The Utility of Simulation Based Learning within Pharmacy School Curriculums

Reid LaPlante, PharmD
PGY1 Pharmacy Resident
University of Maryland Medical Center

         Throughout pharmacy school curricula, the use of simulation-based learning is incorporated into many aspects of the instructional design of each college of pharmacy within the United States, as required to maintain the Accreditation Council for Pharmacy Education (ACPE) Standards.¹ Simulation learning has been utilized for patient-pharmacist, pharmacist-provider, and pharmacist-interprofessional team interactions for abilities labs, integrative problem solving courses, therapeutic modules, and IPPE/APPE simulations. The theory behind using these practices is to develop a more confident, well communicated, and independent pharmacist upon graduation from an ACPE accredited pharmacy school, but the question is does this truly occur due to these simulations or do they just cause extra stress for pharmacy students and extra work for pharmacy school instructors.

        The use of simulation-based learning is a common method utilized by pharmacy schools that allows students to practice their skills by mimicking real-life scenarios, but in a clinical risk-free setting.² To the contrary, during pharmacy school, anecdotally, simulation-based learning made a majority of pharmacy students very nervous and potentially could impact both their performance in the simulation, as well as their confidence as a student pharmacist. Furthermore, many students failed to see the utility of their participation within simulations, and how it would truly benefit them as a practicing pharmacist. Therefore, the benefit of this needs to be elucidated to outweigh weigh this potential risk imposed on pharmacist students. Fortunately, this has been evaluated and studied by various professors of pharmacy and in many different aspects of pharmacy school curricula.

        The most prominent use of simulation-based learning in pharmacy school curricula is within various types of pharmacy abilities/skills labs for objective structured clinical evaluations (OSCE).³ OSCE can utilize many different types of simulation-based learning including high fidelity manikins, medium fidelity manikins, standardized patients, role playing, and computer-based simulations. Furthermore, many different pharmaceutical tasks have been integrated into OSCE through simulation-based learning including physical assessment, medication reconciliation, code response, and provider and patient interactions. When surveyed more than 60% of pharmacy students feel more confident in their communication abilities with patients and making pharmaceutical recommendations after participation within simulation-based learning with standardized patients.⁴ This data comes from Cho et al, where they furthermore demonstrated that more than 60% of pharmacy students felt less anxious after these simulations. This cross-sectional study also surveyed pharmacy practice faculty, where greater than 70% of faculty members found that working with standardized patients was not difficult, and greater than 90% of faculty members would agree to continue to use standardize patients in the future for more simulation-based learning. Another outlook on the use of simulation-based learning within pharmacy labs was by Fidler et al.² In this survey-based study, Fidler utilized virtual patient simulations as part of a required pharmacy course to assess students’ readiness for IPPEs. Fidler found many benefits in various outcomes to using virtual simulations from comparing scores from the beginning of the semester to the end of the semester. All subjective and objective data collected during these assessments showed a statistical significance from the beginning of the semester to the end of the semester, signifying more prepared pharmacy students for IPPE rotations. Furthermore, like Cho et al, Fidler also found a significance in an increase in pharmacy student confidence after the use of simulation-based learning, even with use of a virtually based platform, with an increase from 53% feeling confident pre-simulation to 83% feeling confident post-simulation. All in all, more studies beyond Cho et al and Fidler et al, continued to find these benefits of increased pharmacist student confidence, as well as pharmacy student clinical improvement post-simulation-based learning within OSCE or abilities/skills labs.

        Another major area of use of simulation-based learning is within IPPE and APPE clinical rotations. Similarly, to lab-based simulations, there have been benefits seen of utilizing simulation-based learning during IPPE and APPE clinical rotations.⁵ Clinard et al found using post survey data that full environment simulations utilizing a high-fidelity mannequin with high acuity poisoning scenarios and an antidote tasting sessions that greater than 90% of pharmacy students found value in these simulations.⁵ These sessions were also incorporated with other medical professionals including medical students, emergency medicine residents, and pediatric physician residents that also continued to help pharmacy students to develop their closed-loop communication skills. Furthermore, this led to more than a 50% increase in pharmacy students understanding the term of closed-loop communication. In the end, these simulations enforced interprofessional teamwork, especially in with improved communication skills, with an overwhelming positive experience seen by majority of pharmacy student participating.

The utilization of simulation-based learning has been integrated and thoroughly studied in various settings throughout pharmacy student education. This research overwhelmingly demonstrates a positive utility for producing more prepared, better communicated, and increasingly more independent pharmacists at the end of pharmacy school curricula with incorporated simulation-based learning. Pharmacy educators should advocate for more use of simulation-based learning opportunities for their students, so they can gain more exposure and be better prepared for the workforce upon graduation.

References:

1.   Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree (“Standards 2016”), Accreditation Council for Pharmacy Education (2015) https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf

2.   Fidler BD. Use of a virtual patient simulation program to enhance the physical assessment and medical history taking skills of doctor of pharmacy students. Curr Pharm Teach Learn. 2020 Jul;12(7):810-816. doi: 10.1016/j.cptl.2020.02.008. Epub 2020 Mar 18. PMID: 32540042. https://www-sciencedirect-com.proxy-hs.researchport.umd.edu/science/article/pii/S1877129720300836?via%3Dihub#bb0025

3.   Vyas D, Bray BS, Wilson MN. Use of simulation-based teaching methodologies in US colleges and schools of pharmacy. Am J Pharm Educ. 2013 Apr 12;77(3):53. doi: 10.5688/ajpe77353. PMID: 23610471; PMCID: PMC3631728. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631728/pdf/ajpe77353.pdf

4.   Cho JC, Wallace TD, Yu FS. Pharmacy faculty and students' perceptions of standardized patients for objective structured clinical examinations. Curr Pharm Teach Learn. 2019 Dec;11(12):1281-1286. doi: 10.1016/j.cptl.2019.09.006. Epub 2019 Oct 25. PMID: 31836154. https://www-sciencedirect-com.proxy-hs.researchport.umd.edu/science/article/pii/S1877129718304544?via%3Dihub

5.   Clinard VB, Kearney TE, Repplinger DJ, Smollin CG, Youmans SL. An interprofessional clinical toxicology advanced pharmacy practice experience. Curr Pharm Teach Learn. 2019 May;11(5):505-512. doi: 10.1016/j.cptl.2019.02.002. Epub 2019 May 3. PMID: 31171253. https://www-sciencedirect-com.proxy-hs.researchport.umd.edu/science/article/pii/S1877129718302041?via%3Dihub