Implementation of the WHO-6-step method in the medical curriculum to improve pharmacology knowledge and pharmacotherapy skills

Aim

The only validated tool for pharmacotherapy education for medical students is the 6-step method of the World Health Organization. It has proven effective in experimental studies with short term interventions. The generalizability of this effect after implementation in a contextual-rich medical curriculum was investigated.

Methods

The pharmacology knowledge and pharmacotherapy skills of cohorts of students, from years before, during and after implementation of a WHO-6-step-based integrated learning programme were tested using a standardized assessment containing 50 items covering knowledge of basic (n = 25) and clinical (n = 24) pharmacology, and pharmacotherapy skills (n = 1 open question). All scores are expressed as a percentage of the maximum score possible per (sub)domain.

Results

In total, 1652 students were included between September 2010 and July 2014 (participation rate 89%). The WHO-6-step-based learning programme improved students’ knowledge of basic pharmacology (mean score ± SD, 60.6 ± 10.5% vs. 63.4 ± 10.9%, P < 0.01) and clinical or applied pharmacology (63.7 ± 10.4% vs. 67.4 ± 10.3%, P < 0.01), and improved their pharmacotherapy skills (68.8 ± 26.1% vs. 74.6% ± 22.9%, P 0.02). Moreover, satisfaction with education increased (5.7 ± 1.3 vs. 6.3 ± 1.0 on a 10-point scale, P < 0.01) and as did students’ confidence in daily practice (from −0.81 ± 0.72 to −0.50 ± 0.79 on a −2 to +2 scale, P < 0.01).

Conclusions

The WHO-6-step method was successfully implemented in a medical curriculum. In this observational study, the integrated learning programme had positive effects on students’ knowledge of basic and applied pharmacology, improved their pharmacotherapy skills, and increased satisfaction with education and self-confidence in prescribing. Whether this training method leads to better patient care remains to be established.     

Junior doctor-led ‘near-peer’ prescribing education for medical students

Aims

Prescribing errors are common and inadequate preparation of prescribers appears to contribute. A junior doctor-led prescribing tutorial programme has been developed for Edinburgh final year medical students to increase exposure to common prescribing tasks. The aim of this study was to assess the impact of these tutorials on students and tutors.

Methods

One hundred and ninety-six tutorials were delivered to 183 students during 2010–2011. Each student completed a questionnaire after tutorial attendance which explored their previous prescribing experiences and the perceived benefits of tutorial attendance. Tutors completed a questionnaire which evaluated their teaching experiences and the impact on their prescribing practice. Student tutorial attendance was compared with end-of-year examination performance using linear regression analysis.

Results

The students reported increased confidence in their prescribing knowledge and skills after attending tutorials. Students who attended more tutorials also tended to perform better in end-of-year examinations (Drug prescribing: r = 0.16, P = 0.015; Fluid prescribing: r = 0.18, P = 0.007). Tutors considered that participation enhanced their own prescribing knowledge and skills. Although they were occasionally unable to address student uncertainties, 80% of tutors reported frequently correcting misconceptions and deficits in student knowledge. Ninety-five percent of students expressed a preference for prescribing training delivered by junior doctors over more senior doctors.

Conclusions

A ‘near-peer’ junior doctor-led approach to delivering prescribing training to medical students was highly valued by both students and tutors. Although junior doctors have relatively less clinical experience of prescribing, we believe that this can be addressed by training and academic supervision and is outweighed by the benefits of these tutorials.     

Effectiveness of a national approach to prescribing education for multiple disciplines

Aims

To evaluate the effectiveness of a national approach to prescribing education on health professional students’ prescribing and therapeutics knowledge, across multiple disciplines.

Methods

In a university examination setting, 83 medical, 40 pharmacy and 13 nurse practitioner students from three different universities completed a set of multiple choice questions (MCQs) before and after completing an online module from the National Prescribing Curriculum (NPC). To minimize overestimation of knowledge, students had to indicate the level of certainty for each answer on a three‐point scale. MCQs were scored using a validated certainty‐based marking scheme resulting in a composite score (maximum 30 and minimum −60). Students were asked to rate their perception of usefulness of the module.

