Layered Learning Models

By Jazmin Turner, PGY2 Geriatric Pharmacy Resident, University of Maryland School of Pharmacy

Overview

As pharmacy practice has shifted from a traditional dispensing role to a more clinical role, existing models of care have not always adapted to facilitate and accommodate these changes. A layered learning model (LLM) is comprised of a team of pharmacists and pharmacy learners; it is led by an attending pharmacist and incorporates PGY1 and PGY2 residents and pharmacy students. Members of the team are responsible for precepting learners on the level below them. The attending pharmacist is responsible for all levels of pharmacotherapeutic care and resident/student education. LLMs allow for an expansion of clinical pharmacy services through the use of pharmacist extenders.¹ Various studies have shown that LLMs decrease medication costs, improve medication education for patients, and facilitate the resolution of medication-related problems.^{1, 2, 3} Additionally, by incorporating residents and students, institutions are able to provide enhanced patient care at a lower cost.² This model also allows pharmacy residents to practice and improve upon their teaching skills.

Parallels can be drawn with medical residents who participate in teaching and precepting medical students. In a qualitative study, medical residents stated that teaching students helped them become better clinicians by causing them to think critically, evaluate their knowledge, and keep abreast of current literature.⁴ As there are many parallels between post graduate pharmacy and medical education, it may be reasonable to extrapolate these findings to pharmacy residents and state that through layered learning models, pharmacy residents can enhance their clinical skills. However, additional studies on LLM need to be conducted in order to validate this hypothesis.

Implementation Considerations and Barriers

The limited literature available that details the implementation of LLMs has focused primarily on inpatient clinical pharmacy services. There is currently a wide variance at different institutions in terms of overall clinical pharmacy services. According to a 2013 national ASHP survey, less than 45% of hospitals with fewer than 200 beds had pharmacists that regularly attended rounds versus 100% of hospitals with greater than 600 beds. Despite these numbers, over 70% of hospitals have fewer than 200 beds. Therefore, there are large disparities when it comes to clinical pharmacy services and this shows that there are a multitude of opportunities for expansion, especially with the use of LLMs.²

In order to establish a LLM, there needs to be collaboration and shared leadership between the institution and the school of pharmacy in order to define student goals and outcomes as well as a shared teaching philosophy. There has to be a systematic approach so that the clinician is adequately prepared for this model and so that the learners are properly trained to provide high quality patient care. Adequate resources, such as office space and access to the electronic medical record, for example, are also a key component to implementation so that patient care activities can be executed and documented efficiently. Finally, it is important to continually evaluate the program and obtain feedback from various groups in order to facilitate improvement.^{1, 3}

Time is a large barrier to providing patient care using a LLM.¹ This is especially true in an ambulatory care setting where, for example, a student may take a patient history and conduct a patient assessment, present their findings to the resident, and then both the student and resident present the findings and the plan to the attending pharmacist. Patients often do not want to spend the additional time at the clinic in order for these various steps to occur when it would be faster to interact with the attending pharmacist only. It also can be difficult to accommodate the learners’ abilities¹; for example, if a student is struggling and is unable to see patients independently, the attending pharmacist may have the resident directly oversee the student. This can take away from the residents’ time for their own patient care activities.

My Experience with Layered Learning Models

Over the course of my residency training, I have had the opportunity to participate in various LLMs across mainly ambulatory care and home health care settings. During my PGY1, I was typically responsible for helping to co-precept 3-4 APPE students per rotation and during my PGY2 I helped co-precept 2-3 APPE students throughout the week during the course of my longitudinal rotations. This enhanced responsibility helped me build upon my leadership skills, especially during times when I was starting a rotation at the same time as the student and they looked to me for guidance and support. Similar to what the medical residents stated in the Busari et al article, I feel that LLMs have helped me develop as a clinician because I had to critically evaluate my knowledge while helping students cultivate their own knowledge.

Additionally, by holding topic discussions and journal clubs, I had to stay abreast of current literature and study about certain disease states or clinical problems that I may not have under other circumstances. Student feedback helped me evaluate my approach to precepting and identify the best ways for me to coach and model for my students. One disadvantage to LLMs, in my experience, is that in some scenarios, it decreased my exposure to direct patient care. For example, if only one patient came to their appointment in clinic, the student would be the one to see the patient to ensure that they were meeting their various outcomes. However, my preceptors did not always have students with them on rotation so that was not always a barrier.

