitamin K oral anticoagulant patient education.

METHODS

The study used semi-structured interviews with pharmacists and pre-registration trainees from a wider research study. Interview topics were based on key areas concerning VP use. Interviews were audio-recorded and transcribed verbatim before being analysed using the framework approach to thematic analysis. Ethical approval was granted by Keele University.

RESULTS

There was variation in the type and nature of use of the VP and in the reported learning, which included reinforcement of knowledge, an opportunity to promote reflection, and acquisition and application of knowledge to clinical, patient-facing interactions. The VP was seen as an adjunct to other education and training. The majority of users indicated that they used the VP more than once. Some users seemed to have gamified their learning with a drive to achieve perfect feedback rather than true engagement with the learning, whereas for others the learning appeared to be deep with a reflective focus.

CONCLUSIONS

The VP offered an educational use as experiential learning, although the users experienced the VP differently; commonly the VP facilitated learning via reinforcement of pre-existing knowledge. The users reported that the VP had value as an adjunct to other education and training resources.

Integration of a Virtual Dispensing Simulator "MyDispense" in an Experiential Education Program to Prepare Students for Community Introductory Pharmacy Practice Experience

BACKGROUND

Technology is increasingly used to enhance pharmacy education. We sought to evaluate student learning and preparedness for community introductory pharmacy practice experiences (IPPEs) after implementation of "MyDispense" into experiential education.

METHODS

Both first-year pharmacy students and assigned community IPPE preceptors were eligible. Students were stratified based on previous community pharmacy experience (< or ≥ 50 h), then randomized to complete MyDispense exercises before IPPE (group A) or after 24-32 h of IPPE (group B). We evaluated preceptors' assessment of student readiness using a 6-item Likert scale survey and students' readiness and opinion of MyDispense using an anonymous 9-item survey. Descriptive statistics were used to characterize data. The Mann-Whitney U test was used to compare groups and a p-value < 0.05 was considered statistically significant.

RESULTS

Of 177 eligible students, 155 were randomized and 56 completed study. Group A included 32 students; 56.3% had prior community practice experience. Group B included 24 students; 50% had prior community practice experience. Forty-eight preceptors were enrolled. Students who completed exercises before rotation received higher preceptor scores for patient counseling of self-care and of medications (p < 0.05 for both). Students self-assessed their counseling skills lower than all other skills; 30.4% and 42.9% of students felt mostly or always prepared to counsel for self-care and medications, respectively. Students found MyDispense straightforward, realistic, and appreciated the ability to practice in a safe, electronic, community pharmacy, patient-care environment.

CONCLUSION

Simulation-based software, such as MyDispense, can enhance learner understanding of the prescription fill and counseling process in a community pharmacy practice setting.

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 Student Perceptions and Preferences of In-person Versus Video-Recorded Evaluations in Skills-Based Courses

Objective. To determine pharmacy students' preferences for and perceptions of in-person and video evaluations.Methods. A mixed methods survey was administered to 447 first-, second-, and third-year students enrolled in a public US Doctor of Pharmacy program. A survey instrument with 14 quantitative items and four qualitative items was used to measure student perceptions. Eight response choice items measured preferences. Paired t tests were used to compare students' perceptions. Independent t tests were used to compare perceptions between students who experienced and had not experienced video evaluations. Two researchers performed thematic content analysis of the qualitative responses.Results. Students (n=444, 99.3% response rate) perceived in-person evaluations more positively for all items except nervousness. Students who experienced video technology felt significantly more positive about video evaluations than students who had little or no experience using video technology on nine items. The students who experienced video technology felt significantly less positive toward video evaluations in terms of quality (1.24 vs. 0.83) and amount (1.14 vs 0.77) of written feedback. Although students valued the interaction with a larger, more diverse pool of evaluators that was made possible by video evaluations, they did not view video technology as applicable to their future practice.Conclusion. Students viewed in-person evaluations significantly more positively than video evaluations. This effect was mitigated by greater exposure to video technology, suggesting that concerns regarding video evaluations are based on conjecture rather than experience. This study highlights the need to reduce the technological issues associated with video evaluations and improve the written feedback provided to students.

