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Haruta J, Nakajima R, Monkawa T. Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey. BMC Med Educ 2024; 24:399. [PMID: 38600531 PMCID: PMC11007881 DOI: 10.1186/s12909-024-05386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The use of simulated patients (SPs) to assess medical students' clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students' medical interview. METHODS This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment's internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT's 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach's alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson's correlation coefficient. RESULTS Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach's alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity. CONCLUSIONS Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.
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Affiliation(s)
- Junji Haruta
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan.
| | - Rika Nakajima
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
| | - Toshiaki Monkawa
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, 160-8582, Tokyo, Japan
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Ashjian EJ, Genereaux M, Thompson AN, Ward K, Wells T, Bostwick JR, Vordenberg SE. Transitioning From Points-Based Grading to a Modified Pass/Fail Grading Approach in a Simulated Patient Program. Am J Pharm Educ 2024; 88:100645. [PMID: 38211881 DOI: 10.1016/j.ajpe.2024.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/17/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To determine the impact of transitioning from points-based grading to a modified pass/fail grading approach in a simulated patient (SP) program on first year pharmacy (P1) student performance in a PharmD curriculum. METHODS Course-level data from the 2021-2022 and 2022-2023 academic years were collected to assess the impact of transitioning to a modified pass/fail grading approach on P1 student performance. During the 2021-2022 academic year, points-based grading was used. In 2022-2023, a modified pass/fail grading approach was implemented: communication assessment used pass/fail grading and clinical assessment used points-based grading; each assessment was worth 50% of the total SP activity grade. Chi-square tests were used to compare the percentage of students who passed each assessment (≥70%) with those who failed. RESULTS Across both academic years, students completed 9 formative (18 rubrics) and 6 summative (12 rubrics) SP activities. Each activity included separate communication and clinical assessment rubrics. There were no significant differences in performance on 27 of 30 rubrics. There were two formative SP activities where the percentage of students who passed the communication assessment using pass/fail grading (2022-2023 academic year) was different than points-based grading (2021-2022 academic year). In one fall semester activity, the cohort with the modified pass/fail grading approach had lower pass rates, but the opposite trend was observed in the winter semester. CONCLUSION Our program was able to successfully move to a pass/fail approach for communication assessments of SP activities while maintaining points-based grading for clinical assessments in our P1 curriculum with minimal impact on student performance.
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Affiliation(s)
- Emily J Ashjian
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.
| | - Molly Genereaux
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Amy N Thompson
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Kristen Ward
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Trisha Wells
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Jolene R Bostwick
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Sarah E Vordenberg
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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Alastalo N, Siitonen P, Jyrkkä J, Hämeen-Anttila K. The quality of non-prescription medicine counselling in Finnish pharmacies - a simulated patient study. Explor Res Clin Soc Pharm 2023; 11:100304. [PMID: 37521017 PMCID: PMC10371815 DOI: 10.1016/j.rcsop.2023.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
Background Medication counselling provided by pharmacists is important for ensuring the safe use of medicines. Objective To assess the quality of non-prescription medicines counselling in Finnish pharmacies. Methods Three scenarios using simulated patient methodology were conducted: the patient requesting a specific brand name Burana® (ibuprofen, OTC medicine), Pronaxen® (naproxen, behind-the-counter (BTC) medicine) and a nasal spray. The visits were conducted in 146 pharmacies by trained simulated patients. Each pharmacy was visited twice. The quality of counselling was defined as poor (1-2 points), moderate (3-4 points), or high (5-6 points) based on developed scenario-based scoring criteria. Results The total number of conducted visits was 292, of which only 29 received high quality counselling. The quality was high in 20% of the cases for Pronaxen® and in 7% of the cases for Nasal spray scenarios. In the Burana® scenario, counselling quality was high only in 2% of the cases. Patients who requested a nasal spray were often asked questions about their symptoms (93%). In the Pronaxen®-scenario, the most frequently asked questions were related to contraindications and drug interactions (56%). The most often given instructions varied between the scenarios, being follow-up in the Burana® and Nasal spray scenarios (17% and 70%, respectively) and how to use the medicine in the Pronaxen®-scenario (63%). Conclusions Non-prescription medicine counselling is rarely performed with high quality. However, the quality of counselling depends on the medication in question. There is room to improve medication counselling and the assessment of the necessity and suitability of treatment, especially when a patient requests an OTC pain medicine by its brand name.
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Affiliation(s)
- Niina Alastalo
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Piia Siitonen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| | - Johanna Jyrkkä
- Finnish Medicines Agency Fimea, PO Box 55, 00034 Fimea, Kuopio, Finland
| | - Katri Hämeen-Anttila
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
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Zhou W, Wang J, Chen Q, Huang Z, Zhou N, Hu M. Assessment of the operation status of electronic prescription at community pharmacies in Chengdu, China: a simulated patient study. BMC Health Serv Res 2023; 23:920. [PMID: 37644463 PMCID: PMC10466720 DOI: 10.1186/s12913-023-09742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 06/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Information and technologies relevant to eHealth have developed rapidly over the past two decades. Based on this, China piloted "Internet + " pattern and some regions piloted electronic prescription services to explore telepharmacy services. OBJECTIVE To describe the processes and assess the operation status of electronic prescription services mode for community pharmacies in China. METHODS The simulated patient methodology was used to conduct a cross-sectional study in 317 community pharmacies from six districts in Chengdu, China in 2019. Simulated patients expressed three levels of service demands based on scenario about acute upper respiratory tract infections to evaluate the recommendation strength of electronic prescription services and telepharmacy service in community pharmacies. The descriptive statistics was completed to obtain the characteristics of the visit process, student t-test and χ2 test (P < 0.05 was considered statistically significant) were used for inferential statistical analysis to determine differences in characteristics and degree of recommendation between pharmacies. RESULTS Three Hundred Seventeen record sheets were effectively collected. The third-party platform was recommended in 195 (61.5%) interactions. The main reason for not recommending is non-prescription dispensing of prescription drugs (27.1%). 90.3% interactions waited less than 1 min, the counseling duration was less than 5 min in all interactions, and most community pharmacies had good network conditions (81.5%). 97.4% remote physicians offered professional counseling, only 22.1% of the pharmacists provided medication advice. CONCLUSIONS The electronic prescription services mode for community pharmacies in Chengdu provides a convenient drug purchase process but remains some problems. For example, prescribing drugs without a prescription and services provided by pharmacists was poor, etc. The relevant supporting policies should be improved in future development process.
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Affiliation(s)
- Wenxin Zhou
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China
| | - Jing Wang
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China
- Clinical Research Institute, the Affiliated Hospital of Southwest Medical University, 646000, Luzhou, P.R. China
| | - Qinmin Chen
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China
| | - Zhen Huang
- Market Supervision Administration of Chengdu Municipality, 610041, Chengdu, P.R. China
| | - Naitong Zhou
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China.
| | - Ming Hu
- School of Pharmacy, Sichuan University, No. 17, 3Rd Section, Renmin South Road, 610041, Chengdu, P.R. China.
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Sendekie AK, Ergena AE, Belachew EA, Kasahun AE, Teklie MT, Netere AK. Extent of cardiovascular medications dispensing practice without a prescription: Self-reported and simulated patient-based study at community pharmacies in Northwest Ethiopia. J Pharm Policy Pract 2023; 16:28. [PMID: 36829213 PMCID: PMC9951525 DOI: 10.1186/s40545-023-00533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/12/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Critical actions are required for the proper administration of medications to patients with cardiovascular diseases. However, there has been an increase in irrational use of cardiovascular drugs. The purpose of this study was to determine the extent of non-prescription cardiovascular medicine dispensing practices at community drug retail outlets (CDROs) in Gondar, Northwest Ethiopia. METHODS A cross-sectional survey and simulated patient-based visits were employed at the CDROs in Gondar City, Northwest Ethiopia between June 1 and July 20, 2022. The cross-sectional component that assessed the self-reported practices used a standardized self-reported questionnaire. A simulated patient (SP) case scenario, using different tracer prescriptions only for cardiovascular medications, allowed for the observation of real-world dispensing procedures. SPSS version 22 was used for the data entry and analysis. RESULTS The cross-sectional study approached 76 CDROs, and 71 of them agreed to take part (93.4% response rate). More than half of the respondents (53.5%) were males, with a mean (SD) age of 33.5 ± 9.1 years. Overall, the current self-reported survey showed that 59.2% of the participants provided cardiovascular drugs without a prescription. A total of 213 simulated visits were conducted. Considering all SP scenarios, the percentage of cardiovascular drugs dispensed without a prescription increased to 88.7%. Besides, more than 90% of pharmacists did not demand the SP to have a prescription, did not advise them to visit doctors or clinics, and did not inquire as to whom the medication was required. CONCLUSION A significant proportion of CDROs dispensed cardiovascular medications without a prescription. The findings highlight the disparity between self-reported and actual CDRO practices. Additionally, nearly all of the CDROs approached made it simple to obtain cardiovascular medications. Stakeholders could adherently follow the CDROs' practices to improve their proper dispensing procedures.
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Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, PO. Box: 196, Gondar, Ethiopia.
| | - Asrat Elias Ergena
- grid.59547.3a0000 0000 8539 4635Department of Pharmaceutical Chemistry, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- grid.59547.3a0000 0000 8539 4635Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, PO. Box: 196, Gondar, Ethiopia
| | - Asmamaw Emagn Kasahun
- grid.59547.3a0000 0000 8539 4635Department of Pharmaceutics, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masho Tigabie Teklie
- grid.59547.3a0000 0000 8539 4635Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, PO. Box: 196, Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- grid.59547.3a0000 0000 8539 4635Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, PO. Box: 196, Gondar, Ethiopia
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de Souza EV, Vieira LJSC, dos Santos SNP, Cerqueira-Santos S, Rocha KSS, de Oliveira Santos Silva R, de Lyra Jr DP. Evaluation of pharmacist's practices regarding the antimicrobials dispensing: a simulated patient study. BMC Health Serv Res 2022; 22:1576. [PMID: 36564839 PMCID: PMC9788868 DOI: 10.1186/s12913-022-08853-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The indiscriminate use of antimicrobials is considered a major contributing factor to the increase in antimicrobial resistance. Community pharmacies are the main source of access to antimicrobials, and pharmacists are in a strategic position to promote rational use of these medicines. Therefore, it is important to know dispensing service quality. OBJECTIVE To evaluate the behavior of pharmacists in dispensing antimicrobials in community pharmacies in northeast Brazil. METHODS This cross-sectional pilot study was conducted from August to October 2021 in a private community pharmacy chain in Sergipe. Dispensing was evaluated using the simulated patient (SP) technique. Two SP asked the pharmacists for the antimicrobials (case clinic 1: upper respiratory infection; case clinic 2: urinary tract infection) and recorded the service through audio. Dispensing practices were independently analyzed by two researchers based on the tools available in the literature. Data were presented using descriptive statistics. RESULTS A total of 54 simulated patient visits were conducted. Based on the 12 steps recommended by the research team for good dispensing, pharmacists asked an average of 1 (±1.17) question for upper respiratory infections and 0.3 (±0.54) for urinary tract infections, as well as provided counseling (mean number of recommendations, 2.6 (±1.44) and 4.5 (±2.35), respectively). As for communication skills, pharmacists had a regular score (3.07 ± 0.34). Furthermore, there was no significant difference in the number of steps and counseling recommendations by pharmacists in dispensing clinical cases 1 and 2 (p = 0.0674). CONCLUSION The quality of antimicrobial dispensing was evaluated as suboptimal, requiring improvements in practice and multifaceted strategies to promote continuing education of these professionals. In addition, awareness actions for the population must be implemented to promote the rational use of antimicrobials and reduce microbial resistance.