Summary

The LLM can help with ASHP's Practice Advancement Initiative by enabling pharmacists to interface with a greater number of patients, provide additional pharmacy services, enhance patient care and patient satisfaction, and promote integration into the care team.⁵ LLMs are beneficial to pharmacy residents because they can cultivate skills that can help them develop into better practitioners. However, there should be a balance so that both residents and students have equal opportunities. Overall, it is a model that will likely expand as more residency programs are created across the country and the need for expanded pharmacy services increases.

References:

1.    Pinelli NR, Eckel SF, Vu MB, et al. The layered learning practice model: Lessons learned from implementation. Am J Health-Syst Pharm 2016; 73:2077-82. Available at: http://www.ajhp.org/content/73/24/2077.

2.    Soric MM, Glowczewski JE, Lerman RM. Economic and patient satisfaction outcomes of a layered learning model in a small community hospital. Am J Health-Syst Pharm 2016; 73:456-62. Available at: http://www.ajhp.org/content/73/7/456.

3.    Bates JS, Buie LW, Amerine LB, et al. Expanding care through a layered learning practice model. Am J Health-Syst Pharm 2016; 73:1869-75. Available at: http://www.ajhp.org/content/73/22/1869.long.

4.    Busari JO, Scherpbier AJJA. Why residents should teach: a literature review. J Postgrad Med 2004;50(3):205-10. Available at: http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2004;volume=50;issue=3;spage=205;epage=210;aulast=Busari.

5.    American Society of Health-System Pharmacists. Practice Advancement Initiative. Overview. Available at: http://www.ashpmedia.org/pai/overview.html. Accessed April 16, 2017.

Basics of Interprofessional Educational Activities in Pharmacy

By Paul Solinsky, PharmD

Community Pharmacy Resident, University of Maryland School of Pharmacy

In today's healthcare system, there is a focus on delivering quality and coordinated care between different healthcare disciplines. This type of teamwork will not only decrease the fragmentation of care, but also improve the quality of care and lead to better patient outcomes.¹ Pharmacists are increasingly being involved in the delivery of team-based care. Therefore, having more education regarding interprofessional teams may benefit pharmacy students in the future. Having students from different disciplines, come together to collaborate on patient care can help foster a relationship of teamwork and problem solving.² The WHO, in 2010 released this definition on interprofessional education (IPE): “Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.” ²

One of the organizations that helps to promote interprofessional education is the Interprofessional EducationCollaboration (IPEC)³. It is composed of the education associations of all the major healthcare disciplines including medicine, pharmacy, social work, nursing, podiatry, physical therapy, and others. IPEC has core competencies published concerning interprofessional education. IPEC’s four main core competencies include:

1.       Work with individuals of other professions to maintain a climate of mutual respect and shared values. (Values/Ethics for Interprofessional Practice)

2.       Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations. (Roles/Responsibilities)

3.       Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease. (Interprofessional Communication)

4.       Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable. (Teams and Teamwork)

Interprofessional education activities for students are varied. Health care education literature describes a few different ways interprofessional activities have been developed. One way to create an activity is having a case base discussion between health care disciplines. Greene et al, has described an activity where pharmacy and medical students would collaborate on patient cases. The medical students would present the patient’s current medical problems, while the pharmacy students would review a medication history and discuss with the physicians about the drug for each disease, the rationale, and monitoring parameters.⁴ Having cases during the didactic portion of education may be beneficial in creating the foundations for interprofessional collaboration early in healthcare education.

