FROM CLASSROOM TO CLINICAL AND BEYOND.
Barbara D. Smith, RPh, CDE, Michelle L. Herdman, PhD, Sandra S. Bowles, EdD, RN, CNE,
University of Charleston School of Pharmacy, Charleston, WV.
BACKGROUND
The University of Charleston School of Pharmacy (UCSOP), located in
Charleston, West Virginia, began admitting students in 2006 and graduated
its first class in May 2010.
The program is fully accredited by the
Accreditation Council for Pharmacy Education (ACPE).
The school’s original curriculum was organized around a series of modules
that
integrated
content
from
pathophysiology,
pharmacokinetics,
pharmacology, medicinal chemistry, and pharmacotherapy. These topics
related to a particular body system, a concept such as self-care, or a specific
patient population.
After two years of teaching the module curriculum, the design was modified
to reflect a more traditional, sequential approach to content delivery, with
discrete courses representing each discipline.
This modification
necessitated expansion and/or consolidation of previously offered courses
and raised the question as to whether or not students were successfully
integrating the didactic content.
Current P4 students (2011-2012) were the first to complete the reconfigured
curriculum. Faculty initiated this study to validate that students were able to
apply knowledge and skills attained in the first two years of the curriculum
to experiential education activities in the P3 year. This study represents a
faculty group’s effort to demonstrate that integration is occurring and to
substantiate the effectiveness of the revised curriculum.
OBJECTIVE
The purpose of this study was to determine if students exposed to a traditional
non-integrated course curriculum are able to integrate and apply P1 and P2
basic science, clinical and communication skills to selected patient activities
in a P3 clinical rotation.
RESULTS
RESULTS
CURRICULUM
Table 1
METHODOLOGY
In this study, students were involved in seven activities, including: carrying
out patient interviews to obtain a medical history, measurement of blood
pressure, obtaining a blood glucose reading, completion of a Brown Bag
medication review, interpretation of findings and explanation to patient,
presentation of a patient case to faculty and students, and preparation of
patient education materials.
First Professional Year
Student Survey: Students completed a 35 question survey to determine
retrospectively their use of information gained from P1 and P2 courses (Table
1) as they worked with patients in the P3 IPPE course. Students were asked
to respond to four questions as these pertained to the 7 competencies listed
above. For each activity, students were asked to respond to four questions:
1. Review the Pharmacy curriculum and identify in which courses in your P1
and P2 years (list attached) you learned either the knowledge and/or skills
necessary to conduct this activity, i.e. interview, blood pressure, etc.
2. In preparing to conduct this activity (interview, blood pressure, etc.) did you
refer back to materials from courses in your P1 or P2 curriculum? If so,
please identify these:
3. Please identify any resources other than information presented in (P1 or P2)
Pharmacy courses that you consulted to be able to conduce this activity
(interview, blood pressure, etc.)
4. What other information would have been helpful for you to have had in the
Pharmacy curriculum to be better prepared to conduct this interview? Be as
specific as possible:
As part of the survey, students were asked to respond to a short series of
questions to determine their confidence levels in the above activities.
Surveys were administered using Constant Contact software. Students who
took the P3 IPPE in the spring semester were allowed time in class to
complete the survey if they chose to participate in the study, or they could
take it later outside class. Students who were enrolled in the course in the
fall semester were allowed to take the survey during the same time period
that the spring students took the survey, but those students were sent an
email with a link to the survey.