Using Virtual Patient Software to Improve Pharmacy Students' Knowledge of and Attitudes Toward Geriatric Patients

Objective. To evaluate the effect of using a virtual patient software program to improve pharmacy students' knowledge of and attitudes toward geriatric patients. Methods. The Virtual Patient for Geriatric Education (VIPAGE) software program was used in two Bachelor of Pharmacy (BPharm) degree programs in Brazilian universities. The virtual consultations were divided into an initial evaluation, care plan, letter of referral to another professional, and evaluation of follow-up. Each weekly session lasted two hours. Students answered questionnaires before and after using the virtual patient software relating to the following: demographics, geriatric experiences, Geriatric Attitudes Scale, and the Facts on Aging Quiz. Results. Of the 128 students who completed the baseline questionnaires, 109 students also completed the second questionnaire. The mean Geriatric Attitudes Scale score before the intervention was 3.7 (SD=0.8) and after was 3.9 (SD=0.7). Significant improvements in Geriatric Attitudes Scale scores after using the virtual patient software were seen in students who were male, whose grandparents were still alive, or whose parents were elderly, who had frequent contact with the elderly, who did not have frequent contact with the elderly, and who did not have professional contact with the elderly. The average score on geriatrics knowledge was 44.7 (SD=12.0) before completing the virtual patient consultations and 52.6 (SD=11.9) after. The mean score measuring students' lack of geriatrics knowledge was 27.3 (SD=15.8) before and 19.1 (SD=12.8) after using the software. Conclusion. Completing virtual patient consultations using the VIPAGE software positively impacted pharmacy students' geriatrics knowledge and attitudes.

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.

Curriculum integration of virtual patients

BACKGROUND AND PURPOSE

Virtual patients (VP) offer an enhanced learning experience for students to assume the role of health professional and make therapeutic decisions in a simulated environment. While VPs are valued by students and offer benefits to the learner, little is known about how best to implement them in pharmacy education curricula. The purpose of our study was to investigate students' perceptions of VPs and build understanding about how to optimally implement them in the future.

EDUCATIONAL ACTIVITY AND SETTING

Four VP cases were implemented over the first three years of the entry to practice doctor of pharmacy program. Each case was focused on a different condition and implemented in one of three settings (i.e. integration activities, large lecture setting, or independent review). Students were invited to complete a survey and participate in a focus group after completing the patient case.

FINDINGS

One-hundred eighty students completed the survey and six students participated in a focus group. Ninety-four percent of respondents strongly agreed/agreed that VPs were valuable for their learning. Students preferred the VP cases be implemented in small-group settings and be relevantly timed with course material. Students found helpful that cases were realistic, clear, comprehensive, engaging, and incorporated feedback. Perceived benefits included enhanced learning about medical conditions, development of clinical reasoning skills and processes for working through cases.

SUMMARY

VPs continue to be identified as a valuable learning experience. When implemented it is important to consider the learner setting in order to get the greatest value from their use.

Implementation and evaluation of problem-based video podcasts in an introductory pharmacokinetics course

INTRODUCTION

The use of problem-based video podcasts in health sciences education is limited. Principles of Pharmacokinetics is an introductory course that establishes a foundation for understanding pharmacokinetic concepts. The primary objective was to determine the impact of problem-based video podcasts in an introductory pharmacokinetics course on student learning.

METHODS

Problem-based video podcasts were implemented in an introductory pharmacokinetics course in spring 2015. Student pharmacists in the first professional year enrolled in the course during spring 2015, 2016, and 2017 were included in the study with students enrolled in the course in spring 2014 serving as the control group. The primary outcome was the impact of problem-based video podcasts on student learning as assessed by student performance on the final exam. Other outcomes included student utilization of the video podcasts, overall course grades, and student perceptions of learning using video podcasts.