Sicat et al, describes having an actual primary clinic set up, students from different disciplines come together and collaborate on patient care. Medicine students on clerkships, and pharmacy students on APPE rotations were included in this clinic. The roles and responsibilities of team-members were outlined for the student participants. The students reported having a negative reaction to orientation materials and pre-clinic online modules delineating each role of the healthcare team-member. There was no overall change in attitudes towards interprofessional teamwork and team-members using the Interdisciplinary Education Perception scale (IEPS) and AttitudesToward Health Care Teams scale (ATHCTS). IEPS is a scale which measures how students perceive interprofessional experiences. ATHCTS is a scale which measures interprofessional teamwork and attitude towards team members. However, because of the clinic, participants perceived an increased willingness to seek help from the other profession, comfort working with the other discipline, and recognizing the specific contributions of the other profession to patient care. ⁵

There may also be potential barriers to creating interprofessional educational activities. Finding funding, resources, and support for creating interprofessional education clinics can be a challenging barrier to overcome. Another challenge to IPE activities is preconceived biases of student participants. Having students reflect on importance, abilities, and roles of each healthcare member is a critical first step for students.⁶ Educators may not be aware of any preconceived biases students may have about other healthcare professions. Another barrier may include language of different disciplines. For example, a social work student may not know what “A1C” means. A pharmacy student may not understand certain diagnostic tests or interpreting test results. Finally, conflict may arise during the activity between different health care disciplines. Having the students understand basic principles of conflict resolution may be an important skill for students to learn before the activity. Understanding the barriers to setting up an interprofessional educational activity may be important to creating a team that trusts and relies upon each other.

As healthcare systems move to more team-based care, interprofessional education will become increasingly important towards the standard education to students in healthcare disciplines. Therefore, there is a need for educators to understand the benefits and challenges to creating activities geared towards multiple disciplines.

1(1)      Vazirani S, Hays RD, Shapiro MF, Cowan M. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care. 2005;14(1):71-77.

2(2)      Titzer J, Swenty C, and Hoehn G. An interprofessional Simulation Promoting Collaboration and Problem Solving among Nursing and Allied Health Professional Students. Clinical Simulation in Nursing. 2012; 8(8):e325-e333. doi:10.1016/j.ecns.2011.01.001.

3(3)      WHO staff. World Health Organization (WHO). Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organization. 2010. Available at http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf.

4(4)      Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Interprofessional Education Collaborative.

5(5)      Greene, R. J., Cavell, G. F. and Jackson, S. H. D. (1996), Interprofessional clinical education of medical and pharmacy students. Medical Education, 30: 129–133. doi:10.1111/j.1365-2923.1996.tb00730.x

6(6)      Sicat B, et al. Interprofessional education in a primary care teaching clinic: findings from a study involving pharmacy and medical students. J Interprof Care. 2014 Jan;28(1):71-3. doi: 10.3109/13561820.2013.829424. Epub 2013 Sep 3.

7(7)      Page L, et al. ACCP white paper. Interprofessional education: principles and application. A framework for clinical pharmacy. Available at: https://www.accp.com/docs/positions/whitePapers/InterProfEduc.pdf

Going Global: International Practice Experiences in Pharmacy Education

by Anne Masich, PGY-1 Pharmacotherapy Resident

University of Maryland School of Pharmacy

Pharmacy practice experiences abroad provide students with unique opportunities to expand their education to a global scale, enhancing their cultural awareness through immersion, exchanging information and creating professional partnerships, conducting collaborative research, and learning about other health care systems. Many students find these experiences to be rewarding, both professionally and personally.¹ During international experiences, students’ activities are hands on, which may involve traditional dispensing, direct patient care, patient education and conducting research. Many of practice experiences are interdisciplinary collaborations, in which students worked with other health care professional students or were precepted by practitioners from another discipline. Students do not view opportunities abroad as a “resume builder”, but rather an opportunity to contribute to global health needs, and to work with and learn about people from other cultures.¹

The American Associationof Colleges of Pharmacy (AACP), the International Pharmaceutical Federation (FIP), and the World Health Organization (WHO) have formed special interest groups to promote and develop global education and pharmacy practice, including advance pharmacy practice experiences. In two surveys conducted by the AACP in 2007 and 2010, many US schools of pharmacy offer some type of international experience, several of which are highly competitive to be able to participate.¹ Interest in expanding curricula to include international experiences is expected to continue to grow. Institutions interested in developing or expanding their international experiential opportunities must be strategic to ensure sustainable programs, taking into consideration the institutions vision and strategic plan, student learning outcomes, logistics, finances, communication with the practice sites, etc.

