Impact of an Advanced Cardiac Life Support Simulation Laboratory Experience on Pharmacy Student Confidence and Knowledge

A Scoping Review of Pharmacists' and Pharmacy Students' Knowledge, Skills, and Attitudes in Medical Emergencies

OBJECTIVES

Competence can be defined as a set of knowledge, skills, and attitudes. In a medical emergency scenario, competent pharmacists are increasingly required, mainly as a result of the expansion of professional functions in this context. Therefore, the objective of this study was to map the scientific evidence that shows the development of knowledge and/or skills, and/or attitudes in the training of pharmacists and pharmacy students to work in emergency care.

FINDINGS

The scoping review was conducted in the PubMed, Embase, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases in January 2021, as recommended by the Joanna Briggs Institute. Our study retrieved 6276 files, and 31 articles met the inclusion criteria. It was observed that the studies were developed mainly in the United States of America and addressed the development and/or assessment of knowledge and skills, and training in cardiac emergencies. The most used teaching strategy was simulation, and the most used assessment strategy was feedback and/or debriefing.

SUMMARY

Publications involving the development of at least 1 domain of clinical competence have increased in the last decade. Thus, the mapping of studies has provided subsidies for identifying gaps in the teaching-learning process, as well as the identification of methodologies applied in the development and assessment of clinical competence for the referred population.

Long-Term Retention of Advanced Cardiovascular Life Support Knowledge and Confidence in Doctor of Pharmacy Students

OBJECTIVE

This study aimed to evaluate the impact of American Heart Association (AHA) advanced cardiovascular life support (ACLS) education and training on long-term retention of ACLS knowledge and confidence in Doctor of Pharmacy (PharmD) students.

METHODS

This multicenter study included PharmD students who received ACLS training through different means: 1-hour didactic lecture (didactic), 1-hour didactic lecture with 2-hour skills practice (didactic + skills), and comprehensive AHA ACLS certification through an elective course (elective-certification). Students completed a survey before training, immediately after training, and at least 6-12 months after training to assess demographics and ACLS confidence and knowledge. The primary outcome was a passing score, defined as ≥ 84% on the long-term knowledge assessment. Secondary outcomes included overall knowledge score and perceived confidence, assessed using the Dreyfus model.

RESULTS

The long-term assessment was completed by 160 students in the didactic group, 66 in the didactic + skills group, and 62 in the elective-certification group. Six (4%), 8 (12%), and 14 (23%) received a passing score on the long-term knowledge assessment in the didactic, didactic + skills, and elective-certification groups, respectively. The median (IQR) scores on the long-term knowledge assessment were 50% (40-60), 60% (50-70), and 65% (40-80) in the 3 groups. On the long-term assessment, confidence was higher in the elective-certification group, demonstrated by more self-ratings of competent, proficient, and expert, and fewer self-ratings of novice and advanced beginner.

CONCLUSION

Long-term retention of ACLS knowledge was low in all groups, but was higher in students who received AHA ACLS certification through an ACLS elective course.

Virtual simulations for neonatal education

Virtual simulation (VS) education involves the use of virtual reality, augmented reality, mixed reality and screen-based platforms, collectively referred to as extended reality, to provide education and assessment. This novel simulation modality supports experiential learning and increases access to practice opportunities, supplementing manikin-based simulation. VS has been used successfully for neonatal resuscitation training in high and low resource settings. Virtual simulators can be used to objectively assess learner performance in neonatal resuscitation knowledge and skills. When implementing VS for neonatal resuscitation training, key considerations include matching learning objectives with suitable technology, pre-session preparation, supporting learners, and debriefing. Additional research is needed to evaluate the impact of VS applications on clinical practice and patient outcomes.

Simulation-Based Training to Improve Clinical Pharmacist Self-Efficacy in the Management of a Rapidly Decompensating Patient

Background: The optimal training method to prepare pharmacists as an integral rapid response team or cardiopulmonary arrest responders is poorly described. This study assessed the utility of simulation-based training (SBT) as a training technique for clinical pharmacists. Objective: This study aimed to determine if attending SBT is associated with an improvement in self-efficacy. Methods: This single-center, prospective, interventional cohort study offered three simulations to clinical pharmacists over the course of seven months at a 957-bed quaternary care academic medical center. Pharmacists who participated in at least one simulation were categorized in the intervention group and were compared to pharmacists who did not attend a simulation. All participants were asked to complete a 19-question self-efficacy survey in the form of a 100-point scale, a 15-question multiple-choice knowledge assessment, and a perception survey in the form of 4-point Likert scale administered at baseline and following the conclusion of the SBT. Results: Forty-four clinical pharmacists participated; 20 in the intervention group and 24 in the control group. Median change in self-efficacy score improved significantly in the intervention group compared to the control group (14.3 vs 2.3, P = .009). Median change in perception score improved significantly (2 vs 0, P = .046). Knowledge score did not change significantly from baseline. Conclusion: Simulation-based training improved clinical pharmacist self-efficacy and perceptions in the care of rapidly decompensating patients. These findings support SBT as a viable modality of training clinical pharmacists for the management of rapidly decompensating patients.