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Affiliation(s)
- Elindayane Vieira de Souza
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Lara Joana Santos Caxico Vieira
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Sylmara Nayara Pereira dos Santos
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Sabrina Cerqueira-Santos
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Kérilin Stancine Santos Rocha
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Rafaella de Oliveira Santos Silva
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
| | - Divaldo Pereira de Lyra Jr
- grid.411252.10000 0001 2285 6801Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Department of Pharmacy, Federal University of Sergipe, Avenue Marechal Rondon, Jd. Rosa Elze, São Cristóvão, Sergipe State 49100-000 Brazil
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Sous W, Frank K, Cronkright P, Germain LJ. Use of a simulated patient case and structured debrief to explore trainee responses to a "non-compliant patient". BMC Med Educ 2022; 22:842. [PMID: 36474211 PMCID: PMC9727840 DOI: 10.1186/s12909-022-03894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Labeling a patient "non-compliant" is a form of dehumanization that can deprive the patient of positive human qualities and/or agency in the mind of a physician. The term "non-compliant" is frequently used in medical record documentation and has been shown to compromise care, particularly for marginalized communities. There is limited literature on the impact of the label on medical trainees. We aimed to explore how internal medicine residents and fellows (trainees) perceive the term "non-compliant patient" and its impact on their practice after interacting with a simulated refugee patient who has not followed a physician's recommendations. METHODS Kolb's experiential learning cycle guided the design of the educational session which was part of a required communication skills curriculum for trainees. A scenario was created to simulate a refugee patient who had not adhered to their treatment plan and could potentially be labeled as "non-compliant." Trainees participated in the 3-h session consisting of a remote simulated patient encounter immediately followed by a virtual structured debrief session that was recorded and transcribed. Thematic analysis of debrief transcripts was conducted starting with the use of provisional codes from the literature on the doctor-patient relationship and de/humanization. RESULTS In group debrief sessions, trainees reflected upon the standardized patient case and chose to also discuss similar cases they had experienced in clinical practice. Trainees indicated that the term "non-compliant patient" served as a biasing function and described how this bias negatively impacted the doctor-patient relationship. Trainees described how marginalized communities might be more susceptible to the negative connotation associated with the term "non-compliant patient." For some trainees, the term triggered further investigation of underlying barriers to care and exploration of the social determinants of health. CONCLUSIONS The use of the phrase "non-compliant patient," though common in medical practice, may lead to patient dehumanization among trainees. A simulated refugee patient encounter followed by a facilitated group debrief allowed participants to verbalize and reflect on the meaning and possible impact of the label.
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Affiliation(s)
- Waseem Sous
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.
- Department of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA.
- HEAL Initiative, University of California, San Francisco, San Francisco, CA, USA.
| | - Kay Frank
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Peter Cronkright
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Lauren J Germain
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Azizi H, Majdzadeh R, Ahmadi A, Raeisi A, Nazemipour M, Mansournia MA, Schapira A. Development and validation of an online tool for assessment of health care providers' management of suspected malaria in an area, where transmission has been interrupted. Malar J 2022; 21:304. [PMID: 36303211 DOI: 10.1186/s12936-022-04308-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The alertness and practice of health care providers (HCPs) in the correct management of suspected malaria (CMSM) (vigilance) is a central component of malaria surveillance following elimination, and it must be established before malaria elimination certification can be granted. This study was designed to develop and validate a rapid tool, Simulated Malaria Online Tool (SMOT), to evaluate HCPs' practice in relation to the CMSM. METHODS The study was conducted in East Azerbaijan Province, Islamic Republic of Iran, where no malaria transmission has been reported since 2005. An online tool presenting a suspected malaria case for detection of HCPs' failures in recognition, diagnosis, treatment and reporting was developed based on literature review and expert opinion. A total of 360 HCPs were allocated to two groups. In one group their performance was tested by simulated patient (SP) methodology as gold standard, and one month later by the online tool to allow assessment of its sensitivity. In the other group, they were tested only by the online tool to allow assessment of any possible bias incurred by the exposure to SPs before the tool. RESULTS The sensitivity of the tool was (98.7%; CI 93.6-99.3). The overall agreement and kappa statistics were 96.6% and 85.6%, respectively. In the group tested by both methods, the failure proportion by SP was 86.1% (CI 80.1-90.8) and by tool 87.2% (CI 81.4-91.7). In the other group, the tool found 85.6% (CI 79.5-90.3) failures. There were no significant differences in detecting failures within or between the groups. CONCLUSION The SMOT tool not only showed high validity for detecting HCPs' failures in relation to CMSM, but it had high rates of agreement with the real-world situation, where malaria transmission has been interrupted. The tool can be used by program managers to evaluate HCPs' performance and identify sub-groups, whose malaria vigilance should be strengthened. It could also contribute to the evidence base for certification of malaria elimination, and to strengthening prevention of re-establishment of malaria transmission.
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Affiliation(s)
- Hosein Azizi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, Colchester, UK.,School of Public Health, Knowledge Utilization Research Center, and Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Raeisi
- National Programme Manager for Malaria Elimination, Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nazemipour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Allan Schapira
- Bicol University College of Medicine, Legazpi City, Philippines
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Ge Y, Takeda Y, Liang P, Xia S, Nealy M, Muranaka Y, Sun S, Okada T. Improving the communication skills of medical students --A survey of simulated patient-based learning in Chinese medical universities. BMC Med Educ 2022; 22:539. [PMID: 35831858 PMCID: PMC9281092 DOI: 10.1186/s12909-022-03596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND It is useful to advance simulated patient (SP) participation in teaching to improve the communication skills of medical students, so this study aims to explore the current state of Chinese mainland SP education. METHODS A cross sectional survey was designed utilizing well defined quantitative research methods and descriptive statistics. The questionnaire sought information which elucidated the current status of SP-based education, the origin of SP-based learning, SP training, challenges of this learning strategy and future developments. Questionnaires were distributed to 79 medical colleges in mainland China, and 68 were returned. Of these, 64 constituted valid responses (81%). RESULTS The number of SP-based education activities in medical colleges offering 5-year、7-year and 8-year clinical medicine programs was significantly higher than that in medical colleges which offered only a single 5-year program (p < 0.01). Communication skills training accounted for 73% of the content of SP-based learning activities, and was expected to rise in the future to 90%, in response to a need to improve doctor-patient relationships. Persons recruited as 'simulated patients' included students (21% of the total), residents (49%), medical staff (15%) and teaching staff (14%). Colleges, planning a SP-based education program, preferred teachers (80%) and students (55%) to assume 'simulated patient' roles. In objective structured clinical education (OSCE) scenarios, co-scoring by both SPs and teachers featured more highly in the 'consultation' station and 'doctor-patient communication' station. A number of factors were identified as hindering future development and implementation of SP-based learning including budget restraints, SP selection and training. CONCLUSIONS SP-based learning programs offer clear benefits for improving the clinical education of medical students and their communication skills. The main obstacles to achieving more widespread and higher quality SP-based education are insufficient funding and the lack of standardized training and performance evaluation processes for simulated patients. Medical colleges should consider reducing the proportion of students and teachers acting as SPs, and attract more citizens to participate in SP-based learning activities. Formalised training and evaluation of SPs performance are necessary to establish a 'standard simulated patient' for a particular medical discipline, thus improving SP-based activities and student learning.
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Affiliation(s)
- Yurong Ge
- Department of Teaching Affairs, The First Affiliated Hospital Northwest University for Nationalities, Yinchuan, China.
- People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.
| | - Yuko Takeda
- Department of Medical Education, Juntendo University, Tokyo, Japan
| | - Peifeng Liang
- Department of Medical Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Shilin Xia
- Clinical Laboratory of Integrative Medicine, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Yoko Muranaka
- Graduate School of Health Care and Nursing, Juntendo University, Chiba, Japan
| | - Shishu Sun
- Department of Medical Education, Juntendo University, Tokyo, Japan
| | - Takao Okada
- Department of Medical Education, Juntendo University, Tokyo, Japan
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Karout S, Khojah HMJ, Itani R, Jaffal F, El-Lakany A. Assessing the pharmaceutical care provision to suspected COVID-19 patients in community pharmacies: a simulated patient study. BMC Health Serv Res 2022; 22:467. [PMID: 35397543 PMCID: PMC8994087 DOI: 10.1186/s12913-022-07870-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the wake of COVID-19, community pharmacists (CP) were called upon to free up healthcare providers to treat more serious conditions and alleviate overcrowded healthcare centers. CPs were placed under tremendous pressure, where many patients primarily sought their health advice. This situation raised concerns about the preparedness of CPs in facing these challenges. Therefore, this study aimed to assess the appropriateness of pharmaceutical care provided by CPs to patients with suspected COVID-19 and to investigate their communication skills. METHODS A simulated patient (SP) study was conducted among randomly selected community pharmacies in Beirut, Lebanon. Each pharmacy was visited by the SP who complained of fever and loss of smell sensation. Interactions between the attending pharmacist and the suspected COVID-19 patient were documented directly after each visit in a standardized data collection form. RESULTS More than half of the CPs (56%) did not retrieve any relevant information to assess the patient's condition. While pharmacists' responses were limited to one to two recommendations, with the majority recommending the patient to perform the PCR test (90%). Inappropriate recommendations made by the CPs included mainly the confirmation that the patient had COVID-19 without prior testing (9%), and prescribing either an antimicrobial drug (5%) or dietary supplements (20%), claiming that the latter are essential to boost the patient's immunity. As for the pharmacist-patient communication skills, the mean total score was 2.25 ± 0.79 (out of 4), displaying nonoptimal and ineffective communication. CONCLUSION An unsatisfactory and suboptimal provision of pharmaceutical care to a suspected COVID-19 case was evident. This may be a public health threat, particularly for developing countries that lack an efficient and unified healthcare system. The findings should alert health authorities to support and guide community pharmacists in assisting suspected COVID-19 patients.