Strategies for developing global pharmacy practice training

Partner organizations

Optimal practice sites are experienced academic learning sites that can adjust based on curricular needs, and that employs permanent staff and licensed health care professionals.^2-3 Institutions should seek out organizations that promote pharmacy education. They should ask questions and begin to develop an understanding of the organization’s abilities and limitations. Once practice site(s) is identified, regular communication and plan for a site visit should be initiated to determine the opportunities of patient care and projects for students. Discuss the organization, competency, safety and management of the program with the organizations leaders, physicians and other staff. Collaboration between the institution and the host organization to develop a quality program will strengthen the partnership and ensure both organizations benefit from the program.⁴

Preceptor considerations

Schools of pharmacy should be flexible in preceptor selection, as in many cases, preceptors abroad will either be a local pharmacist or another member of the healthcare team. Regardless of the preceptor’s background, pharmacist or other healthcare professional, they must meet ACPE (Accreditation Council for Pharmacy Education) qualifications and practice standards of practice.^3-4 The preceptor should receive a school orientation to understand the institution’s curriculum, teaching methodologies and student performance assessment. In addition to key preceptor characteristics provided by the AACP Professional Affairs Committee, preceptors of both US students abroad and international students visiting should have an understanding of their own culture and possess cultural sensitivity in student learning and patient care.⁴

Student considerations

Students participating in international programs should be carefully selected and meet the minimal requirements established by the institution. The school of pharmacy should select students who possess the necessary professional skills, cultural sensitivity, and intercultural communication skills.³ Some schools of pharmacy undergo an application process, in which the students’ express their interest, state their objectives, and demonstrate their preparation for the experience. Programs and students should be explicit in their expectations and objectives of the experience. There are several barriers institutions must account for when recruiting students, including funding, faculty and student interest, and timing during the curriculum. Schools of pharmacy should provide assistance to students in the form of monetary scholarships/loans or through support of fundraising activities.

With the globalization of education, there is an increase in the number of colleges and schools of pharmacy interested in creating international pharmacy practice experiences for their students.^1,5 As schools of pharmacy expand their reach beyond our borders, they should take into consideration the practice site, preceptors and students to ensure pharmacy practice standards are achieved. International pharmacy practice experiences provide students with unique opportunities to develop cultural awareness, provide health care to underserved populations, participate in exchanging of information, and form professional partnerships.

References

1.   Cisneros RM, Jawaid SP, Kendall DA, McPherson CE, et al. International practice experiences in pharmacy education. Am J Pharm Educ 2013; 77(9): Article 188.

2.   Global Pharmacy Education Special Projects and Information. American Association of Colleges of Pharmacy. Available online at: http://www.aacp.org/governance/SIGS/global/Pages/GlobalPharmacyEducationSpecialProjectsandInformation.aspx

3.   Dornblaser EK, Ratka A, Gleason SE, Ombengi DN, et al. Current practices in global/international advanced pharmacy practice experiences: preceptor and student considerations. Am J Pharm Educ 2016; 80(3): Article 39.

4.   Alsharif NZ. Globalization of pharmacy education: what is needed? Am J Pharm Educ 2012; 76(5): Article 77.

5.   Steeb DR, Overman RA, Sleath BL, Joyner PU. Global experiential and didactic education opportunitites at US colleges and schools of pharmacy. Am J Pharm Educ 2016; 80(1):7

Ramsey Musallam’s 3 Rules to Spark Learning

By Stormi Gale, Cardiology Pharmacy Resident at the University of Maryland School of Pharmacy

I recently listened to a TED talk by Ramsey Musallam on “the 3 rules to spark learning”.¹ 

https://www.ted.com/talks/ramsey_musallam_3_rules_to_spark_learning

I found this lecture to be of particular interest because I believe one of the most important things that we can do for our students is to motivate them. Specifically, I mean creating a desire to learn that is unrelated to a report card or a class rank. What I am referring to is inspiring something that Ramsey Mussalam mentions throughout this short video – curiosity.  Musallam, a chemistry teacher, begins with an anecdote about a student that left his classroom and repeated one of his experiments from home in a YouTube video. If every concept we taught were so invigorating that students would reflect on them by choice afterwards, teaching would be a much easier profession.