The effect of interprofessional simulations on pharmacy and physician assistant students' learning of advanced cardiac life support concepts

BACKGROUND

The Interprofessional Education Collaborative (IPEC) defined core competencies for IPE in 2011, and use of simulation in interprofessional education (IPE) continues to be developed in prelicensure health education programs.

INTERPROFESSIONAL EDUCATION ACTIVITY

In this prospective, observational study, interprofessional student teams addressed reversible causes of cardiac arrest in weekly simulations during an Emergency Medicine course. Each simulation was followed by sequential team debriefs, first regarding the IPEC core competencies of interprofessional communication, teamwork, and roles and responsibilities, and second regarding the patient-related content of the case.

DISCUSSION

Twenty-eight pharmacy students and 60 physician assistant students completed the course. A didactic knowledge exam was administered before, immediately after, and 150 days after the course. Both disciplines' exam scores significantly increased from baseline to the end of the course and from baseline to the 150-day follow-up. Students also completed the validated Interprofessional Perceptions Survey before and after the course. Both disciplines demonstrated significant increases in Team Value, Efficiency and Interprofessional Accommodation components.

IMPLICATIONS

Participation in this simulation-based course resulted in 150-day retention of advanced cardiovascular life support knowledge and improved interprofessional perceptions in both pharmacy and physician assistant students.

Closing the Integration Gap: A Pilot for Incorporating Foundational Sciences, DEI-Decision Making, Empathy, and Communication for Congestive Heart Failure and Arrhythmia Management by Pharmacy Students

Pharmacists must integrate foundational sciences with pharmacy practice for providing optimal patient care. Pharmacy students need to be trained to provide culturally competent, linguistically accessible, and empathetic care while integrating foundational science principles. However, such holistic integration is challenging to achieve and assess. To bridge this gap, we implemented and assessed an “integrated cardiovascular simulation” (ICS) module for P2 students, employing case-based and team-based learning. ICS focused on congestive heart failure with preexisting arrhythmia and incorporated patient counseling relating to diversity factors such as cultural competency, linguistic challenges, and the impact of population diversity on cardiac diseases. Students learned the SBAR communication technique (situation, background, assessment, and recommendation) and recommended therapy while elaborating on drug MOA and adverse effects. ICS was assessed through pre-and post-session quizzes and perception data immediately after the activity, and after two years, when students progressed to the cardiovascular APPE block. Student performance improved on a post-test (80.2%) compared to the pre-test (66.9%), p < 0.01 paired student t-test, with an increase in symptom and arrhythmia pattern recognition (41.2% and 36.7%, respectively). ICS was effective for teaching (1) arrhythmia pathophysiology (85%), (2) EKG interpretation (89%), (3) drug adverse effects (93%), (4) DEI-clinical decision making (92%), and (5) communication skills (85%).

Promoting Nurses' Self-Efficacy in Advanced Cardiac Life Support Through High-Fidelity Simulation

Background Self-efficacy in resuscitation is influenced by various educational models, including high-fidelity simulation (HFS). Method Sixty-two nurses who were enrolled in an Advanced Cardiac Life Support (ACLS) course using HFS were recruited for this pretest-posttest, quasi-experimental study. Self-efficacy was assessed three times-twice via the participants' self-report and once via the instructor's assessment-using the Resuscitation Self-Efficacy Scale (RSES). Results The four dimensions of self-efficacy-recognition, debriefing and recording, responding and rescuing, and reporting-improved after the HFS education (t = 4.89, SE = 1.84, p < .001, confidence interval [-12.7, -5.33]). The instructor's scoring was higher than the participants' scoring in two of the four dimensions. The score on the ACLS written examination was positively correlated with the posttest RSES score (r = 0.303, p = .017). Despite minimal variations between demographic subgroups, nurses who had never been involved in resuscitation exhibited a significant improvement in self-efficacy after the HFS ACLS education (t = 4.72, SE = 2.54, p < .001, confidence interval [-17.3, -6.7]). Conclusion Self-efficacy can be a core measurable outcome that gauges nurses' clinical competency concerning HFS education for ACLS. [J Contin Educ Nurs. 2022;53(4):185-192.].