Results

At the pre‐module phase, there were no significant differences in the composite MCQ scores between the medical (9.0 ± 10.3), pharmacy (10.2 ± 10.6) and nurse practitioner (8.0 ± 10.7) students. The scores improved significantly for all groups at the post‐module phase (P < 0.01 for all groups) by similar extents (post‐module results: medical, 14.5 ± 9.6; pharmacy, 14.4 ± 9.9; nurse practitioner, 12.1 ± 9.6). 39.4% of the MCQs answered incorrectly with high level of certainty at the pre‐module phase were still answered incorrectly with high level of certainty at the post‐module phase. Almost all students (with no significant difference between the groups) found the NPC modules, post‐module MCQs and feedback useful as a learning tool.

Conclusions

A national online approach to prescribing education can improve therapeutics knowledge of students from multiple disciplines of health care and contribute towards streamlining interdisciplinary learning in medication management.     

First-year Pharmacy Students' Self-Assessment of Communication Skills and the Impact of Video Review

Objectives

To determine the ability of first-year students to self-assess communication skills and measure the impact of video review on students'' self-assessment.

Design

Students participated in a digital video-recorded, counseling-simulation exercise and completed self-assessment before and after viewing their video. A faculty member evaluated the students using the same counseling assessment tool.

Assessment

Correlation between the students'' self-assessment scores and the faculty member''s scores were poor (pre-video: r = 0.38, post-video: r = 0.46). The largest portion of the students overestimated their skills in comparison to the faculty member''s evaluations (47.1% pre-video and 67.9% post-video). Those in the lowest quartile overestimated their skills, while those in the upper quartile underestimated their skills (pre-video). Video review brought about an increase in the self-assessment scores for nearly two-thirds (62.1%) of the students.

Conclusion

First-year pharmacy students had difficulty self-assessing, and video review increased their perception of skill achievement. A curriculum should include opportunities for students to develop self-assessment skills early in the program, and this should be reinforced throughout the curriculum.     

Pharmacy Student Knowledge and Communication of Medication Errors

Objectives

To describe and evaluate pharmacy students'' knowledge of and comfort in communicating, managing, and preventing medication errors.

Methods

Using a cross-sectional design, a survey instrument was administered to fifth-year pharmacy students. The survey instrument included both open- and close-ended questions to describe and examine factors associated with knowledge and comfort in communication of medication errors.

Results

Survey instruments were completed by 93 students (90% response rate). Nearly 80% reported not having received training in communicating medication errors. The perception of having more adequate training was related to greater knowledge in the communication of medication errors (p ≤ 0.001). Knowledge was also associated with students having greater comfort in communicating medication errors (p ≤ 0.05).

Conclusions

The need and value of additional training for pharmacy students in communicating medication errors was demonstrated. Educational interventions should be developed to provide consistent instruction on these communication issues.     

Impact of an Introductory Pharmacy Practice Experience on Students' Performance in an Advanced Practice Experience

Objective

To determine the impact of an introductory pharmacy practice experience (IPPE) on students'' clinical skills during their initial advanced pharmacy practice experience (APPE).

Design

A 4-week First Steps course that focused on students developing pharmacy practice skills, clinical communications skills, and effective use of reference materials was introduced in 2006 at the end of the third-year curriculum, prior to students beginning their APPEs.

Assessment

During the third week of the first APPE, faculty members rated students'' demonstration of 9 clinical skills on a 5-point Likert scale (1 being always and 5 being never). The evaluation was performed in 2005 prior to implementation of the course (control group) and again in 2006 after implementation of the course. Students who completed the First Steps course scored better on all 9 skills and had a better average clinical skills value (2.3) compared to the control group (2.6, p < 0.01).

Conclusion

Completion of an IPPE course that focused on critical pharmacy practice aspects, clinical communication skills, and use of reference materials resulted in increased frequency of desired clinical behaviors on a subsequent APPE.     

A Computer-based Module for Prescribing Error Instruction

Objective

To evaluate an instructional module''s effectiveness at changing third-year doctor of pharmacy (PharmD) students'' ability to identify and correct prescribing errors.

Design

Students were randomized into 2 groups. Using a computer-based module, group 1 completed worksheet A, watched a presentation on medication errors, and then completed worksheets B and C. Group 2 completed worksheets A and B, watched the presentation, and then completed worksheet C.