An unforeseen medical illness lead to Musallam’s realization that he had spent the last 10 years of his life “pseudo-teaching”, a concept that often plagues present-day classrooms. Pseudo-teaching heavily relies on curriculums that have specific standards for education, without an emphasis on the learner’s incentive for acquiring knowledge. Musallam mimics his three rules after his physician’s journey from medical student to cardiothoracic surgeon.

Rule number one - Curiosity comes first. Questions can be windows to instruction but not the other way around. Musallam describes curiosity as “magnets that draw us towards our teachers” that “transcends all technology or buzzwords in education”. He goes on to suggest that technology may be detrimental to a student’s learning through the minimization of student’s questions. The flipped classroom is specifically mentioned; Musallam feels that bringing lectures to the computer screen is hardly an improvement over the traditional classroom. He describes this method as “dehumanizing chatter just wrapped up in fancy clothing.” He challenges teachers to confuse our students in a way that triggers them to ask questions, referring to student questions as “the seeds of real learning”. Through their natural inquisitiveness, we can create an environment that yields greater learning potential. This is to say that we as teachers can learn how to tailor our lessons through culturing what our students want to know.

Rule number two - Embrace the mess. We know learning is ugly. Musallam’s surgeon did not have perfect technique during his very first procedure. His expertise is a culmination of thousands of procedures he performed amateur hands. Mussalam challenges “not to fear the inevitable process of trial and error”.  We have to be willing to take risks with our students. This may mean not following specific layouts in textbooks or in the map of the curriculum. This often becomes a point of contention for today’s educators. We often are trying to find a balance between governmental or institutional standards and have difficulty straying from these requirements. However, it is imperative that we keep the best interest of our students in mind, always. Teachers must be open to creating something innovative, and must be able to accept that new methods may fail.

Rule number three - Practice reflection. What we do deserves our revision. We must be able to recognize that current processes are never perfect, and be able to devise improvements in our teaching. This is by no means a foreign concept; we have long known the importance of devising ways to improve our work. As teachers we are accustomed to receiving evaluations from our students and mentors. However, equally important feedback is self-addressed. The evaluations we receive from others lack utility if we do not take the time to actively participate in our development. It is no coincidence that this concept comes up repeatedly in various educational theories - we cannot ask our students to grow without challenging ourselves to do the same. If we are truly embracing our mess, as is discussed in rule number two, then we must then be willing to clean it up.

Musallam closes his talk by describing his soon to be four-year-old daughter’s vast ability to learn simply because of her innate desire to learn. It is well-known that young children are rapidly absorbing information from the world around them. I would argue that the hasty acquisition of data is not solely attributable to neural plasticity, but rather a combination of physiologic differences as well as innate curiosity.  We as teachers must recognize that the rate-limiting step to our students’ potential most often has nothing to do with cognitive ability, but rather with a lack of interest. If we can spark learning through these aforementioned three rules, we can overcome these barriers. As educators we owe it to our learners to “leave behind the simple role of disseminators of content and embrace a new paradigm as cultivators of curiosity and inquiry”.

References:

Musallam, R. (2013, April). Ramsey Musallam: 3 rules to spark learning [Video file]. Retrieved from https://www.ted.com/talks/ramsey_musallam_3_rules_to_spark_learning

The Importance of Multicultural Education

by Adriana E. Soto-Aviles, PharmD

PGY-1 Pharmacy Resident, Suburban Hospital – Johns Hopkins Medicine

In today’s increasingly multicultural world, it has become more important than ever to be cognizant of the varying needs of people from different backgrounds. While deciding on what to focus on in this essay, I found an online article titled “Reflective Leadership for Multicultural Education”. The article discusses how understanding and relating to the students helps you close the achievement gap¹. This relates to the first readings we completed during the second week of the Teaching Certificate Program, where the chapters covered the importance of understanding your students.

In the article, the author highlights how a leader will succeed in multicultural education. Harvard Business Review defines multicultural leadership as leadership that leverages deep immersion within different cultures to understand their values and specific context². The value of this kind of insight is so powerful that many kinds of industries are making multicultural understanding central to their business to better suit the needs of their individual customers². Just like businesses need to ensure that each customer feels that their needs are taken care of, learners also need to feel that they are being heard and their educational needs are going to be met.

