Interprofessional Experiential Education in the Hospital

Elizabeth You, PharmD

PGY1 Non-traditional Pharmacy Resident

Children’s National Hospital

“Learning is the process whereby knowledge is created through the transformation of experience.”

- David Kolb

Working in the healthcare setting requires health professionals to work collaboratively to provide high quality patient care. Several accrediting institutions for healthcare education have required the incorporation of interprofessional education (IPE) and in 2007, the Accreditation Council for Pharmacy Education issued the incorporation of direct patient care into the Doctor of Pharmacy program¹. Students are now exposed to working cooperatively within a group of pharmacy, medical, nursing, and physical therapy students, among other practicing professionals. Together, they practice and demonstrate proficiency in providing patient care as part of a multi-disciplinary healthcare team.

As part of the Doctor of Pharmacy experiential curriculum, pharmacy students are required to practice in patient care during clinical rotations and are incorporated into the medical team. Students conduct medication reconciliation, refer complicated cases to clinical specialists, answer drug information questions, and perform discharge counseling¹. Along with a preceptor, students also evaluate patients’ medical charts and make interventions on medication therapy. For example, a patient with stage 3 chronic kidney disease with a creatinine clearance of 10mL/min developed an infectious disease. The physician on the primary team consulted the infectious disease fellow, who asked the pharmacy student on his infectious disease rotation to provide renal dosing information for an antibiotic he recommended. The student came up with the renal dosing of the antibiotic, then contacted the physician on the primary team to inform him of the dose. The pharmacy student also informed the nurse that the oral antibiotic should be taken with food. Patient care activities such as these enhance the student’s proficiency in managing drug therapy problems and ability to effectively communicate and work through the problems with other health professionals.

Embedded in interprofessional education is the constructivism learning theory that David Kolb alluded to in his introduction of the experiential learning cycle². His theory postulates that people learn by integrating their concrete emotional experiences with reflection. A learner goes through four stages that occur in a cycle, where new knowledge and skills are achieved through concrete experience, reflective observation, abstract conceptualization, and subsequent active experimentation². In the healthcare profession, this process can be observed in active learning through role playing, such as when a pharmacy student fulfills his or her role as the clinical pharmacist within a multi-disciplinary healthcare team.

An article by Coppock demonstrated the benefits of an interprofessional program in which pharmacy and optometry students participated in the presentation of topic discussions, examination of over-the-counter ophthalmic products, and discussion of the clinical implications of medications in patient cases³. In the post-activity survey, pharmacy students said that they gained a deeper understanding of ophthalmic conditions, and optometry students learned more about the usage of ophthalmic medications³. In a meta-analysis conducted by Guraya et al., the analysis of 12 articles showed that multidisciplinary health professional students experienced statistically significant improvement in objective knowledge, understanding the role of other disciplines, and attitudes toward health care teams⁴.

Kolb and other theorists of constructivism maintain that experience alone does not teach a person. To acquire a new skill, the student must reflect on his or her experiences, and process internally about how they will make sense of their experience. The student then shapes or changes his or her previous understanding, which will enable the student to test out their ideas actively⁵. Application of this theory will catalyze the beginning of a new experiential learning cycle, where the learner can reinforce or re-shape the idea depending on what happens during the experimentation. Lifelong learning defines a healthcare professional’s career, especially while he or she directly cares for patients in a clinical setting. Interprofessional experiential education should be introduced early in a health professional student’s career, as it will be instrumental in preparing the student to become a successful clinical pharmacist. 

References:

1.    Rathbun RC, Hester EK, Arnold LM, et al. Importance of Direct Patient Care in Advanced Pharmacy Practice Experiences. Pharmacotherapy. 2012;32(4):e88-e97.

2.    Kolb, D. A. Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, NJ: Prentice Hall; 1984.

3.    Coppock, K. Interprofessional Education Programs Focus on Pharmacists as Patient Care Providers. Pharmacy Careers. 2019;13(2). November 5, 2019. Accessed August 29, 2021. https://www.pharmacytimes.com/view/interprofessional-education-programs-focus-on-pharmacists-as-patient-care-providers

4.    Guraya SY, Barr H. The Effectiveness of Interprofessional Education in Healthcare: A Systematic Review and Meta-analysis. Kaohsiung J Med Sciences. 2018;34:160-165.

5.    Fenwick TJ. Experiential Learning: A Theoretical Critique from Five Perspectives. Information Series 385. Columbus, OH: ERIC Clearinghouse; 2001.