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Affiliation(s)
- Samar Karout
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, P.O.Box: 11-5020, Riad El Solh, Beirut, 1107 2809, Lebanon
| | - Hani M J Khojah
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University, P.O.Box: 30051, Madinah, 41477, Kingdom of Saudi Arabia
| | - Rania Itani
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, P.O.Box: 11-5020, Riad El Solh, Beirut, 1107 2809, Lebanon.
| | - Fatima Jaffal
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, P.O.Box: 11-5020, Riad El Solh, Beirut, 1107 2809, Lebanon
| | - Abdalla El-Lakany
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Beirut Arab University, P.O.Box: 11-5020, Riad El Solh, Beirut, 1107 2809, Lebanon
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Segun SJ, Damilola LS. Drug therapy-related problem management in Nigeria community pharmacy - process evaluation with simulated patient. BMC Health Serv Res 2022; 22:209. [PMID: 35172827 DOI: 10.1186/s12913-022-07535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unresolved drug therapy-related problems (DTRPs) have economic and clinical consequences and are common causes of patients' morbidity and mortality. This study evaluated the ability of community pharmacists to identify and resolve DTRPs and assessed the perceived barriers to DTRP identification and resolution. METHODS A cross-sectional study which employed the use of three simulated patients (SPs) visit to 36 selected community pharmacies in 11 local government areas in Ibadan, Nigeria. The SPs played the role of a patient with prescription for multiple ailments (23-year-old male), type 2 diabetes and hypertensive patient with medication packs (45-year-old male) and hypertensive patient with gastric ulcer with a prescription (37-year-old female). They re-enacted three rehearsed vignettes when they spoke with the pharmacists. A five-member panel of experts predetermined the DTRPs present in the vignettes (n = 11), actions to take to investigate the DTRPs (n = 9) and recommendations to resolve the DTRPs (n = 9). Pharmacists' perceived barriers to the identification and resolution of DTRPs were assessed with a self-administered questionnaire. The percentage ability to detect and resolve DTRPs was determined and classified as poor ability (≤30%), fair ability (> 30 - ≤50%), moderate ability (> 50 - ≤70%) and high ability (> 70%). RESULTS One hundred and eight visits were made by the three SPs to the pharmacies. In total, 4.42/11 (40.2%) DTRPs were identified, 3.50/9 (38.9%) actions were taken, and 3.94/9 (43.8%) recommendations were made to resolve the identified DTRPs. The percentage ability of the community pharmacists to detect and resolve DTRPs varied slightly from one vignette to another (vignette 1-49.3%, vignette 2-39.1%, vignette 3-38.8%). But overall, it was fair (40.9%). Pharmacists' perceived barriers to DTRP detection and resolution included lack of access to patient's/client's medical history and lack of software for DTRP detection. CONCLUSIONS The community pharmacists displayed fair ability in detecting and resolving DTRPs. Several barriers preventing the optimal performance of pharmacist in DTRP identification and resolution were identified including inaccessibility of patient's/client's medical history. The regulatory authority of pharmacy education and practice in Nigeria need to mount Continuing Education Program to address this deficit among community pharmacists.
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Counts S, Fairman KA. A "Virtual Pharmacy Shelf" to Enhance the Rigor and Efficiency of Standardized-Patient OSCEs for Over-the-Counter Medication Advice. Med Sci Educ 2022; 32:63-67. [PMID: 35186433 PMCID: PMC8814265 DOI: 10.1007/s40670-021-01494-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Realistic simulation in health professional education can be costly or cumbersome. ACTIVITY A low-cost, tablet-based simulated "virtual shelf" of over-the-counter (OTC) medications, hyperlinked to Drug Facts labels, eliminated use of physical product boxes or printed drug lists in objective structured clinical examinations (OSCE) for Doctor of Pharmacy students learning to provide OTC advice. RESULTS AND DISCUSSION The application reduced instructor preparation and OSCE administration time by allowing students to tap product options instead of thumbing through medication lists. The shelf is realistic, easily updated, and transferable to other OSCEs when visual recognition is important or treatment options change frequently.
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Affiliation(s)
- Stephanie Counts
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale, Glendale, AZ USA
| | - Kathleen A. Fairman
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale, Glendale, AZ USA
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Alzubaidi H, Austin Z, Saidawi W, Rees VW. Exploring the quality of smoking cessation in community pharmacies: A simulated patient study. Res Social Adm Pharm 2021:S1551-7411(21)00271-0. [PMID: 34284972 DOI: 10.1016/j.sapharm.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The prevalence of cigarette smoking continues to be a major public health problem In the United Arab Emirates (UAE); the government has recently implemented policies to reduce smoking prevalence. Innovative strategies to support cessation are needed. Community pharmacies are vital venues to extend the reach and effectiveness of smoking cessation support. OBJECTIVE To evaluate the quality of community pharmacist smoking cessation counseling in the UAE. METHODS A cross-sectional, simulated patient (SP) study was conducted among N = 111 urban community pharmacies selected at random in Sharjah city. Two scenarios were developed to cover different types of cessation needs of treatment-seeking smokers and where pharmacists could have a major role in assisting with smoking cessation pharmacotherapy. The quality of pharmacist counseling was defined in terms of comprehensiveness and communication skills. Two formal assessment tools were used; an analytical checklist to assess the comprehensiveness of pharmacists smoking cessation counseling, and a global assessment form to evaluate communication skills. A descriptive analysis of the data was undertaken. RESULTS A total of 101 pharmacists participated in the study. Pharmacist assessment of smoking cessation-specific information and provision of counseling were minimal. Pharmacists most frequently assessed nicotine dependence and provided generic guidance on the use of nicotine replacement products (NRTs) to manage withdrawal, but they largely did not obtain relevant histories (e.g., medical/medication histories, previous quit attempts, smoking triggers), explain individualized management strategies (e.g., setting quit date, changing environment, reassurance and encouragement), or provide advice about ongoing support. Pharmacists attained low scores in verbal and nonverbal communication and were frequently unempathetic and judgmental towards female SPs. CONCLUSIONS Pharmacist-led smoking cessation programs can expand primary care-based cessation opportunities in the UAE and address the demand for cessation services. Pharmacists will benefit from additional training on the provision of smoking cessation interventions, with an emphasis on patient-centered communication skills.
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Sandoval-Cuellar C, Alfonso-Mora ML, Castellanos-Garrido AL, Del Pilar Villarraga-Nieto A, Goyeneche-Ortegón RL, Acosta-Otalora ML, Del Pilar Castellanos-Vega R, Cobo-Mejía EA. Simulation in physiotherapy students for clinical decisions during interaction with people with low back pain: randomised controlled trial. BMC Med Educ 2021; 21:375. [PMID: 34243767 PMCID: PMC8268327 DOI: 10.1186/s12909-021-02812-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Low back pain (LBP) is a condition with a high global prevalence, which is getting health professionals' attention, including physiotherapists as they must have the skills to provide treatment that increases the patient's quality of life. Clinical simulations could be a pedagogic strategy that facilitates adequate training for students to acquire skills to improve their professional reasoning in this clinical situation. OBJECTIVE This study sought to determine the effects of clinical simulations with simulated patients (SP) on the physiotherapy students' clinical decision-making within a role-playing (RP) scenario while caring of LBP patients. METHODS This experimental study included 42 participants from two Colombian universities, randomized into two groups (SP, n = 21; RP, n = 21). The clinical skill of performing the Objective Structured Clinical Examination (OSCE-LBP) was evaluated while students cared for patients with LBP; after that, a pedagogical method was conducted that included clinical simulation and, finally, the OSCE-LBP was applied again to compare both groups. RESULTS Changes occurred in the OSCE-LBP among both groups of students: the scores increased (0.66 and 0.59 in RP and SP, respectively), and neither of the two was superior (p value 0.01; 95%CI - 0.21 to 0.23). CONCLUSION Both types of simulation favor decision-making in professional reasoning in physiotherapy students during interactions with individuals with LBP. Trial registration https://clinicaltrials.gov/ct2/show/NCT04428892 Identifying number: NCT04428892. It was retrospectively registered.
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Younes N, Delaunay AL, Roger M, Serra P, Hirot F, Urbain F, Godart N, Speranza M, Passerieux C, Roux P. Evaluating the effectiveness of a single-day simulation-based program in psychiatry for medical students: a controlled study. BMC Med Educ 2021; 21:348. [PMID: 34134692 PMCID: PMC8207590 DOI: 10.1186/s12909-021-02708-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/29/2021] [Indexed: 06/03/2023]
Abstract
BACKGROUND Training in psychiatry requires specific knowledge, attitudes, and skills that are obtainable by simulation, of which the use is only recent and still needs further development. Evidence is accumulating on its effectiveness but requires further validation for medical students. We aimed to evaluate the effectiveness of a single-day optional teaching program in psychiatry by simulation for medical students and validate a scale measuring Confidence in Psychiatric Clinical Skills (CPCQ), as part of the assessment. METHODS This was a controlled study in a French University that compared (using paired-sample Student t-tests) knowledge and attitudes (university grades and CPCQ scores) before, just after teaching with simulated patients, and 2 months later. Satisfaction with the program (including the quality of the debriefing) was also investigated. The CPCQ scale was validated by assessing the factor structure, internal consistency, and test-retest reliability. Finally, a comparison was run with a control group who received the usual psychiatric instruction using covariance analyses. RESULTS Twenty-four medical students were included in the simulation group and 76 in the control group. Just after the simulation, knowledge and attitudes increased significantly in the simulation group. Satisfaction with the training and debriefing was very high. The CPCQ scale showed good psychometric properties: a single-factor structure, acceptable internal consistency (α = 0.73 [0.65-0.85]), and good test-retest reliability (ICC = 0.71 [0.35-0.88]). Two months after the simulation, knowledge and attitudes were significantly higher in the simulation group than the control group, despite a lack of difference in knowledge before the simulation. CONCLUSIONS Adding a simulation program in psychiatry to the usual teaching improved the knowledge and confidence of medical students. The CPCQ scale could be used for the evaluation of educational programs.
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Affiliation(s)
- Nadia Younes
- Université Paris Saclay, Université Versailles Saint Quentin, CESP, Team DevPsy, 94807, Villejuif, France.
- Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, 177 Rue de Versailles, 78157, Le Chesnay, Cedex, France.
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France.
| | - Anne Laure Delaunay
- Université Paris Saclay, Université Versailles Saint Quentin, CESP, Team DevPsy, 94807, Villejuif, France
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France
- Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatre de l'Enfant et de l'Adolescent, F-78157, Le Chesnay, France
| | - M Roger
- Université Paris Saclay, Université Versailles Saint Quentin, CESP, Team DevPsy, 94807, Villejuif, France
- Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, 177 Rue de Versailles, 78157, Le Chesnay, Cedex, France
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France
| | - Pierre Serra
- Université Paris Saclay, Université Versailles Saint Quentin, CESP, Team DevPsy, 94807, Villejuif, France
- Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, 177 Rue de Versailles, 78157, Le Chesnay, Cedex, France
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France
| | - France Hirot
- Université Paris Saclay, Université Versailles Saint Quentin, CESP, Team DevPsy, 94807, Villejuif, France
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France
- Fondation Santé des Etudiants de France (FSEF), Paris, France
| | - Frédéric Urbain
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France
- Département de médecine générale, UFR des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Paris, France
| | - Nathalie Godart
- Université Paris Saclay, Université Versailles Saint Quentin, CESP, Team DevPsy, 94807, Villejuif, France
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France
- Fondation Santé des Etudiants de France (FSEF), Paris, France
| | - Mario Speranza
- Université Paris Saclay, Université Versailles Saint Quentin, CESP, Team DevPsy, 94807, Villejuif, France
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France
- Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatre de l'Enfant et de l'Adolescent, F-78157, Le Chesnay, France
| | - Christine Passerieux
- Université Paris Saclay, Université Versailles Saint Quentin, CESP, Team DevPsy, 94807, Villejuif, France
- Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, 177 Rue de Versailles, 78157, Le Chesnay, Cedex, France
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France
| | - Paul Roux
- Université Paris Saclay, Université Versailles Saint Quentin, CESP, Team DevPsy, 94807, Villejuif, France
- Centre Hospitalier Versailles, Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, 177 Rue de Versailles, 78157, Le Chesnay, Cedex, France
- Center for medical simulation of UVSQ, Université de Versailles Saint Quentin en Yvelines UFR des Sciences de la Santé Simone Veil, Montigny le Bretonneux, France
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Hasan S, Al Oum L, Hassan NA. A simulated patient study to evaluate community pharmacist assessment, management and advice giving to patients with asthma. J Pharm Policy Pract 2021; 14:8. [PMID: 33436091 PMCID: PMC7805111 DOI: 10.1186/s40545-020-00294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has shown that there is an increase in the global prevalence of asthma. Pharmacists are well positioned to screen and refer patients for better management of asthma. This study aimed to evaluate community pharmacists' ability to assess the 3 C's (Control, Compliance, Complications) and offer Management and Advice for patients with asthma in the UAE. METHODS Three fifth year pharmacy students role played a mystery shopper visiting community pharmacies and requesting symptom relief from uncontrolled asthma. Incidence of cough syrup and reliever inhaler supply, physician referral rate, correction of inhaler technique, and counseling on the medications, adherence to the medications and adverse drug reactions were calculated. RESULTS One hundred, ninety five pharmacies were visited, 27% of pharmacists asked about the need for cough syrup and 60% asked about the need for albuterol inhaler. Only 26% asked about other medications. Less than 20% assessed inhaler technique, only one pharmacist asked about regular use of preventer medications and if the patient was adhering to them and only 16% asked about side effects from medications. Most pharmacists (67%) supplied at least one of the medications, while 65% referred the patient to a physician. Only 21% gave information about correct inhaler technique, the majority (> 60%) being incomplete, only 16 pharmacists gave information about asthma and its triggers; the majority (63%) being incomplete. One third of the pharmacists counselled the patient on the medications with one giving complete information. CONCLUSIONS The study highlighted suboptimal assessment of control, compliance to preventer medications and complications of asthma and the medications that treat it. It also highlighted suboptimal Management and Advice giving and counseling on medication use by pharmacists. Training pharmacists in all aspects of asthma handling is clearly indicated. Despite the high rate of correct patient referral to a physician noted in this study, there is risk to it, as patients might not actually go to see their physician and continue to depend on symptom relief for the management of their asthma. This study highlighted the importance of improving patient education and information seeking attitude.