During the past weeks, we have been learning about instructional design and have been creating our own design project. We learned that to have a successful instructional design, we need to know our target audience. This means that before even creating an activity, we must have an idea about who it is for: their way of learning, what they already know, what is the best way to deliver a message to them, and what they expect from the educator. This becomes a complicated task when you have an audience with different backgrounds. The only way to be successful with your activity is to be a leader with multicultural awareness. A great way to gain this awareness is by reflecting on the kinds of issues that individuals from different backgrounds and cultures may face. It is vital to put yourself in their shoes and understand where they come from, how they were brought up, what their values and priorities are. This information can then be used to project your message in a way that will reach them. The article emphasizes that this reflection occurs continuously, and it must include yourself, the population and future outcomes. You must know how you are impacting your environment and how you are making a change to allow for everyone to obtain the same education and be able to close the achievement gap³.

It is important to note that the education that students receive while in the school of pharmacy forms the foundation for their careers as pharmacists. Throughout workshops and abilities labs, students learn how to interact and communicate with a diverse pool of patients, including how to approach them with difficult questions without making them uncomfortable. A pharmacy teaching culture based on multicultural education will create new pharmacists that are better able to offer their services to the diverse population around them.

Multicultural education can easily be applied to the ADDIE model, where each of the five phases (analysis, design, development, implementation, and evaluation) can benefit from a reflection about the diversity of your audience and how you can tailor your teachings to give each of them the same opportunity to learn. Before coming across this article, I was not aware of the importance of equity in teaching, especially regarding learners of different backgrounds. This new knowledge will have an impact on my self-directed design project, because the project involves reflecting on who my target audience is and why it’s important to teach the topic to that audience. Educators can utilize this article to self-evaluate their teaching styles, and ask themselves if they are doing their part to close the knowledge gap. It will help all educators to adjust their styles and prioritize the learning styles of the target audience. By adjusting to your audience, you are being a leader and you are being responsible in the knowledge you are about to impart to the students. Educational leaders need to “create a new language capable of asking new questions and generating more critical practices⁴”.

Virtual Patient Simulation and the Promotion of Clinical Reasoning Abilities

Sarah Neeler, PharmD, PGY-1 Pharmacy Practice Resident at Kaiser Permanente of the Mid-Atlantic States

          In 2011, it was estimated that nearly all US accredited colleges and schools of pharmacy were utilizing technology to present material and information to students, whether that was through presentation software, videoconferencing, audio response systems, or hardware.⁶  As students of the Educational Theory and Practice course, we are using education technology though blogging, document collaboration, and web-based learning activities.  While we all may be familiar with using technology for education in these ways, new and more sophisticated technology is constantly being developed to increase education and knowledge.  Specifically in the medical field, we have seen great developments in technology to teach upcoming healthcare professionals important patient care and clinical skills.

The Association of American Medical Colleges (AAMC) divides educational technology into three categories: 1) Computer-aided instruction, 2) Human-patient simulation, and 3) Virtual patients.⁴  Computer-aided instruction incorporates interactive instruction that is delivered and directed to learners using computer technology.  This technology utilizes web-based learning and allows individuals to independently explore complex processes and learning.  Human-patient simulation utilizes mannequin and models to simulate a patient care environment.  This helps teach students specific tasks, such as a virtual labor and delivery or endoscopy.  Virtual patient simulation is a specific type of computer-based instruction that simulates actual clinical scenarios and changes in response to learner input.⁴  In today’s blog, I am going to expand upon virtual patient simulation and the impact on clinical reasoning skills and healthcare professionals’ education.