RESULTS

A total of 633 students in four academic years were included for analysis. Final exam scores were significantly higher in spring 2015 and 2016 compared to 2014. The 2017 final exam scores were similar to the final exam scores in 2014. Students perceived the problem-based video podcasts enhanced their ability to apply concepts to a patient case, reinforced concepts from lectures, and improved their understanding of clinical pharmacokinetics.

CONCLUSION

The use of problem-based video podcasts is an innovative method to augment learning outside of the traditional class time and may enhance learning without replacing direct instructor-student contact. Students reported the video podcasts improved their understanding of clinical pharmacokinetics.

A systematic review of audience response systems in pharmacy education

BACKGROUND

Audience response systems (ARS) are increasingly being used to support learning and assessment. Despite widespread use, the effects on educational outcomes and student learning are largely unknown. The objective of this systematic review was to assess the impacts of using ARS in pharmacy education.

METHODS

A literature search was conducted on PubMed, Embase, Google Scholar, and three pharmacy education journals. Articles were eligible for inclusion if they reported outcomes relating to the use of ARS in student pharmacist education and were published in English.

RESULTS

Eleven studies were included. Endpoints related to course grades, information recall, student perceptions, and faculty perceptions. Few studies were identified that assessed the impact of ARS on course grades and those that did reported mixed results. ARS demonstrated improved student recall immediately following an educational activity but effects were not lasting. Students had positive perceptions regarding ARS classroom use, especially for participation, engagement, and attention to educational content. Faculty members were positive towards the use of ARS for teaching purposes but expressed concerns regarding the use for assessment.

IMPLICATIONS

The use of ARS positively benefited student participation and engagement in the classroom setting, as a tool to enhance active learning. Positive perceptions from faculty and feasibility of use also support that ARS may be an effective teaching strategy to better engage students in the learning process. The impact on student academic performance is inconclusive and must be further explored.

Considerations When Incorporating Technology Into Classroom and Experiential Teaching

Technology and education are merging in today's society. Students in primary and secondary education recognize technology incorporated into teaching as a standard practice, not a unique experience. Curriculum standards in professional health sciences education have changed to promote the increased use of technology, with the purpose of enhancing student skills and engagement. The classroom and experiential settings offer opportunities for technology to be incorporated in a variety of ways. Technology can be useful for the teacher and student; however, challenges do exist. This paper highlights the benefits and challenges of incorporating technology into the settings of classroom and experiential teaching. Specifically, the purpose and use of technology, equipment, accessibility, time, and costs are discussed and example software programs are described.

The Need for Palliative Care in Pharmacy Education

There is a growing need for palliative care pharmacists in the United States. There is also a gap in the education of palliative care for pharmacy students. To address both, pharmacy schools must develop and disseminate palliative care-focused experiences, including traditional didactic lectures, problem-based learning, interactive skills, laboratory- and web-based experiences. This commentary presents the need for palliative care-focused experiences in the Doctor of Pharmacy (PharmD) degree program, and how schools can take smaller steps to tackle this issue.

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.

An open randomized controlled study comparing an online text-based scenario and a serious game by Belgian and Swiss pharmacy students

INTRODUCTION

To compare online learning tools, looped, branch serious game (SG) and linear text-based scenario (TBS), among a sample of Belgian and Swiss pharmacy students.

METHODS

Open randomized controlled study. The lesson was based on the case of a benign cough in a healthy child. A randomized sample of 117 students: only the Swiss students had attended a previous lecture on coughs. Participation rate, pre- and post-experience Likert scales and students' clinical knowledge were measured.

RESULTS

Our primary hypothesis was demonstrated: students favored the SG even if navigation was rated as more complex, and students who performed the SG better understood the aim of pharmacist triage in case of cough. The influence of the SG appeared to be linked to the presence of a previous lecture in the curriculum.