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Affiliation(s)
- Sanah Hasan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates.
| | - Lujain Al Oum
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Nageeb AbdulGalil Hassan
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Ajman, United Arab Emirates
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Cowperthwait A, Graber J, Carlsen A, Cowperthwait M, Mekulski H. Innovations in virtual education for clinical and simulation learning. J Prof Nurs 2021; 37:1011-7. [PMID: 34742504 DOI: 10.1016/j.profnurs.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Indexed: 12/24/2022]
Abstract
The global impact of COVID-19 forced nursing education to provide an alternative for scheduled clinical experiences during the Spring and Fall of 2020. Many programs selected the pre-packaged, web-based solutions at the onset of the pandemic due to the uncertainty and recommendation of social distancing. Clinical and simulation faculty began to look for educational alternatives to provide meaningful learning experiences that more closely replicated clinical learning because students expressed displeasure with the asynchronous web-based options. This article outlines how an innovative partnership between clinical faculty, simulation faculty, and the Theatre Department modified an in-person simulation activity designed for groups of two students into a web-based "clinical" experience that included the assigned clinical faculty, eight nursing students, and one simulated patient. This active learning strategy was able to meet the course objectives, required little additional resources, and most importantly, underwent positive evaluation by the weary, screen-based learners.
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Bagacean C, Cousin I, Ubertini AH, El Yacoubi El Idrissi M, Bordron A, Mercadie L, Garcia LC, Ianotto JC, De Vries P, Berthou C. Simulated patient and role play methodologies for communication skills and empathy training of undergraduate medical students. BMC Med Educ 2020; 20:491. [PMID: 33276777 PMCID: PMC7716460 DOI: 10.1186/s12909-020-02401-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/24/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Verbal and non-verbal communication, as well as empathy are central to patient-doctor interactions and have been associated with patients' satisfaction. Non-verbal communication tends to override verbal messages. The aim of this study was to analyze how medical students use verbal and non-verbal communication using two different educational approaches, student role play (SRP) and actor simulated patient (ASP), and whether the non-verbal behaviour is different in the two different poses. METHODS Three raters evaluated 20 students playing the doctor role, 10 in the SRP group and 10 in the ASP group. The videos were analyzed with the Calgary-Cambridge Referenced Observation Guide (CCG) and, for a more accurate evaluation of non-verbal communication, we also evaluated signs of nervousness, and posture. Empathy was rated with the CARE questionnaire. Independent Mann Whitney U tests and Qhi square tests were performed for statistical analysis. RESULTS From the 6 main tasks of the CCG score, we obtained higher scores in the ASP group for the task 'Gathering information' (p = 0.0008). Concerning the 17 descriptors of the CCG, the ASP group obtained significantly better scores for 'Exploration of the patients' problems to discover the biomedical perspective' (p = 0.007), 'Exploration of the patients' problems to discover background information and context' (p = 0.0004) and for 'Closing the session - Forward planning' (p = 0.02). With respect to non-verbal behaviour items, nervousness was significantly higher in the ASP group compared to the SRP group (p < 0.0001). Concerning empathy, no differences were found between the SRP and ASP groups. CONCLUSIONS Medical students displayed differentiated verbal and non-verbal communication behaviour during the two communication skills training methodologies. These results show that both methodologies have certain advantages and that more explicit non-verbal communication training might be necessary in order to raise students' awareness for this type of communication and increase doctor-patient interaction effectiveness.
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Affiliation(s)
- Cristina Bagacean
- Univ Brest, Inserm, UMR1227, Lymphocytes B et Autoimmunité, Brest, France
- Department of Clinical Hematology, CHU de Brest, Brest University Medical School Hospital, 2 Av Foch, 29609 Brest, France
| | - Ianis Cousin
- Department of Pediatric Surgery, CHU de Brest, Brest, France
| | | | - Mohamed El Yacoubi El Idrissi
- Department of Clinical Hematology, CHU de Brest, Brest University Medical School Hospital, 2 Av Foch, 29609 Brest, France
| | - Anne Bordron
- Univ Brest, Inserm, UMR1227, Lymphocytes B et Autoimmunité, Brest, France
| | - Lolita Mercadie
- Univ Brest, Department of Humanities and Social Sciences (SHS), Brest, France
| | | | - Jean-Christophe Ianotto
- Department of Clinical Hematology, CHU de Brest, Brest University Medical School Hospital, 2 Av Foch, 29609 Brest, France
| | | | - Christian Berthou
- Univ Brest, Inserm, UMR1227, Lymphocytes B et Autoimmunité, Brest, France
- Department of Clinical Hematology, CHU de Brest, Brest University Medical School Hospital, 2 Av Foch, 29609 Brest, France
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Pritchard SA, Keating JL, Nestel D, Blackstock FC. Physiotherapy students can be educated to portray realistic patient roles in simulation: a pragmatic observational study. BMC Med Educ 2020; 20:471. [PMID: 33243213 PMCID: PMC7689969 DOI: 10.1186/s12909-020-02382-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Simulation-based education (SBE) has many benefits for learners, but costs can limit embedding SBE in health professional curricula. Peer simulation involves students portraying patient roles, and may reduce costs while still providing the benefits of other SBE experiences. However, the quality of the SBE may be impacted if students cannot portray authentic and realistic patient roles. The aim of this study was to investigate whether targeted education was associated with observable changes to physiotherapy students' abilities to portray patient roles in SBE. METHODS Second year pre-registration physiotherapy students (n = 40) participated. Students completed online and face-to-face education about SBE, patient portrayal skills, and how to portray a specific patient role. Students were video-recorded portraying patient roles in practical exams before and after the program. Three blinded independent assessors rated the overall quality of portrayals using a purpose-developed assessment instrument. RESULTS Twenty-three sets of pre- and post-program videos were analysed. Correlations between assessor scores spanned 0.62 to 0.82 for analyses of interest, which justified using average assessor ratings in analysis. Statistically significant higher scores were seen for post-program assessments for overall portrayal scores (mean difference 6.5, 95%CI [1.51-11.45], p = 0.013), accuracy (mean difference 3.4, 95%CI [0.69-6.13], p = 0.016) and quality (mean difference 3.1, 95%CI [0.64-5.49], p = 0.016). CONCLUSIONS Physiotherapy students appear capable of playing realistic patient roles. Peer simulation can be embedded into health professional programs, and education in patient role portrayal appears to be associated with improvements in portrayal quality and realism. Given these findings, further investigation, including testing program effects in a randomised study, is warranted.
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Affiliation(s)
- Shane A. Pritchard
- Department of Physiotherapy, Monash University, Moorooduc Highway, Frankston, Victoria 3199 Australia
| | - Jennifer L. Keating
- Department of Physiotherapy, Monash University, Moorooduc Highway, Frankston, Victoria 3199 Australia
| | - Debra Nestel
- Monash Institute for Health and Clinical Education (MIHCE), Monash University, Clayton, Victoria Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria Australia
| | - Felicity C. Blackstock
- School of Science and Health, Western Sydney University, Campbelltown, New South Wales Australia
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Gamble A, Nestel D, Bearman M. Power and adolescent simulated patients: A qualitative exploration. Nurse Educ Pract 2020; 48:102871. [PMID: 32920370 DOI: 10.1016/j.nepr.2020.102871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/15/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022]
Abstract
Adolescent simulated patients (SPs) work in an environment where complex and dynamic power relationships are at play. These relationships differ to those encountered in clinical practice. Instead of health professionals exerting their power from a foundation resting on knowledge, to a patient consumed with worry, SPs in simulation scenarios often have less worry and more knowledge than the learner. Combined with this, their role in judging and assessing learner performance adds to their power base. Adolescent SPs also experience power from the opposite perspective; where they have power exerted upon them, with limited ability to resist. This research aims to explore power relationships from adolescent SP's perspectives. Ten adolescent SPs, (10-19 years), participated in semi-structured interviews that were analysed using an interpretive phenomenological approach. Four themes resulted from an in-depth analysis of interview transcripts: 1) Becoming and being a powerful simulated patient; 2) redirection, resistance & responsibility; 3) the power of the role; and 4) a complex maze of interactions. These themes reflect the experiences adolescent SPs are exposed to and the powerful interactions that can result. Whilst there are positive outcomes for adolescent SPs, there is also a risk of harm. Recognizing this is an ethical imperative to ensure adolescent safety during the simulation process.