          Virtual patient simulation involves an interactive, simulated patient generated by a computer software program that is used to emulate a realistic clinical scenario.^4-7  You can think of it as a computer-based virtual reality program. Students adopt the role of the healthcare provider and are able to provide therapeutic treatment plans in a safe, controlled environment.^1,7  The computer software allows students to gather information for clinical diagnosis or treatment.  This may involve permitting students to access to the virtual patient’s medical records for them to review laboratory values, past medical history, and medications.  The software does not provide any direction or instruction to the student in regards of what to view or evaluate prior to making a clinical decision.  What is truly unique about virtual patient simulation is that the computer software will adapt and provide non-sequential, individualized responses to the therapy recommended by the students.^1,4-7  It is a safe environment that allows students to practice implementing decisions without posing risk to patients.  It is an environment where students are allowed to make mistakes and evaluate the results of their decisions.  Another benefit of virtual patient simulations is that students can practice working with unique disease states that may not be typically seen in their own practice sites.²  For example, while we have all learned about statin myopathy, we may not see very rare cases of autoimmune myopathy in patients treated with statins in our clinical practices.  Virtual patient simulations help bring both commonly seen and rare disease states together into one program for the benefit of all learners.

          Why should we utilize this technology in pharmacy education?  Virtual patient simulation enables students to adopt the role of healthcare providers and implement their own medical decisions without risk to a patient.^6,7  Students will be able to interview, assess, and propose interventions.  Additionally, students will be able to enhance their counseling skills.  Virtual patients emulate the psychological state of different types of patients and may show a wide spectrum of emotions such as becoming angry, anxious, persuasive, or tearful.⁷  Students will be able to practice real-world skills in a controlled, protected environment to allow them to learn on their own without only watching their preceptors counsel patients and make clinical decisions.  Additionally, educators will be able to assess their clinical and critical thinking skills by reviewing the decisions the students made.^6,7  Teachers will be able to target exact points of care that should have been done differently that would have resulted in a successful outcome for their patients, if needed.

According to the Accreditation Council for Pharmacy Education (ACPE), “graduating pharmacy students must have a competence in providing independent, patient-centered, evidence-based pharmaceutical care”.³  The ACPE has acknowledged virtual patient simulation as an acceptable learning experience in early pharmacy curriculum that is comparable to direct patient care and in June 2010, ACPE’s board approved a policy to allow 20%, or approximately 60 hours, of introductory pharmacy practice experience (IPPE) time to be simulations.³

          So what’s the catch?  Virtual patient simulation has a lot of positive effects on learning and has been accepted by the ACPE as an appropriate form of teaching students, however it comes with a price.  There are high financial costs associated with virtual patient simulation and there is a large time commitment to develop and maintain the technology.  As guidelines change annually and new recommendations and drugs are developed, this technology must be updated to include appropriate medication options and responses.^4,6  Additionally, if patients are interacting with a computer system, they are losing time in an environment that allows physical interaction between students and professors.

          Overall, virtual patient simulation is an up and coming educational technique that provides a fun and interesting opportunity for students to learn in a safe environment.  If facilities are willing to take on the financial and time commitments to optimize virtual patient simulations, students have a great learning opportunity to enhance their clinical reasoning skills.

References:

1.    Aghili R, et al. Virtual patient simulation: Promotion of clinical reasoning abilities of medical students. Knowledge Management & E-Learning: An International Journal. 2012;4(4):518-527

2.    Zary N, et al. Development, implementation, and pilot evaluation of a web-based virtual patient case simulation environment. BMC Medical Education. 2006;6(10):1-17 DOI: 10.1186/1472-6920-6-10

3.    Accreditation Council for Pharmacy Education. Guidance for the accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree. ACPE 2015

4.    Effective Use of Educational Technology in Medical Education. AAMC Institute for Improving Medical Education. Website: https://members.aamc.org/eweb/upload/effective%20use%20of%20educational.pdf Published March 2007.  Accessed March 16, 2017.

5.    Koller V, et al. Technology-based learning strategies. Social Policy Research Associates. Website: http://www.doleta.gov/reports/papers/TBL_Paper_FINAL.pdf Published 2006. Accessed March 16, 2017

6.    Smith M and Benedick N. Effectiveness of educational technology to improve patient care in pharmacy curricula. American Journal of Pharmacy Education. 2015 Feb 17;79(1):15 doi: 10.5688/aipe79115

7.    Jabbur-Lopes M, et al. Virtual patients in pharmacy education. American Journal of Pharmacy Education. 2012 Jun 18;76(5):92.