The Accuracy of Health Professions Students' Self-Assessments Compared to Objective Measures of Competence

Objective. To review the literature related to potential associations between self-assessed perceptions of knowledge and/or confidence with actual competence.Findings. Twenty-two articles involving a variety of disciplines, including undergraduate studies, dentistry, medicine, and pharmacy were included following the screening process. Most studies focused on student self-reported confidence rather than competency assessed by a formative examination. Only a handful of studies were centered on pharmacy education.Summary. Educational research that evaluates student learning should employ measures of competency as the primary outcome rather than student perceptions. Using student perceptions as the primary measure of student learning should be avoided, but student perceptions may have some utility as an adjunct to competency data.

Advanced cardiac life support certification for student pharmacists improves simulated patient survival

BACKGROUND AND PURPOSE

Basic life support (BLS) and advanced cardiac life support (ACLS) skills performance, as well as simulated patient survival, were compared for student pharmacist teams with and without at least one member with American Heart Association (AHA) ACLS certification.

EDUCATIONAL ACTIVITY AND SETTING

Doctor of pharmacy students in their third professional year completed a high-fidelity mannequin simulation. Within the previous year, 30 of 184 students (16%) completed ACLS certification. Rapid response teams (n = 31) of five to six members were formed through random student assignment. Two AHA instructors recorded and assessed performance using a checklist adapted from the AHA's standardized forms for BLS and ACLS assessment. Teams with and without ACLS certified members were compared for skills performance and simulated patient survival (i.e. correct performance of all BLS and ACLS skills).

FINDINGS

Teams with ACLS certified members (n = 21) were superior to teams without certified members (n = 10) for correct performance of all observed BLS and ACLS skills, including pulse assessment and medication selection for cardiovascular support. For teams who had ACLS certified members, simulated patient survival was 86% higher. The study groups did not differ in their ability to calculate a correct vasopressor infusion rate if warranted.

SUMMARY

BLS and ACLS skills performance were improved by AHA ACLS certification. Additionally, simulated patient survival was improved for teams with students who had at least one ACLS certified member.

Integrating simulation into advanced pharmacy practice experience curriculum: An innovative approach to training

Background

The use of simulation-based education (SBE) in pharmacy education can help students acquire the essential clinical knowledge and skills for practice and can enhance patients' safety. Simulation-based training has been implemented in inter-professional education training, introductory pharmacy practice experiences, pharmacy residency training. Still, there is limited information in the literature that assesses the use of simulation in advanced pharmacy practice experience (APPE).

Objective

To evaluate the impact of integrating SBE into APPE on students' learning outcomes, training costs, and satisfaction.

Method

This study presents a new training model of a 5-week clerkship experience where sixth-year pharmacy students alternate between hospital wards and simulation rooms. Student assessment rubrics were used to measure students’ achievements and report faculty feedback. Students filled scenario evaluation forms to assess their simulation satisfaction rate.

Results

A total of 57 students completed a full block of simulation-based, followed by hospital-based blocks practicing in the same medical specialty in both blocks. This newly structured experience provided fourteen direct patient care training seats per rotation and saved around 25,000 Saudi Riyals per rotation. The mean grades in both simulation and hospital-based blocks were mostly above 90% in all learning outcomes. Cognitive skills and affect learning outcomes mean grades were higher in the simulation-based group—most of the students being satisfied with the simulation scenarios.

Conclusion

SBE integration into APPE can supplement hospital-based experiential training to achieve the best learning outcomes with improved students' satisfaction.

Considerations in training student pharmacists to perform physical assessment

BACKGROUND AND PURPOSE

Patient assessment skills are an integral component of pharmacy education. Fostering a realistic learning experience requires simulated interaction with standardized patients (SPs). Cost, student performance, and student preference are important factors to consider when selecting a SP option. The study objective was to compare student peer SPs (SPSPs) and manikins for training student pharmacists to perform physical assessment skills.

EDUCATIONAL ACTIVITY AND SETTING

First-year student pharmacists were taught five physical assessment techniques and practiced on both a manikin and SPSPs. An examination was administered to assess student knowledge and technique performance. Student preference was assessed via survey. A cost utility analysis compared the costs of a SimMan manikin with SPSPs.

FINDINGS

All enrolled student pharmacists met competency during the final exam. Students strongly agreed or agreed: practicing on a live simulated patient enhanced my ability to perform physical assessment skills (95%); practicing on SimMan enhanced my ability to perform physical assessment skills (88%); I am interested in incorporating physical assessments in my future pharmacy (88%); and I believe future practice will support implementing physical assessments (85%). The cost utility analysis determined a utility of 4.74 with student peer SPs and 4.49 with SimMan.