DISCUSSION AND CONCLUSION

SG and TBS are effective to teach pharmacist triage. Higher SG complexity should be used to teach the aim of pharmacist triage in the case of a specific disease and could be an alternative to simulated patients. A simpler TBS does not require a previous lecture and a debriefing to be fully effective.

Virtual Pediatric Patient Activities With Randomized Scenarios as an Instructional Tool for Pharmacy Students

OBJECTIVES

To assess student pharmacist best activity scores and related exam question performance based on the number of pediatric virtual patient activity (VPA) attempts.

METHODS

A 40-point asthma VPA was implemented and included three possible randomized scenarios. A 60-point meningitis VPA was implemented and included three possible randomized scenarios followed by an additional three possible randomized scenarios only if the first scenario was correctly completed. Points were awarded in the VPA based on appropriateness of treatment decisions. Students were allowed unlimited VPA attempts individually and as a group in class. Three exam questions were based on a fourth scenario of each randomized portion of the VPAs. The Kruskal-Wallis test, Mann-Whitney U test, and T-test were used for statistical comparisons when appropriate.

RESULTS

Of 132 students, median individual best asthma VPA scores were 15.25, 22, and 30 for those with 1, 2, and ≥3 asthma attempts, respectively (p < 0.001). Median individual best meningitis VPA scores were 4, 5, 7, and 45.5 for those with 1, 2, 3 to 4, and ≥5 attempts, respectively (p < 0.001). Median number of group VPA attempts was higher among students who correctly answered the exam question related to the first randomized meningitis scenario (10 versus 4, p = 0.015), although no differences in attempts were found for the other related questions (all p > 0.05).

CONCLUSIONS

Students who completed the VPAs more times achieved greater individual best scores. Students who correctly answered related exam questions had a higher number of group VPA attempts only when continuation of the VPA required correct randomized scenario completion.

Evaluation of the Use of a Virtual Patient on Student Competence and Confidence in Performing Simulated Clinic Visits

Objective. To assess the effect of incorporating virtual patient activities in a pharmacy skills lab on student competence and confidence when conducting real-time comprehensive clinic visits with mock patients. Methods. Students were randomly assigned to a control or intervention group. The control group completed the clinic visit prior to completing virtual patient activities. The intervention group completed the virtual patient activities prior to the clinic visit. Student proficiency was evaluated in the mock lab. All students completed additional exercises with the virtual patient and were subsequently assessed. Student impressions were assessed via a pre- and post-experience survey. Results. Student performance conducting clinic visits was higher in the intervention group compared to the control group. Overall student performance continued to improve in the subsequent module. There was no change in student confidence from pre- to post-experience. Student rating of the ease of use and realistic simulation of the virtual patient increased; however, student rating of the helpfulness of the virtual patient decreased. Despite student rating of the helpfulness of the virtual patient program, student performance improved. Conclusion. Virtual patient activities enhanced student performance during mock clinic visits. Students felt the virtual patient realistically simulated a real patient. Virtual patients may provide additional learning opportunities for students.

Combination of a Flipped Classroom Format and a Virtual Patient Case to Enhance Active Learning in a Required Therapeutics Course

Objective. To design and evaluate the integration of a virtual patient activity in a required therapeutics course already using a flipped-classroom teaching format. Design. A narrative-branched, dynamic virtual-patient case was designed to replace the static written cases that students worked through during the class, which was dedicated to teaching the complications of liver disease. Students completed pre- and posttests before and after completing the virtual patient case. Examination scores were compared to those in the previous year. Assessment. Students' posttest scores were higher compared to pretest scores (33% vs 50%). Overall median examination scores were higher compared to the historical control group (70% vs 80%), as well as scores on questions assessing higher-level learning (67% vs 83%). A majority of students (68%) felt the virtual patient helped them apply knowledge gained in the pre-class video lecture. Students preferred this strategy to usual in-class activities (33%) or indicated it was of equal value (37%). Conclusion. The combination of a pre-class video lecture with an in-class virtual patient case is an effective active-learning strategy.