Credit Hrs
PHAR 501L Prof. Awareness Prep. Seminar
1
PHAR 520 Pathophysiology
4
PHAR 510 Intro. To Pharmacy Pr. & Law
3
PHAR 522 Pharmaceutics II
3
PHAR 511 Drug Literature Evaluation
3
PHAR 523L Pharmaceutical Compounding
1
PHAR 512 Immunology
3
PHAR 524 Clinical Research Methods
2
PHAR 513 Biochemistry
3
PHAR 525L Intro. Practice Experience I*
1
PHAR 514 Pharmaceutics I (Calculations)
2
PHAR 527 Lifestyle Mod. & Dx Prevention
2
PHAR 515L Pharmaceutical Science Lab
1
PHAR 525L Intro. Practice Experience I
1
Elective
3
16(17)
Syllabus
Taking Blood
Pressure
Student
Student
Syllabus
Student
Syllabus
Fall
PHAR 643 Strat for Positive Hlth Outcomes
3
PHAR 611L Pharmacy Skills Laboratory
1
PHAR 626L Intro. Practice Experience III
3
PHAR 612
Pharmacology I
4
PHAR 629
HC Communications & Ethics
3
PHAR 614
Medicinal Chemistry
3
PHAR 640
Pharmacotherapy I
8
PHAR 615L Intro. Practice Experience II
3
PHAR 641
Pharmacology II
4
PHAR 617L Patient Assessment Skills Lab
1
Elective
3
Figure 1
18
Student
Syllabus
Student
Syllabus
Patient Education
Materials
Student
Syllabus
Student
511 (3)
520
611L (7)
617L
523L (1)
511
511 (1)
525L
511 (1)
501L
511 (1)
510
510 (1)
525L (7)
617L
614 (1)
640
611L (9)
514
525L (1)
520
512 (1)
510
611L (10)
511
512 (6)
611L
520 (1)
640
615L (1)
614 (1)
525L
527 (1)
527
525L (1)
511
612 (1)
512
525L (1)
615L
527 (7)
617L (32)
615L (2)
522
611L (12)
611L
520 (3)
514
615L (2)
513
524 (5)
617L
611L (23)
626L (2)
617L (29)
527
612 (5)
615L
527 (3)
525L
617L (1)
514
527 (1)
626L
612 (2)
640 (2)
640 (1)
610
614 (1)
617L
611L (14)
522
626L (2)
525L
611L (1)
629
615L (6)
611L
617L (6)
643
612 (6)
523L
640 (13)
520
617L (1)
643
617L (18)
612
640 (9)
640
614 (2)
524
641 (1)
524
643 (1)
512L**
626L (5)
614
641 (4)
521
615L (1)
527
527
629 (5)
629 (2)
615L
512L**
617L (22)
610
612
640 (2)
640 (5)
643
640 (17)
612
643
641 (2)
640
641 (6)
614
629
615L
640
641
617L
641
643
513L**
626L
629
640
641
512L**
** Course no longer offered
Patient
Interview
/
Medical
History
Taking
Blood
Pressure
Semester Total
21
STUDENT CONFIDENCE SURVEY
RESPONSES
1 = Strongly Disagree; 2 = Disagree; 3 = Neither Agree nor Disagree; 4 = Agree; 5 = Strongly Agree
1. My confidence level in conducting a patient interview has increased as a
result of my experiences in PHAR 716L. Rating score 4.3 - 90% agree or
strongly agree
2. My confidence level in taking an accurate blood pressure has increased as
a result of my experiences in PHAR 716L. Rating score 4.0 – 80% agree or
strongly agree
3. My confidence level in performing a blood glucose screening and
interpreting the results has increased as a result of my experiences in
PHAR 716L.
Rating score 4.4 – 92% agree or strongly agree
4. My confidence level in conducting a Brown Bag medication review has
increased as a result of my experiences in PHAR 716L.
Rating score 3.1 –
25% agree or strongly agree*
Student responses to these questions were tabulated and compared with
syllabi content analysis as depicted in the Results section of this poster.
1. My confidence level in creating a display board or flier appropriate for
patient education has increased as a result of my experiences in PHAR
716L.
Rating score 3.7 – 60% agree or strongly agree*
5. My confidence level in presenting a patient case to my peers has increased
as a result of my experiences in PHAR 716L.
Rating score 4.3 – 92%
agree or strongly agree
Responses: n = 31.
*Not all students were able to participate in this activity.