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Libert Y, Peternelj L, Canivet D, Farvacques C, Liénard A, Ménard C, Merckaert I, Reynaert C, Slachmuylder JL, Razavi D. How does physicians' decisional conflict influence their ability to address treatment outcomes in a decision-making encounter with an advanced-stage cancer simulated patient? A descriptive study. Patient Educ Couns 2020; 103:1752-1759. [PMID: 32234266 DOI: 10.1016/j.pec.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This descriptive study assesses how physicians' decisional conflict influences their ability to address treatment outcomes (TOs) in a decision-making encounter with an advanced-stage cancer simulated patient (SP). METHODS Physicians (N = 138) performed a decision-making encounter with the SP trained to ask for TOs information. The physicians' decisional conflict regarding patients' cancer treatments in general was assessed with the General Decisional Conflict Scale (Gen-DCS). The physicians' decisional conflict regarding the SP's cancer treatments was assessed with the Specific Decisional Conflict Scale (Spe-DCS). Physicians' ability to address TOs during the encounter was assessed with an interaction analysis system: the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP). Weekly time spent with cancer patients was assessed with a questionnaire. RESULTS Physicians' Spe-DCS (β = -.21 ; p = .014) and weekly time spent with cancer patients (β = .22 ; p = .008) predicted the number of TOs addressed during the encounter. Spe-DCS scores predicted nearly all MD.POP dimensions (r = -.18 ; p = .040 to r = -.30 to p < .001) whereas Gen-DCS scores predicted nearly none MD.POP dimensions. CONCLUSION Physicians' specific decisional conflict interferes with their ability to address TOs in a decision-making encounter with an advanced-stage cancer SP. PRACTICE IMPLICATIONS Physicians should be trained to address TOs according to patient preferences, despite their own decisional conflict.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Livia Peternelj
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Delphine Canivet
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Hôpital Universitaire Erasme, Service de Psychologie, Brussels, Belgium.
| | | | - Aurore Liénard
- Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Catherine Ménard
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.
| | - Isabelle Merckaert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Christine Reynaert
- Université Catholique de Louvain, Faculté de Médecine, Brussels, Belgium.
| | | | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
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Lam M, Jakeman N. Are you on the right trach? A hybrid simulation package for tracheostomy emergency management. Br J Oral Maxillofac Surg 2021; 59:e27-8. [PMID: 33436153 DOI: 10.1016/j.bjoms.2020.08.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/12/2020] [Indexed: 11/20/2022]
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Abstract
Surgical training is long and complex. At the core of clinical practice is communication. Voice is central to relationships of care. Communication and other person-centred competencies are well articulated in surgical training programs. Simulated participant (SP) methodology has seen significant development over its contemporary history. Most commonly in paediatrics SPs portray the roles of parents. However, children and adolescents as SPs are increasingly employed to support the development and assessment of the complex concept of voice. There are specific considerations in all phases of SP-based work, and these are heightened for children and adolescents. This article explores contemporary SP practices in health professional education with a focus on paediatric surgery training.
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Affiliation(s)
- D Nestel
- Monash Institute for Health & Clinical Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Bldg. 13D, Room DG11, 35 Rainforest Walk, Clayton, VIC 3168, Australia; Department of Surgery (Austin), University of Melbourne, Heidleberg, Australia.
| | - D Ljuhar
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgical Simulation, Monash Children's Hospital, Melbourne, Australia
| | - A Gamble
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
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Coleman D, McLaughlin D. Using simulated patients as a learning strategy to support undergraduate nurses to develop patient-teaching skills. ACTA ACUST UNITED AC 2020; 28:1300-1306. [PMID: 31714829 DOI: 10.12968/bjon.2019.28.20.1300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND An increase in the number of patients with long-term conditions has required a greater focus on nurse-led educational interventions to enable patients to develop self-management strategies. However, patient education is frequently taken for granted, and nurses sometimes consider that their undergraduate training does not prepare them to participate in effective patient teaching. AIM The study aimed to formatively evaluate a simulated role-play scenario facilitated with third-year nursing students to support the development of patient-teaching skills. METHOD The study combined two approaches to simulation, using high-fidelity and mid-fidelity simulation scenarios sequentially. This enabled students (n=20) to apply the communication strategies learnt to both a skills-based procedural situation and a patient-teaching simulation. A five-item pro forma with four open questions and one closed question was used for formative evaluation. FINDINGS The results indicated that using a simulated patient to practise patient-teaching skills was perceived by the students to be a valuable method of learning that they could transfer to clinical practice. CONCLUSION The findings suggested that facilitating learning with a simulated patient is useful in replicating authentic verbal and practical interactions with a patient in practice.
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Affiliation(s)
| | - Dorry McLaughlin
- Lecturer in Palliative Care and Chronic Illness, Queen's University, Belfast
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Reeves NE, Waite MC, Tuttle N, Bialocerkowski A. Simulated patient contributions to enhancing exercise physiology student clinical assessment skills. Adv Simul (Lond) 2019; 4:15. [PMID: 31890315 PMCID: PMC6923845 DOI: 10.1186/s41077-019-0097-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 01/22/2023] Open
Abstract
Background The aim of this study was to evaluate exercise physiology students' perceptions of two simulation-based learning modules focused on communication and interpersonal skills during history taking. Methods A prospective, repeated-measures cohort study was conducted with 15 participants. The study evaluated two simulation-based learning modules in a 1-year Graduate Diploma of Exercise Science program. Surveys were administered at four time points: prior to each module and following each module. Students rated their confidence in communication and history taking, and perception of preparedness for practice, motivation for learning, and benefits of undertaking simulation-based learning. Quantitative data were analyzed descriptively and by using repeated measures tests. Qualitative data underwent thematic analyses. Results Students reported a significant improvement in their confidence in communication (P = 0.043) and in two parameters related to history taking (P = 0.034 and 0.035) following the completion of the two modules. There was 96% agreement that the simulation-based learning better prepared students for practice as an exercise physiologist. Significant changes occurred in all aspects of motivation for learning (P ranging from < 0.001 to 0.036) except for usefulness, where there was a ceiling effect (medians of 7 on a 7-point scale). Qualitative analysis demonstrated benefit to participants around themes of experiential learning, realism, opportunity to develop clinical skills, and debriefing. Students also made suggestions with respect to the activity structure of the simulation-based learning modules. Conclusions The results of this study indicated that simulation-based learning employing SPs increased the confidence and preparedness of exercise physiology students for conducting history taking, a requisite exercise physiology skill. Future studies should include behavioral measures of skill attainment and include follow-up evaluation to appraise the application of these skills into clinical practice.
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Affiliation(s)
- Nathan E Reeves
- 1School of Allied Health Sciences, Gold Coast Campus, Griffith University, Southport, QLD 4222 Australia
| | - Monique C Waite
- 2School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4222 Australia
| | - Neil Tuttle
- 3Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Southport, QLD 4222 Australia
| | - Andrea Bialocerkowski
- 1School of Allied Health Sciences, Gold Coast Campus, Griffith University, Southport, QLD 4222 Australia
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O’Shea MC, Reeves NE, Bialocerkowski A, Cardell E. Using simulation-based learning to provide interprofessional education in diabetes to nutrition and dietetics and exercise physiology students through telehealth. Adv Simul (Lond) 2019; 4:28. [PMID: 31890319 PMCID: PMC6923831 DOI: 10.1186/s41077-019-0116-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/10/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Current workforce demands require new graduates to competently work within health care teams and often in remote settings. To better prepare students for this work, universities have spent much time developing interprofessional education (IPE) activities. The body of literature supporting IPE of allied health students is growing. Simulation-based learning with simulated patients is one platform through which IPE can be implemented in a dedicated, supported environment and potentially at scale. This study describes an interprofessional simulation-based learning experience with nutrition and dietetics and exercise physiology students. The common practice area of interacting with patients who have type 2 diabetes was targeted, and the simulation was delivered in partnership with simulated patients via a telehealth platform to allow interprofessional teams to work collaboratively in remote locations. METHODS Ten nutrition and dietetics and 13 exercise physiology students participated in a simulation module in which students observed and collaborated in the development and delivery of an interprofessional treatment plan for patients with diabetes. Learning outcomes were measured according to the first two levels of Kirkpatrick's (1994) model for training evaluation (i.e. reaction and learning), as well as the perceived impact on behaviour. RESULTS The students' confidence in communication, assessment, management and ability to work with another health professional significantly increased (p < 0.05) post-activity. Students perceived that the simulation-based learning would have a positive impact on their clinical skills and ability to work with other health professionals. Students reported that the most effective aspects of the simulation module were learning from and about each other, the opportunity for experiential learning and the supportive learning environment. However, the telehealth platform audio clarity and delay had negative impact on the learning experiences for students. CONCLUSION The overall positive results demonstrate the potential of simulation-based learning activities for preparing allied health students for working in interprofessional teams. Although remote access was possible, the telehealth platform was identified as a limiting factor to this simulation-based learning experience. However, videoconferencing technology has advanced considerably since this study. Hence, there is an opportunity to employ more reliable technology for future simulations.
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Affiliation(s)
- Marie-Claire O’Shea
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD 4222 Australia
| | - Nathan E. Reeves
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD 4222 Australia
| | - Andrea Bialocerkowski
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD 4222 Australia
| | - Elizabeth Cardell
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD 4222 Australia
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Schelgel C, Smith CM. "Please let me know when I do not realize it myself": a qualitative analysis of senior simulated patients' experiences. Adv Simul (Lond) 2019; 4:18. [PMID: 31384486 PMCID: PMC6664734 DOI: 10.1186/s41077-019-0109-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Simulated patients (SPs), defined as being over 65 years old, are valuable partners in the training of health professionals related to the care of our aging population. Many senior SPs have been long-time members of SP programs. As SPs age, shifts in their abilities may be observed that, in turn, can affect the overall quality and effectiveness of their participation. It can be challenging and distressing for both the SP educator and the SP to acknowledge these changes and to respond in a compassionate, respectful, and ethical manner that ensures the safe and effective delivery of a simulation for all stakeholders. SP educators are looking for guidance. The aim of this study was to ask SPs from two countries (Switzerland and Canada) to identify the benefits and challenges of working as SPs as they age and to offer strategies to SP educators to accommodate and facilitate their participation. METHOD A qualitative thematic analysis research design was implemented to address the study aims. A semi-structured approach with a topic guide was used to individually interview 16 SPs (9 in Switzerland; 7 in Canada). Researchers iteratively compared their results until consensus was reached in terms of identifying the themes and subthemes. RESULTS Three main themes, with corresponding subthemes, were identified: giving and receiving value as senior SPs, recognizing challenges when working as a senior SP, and fostering meaningful involvement for senior SPs. Meaningful involvement focused on creating a sense of security, adapting to changing abilities, acknowledging contributions, and providing opportunities to stay connected to the program. CONCLUSION This study illustrates the importance of SP educators working with SPs to co-create a safe and effective work environment. Studies like this can serve as a model to provide practical strategies. Through this study, we have learned from senior SPs how we can best support them in their important work.
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Affiliation(s)
- Claudia Schelgel
- Berne College of Higher Education of Nursing, Freiburgstrasse 133, 3008 Berne, Switzerland
| | - Cathy M. Smith
- Division of Training & Simulation, Centre for Education, Baycrest, 3560 Bathurst Street, Toronto, Canada
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Cobb BT, Bowen JF, Pontiggia L, Koffer KF, Scholtz JM. Evaluation of an individualized vs non-specific standardized patient activity in improving communication skills amongst pharmacy students. Curr Pharm Teach Learn 2019; 11:603-608. [PMID: 31213316 DOI: 10.1016/j.cptl.2019.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/07/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate the impact of two standardized patient (SP) approaches on student communication skills and self-perceived confidence. EDUCATIONAL ACTIVITY AND SETTING Second professional year pharmacy students were assessed on overall and area of improvement (AOI) communication skills and self-perceived confidence. Students were invited to participate in a SP intervention activity, following a fall and before a spring class assessment, where they were randomized to an individualized or non-specific SP group. Communication skills were assessed using a four component 64-point rubric; confidence was assessed using an 11-question Likert-type survey. FINDINGS Nineteen students participated in the SP intervention activity; 11 students comprised the individualized group and eight students comprised the non-specific group. Students in the individualized group demonstrated a significantly higher median change in AOI communication scores compared to the non-specific group [five points vs. three points, respectively (p = 0.033)]. There was a significantly higher median change in overall communication skills in the individualized compared to the non-specific group of 12 points and 6.5 points, respectively (p = 0.017). Student self-perceived confidence in the individualized and non-specific group showed similar improvements overall from pre- to post assessment [seven points vs. eight points, respectively (p = 0.62)]. SUMMARY The use of SPs in pharmacy curricula can improve student communication skills. However, tailoring the activity to students' needs significantly improves their communication AOI and overall communication skill scores more than a non-specific activity. Student self-perceived confidence improved similarly in both groups, although no statistically significant differences were found between groups.
