Simulation-Based Instruction

Terra Landis, Pharm.D.

The most prominent goal in any educational setting is to produce an individual who is ready to handle the real-world situations they shall face in their profession. The Accreditation Council for Pharmacy Education (ACPE) Standards and Guidelines states that colleges and schools of pharmacy are expected to graduate pharmacists who are competent to provide patient care.1,2,3 In order to produce confident and competent professionals, it makes a great deal of sense that those individuals shall have practiced using their clinical skills as a part of their school’s curriculum. Instructional design shall always involve analyzing the learning needs of a group of students and designing methods to meet those needs.4 For well over a decade, simulation-based instruction has become increasingly popular in pharmacy schools as a means of producing confident practitioners. Simulation-based learning provides an opportunity to apply previously acquired knowledge and skills in a realistic setting. It allow for control over the content of a learning situation while limiting the risk that may be associated with students making direct patient care decisions.1 In 2010, ACPE acknowledged this type of learning as valuable and now allows for simulation-based activities to account for up to 20% of the total required introductory pharmacy practice experience (IPPE) time.1,2,3

The Literature
Literature suggests that simulation-based instruction enhances student learning while targeting a higher level of Bloom’s Taxonomy.1,2,3 In a recent review by Hasan, et al.1 of the literature surrounding simulation-based learning, it was noted that simulation in nursing school curriculum, when combined with experiential learning, was associated with the highest scores in knowledge retention and clinical skills. With that being said, it appears that neither direct patient care experience nor simulation-based learning is superior to the other, and the best results come from a combination of the two. In terms of pharmacy school education, the evidence points towards simulation-based learning as being associated with enhanced abilities for resolving medication-related problems, performing medication reviews, and performing physical examinations. It was also associated with improved psychomotor abilities such as taking a blood pressure. As well, the literature shows that, compared to pharmacy students who do not participate in simulation exercises, pharmacy students who participate in simulation exercises have significantly increased knowledge retention for disease states such as asthma, decompensated heart failure, and infective endocarditis.3 From an economical stand-point, simulation-based learning has been shown to be much more feasible given that standardized patients are readily available. The largest limiting factor in this type of learning environment is simply that these are not real patients or situations, which may affect student engagement. As long as students are engaged in the learning activity, positive outcomes can be expected and skills may be transferable to real patient care.1,2

Application
There is a clear benefit to introducing simulation-based learning activities throughout the pharmacy school curriculum. From the literature, as well as from personal experience, simulation-based learning models build confident practitioners and reduce the risk of mistakes when delivering actual patient care. As an educator, this type of learning should always be considered as an option in order to allow students the opportunity to apply new knowledge in ways that reflect real situations they will encounter on rotations and in practice. It is important to keep in mind that there are several manners through which simulation can be provided. Examples of simulation-based instruction include: standardized patients, virtual patients, computer-based simulations, objective structured clinical examination, and human patient simulation.2 In designing instruction to best fit the needs of soon-to-be pharmacists, one can use any and all of these delivery methods to ensure the
development of confident and competent practitioners. Another method that I have found to be of great benefit is the use of interprofessional simulation, which best reflects team dynamics and obstacles that are encountered in real-world practice.2



References:
1. Hasan S, Chong D, Se W, et al. Simulation-based instruction for pharmacy practice skill development: A review of the literature. Arch Pharma Pract [Internet]. 2017 [cited 4 Nov 2018];8(2):43. Available from: http://www.archivepp.com/article.asp?issn=2045-080X;year=2017;volume=8;issue=2;spage=43;epage=50;aulast=Hasan
2. Kane-Gill S, Smithburger P. Transitioning knowledge gained from simulation to pharmacy practice. Am J Pharm Educ [Internet]. 2011 [cited 4 Nov 2018];75(10):210. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279027/
3. Bray B, Schwartz C, Odegard P, et al. Assessment of human patient simulation-based learning. Am J Pharm Educ [Internet]. 2011 [cited 4 Nov 2018];75(10):208. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279041/
4. Khalil M, Elkhider I. Applying learning theories and instructional design models for effective instruction. Adv Physiol Educ. [Internet]. 2016 [cited 4 Nov 2018];40(2):147-156. Available from: https://www.physiology.org/doi/full/10.1152/advan.00138.2015