C. Student Reported Prior Information or Experience
That Could Have Aided Their Success in PHAR 716L
511 (2)
617L (1)
Blood
Glucose
Brown Bag
Medicatio
n Review
Interpret
Findings/
Explain to
Patient
Case
Presentation
Patient
Education
Materials
617L (5)
520 (1)
512 (1)
611L (1)
629 (1)
640 (1)
527 (1)
611L (3)
617L (1)
512 (1)
611L (10)
617L (4)
611L (1)
612 (1)
612 (1)
643 (4)
640 (7)
524 (1)
640 (2)
640 (2)
614 (1)
617L (1)
640 (2)
641 (2)
640 (7)
641 (1)
527 (1)
Credit Hrs
3
Semester Total
Case Presentation
527
Spring
Credit Hrs
Pharmacokinetic Principles
Interpret Findings/
Explain to Patient
525L
Second Professional Year
PHAR 610
Brown Bag
Medication Review
Blood Glucose
Syllabus
16(15)
Syllabus analysis: Syllabi were collected from all courses that the students
were required to take during their P1 and P2 years. Syllabi were analyzed to
determine which content directly related to the seven competencies
highlighted in this study. The content was identified from both topical lists of
lectures and from assignments in the course. For example, if a course had an
oral presentation assignment, then that course was identified as related to
preparing students to present case studies.
This project was approved by the University of Charleston Institutional
Review Board (IRB): #11-0021.
Patient Interview/
Medical History
A. Student Reported Previous Course Materials Referenced During PHAR 716L
Spring
Credit Hrs
Semester Total
Analysis of Syllabi from P1 and P2 Courses and Student Survey Responses to Determine Content Relevant to PHAR 716L P3 IPPE – Courses with relevant content
identified in the syllabi are listed in the left-hand column, and those courses with relevant content identified by students, with response numbers, are listed in the righthand column under each competency heading. Courses identified by both syllabi and students are highlighted in yellow.
Table 3
Fall
In PHAR 716L P3 IPPE, students were assigned to work with Professor
Barbara Smith, a UCSOP faculty member, at Roane General Hospital (RGH), a
small community hospital. Half of the class was assigned to the fall semester
and the other half to the spring semester; students were further divided into
three groups, with each group traveling to the site three times to work seven
hours each trip. Over the semester, students provided pharmaceutical care to
patients in the RGH Diabetes Management Program, Roane General Medical
Clinic, the RGH Fitness Complex, Roane County Committee on Aging, and the
Miletree Center (a long-term care facility).
SYLLABUS ANALYSIS AND STUDENT
IDENTIFICATION OF RELEVANT COURSES
Table 2
A majority of students reported increased confidence levels in conducting
patient interviews, taking an accurate blood pressure, performing a blood
glucose screening, presenting a patient case to their peers, and preparing
patient education materials. Only one quarter of the students indicated that
their confidence levels had increased in conducting Brown Bag medication
reviews.
In analyzing syllabi, faculty found that many courses contained relevant
content or assignments/activities that prepared students for the P3 IPPE
course, with the exception of taking blood pressures and performing a blood
glucose test. These skills are learned in specific courses, and are not
referred to in most other courses. Students listed similar courses as those
identified in the syllabus analysis. In the case of four competencies (1-3, 5),
students identified more courses than were apparent from syllabi content,
but with the remaining three competencies, the students listed few courses.
In general, the courses that the majority of students listed as containing
relevant information were also identified by the syllabus analysis.
While some students indicated that they referred to information from
previous courses, most students indicated that they did not refer back to
materials from previous courses.
Students cited a variety of materials and resources that were referred to
during PHAR 716L. Some of the sources were reliable standard resources
that are introduced in courses, such as JNC7 Guidelines, but other sources
were less specific, such as relatives or Google searches. Still others cited
personal experiences outside of course work, such as working as a
pharmacy intern. The lists were lengthy and varied, indicating that students
are integrating a variety of experiences from coursework, outside resources,
and personal experiences.
While many students indicated that no other prior preparation could have
helped them achieve success in PHAR 716L, others indicated that having
more introductory experiences and more practice in the individual activities
prior to the course would have been helpful. Others students indicated more
specific needs, such as a course in Microsoft PowerPoint and Publisher.