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Affiliation(s)
- Brooklyn T Cobb
- Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd Street, Philadelphia, PA 19104, United States.
| | - Jane F Bowen
- Philadelphia College of Pharmacy, 600 S. 43rd Street, Philadelphia, PA 19104, United States.
| | - Laura Pontiggia
- Misher College, University of the Sciences, 600 South 43rd St., Philadelphia, PA 19104, United States.
| | - Katherine F Koffer
- Philadelphia College of Pharmacy, 600 S. 43rd Street, Philadelphia, PA 19104, United States.
| | - Jean M Scholtz
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, 600 S. 43rd St., Philadelphia, PA 19104, United States.
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Kelly T, Surjan Y, Rinks M, Beech J, Warren-Forward HM. Communication: Preparing undergraduate radiation therapy students for initial clinical patient interactions. Radiography (Lond) 2019; 25:320-326. [PMID: 31582239 DOI: 10.1016/j.radi.2019.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/28/2019] [Accepted: 02/21/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Radiation therapy students need to demonstrate appropriate communication skills when entering the clinical environment. To assist students with preparation for their first clinical placement a clinical reasoning module comprising theory and practical sessions was developed. This paper describes the module and presents the results of student evaluations. METHODS The module consisted of lectures, observational role-play and participatory role-play. Students were ultimately tasked with providing information to a simulated patient (SP). Each student received feedback independently from the SP, peers and facilitator. At the conclusion of the module, students had the opportunity to provide feedback via an anonymous survey (8 Likert scale questions with space for written comment). Data was analysed both quantitatively and qualitatively. RESULTS Four hundred and thirty seven students were enrolled in the course between 2008 and 2016 and the response rate of the survey was 93%. Even though most students reported some level of anxiety before and during the role-play sessions, the majority of students perceived all aspects of the module to be extremely/very useful. The most useful aspect of the module (Likert scale assessment) was the feedback provided by the SP. The two most important themes arising from the thematic analysis were gaining an understanding of the role of the radiation therapist and the complexities of patient interactions. CONCLUSION Overall, the module was deemed successful with students becoming conscious of newly acquired clinical knowledge whilst acknowledging patient feelings during interactions. Collaborative critiquing contributed to students' ability to self-reflect to improve clinical interactions.
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Affiliation(s)
- T Kelly
- Illawarra Shoalhaven Local Health District, NSW Health, Australia; School of Health Sciences, University of Newcastle, Australia.
| | - Y Surjan
- School of Health Sciences, University of Newcastle, Australia
| | - M Rinks
- Illawarra Shoalhaven Local Health District, NSW Health, Australia
| | - J Beech
- South West Sydney Local Health District, NSW Health, Australia
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Pilnick A, Trusson D, Beeke S, O’Brien R, Goldberg S, Harwood RH. Using conversation analysis to inform role play and simulated interaction in communications skills training for healthcare professionals: identifying avenues for further development through a scoping review. BMC Med Educ 2018; 18:267. [PMID: 30453956 PMCID: PMC6245918 DOI: 10.1186/s12909-018-1381-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/05/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND This paper responds to previously published debate in this journal around the use of sociolinguistic methods in communication skills training (CST), which has raised the significant question of how far consultations with simulated patients reflect real clinical encounters. This debate concluded with a suggestion that sociolinguistic methods offer an alternative analytic lens for evaluating CST. We demonstrate here that the utility of sociolinguistic methods in CST is not limited to critique, but also presents an important tool for development and delivery. METHODS Following a scoping review of the use of role play and simulated interaction in CST for healthcare professionals, we consider the use of the specific sociolinguistic approach of conversation analysis (CA), which has been applied to the study of health communication in a wide range of settings, as well as to the development of training. DISCUSSION Role play and simulated interaction have been criticised by both clinicians and sociolinguists for a lack of authenticity as compared to real life interactions. However they contain a number of aspects which healthcare professionals report finding particularly useful: the need to think on one's feet in real time, as in actual interaction with patients; the ability to receive feedback on the simulation; and the ability to watch and reflect on how others approach the same simulation task in real time. Since sociolinguistic approaches can help to identify inauthenticity in role play and simulation, they can also be used to improve authenticity. Analysis of real-life interactions using sociolinguistic methods, and CA in particular, can identify actual interactional practices that are used by particular patient groups. These practices can then be used to inform the training of actors simulating patients. In addition, the emphasis of CA on talk as joint activity means that proper account can be taken of the way in which simulated interaction is co-constructed between simulator and trainee. We suggest that as well as identifying potential weaknesses in current role play and simulation practice, conversation analysis offers the potential to enhance and develop the authenticity of these training methods.
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Affiliation(s)
- Alison Pilnick
- School of Sociology and Social Policy, University of Nottingham, Nottingham, NG7 2RD UK
| | - Diane Trusson
- Institute for Mental Health, University of Nottingham, Nottingham, UK
| | - Suzanne Beeke
- Language and Cognition Research Department, University College London, London, UK
| | - Rebecca O’Brien
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Erku DA, Aberra SY. Non-prescribed sale of antibiotics for acute childhood diarrhea and upper respiratory tract infection in community pharmacies: a 2 phase mixed-methods study. Antimicrob Resist Infect Control 2018; 7:92. [PMID: 30079248 PMCID: PMC6069571 DOI: 10.1186/s13756-018-0389-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/25/2018] [Indexed: 11/23/2022] Open
Abstract
Background Although prohibited by law and legal regulatory frameworks, non-prescribed sale of antibiotics in community medicine retail outlets (CMROs) remains a serious problem in Ethiopia. The aim of this study was to document the extent of and motivations behind non-prescribed sale of antibiotics among CMROs in Gondar town, Ethiopia. Methods A 2 phase mixed-methods study (a simulated patient visit followed by an in-depth interview) was conducted among CMROs in Gondar town, Ethiopia. Two clinical case scenarios (acute childhood diarrhea and upper respiratory tract infection) were presented and the practice of non-prescribed sale were measured and results were reported as percentages. Pharmacy staff (pharmacists and pharmacy assistants) were interviewed to examine factors/motivations behind dispensing antibiotics without a valid prescription. Results Out of 100 simulated visits (50 each scenarios) presented to drug retail outlets, 86 cases (86%) were provided with one or more medications. Of these, 18 (20.9%) asked about past medical and medication history and only 7 (8.1%) enquired about the patient’s history of drug allergy. The most frequently dispensed medication for acute childhood diarrhoea simulation were oral rehydration fluid (ORS) with zinc (n = 16) and Metronidazole (n = 15). Among the dispensed antibiotics for upper respiratory infection simulation, the most common was Amoxicillin (n = 23) followed by Amoxicillin-clavulanic acid capsule (n = 19) and Azithromycin (n = 15). Perceived financial benefit, high expectation and/or demand of customers and competition among pharmacies were cited as the main drivers behind selling antibiotics without a prescription. Conclusions A stringent law and policy enforcement regarding the sale of antibiotics without a valid prescription should be in place. This will ultimately help to shift the current pharmacy practices from commercial and business-based interests/practices to the provision of primary healthcare services to the community. Electronic supplementary material The online version of this article (10.1186/s13756-018-0389-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Asfaw Erku
- 1School of Pharmacy, University of Gondar, Lideta kebele 16, P.O.Box: 196, Gondar, Ethiopia
| | - Sisay Yifru Aberra
- 2College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kearney GP, Gormley GJ, Wilson D, Johnston JL. Blurred boundaries: sexuality and power in standardised patients' negotiations of the physical examination. Adv Simul (Lond) 2018; 3:11. [PMID: 29983995 PMCID: PMC6019710 DOI: 10.1186/s41077-018-0069-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
Background Working with standardised or simulated patients (SPs) is now commonplace in Simulated Learning Environments. Embracing the fact that they are not a homogenous group, some literature suggests expansion of learning with SPs in health professional education by foregrounding their personal experiences. Intimate examination teaching, whether with or without the help of SPs, is protected by a particular degree of ceremony given the degree of potential vulnerability. However, other examinations may be equally intrusive for example the close proximity of an eye examination or a chest examination in a female patient. In this study, we looked at SPs' experiences of boundary crossing in any examinations, sensitised by Foucault's concept of the clinical gaze. We wished to problematise power relations that construct and subject SPs as clinical tools within simulation-based education. Methods We collected data from 22 SPs, through five focus groups. Analysis was an iterative process, using thematic analysis. Data collection and reflexive analysis continued iteratively until concepts were fully developed and all theoretical directions explored. Results Students and SPs construct simulated teaching consultations by negotiating the unequal distribution of power between them. The SPs themselves discussed how they, perhaps unknowingly, acted in accordance with the discourse of the clinical gaze. However, SPs became disempowered when students deviated from the negotiated terms of consent and they used their agency to resist this. The SPs used strong sexual metaphors to express the subjugation they experienced, as discourses of sexuality and gender played out in the Simulated Learning Environment. Conclusion We demonstrate that power dynamics and the clinical gaze can have important consequences within the Simulated Learning Environment. Every physical examination can be potentially 'intimate' and can therefore be underpinned by discourses of sexuality and gendered undertones. In partnership with SPs, simulation-based education should create a teaching space that no longer fosters the discourse of the clinical gaze but facilitates students to learn to reflectively navigate, in the moment, the fine line between touching patients versus touching loved ones, and the blurred boundaries that exist in the gulf between sexual contact and benevolent touch.
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Affiliation(s)
- Grainne P Kearney
- 1Centre for Medical Education, Queen's University, Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Gerard J Gormley
- 2Clinical Skills Education Centre, Queen's University, Belfast, 2nd Floor Medical Biology Centre, Lisburn Road, Belfast, BT9 7BL UK
| | - Diane Wilson
- 2Clinical Skills Education Centre, Queen's University, Belfast, 2nd Floor Medical Biology Centre, Lisburn Road, Belfast, BT9 7BL UK
| | - Jennifer L Johnston
- 1Centre for Medical Education, Queen's University, Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL UK
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Zolezzi M, Abdallah O, Kheir N, Abdelsalam AG. Evaluation of community pharmacists' preparedness for the provision of cardiovascular disease risk assessment and management services: A study with simulated patients. Res Social Adm Pharm 2018; 15:252-259. [PMID: 29753643 DOI: 10.1016/j.sapharm.2018.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/22/2018] [Accepted: 04/26/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Individuals who suffer from major cardiovascular events every year have one or more risk factors. Cardiovascular disease (CVD) risk assessment is an important strategy for the early identification of modifiable risk factors and their management. There is substantial evidence that shifting the focus from treatment to primary prevention reduces the burden of CVD. OBJECTIVES To evaluate the preparedness of community pharmacists in Qatar for the provision of CVD risk assessment and management services; and to explore the pharmacists' views on the provision of these services. METHODS A cross-sectional study using simulated-client methodology. Using standardized scenarios, community pharmacists were approached for consultation on two medicines (Aspirin® and Crestor®) used for managing specific CVD risk factors. Pharmacists' competency to assess CVD risk was the primary outcome evaluated. Scores for each outcome were obtained based on the number of predefined statements addressed during the consultation. RESULTS The mean cumulative score for all the competency outcomes assessed was 11.7 (SD 3.7) out of a possible score of 31. There were no differences for the majority of the competencies tested between the two scenarios used. Significantly more pharmacists exposed to the Aspirin® scenario than to the Crestor® scenario addressed hypertension as one of the risk factors needed to assess CVD risk (22% versus 11%, p = 0.03); whereas significantly more pharmacists in the Crestor® scenario compared to the Aspirin® scenario, addressed dyslipidemia as one of the risk factors needed to assess CVD risk (30% versus 7%, p = 0.02). Significantly more pharmacists exposed to the Aspirin® scenario provided explanation about CVD risk than those exposed to the Crestor® scenario 36% versus 8%, p < 0.01). CONCLUSION The results suggest that many community pharmacists in Qatar are not displaying competencies that are necessary for the provision of CVD prevention services.