Assessment

Both groups scored a median 50% on worksheet A and 66.7% on worksheet C (p < 0.001). Median scores on worksheet B differed between groups (p = 0.0014). Group 1 viewed the presentation before completing worksheet B and scored 62.5%, while group 2 viewed the presentation after scoring 50% on worksheet B.

Conclusion

The module effectively taught pharmacy students to identify and correct prescribing errors.     

Online learning applied to a course on rational therapeutics: an international comparison between final year students of two medical schools

Introduction

Poor prescribing is probably the most common cause of preventable medication errors and many of these events involve junior doctors. In 2009, an electronic problem-based therapeutics course developed at the University of Michigan Medical School (UMMS) was translated and adapted for use at the University of Zagreb Medical School (UZMS).

Methods

After students from both schools took the course in 2010, we compared their responses with an online questionnaire addressing the course quality and its effectiveness.

Results

There were no statistically significant differences in the overall average grades awarded for the course (UZMS 4.11 ± 0.86 vs. UMMS 3.96 ± 0.93; 95% CI mean difference (MD) – 0.36, 0.07; P = 0.175) with both student groups expressing high satisfaction rates with its quality, accessibility and overall design. UZMS students reported spending less time working through the course than their American colleagues (2.14 ± 1.01 vs. 2.89 ± 1.02 on a five point Likert scale; 95% CI MD 0.51, 0.99; P < 0.05). Furthermore, Croatian students indicated greater difficulty with course materials (3.54 ± 0.59 vs. 3.25 ± 0.59; 95% CI MD – 0.42, – 0.15; P < 0,05) and weekly multiple choice questions (3.83 ± 0.62 vs. 3.4 ± 0.61; 95% CI MD – 0.58, – 0.29; P < 0,05) compared with the UMMS students.

Conclusion

It is possible to adapt and translate successfully whole online teaching resources and implement them internationally in different countries and health care systems, achieving similar, high student satisfaction rates while decreasing administrative and cost burdens. Web based learning may have great potential to offer a cost effective and safe environment in which prescribing skills can be improved.     

Junior doctors' perceptions of their self-efficacy in prescribing,their prescribing errors and the possible causes of errors

Aims

The aim of the study was to explore and compare junior doctors'' perceptions of their self-efficacy in prescribing, their prescribing errors and the possible causes of those errors.

Methods

A cross-sectional questionnaire study was distributed to foundation doctors throughout Scotland, based on Bandura''s Social Cognitive Theory and Human Error Theory (HET).

Results

Five hundred and forty-eight questionnaires were completed (35.0% of the national cohort). F1s estimated a higher daytime error rate [median 6.7 (IQR 2–12.4)] than F2s [4.0 IQR (0–10) (P = 0.002)], calculated based on the total number of medicines prescribed. The majority of self-reported errors (250, 49.2%) resulted from unintentional actions. Interruptions and pressure from other staff were commonly cited causes of errors. F1s were more likely to report insufficient prescribing skills as a potential cause of error than F2s (P = 0.002). The prescribers did not believe that the outcomes of their errors were serious. F2s reported higher self-efficacy scores than F1s in most aspects of prescribing (P < 0.001).

Conclusion

Foundation doctors were aware of their prescribing errors, yet were confident in their prescribing skills and apparently complacent about the potential consequences of prescribing errors. Error causation is multi-factorial often due to environmental factors, but with lack of knowledge also contributing. Therefore interventions are needed at all levels, including environmental changes, improving knowledge, providing feedback and changing attitudes towards the role of prescribing as a major influence on patient outcome.     

An elective course on lifestyle modifications in pharmacotherapy

Objectives

Develop and implement a pharmacy course explaining basic lifestyle modification components and assess changes in student knowledge, skills, beliefs, and confidence after completing the course.

Design

A 2-credit hour elective course was offered to pharmacy students in which basic lifestyle modification components were applied to case-based patients with hypertension, dyslipidemia, diabetes mellitus, obesity, and metabolic syndrome in the pharmacy practice setting through comprehensive wellness programs. Knowledge, skills, beliefs, and confidence assessments were embedded into the course.

Assessment

There were significant improvements in students'' skills and confidence, and in most knowledge areas, but not in their beliefs regarding health behaviors.