DISCUSSION & CONCLUSIONS
None-N/A
(20)
None-N/A
(33)
None-N/A
(25)
None – N/A
(29)
None-N/A (16)
All
lectures/textbooks
(2)
None-N/A (21)
Yes, textbook
(not specified)
Yes, from all of
the courses
stated
previously.
Yes, lab
materials
(patient
communication)
Blood Glucose
Previous experience
(4)
Micromedex (3)
LexiComp (3)
Database on iPhone
(2)
Clinical
Pharmacology (1)
ADA Guidelines (2)
AACE Guidelines (1)
JNC 7 Guidelines (1)
Personal experience
(4)
ACEE Guidelines (1)
ADA Guidelines (1)
Ms. Smith (1)
Website of
glucometer (1)
None (26)
Taking Blood
Pressure
Brown Bag
Medication
Review
JNC7 Guidelines (5)
Am Heart Asso (1)
Googled it (1)
Past experience (2)
Pharmacotherapy I
(2)
Mother a RN (1)
No/None (24)
Lexicomp (7)
Accumulation of
Courses (1)
Pharmacotherapy I
notes (1)
Epocrates (2)
Facts &
Comparisons (1)
Clinical
Pharmacology (2)
Class would be fine
(1)
Personal experience
/ Intern (2)
Micromedex (1)
None (19)
Interpret Findings/
Explain to Patient
Lexicomp (5)
Clinical Pharmacology
(5)
Facts and
Comparisons (1)
Epocrates (2)
Internet/Online
Resources (2)
WebMD (1)
Wikipedia (1)
Micromedex (1)
Google (1)
Medscape (1)
Lab values (2)
Pharmacy Journals (1)
Outside Professors (1)
Pharmacists in the
community (1)
ADA Guidelines (3)
JNC 7 Guidelines (1)
Websites for
guidelines (1)
Drug References (1)
Doing Cases (1)
Working in a pharmacy
as an intern (1)
None (15)
Case
Presentation
Micromedex (1)
Lexicomp (3)
Clinical
Pharmacology (3)
Epocrates (2)
Online resources (1)
Skills lab notes (1)
All was presented in
class (1)
JNC Guidelines (1)
ADA Guidelines (1)
Life experience with
presentations (1)
All pharmacy
resources (1)
Working in the
pharmacy (2)
Example care plans
(1)
lab (1)
Peers (1)
Pharmacotherapy
cases (1)
None (17)
IMPLICATIONS
Findings of this study appear to validate that those students participating in
the survey are able to integrate and apply knowledge and skills obtained
though successful completion of courses in the current P1 and P2 years of
the UCSOP curriculum. A follow-up study with students in the P3 year during
the 2011-2012 academic year may further support this assumption.
Patient Interview/Medical History
Teach Drug Lit later in curriculum (1)
More drill on correct B/P, glucose, lipid values (1)
Taking Blood Pressure
It may be helpful for faculty teaching in the P1 and P2 courses to further
analyze results of this study to identify indications for further curriculum
revision, particularly as related to comments in which students identified
need for further hands on experience or didactic exposure to specific
concepts needed to carry out the seven activities included in this study.
Need more practice (8)
Need opportunity to take in quiet place (3)
How to select cuff size (1)
Require re-certification annually (2)
None-N/A (22)
Blood Glucose
None-N/A (25)
Past
newsletter/pos
ter projects
More participation in health fairs/practice (4)
Treating hyper- & hypoglycemia (1)
Drilling us on correct glucose values/goals (1)
None-N/A (28)
STUDENT COMMENTS
Brown Bag Medication Review
Simulation of a Brown Bag Event in Pharmacotherapy (1)
Drug references on hand would have been helpful (1)
Practice in Class (7)
Actually performing a Brown Bag Event (2)
None-N/A (21)
B. Student Reported Other Materials Referenced During PHAR 716L
Patient
Interview/
Medical History
Most students reported that their confidence levels increased in the indicated
patient care areas, but only 25% indicated that their confidence increased in
the area of Brown Bag Medication reviews, with 58% indicating neither agree
nor disagree. Not all students were able to participate in this activity, and
those that did may have only participated one time, perhaps explaining the
low numbers in this category. While more experience may be needed in the
medication review area, the other activities appear sufficient to increase the
confidence levels of most students responding to the survey.