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Affiliation(s)
| | | | - Nadir Kheir
- College of Pharmacy Qatar University, Doha, Qatar.
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Himmelbauer M, Seitz T, Seidman C, Löffler-Stastka H. Standardized patients in psychiatry - the best way to learn clinical skills? BMC Med Educ 2018; 18:72. [PMID: 29625572 PMCID: PMC5889557 DOI: 10.1186/s12909-018-1184-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standardized patients (SP) have been successfully utilized in medical education to train students' communication skills. At the Medical University of Vienna communication training with SPs in psychiatry is a mandatory part of the curriculum. In the training, the SP plays the role of four different patients suffering from depression/suicidal tendencies, somatoform disorder, anxiety disorder, or borderline disorder while the student attempts to gather the patient's medical history. Both the instructor and SP then give the student constructive feedback afterwards. METHOD The aim of the study was to evaluate the quality of the SP's roleplay and feedback, using a self-created questionnaire. Additionally, we wanted to gauge the differences between the students' and teachers' evaluations of the SP's role playing performance and feedback. RESULTS The questionnaire was completed by 529 students and 29 teachers who attended the training. Overall, both students and teachers evaluated the SPs' performance and feedback very well. In comparison to the responses given by the teachers, more students reported that the "SP overacted" while fewer students believed that the "SP could be a real patient". The feedback given by the SP was evaluated similarly by students and teachers, suggesting that students are able to recognize the quality of constructive feedback. Furthermore, the SP's quality of roleplaying was evaluated as the poorest while playing the psychiatric disorder "depression/suicidal tendencies." CONCLUSIONS Our study showed that students and teachers appreciate SPs' competence of role play and of giving feedback. However, further studies should be performed to figure out why both students and teachers alike evaluated the played psychiatric disorder "depression/suicidal tendencies" to be the worst.
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Affiliation(s)
- Monika Himmelbauer
- 0000 0000 9259 8492grid.22937.3dTeaching Center, Medical University of Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, SMZ Süd, Kundratstraße 10, 1100 Wien, Austria
| | - Charles Seidman
- 0000000419368729grid.21729.3fColumbia University, New York, USA
| | - Henriette Löffler-Stastka
- 0000 0000 9259 8492grid.22937.3dDepartment of Psychoanalysis and Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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MacLean S, Geddes F, Kelly M, Della P. Simulated patient training: Using inter-rater reliability to evaluate simulated patient consistency in nursing education. Nurse Educ Today 2018; 62:85-90. [PMID: 29306751 DOI: 10.1016/j.nedt.2017.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 11/20/2017] [Accepted: 12/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Simulated patients (SPs) are frequently used for training nursing students in communication skills. An acknowledged benefit of using SPs is the opportunity to provide a standardized approach by which participants can demonstrate and develop communication skills. However, relatively little evidence is available on how to best facilitate and evaluate the reliability and accuracy of SPs' performances. AIM The aim of this study is to investigate the effectiveness of an evidenced based SP training framework to ensure standardization of SPs. The training framework was employed to improve inter-rater reliability of SPs. METHODS A quasi-experimental study was employed to assess SP post-training understanding of simulation scenario parameters using inter-rater reliability agreement indices. Two phases of data collection took place. Initially a trial phase including audio-visual (AV) recordings of two undergraduate nursing students completing a simulation scenario is rated by eight SPs using the Interpersonal Communication Assessments Scale (ICAS) and Quality of Discharge Teaching Scale (QDTS). In phase 2, eight SP raters and four nursing faculty raters independently evaluated students' (N=42) communication practices using the QDTS. RESULTS Intraclass correlation coefficients (ICC) were >0.80 for both stages of the study in clinical communication skills. CONCLUSION The results support the premise that if trained appropriately, SPs have a high degree of reliability and validity to both facilitate and evaluate student performance in nurse education.
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Affiliation(s)
- Sharon MacLean
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Fiona Geddes
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Michelle Kelly
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Phillip Della
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
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Alvarez S, Schultz JH. Medical educators' perception of communication training with simulated patients: an explorative study approach. BMC Res Notes 2017; 10:650. [PMID: 29187258 PMCID: PMC5707823 DOI: 10.1186/s13104-017-2988-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/25/2017] [Indexed: 11/10/2022] Open
Abstract
Objective Medical students’ perceptions of the use of simulated patients (SP) in communication training in medicine have been studied intensively, but insights about faculty perception of this type of simulation training remain rare. This study aimed to assess medical educators’ perception of the relevancy of SP communication training, as well as its closeness to reality. Medical educators were surveyed by standardized questionnaire and open-ended questions. The questionnaire allowed educators to rate several aspects of the training such as its closeness to reality and relevancy to real-life physician–patient interaction. Results Educators’ perception of relevance and realism of SP training increases with teaching experience. This appears to be influenced by factors such as internal or external status of the educator, personal experience with communication training during medical studies, as well as medical field taught. Communication training with SP is valued highly by medical educators mainly because of its versatility and broad spectrum of applicability. The wide range of application of SP in medical education seems most evident to senior educators because of their increased amount of experience with physician–patient interaction, whereas junior educators appear often hindered by the aspect of simulation caused by the thought that the patients are “merely” actors.
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Affiliation(s)
- Simone Alvarez
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Libert Y, Canivet D, Ménard C, Van Achte L, Farvacques C, Merckaert I, Liénard A, Klastersky J, Reynaert C, Slachmuylder JL, Durieux JF, Delvaux N, Razavi D. Predictors of physicians' communication performance in a decision-making encounter with a simulated advanced-stage cancer patient: A longitudinal study. Patient Educ Couns 2017; 100:1672-1679. [PMID: 28404208 DOI: 10.1016/j.pec.2017.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/17/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Physicians' characteristics that influence their communication performance (CP) in decision-making encounters have been rarely studied. In this longitudinal study, predictors of physicians' CP were investigated with a simulated advanced-stage cancer patient. METHODS Physicians (n=85) performed a decision-making encounter with a simulated patient (SP). Their CP was calculated by analyzing encounter transcripts with validated interaction analysis systems. Potential specific psychological predictors were physicians' empathy towards the SP (Jefferson Scale of Physician Empathy, JSPE) and their decisional conflict about the treatment (Decisional Conflict Scale, DCS). Potential general psychological predictors were physicians' empathy towards cancer patients (JSPE), their decisional conflict about cancer patients' treatments (DCS), and their affective reactions to uncertainty (Physicians' Reactions to Uncertainty, PRU). RESULTS Physicians' CP was predicted by their decisional conflict about the SP's treatment (DCS) (β=0.41; p< 0.001) and their affective reactions to uncertainty regarding cancer treatments (PRU) (β=-0.31; p=0.003). CONCLUSION During encounters with advanced-stage cancer patients, physicians' awareness of uncertainty about which treatments to consider may facilitate their communication performance, whereas physicians' affective reactions to uncertainty may inhibit their performance. PRACTICE IMPLICATIONS Physicians' decisional conflict and reactions to uncertainty should be addressed in communication skills training programs.
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Affiliation(s)
- Yves Libert
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium.
| | - Delphine Canivet
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Service de psychologie, Hopital Universitaire Erasme, Brussels, Belgium.
| | | | - Laëtitia Van Achte
- Faculté de psychologie, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Christine Farvacques
- Centre de Psycho-Oncologie (CPO): training and research group, Brussels, Belgium
| | - Isabelle Merckaert
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium
| | | | | | - Christine Reynaert
- Faculté de psychologie, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | | | | | - Nicole Delvaux
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Service de psychologie, Hopital Universitaire Erasme, Brussels, Belgium
| | - Darius Razavi
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium
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Collins JC, Schneider CR, Faraj R, Wilson F, de Almeida Neto AC, Moles RJ. Management of common ailments requiring referral in the pharmacy: a mystery shopping intervention study. Int J Clin Pharm 2017; 39:697-703. [PMID: 28685179 DOI: 10.1007/s11096-017-0505-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
Background Pharmacists can play a key role in managing ailments through their primary roles of supplying over-the-counter (non-prescription) medicines and advice-giving. It must be ensured that pharmacy staff practise in an evidence-based, guideline-compliant manner. To achieve this, mystery shopping can be used as an intervention to assess and train pharmacy staff. Objective To determine if repeated student pharmacist mystery shopping with immediate feedback affected the outcome of scenarios requiring referral to a medical practitioner. To determine what, if any, factors may influence whether referral occurred. Setting Thirteen community pharmacies across metropolitan Sydney, Australia. Methods Sixty-one student pharmacist mystery shoppers visited 13 community pharmacies across metropolitan Sydney once weekly over nine weeks between March-October 2015 to conduct audio-recorded mystery shopping visits with assigned scenarios (asthma, dyspepsia, diarrhoea). Students returned to the pharmacy immediately to provide staff members with feedback. Pharmacy staff were scored by mystery shoppers according to a standardised scoresheet. Score data and other characteristics, such as the assigned scenario, were analysed via correlation and logistic regression modelling. Main outcome measure Whether a student mystery shopper was appropriately referred to a medical practitioner based on the presenting symptoms. Results 158 visits were eligible for analysis. Referral to a medical practitioner was appropriately made in 66% of visits. The regression model provided an R2 value of 0.73; the questioning score of the interaction and if a pharmacist was involved in the interaction were significant predictor of appropriate outcome (p < 0.001 and p < 0.01 respectively). Statistically significant differences were found between median questioning and total scores of interactions involving a pharmacist compared to those that did not (p < 0.001). No statistically significant correlation was found between the number of visits and appropriate outcome (p > 0.05). Conclusions Mystery shopping with feedback did not improve pharmacy staff performance over time. Increased questioning and involvement of a pharmacist in the interaction were significant predictors of referral to a medical practitioner occurring.
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Lewis KL, Bohnert CA, Gammon WL, Hölzer H, Lyman L, Smith C, Thompson TM, Wallace A, Gliva-McConvey G. The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP). Adv Simul (Lond) 2017; 2:10. [PMID: 29450011 PMCID: PMC5806371 DOI: 10.1186/s41077-017-0043-4] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/29/2017] [Indexed: 11/10/2022] Open
Abstract
In this paper, we define the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) for those working with human role players who interact with learners in a wide range of experiential learning and assessment contexts. These human role players are variously described by such terms as standardized/simulated patients or simulated participants (SP or SPs). ASPE is a global organization whose mission is to share advances in SP-based pedagogy, assessment, research, and scholarship as well as support the professional development of its members. The SOBP are intended to be used in conjunction with the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM, which address broader simulation practices. We begin by providing a rationale for the creation of the ASPE SOBP, noting that with the increasing use of simulation in healthcare training, it is incumbent on ASPE to establish SOBP that ensure the growth, integrity, and safe application of SP-based educational endeavors. We then describe the three and a half year process through which these standards were developed by a consensus of international experts in the field. Key terms used throughout the document are defined. Five underlying values inform the SOBP: safety, quality, professionalism, accountability, and collaboration. Finally, we describe five domains of best practice: safe work environment; case development; SP training for role portrayal, feedback, and completion of assessment instruments; program management; and professional development. Each domain is divided into principles with accompanying key practices that provide clear and practical guidelines for achieving desired outcomes and creating simulations that are safe for all stakeholders. Failure to follow the ASPE SOBP could compromise the safety of participants and the effectiveness of a simulation session. Care has been taken to make these guidelines precise yet flexible enough to address the diversity of varying contexts of SP practice. As a living document, these SOBP will be reviewed and modified periodically under the direction of the ASPE Standards of Practice Committee as SP methodology grows and adapts to evolving simulation practices.