Conclusion

Implementing an elective course on lifestyle modifications is an effective means of teaching students about wellness and disease prevention.     

A Spanish language and culture initiative for a doctor of pharmacy curriculum

Objective

To implement a Spanish language and culture initiative in a doctor of pharmacy (PharmD) curriculum that would improve students'' Spanish language skills and cultural competence so that graduates could provide competent pharmaceutical care to Spanish-speaking patients.

Design

Five elective courses were created and introduced to the curriculum including 2 medical Spanish courses; a medical Spanish service-learning course; a 2-week Spanish language and cultural immersion trip to Mexico; and an advanced practice pharmacy experience (APPE) at a medical care clinic serving a high percentage of Spanish-speaking patients. Advisors placed increased emphasis on encouraging pharmacy students to complete a major or minor in Spanish.

Assessment

Enrollment in the Spanish language courses and the cultural immersion trip has been strong. Twenty-three students have completed the APPE at a Spanish-speaking clinic. Eleven percent of 2010 Butler University pharmacy graduates completed a major or minor in Spanish compared to approximately 1% in 2004 when the initiative began.

Conclusion

A Spanish language and culture initiative started in 2004 has resulted in increased Spanish language and cultural competence among pharmacy students and recent graduates.     

A Pharmacy Course on Leadership and Leading Change

Objective

To develop and implement a course that develops pharmacy students'' leadership skills and encourages them to become leaders within the profession.

Design

A leadership course series was offered to pharmacy students on 2 campuses. The series incorporated didactic, experiential, and self-directed learning activities, and focused on developing core leadership skills, self-awareness, and awareness of the process for leading change.

Assessment

Students reported increased knowledge and confidence in their ability to initiate and lead efforts for change. The learning activities students'' valued most were the StrengthsFinder assessment (67% of students rated “very useful”) and a Leadership Networking Partners (LNP) program (83% of students rated “very useful”).

Conclusion

Teaching leadership skills poses a significant challenge in curriculum development and requires multifaceted course design elements that resonate with students and engage the practice community. Addressing these requirements results in a high level of student engagement and a desire to continue the development of leadership skills.     

Evaluating the accuracy of pharmacy students' self-assessment skills

Objectives

To evaluate the accuracy of self-assessment skills of senior-level bachelor of science pharmacy students.

Methods

A method proposed by Kruger and Dunning involving comparisons of pharmacy students'' self-assessment with weighted average assessments of peers, standardized patients, and pharmacist-instructors was used.

Results

Eighty students participated in the study. Differences between self-assessment and external assessments were found across all performance quartiles. These differences were particularly large and significant in the third and fourth (lowest) quartiles and particularly marked in the areas of empathy, and logic/focus/coherence of interviewing.

Conclusions

The quality and accuracy of pharmacy students'' self-assessment skills were not as strong as expected, particularly given recent efforts to include self-assessment in the curriculum. Further work is necessary to ensure this important practice competency and life skill is at the level expected for professional practice and continuous professional development.     

Pharmacy education instruction: Preference and practices,Saudi students’ perception

Aim/Background

The methods of instruction in pharmacy education are crucial and meant to suit the professional development and encompass the advanced variety of services and functions provided by the pharmacists to serve individual patients. The aim of this study was to determine the students’ opinions on the adopted and preferred methods of instruction in pharmacy colleges in Kingdom of Saudi Arabia.

Methods

Opinions of Saudi pharmacy students regarding the adopted methods of learning were measured using a pretested questionnaire combined with Likert-type scales.

Results

Three hundred pharmacy students were interviewed. Direct type of lecturing was dominant (53.7%). The most frequently used language of instruction was combined English and Arabic (48.8%), that was mostly preferred by 52.5% of the students. Handouts were the most adopted post-lecture learning method (48.3%), while only 5.9% used student’s self-written notes. A cocktail of traditional and electronic aids was used as admitted by 68.7% and 59.3% of the students who preferred this lecture delivery method. Almost half (49.3%) of the students agreed of having a routine fair guidance and support when referring to their lecturers.

Conclusion

The study outcomes had revealed a practical guidance to be considered for instituting preferred modes of instruction to upgrading students’ capacities for better understanding and acquiring academic and professional skills.