The courses that the majority of students listed as containing relevant
information were also identified by the syllabus analysis. However, in the
case of four competencies, students listed more courses as containing
relevant content than were identified in the syllabus analysis.
This
discrepancy may be due to individual variation in student experiences within
a particular course. For example, if a student had an early experiential course
in the P1 or P2 year that focuses on a diabetes-related area, such as working
in the dialysis center, or a community pharmacy that does diabetes education,
then that student may have indicated that course as relevant, whereas
another student at a site focused on substance abuse may not have found the
course relevant to the P3 course. Additionally, some activities may not be
evident in the syllabus, and, therefore, were not identified in the syllabus
analysis.
On the other hand, for three of the competencies, students
identified few courses than were listed in the syllabus analysis. A variety of
explanations are possible for this discrepancy. In one case, many of the
courses were P1 courses, and students may have not remembered all of the
relevant content at the time of the survey because a long time had elapsed
since students took the course.
Many students reported that they did not refer to materials from previous
courses, and some indicated that they felt prepared and did not need to.
However, others did not indicate the reason, so the study is limited in the
ability to determine the reason why students are not referring back to
information from previous courses.
While many students felt prepared for the course, some students provided
suggestions that faculty members may find useful in preparation of future
courses, and these lists will be provided to faculty members.
In analyzing the information, most students appear to recognize that
information from previous courses carries forward to experiential courses and
are using this information in the daily activities in the P3 IPPE.
Patient
Education
Materials
Lexicomp (1)
Clinical
Pharmacology (1)
Looked up needed
resources (1)
Internet (3)
Microsoft Publisher
(1)
Powerpoint (1)
JNC7 (1)
ADA (2)
mypyramid.gov (1)
Life experience (2)
Example posters (1)
AHA (1)
AMA (1)
Pharmacotherapy
text (1)
No/None (16)
Interpret Findings/Explain to Patient
Not sure (2)
Felt prepared (8)
More opportunity for practice (1)
Mote handouts, drug references (2)
None-N/A (19)
The faculty member working with these students made direct observations of
student interactions, patients completed questionnaires related to their
experience, and students completed a self-report of their experience. From
the student self-report tool, it was apparent that students enjoyed this
experience and viewed it as a valuable learning opportunity as they shared
the following comments:
“. . . we were able to apply our knowledge and skills as well as get more
hands on practice with blood pressure and blood glucose readings.”
“A patient said we made her day by taking her B/P and glucose and the value
was within goal.”
“ . . . it was gratifying for me to talk to an actual patient who needs help.”
Case Presentation
Journal club (1)
Not sure (3)
More opportunity for practice (1)
Maybe some info on how to present a patient case (1)
Incorporate presenting pt cases into one of the labs (1)
Possibly one more assessment-based class (1)
Presenting pt cases in pharmacotherapy (1)
None-N/A (23)
“I became more comfortable in reviewing patient’s charts and finding
pertinent information.”
“ . . . it was helpful to let people know what the glucometer readings actually
meant. It was also helpful to review charts and put practical use to
knowledge learned in class.”
“Applied what I’ve learned and love interacting with patients.”
“Definitely got to practice what I learned in class.”
Patient Education Materials
More info on poster creation (4)
Course on Microsoft Publisher & PowerPoint (1)
No/None (26)
Students Conducting
Blood Pressure
Screening
ACKNOWLEDGEMENTS
Students Conducting
Medication Review and
Blood Pressure
Screening
Roane General Hospital
Roane General Medical Clinic
Dr. Maria Kessell
Dr. Grant Parkins
Dr. Kenneth Seen
Roane County Committee on Aging
The Fitness Complex
Miletree Center
Class of 2012 students that participated in the study
UCSOP faculty members that shared syllabi for the
study