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Affiliation(s)
- Karen L Lewis
- 1Clinical Learning and Simulation Skills Center, The George Washington University School of Medicine and Health Sciences, Washington, DC USA
| | - Carrie A Bohnert
- 2Standardized Patient Program, University of Louisville School of Medicine, Louisville, KY USA
| | - Wendy L Gammon
- New England Clinical Skills Consulting, Westborough, MA USA
| | - Henrike Hölzer
- 4Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Lorraine Lyman
- 5Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, VA USA
| | - Cathy Smith
- Division of Training and Simulation, The Centre for Education and Knowledge Exchange in Aging, Baycrest Health Sciences, Toronto, Ontario Canada
| | - Tonya M Thompson
- 7Simulation and Education Center, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Amelia Wallace
- 5Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, VA USA
| | - Gayle Gliva-McConvey
- 5Sentara Center for Simulation and Immersive Learning, Eastern Virginia Medical School, Norfolk, VA USA
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MacLean S, Kelly M, Geddes F, Della P. Use of simulated patients to develop communication skills in nursing education: An integrative review. Nurse Educ Today 2017; 48:90-98. [PMID: 27741440 DOI: 10.1016/j.nedt.2016.09.018] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/02/2016] [Accepted: 09/21/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND Registered nurses are expected to communicate effectively with patients. To improve on this skill education programmes in both hospital and tertiary settings are increasingly turning to simulation modalities when training undergraduate and registered nurses. The roles simulated patients (SPs) assume can vary according to training purposes and approach. AIMS The first aim is to analyse how SPs are used in nursing education to develop communication skills. The second aim is to evaluate the evidence that is available to support the efficacy of using SPs for training nurses in communication skills and finally to review the SP recruitment and training procedure. DESIGN An Integrative review. DATA SOURCES A search was conducted on CINAHL, Psych-info, PubMed, Google Scholar, Scopus, Ovid, Medline, and ProQuest databases. Keywords and inclusion/exclusion criteria were determined and applied to the search strategy. REVIEW METHODS The integrative review included Nineteen studies from 2006-2016. Critical Appraisal Skills Program (CASP) method of evaluation was utilised. Emergent themes were extracted with similar and divergent perspectives. RESULTS Analysis identified seven clinical contexts for communication skills training (CST) and two SP roles from the eighteen studies. SPs were either directly involved in the teaching of communication (active role) or used in the evaluation of the effectiveness of a communication skills program (passive role). A majority of studies utilised faculty-designed measurement instruments. CONCLUSION The evidence presented in the 19 articles indicates that the use of SPs to teach nurse-patient communication skills targets more challenging clinical interactions. Engaging SPs in both CST program facilitation and course evaluation provides nurse educators with a strong foundation to develop further pedagogical and research capacity. Expanding the utilisation of SPs to augment nurses' communication skills and ability to engage with patients in a broader range of clinical contexts with increased methodological rigor is recommended.
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Affiliation(s)
- Sharon MacLean
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Michelle Kelly
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Fiona Geddes
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
| | - Phillip Della
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
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Libert Y, Canivet D, Ménard C, Van Achte L, Farvacques C, Merckaert I, Liénard A, Klastersky J, Reynaert C, Slachmuylder JL, Durieux JF, Delvaux N, Razavi D. Predictors of physicians' satisfaction with their management of uncertainty during a decision-making encounter with a simulated advanced stage cancer patient. Patient Educ Couns 2016; 99:1121-1129. [PMID: 26969412 DOI: 10.1016/j.pec.2016.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/28/2015] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To optimize their training, predictors of physicians' satisfaction with their management of uncertainty should be examined. This study investigated these predictors by using a simulated advanced stage cancer patient. METHODS Physicians (n=85) rated their satisfaction with their management of uncertainty (Visual Analog Scale-100mm) after a decision-making encounter. Communication predictors were examined with the: Observing Patient Involvement scale (OPTION), Multidimensional analysis of Patient Outcome Predictions (MD.POP) and Communication Content Analysis Software (LaComm). Psychological predictors were assessed with the: Intolerance of Uncertainty Inventory (IUI), Physicians' Reactions to Uncertainty scale (PRU), Decisional Conflict Scale (DCS), and Jefferson Scale of Physician Empathy (JSPE). RESULTS Physicians' satisfaction (mean=67mm; standard deviation=17mm) was not predicted by their communication, but by their anxiety due to uncertainty (PRU) (β=-.42; p=<.001) and their perceived empathy (JSPE) (β=.26; p=.009). These variables accounted for 25% of variance in physicians' satisfaction. CONCLUSIONS Physicians' satisfaction with their management of uncertainty was not affected by their communication performance, but by their psychological characteristics. PRACTICE IMPLICATIONS Training programs should increase physicians' awareness regarding the communication performance required in decision-making encounters under conditions of uncertainty.
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Affiliation(s)
- Y Libert
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium
| | - D Canivet
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Service de psychologie, Hopital Universitaire Erasme, Brussels, Belgium.
| | - C Ménard
- Institut Jules Bordet, Brussels, Belgium
| | - L Van Achte
- Faculté de psychologie, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - C Farvacques
- Centre de Psycho-Oncologie (CPO): training and research group, Brussels, Belgium
| | - I Merckaert
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium
| | - A Liénard
- Institut Jules Bordet, Brussels, Belgium
| | | | - C Reynaert
- Faculté de psychologie, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - J-L Slachmuylder
- Centre de Psycho-Oncologie (CPO): training and research group, Brussels, Belgium
| | - J-F Durieux
- Centre de Psycho-Oncologie (CPO): training and research group, Brussels, Belgium
| | - N Delvaux
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Service de psychologie, Hopital Universitaire Erasme, Brussels, Belgium
| | - D Razavi
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium
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Salter SM, Loh R, Sanfilippo FM, Clifford RM. Demonstration of epinephrine autoinjectors (EpiPen and Anapen) by pharmacists in a randomised, simulated patient assessment: acceptable, but room for improvement. Allergy Asthma Clin Immunol 2014; 10:49. [PMID: 25264449 PMCID: PMC4177155 DOI: 10.1186/1710-1492-10-49] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/16/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Successful treatment of anaphylaxis in the community relies on early and correct use of epinephrine autoinjectors. Community pharmacists supply these devices and have a crucial role teaching patients how to use them. Supply of epinephrine autoinjectors in Australia increased 70-fold in the past decade. New EpiPen and Anapen autoinjectors were launched in Australia in 2011 and 2012, with the potential to cause confusion. However there is no information about how pharmacists demonstrate epinephrine autoinjectors to patients. Therefore the aim of this study was to assess real-world community pharmacist demonstrations of EpiPen and Anapen. We also sought to identify consultation-based predictors of accurate demonstration. METHODS Demonstration accuracy was assessed in simulated patient visits to 300 randomly selected pharmacies. Pharmacists were asked by the simulated patient how to use original EpiPen, new-look EpiPen or Anapen, and assessed against the relevant Australasian Society of Clinical Immunology and Allergy (ASCIA) Action Plan for Anaphylaxis. Other anaphylaxis advice provided by the pharmacist was also recorded. Accuracy was analysed descriptively. Binary logistic regression was used to identify predictors of accurate demonstration. RESULTS All 300 pharmacies were visited. Of 250 pharmacist demonstrations, 46 (18.4%) accurately demonstrated all four steps on ASCIA Action Plan. Failure to state 'do not touch the needle' (74.8%) or 'massage injection site' (68.8%) reduced accuracy. However 163 (65.2%) accurately demonstrated the three steps required to inject epinephrine (no difference by device, p = 0.15). Associations with accurate demonstration were: checking if the patient had an anaphylaxis action plan (odds ratio, OR = 16.1; 95% CI: 3.86-67.3); stating to call an ambulance after use (OR = 4.0; 95% CI: 1.44-11.1); or explaining side effects of epinephrine (OR = 4.5; 95% CI: 1.48-13.4). CONCLUSIONS It is critical that anaphylaxis patients know how to use their prescribed epinephrine autoinjector correctly. Pharmacists have acceptable rates of EpiPen and Anapen demonstration accuracy, although more is needed to improve this. Those who pay attention to the need for action plans, emergency care after epinephrine use, and informing patients about the side effects of epinephrine may have better knowledge about anaphylaxis, and in turn significantly improve demonstration accuracy.
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Affiliation(s)
- Sandra M Salter
- />Pharmacy Program, Centre for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, M315, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Richard Loh
- />The Australasian Society of Clinical Allergy and Immunology (ASCIA), Sydney, NSW Australia
- />School of Paediatrics and Child Health, The University of Western Australia, Crawley, WA Australia
| | - Frank M Sanfilippo
- />School of Population Health, The University of Western Australia, Crawley, WA Australia
| | - Rhonda M Clifford
- />Pharmacy Program, Centre for Optimization of Medicines, School of Medicine and Pharmacology, The University of Western Australia, M315, 35 Stirling Highway, Crawley, WA 6009 Australia
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Unver V, Başak T, İyigün E, Taştan S, Demiralp M, Yıldız D, Ayhan H, Köse G, Yüksel Ç, Çelikel AS, Hatipoglu S. An evaluation of a course on the rational use of medication in nursing from the perspective of the students. Nurse Educ Today 2013; 33:1362-1368. [PMID: 22884567 DOI: 10.1016/j.nedt.2012.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/25/2012] [Accepted: 07/05/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The objectives of educational instruction on the rational use of medication are to teach students about frequent pharmaceutical applications, dosage calculations, observation of adverse side effects and patient training. A simulation project was used in nursing education/medical staff education to effectively gain knowledge and skills. OBJECTIVES In this study, our first aim was to investigate the effect of using a simulated patient as a teaching method on the performance of students in medication administration. Our second aim was to explore the students' views on the simulated patient teaching method in terms of the skills acquired in administering medication. DESIGN The study was designed and carried out as a quasi-experimental investigation in Turkey between September 2011 and December 2011. PARTICIPANTS The participants in the study were senior nursing students at a nursing school in Turkey. The data from eighty-five nursing students were obtained both at pretest and posttest. The views of all eighty-two students regarding a course on the rational use of medications were taken into consideration. Simulated patients were used throughout the entire course. SETTING An objectively constructed evaluation form (OCEF) was administered both at pretest and posttest to obtain participant feedback on a course on the rational use of medication. Descriptive statistics and a paired sample t-test were used in the data analyses. RESULT The mean pre-test score on the evaluation form was 24.02 ± 16.06, whereas the mean post-test score was 54.28 ± 14.54. Therefore, there was a statistically significant difference between the mean pre- and post-test scores (p<0.01; t=14.35). CONCLUSION The use of a simulated patient in a course on the rational use of medication proved effective. Furthermore, the students gave positive feedback regarding the use of the simulated patient as a teaching method.
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Affiliation(s)
- Vesile Unver
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey.
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