SUMMARY

Student pharmacists were successfully trained to perform physical assessment techniques utilizing both SPSPs and a manikin. Understanding differences in instructional methods allows educators to determine best practices when teaching physical assessment.

Focus group describing simulation-based learning for cardiovascular topics in US colleges and schools of pharmacy

INTRODUCTION

This qualitative focus group study sought to describe how colleges of pharmacy use simulation-based learning (SBL) to teach cardiovascular topics and to identify challenges and benefits.

MATERIAL AND METHODS

Participants were recruited from a screening survey disseminated via e-mail to select American College of Clinical Pharmacy Practice and Research networks. Subjects were selected based on diversity in institution and simulation types. Two 1-hour focus group sessions were conducted by the primary investigator following a script designed by the research team. Each recorded session was independently reviewed by all investigators and coded into final themes. Results are reported in a qualitative fashion.

RESULTS

Five individuals provided consent and participated. Themes identified include topics, formats, interprofessional education, challenges, strategies for success, and benefits. Frequent topics included advanced cardiac life support, heart failure, hypertension, and transitions of care. Multiple formats were used including standardized patients or providers, task trainers, and high-fidelity mannequins. Multiple institutions reported simulating interprofessional teams by involving students from other health professions. Scheduling, pharmacy program size, faculty availability, and logistics around planning and/or conducting an event were identified challenges. Institutions reported success when clear expectations were provided to students and skill development progressed from low-stakes to high-stakes events. Benefits reported included real world applicability with participants noting that students do not realize the importance of SBL until they have reached rotations.

CONCLUSIONS

Various topics and simulation methods were employed to teach cardiovascular topics. While challenges exist, institutions have identified strategies for success and report students recognized the benefits to their learning.

Evaluation of a sepsis teaching rounds simulation for pharmacy students

BACKGROUND AND PURPOSE

The goal of this prospective, observational cohort study was to determine if simulated interdisciplinary teaching rounds improved student perceptions of confidence and attitudes towards working as part of a team. The secondary objective of this study was to investigate changes in student knowledge of the management of sepsis.

EDUCATIONAL ACTIVITY AND SETTING

Students participated in a traditional sepsis lecture followed by a simulated interdisciplinary rounding experience. Confidence and collaborative attitudes were assessed using a 5-point Likert scale (1=strongly disagree, 5=strongly agree). Changes in knowledge were measured using multiple choice questions. Students completed these tools at three points in time: pre-lecture, post-lecture, and post-simulation.

FINDINGS

Student confidence and attitudes related to interdisciplinary rounds improved following the simulation (2 of 4 items, p=0.003; 2 of 5 items, p<0.05). Also, most students agreed or strongly-agreed that the simulation reinforced knowledge gained from lecture (94.7%), that lecture followed by a simulation was the most effective way to learn about sepsis (94.7%), and that the simulation helped reinforce critical-thinking skills (94.7%). Knowledge improved between the didactic lecture and the simulation, but these differences were not found to be statistically significant.

SUMMARY

A simulated interdisciplinary rounding experience may increase student confidence during teaching rounds and improve attitudes towards working alongside other healthcare professionals. Incorporating rounding simulations into pharmacy curricula may be beneficial towards student success on rounds.

Implementation of a Renal Replacement Therapy Simulation to Strengthen Essential Pharmacist Skills

Objective. To assess third-year pharmacy students' knowledge and application of renal pharmacotherapy using a renal replacement therapy (RRT) simulation. Methods. A simulation was developed that involved three stations related to RRT: peritoneal dialysis, continuous renal replacement therapy (CRRT), and hemodialysis. Stations involved demonstration of each modality, literature searches for drug information questions related to renal dosing with written recommendations, and utilization of an electronic medical record (EMR) to develop a verbal Situation, Background, Assessment, Recommendation (SBAR) for a patient with chronic kidney disease (CKD). Pre- and post-simulation assessments regarding therapeutic knowledge of RRT was used. Results. All 174 students completed the pre- and post-simulation assessments over the course of two years. Student performance indicated significant improvement in overall knowledge based on the assessments with significant overall differences in questions relating to indications for RRT, type of RRT indicated for hemodynamic instability, and agents used to maintain circuit patency. Overall inter-class differences were also identified at baseline and specifically for the questions regarding indications for RRT and agents used to maintain circuit patency. Both classes showed significant improvement in overall knowledge based on the post-simulation assessments. Debrief sessions and course evaluations indicated student satisfaction with the simulation experience. Students reported that the experience met the simulation objectives. Conclusion. Participation in an RRT simulation allowed pharmacy students to apply knowledge and skills learned didactically related to renal pharmacotherapy.