Monday, September 19, 2022

Teaching Student Pharmacists to Apply Drug Literature

Ji-Yeon ‘Lis’ Kim

PGY-1 Pharmacy Resident

Sinai Hospital of Baltimore (Lifebridge Health)


In 2014, the Joint Commission of Pharmacy Practitioners published the Pharmacists’

Patient Care Process (PPCP).1 It is meant to provide pharmacists with a patient-

centered framework on providing clinical care through five steps: collecting patient

information, assessing patient information, developing an evidence-based care plan,

implementing the care plan, and following up to evaluate the effectiveness of the

plan. When it comes to the third step, developing an evidence-based care plan, it is a

key element for pharmacists to be able to interpret and evaluate medical literature

before applying its findings to a patient.1

Journal clubs are a common learning tool for student pharmacists and have been

utilized in healthcare professional education for over 150 years.2 The main goal is to

discuss medical literature in a group setting with other healthcare professionals,

improve evidence-based practice skills, and bring to attention new drug information

in studies. The focus of journal clubs is usually on the primary article at hand, and

potentially on related pharmacology, general drug information, clinical practice

guidelines, and key prior studies. However, there is a lack of evidence on whether

describing published articles in journal clubs truly help students to integrate the drug

literature evaluation to the care of an actual patient.1

The Manchester University PharmD program set out to assess the impact of drug

literature evaluation activities on pharmacy students’ ability to apply the primary

literature to patient cases. Foundational principles of evidence-based medicine were

taught in two courses in the first professional (P1) year that focused on first

gathering and interpreting information from tertiary drug information sources before

moving on to interpreting primary drug literature. The students further practiced in

their pharmacy practice laboratory (PPL) into their third professional (P3) year to

build on concepts already taught in the didactic curriculum.1

Manchester University transitioned from an ability-based outcomes (ABO) model to

an entrustable professional activities (EPA) model which ensures that learners

become proficient in essential competencies before undertaking them independently.

The didactic courses incorporated active-learning, such as project-based learning,

flipped classroom, and discussion guided by a constructivist approach to pedagogy.1

2-hour case-based article discussions were introduced in their P2 year, and during

class, students engaged in small-group discussion-based activities where they

applied these studies to a patient case. The primary class objectives were for

students to determine whether the study would apply to the patient according to the

inclusion/exclusion criteria and baseline characteristics, and whether results were

statistically and clinically significant to warrant use for the patient. During their P3

year, students engaged in a journal club series to prepare them for APPEs by

continuing to practice evaluating primary literature, use tertiary drug information

sources, and eventually apply to patient cases.1

A longitudinal assessment based on performance and perceptions was conducted by

Manchester University on a cohort of enrolled P3 students. Instructors were

responsible for evaluating the students’ journal clubs based on a standard rubric, and

an electronic assessment was created with multiple-choice/multiple-select questions

on determining whether a study would apply to a patient based on

inclusion/exclusion criteria and baseline characteristics (71.8% selected the correct

answer), whether results were statistically significant (100% selected the correct

answer), and whether results were clinically significant. The last objective used a

multiple-select question, with 62% selecting the three correct answers. Ultimately,

the study found a substantial improvement in pass rate from the initial evaluation to

their final evaluation at the end of P3 semester. Subjectively, an improvement in

self-confidence among P3 students to lead and participate in journal club discussions

was found in a post-intervention assessment.1

The integration of evaluating primary drug literature through journal club activities

into the students’ longitudinal pharmacy curriculum may be helpful in training

student pharmacists to apply future literature to patient cases in healthcare settings.

While journal clubs are traditionally used to discuss emerging literature, there is a

lesser used method of using clinical debates in health education, with both sides

presenting an argument with a rebuttal following and finally a summarization of the

argument at the end. A recent study in 2021 by Steuber et al. conducted a two-year

prospective study in which 50 students participated in a journal club as well as a

clinical debate during their APPE experience.2 The students completed a 10-item

knowledge assessment after each activity.2 After assessment scores were analyzed,

there were no differences between journal club and clinical debate assessment

scores.2

Regardless of the methods used, journal clubs or clinical debates, the ability to

critically evaluate up-to-date information on the treatment for patients is a vital role

for pharmacists on a healthcare team. It is also a skill that is necessary to complete

the Pharmacists’ Patient Care Process, which is a key element of the 2016 ACPE

standards in creating the Doctor of Pharmacy program curricula in using the PPCP in

practice. Therefore, it is crucial for pharmacy curricula to ensure that student

pharmacists are trained and able to demonstrate competence in evaluating literature

and applying the results to patient cases.

References

1. Beckett RD, Henriksen JA, Hanson K, Robison HD. Teaching student pharmacists to apply drug literature to patient cases. American Journal of Pharmaceutical Education. 2017;81(2):34. doi:10.5688/ajpe81234

2. Steuber T, Isaacs AN, Howard ML, Nisly SA. Effectiveness of journal club activities versus clinical debate activities in pharmacy experiential education. American Journal of Pharmaceutical Education. 2021;86(1):8562. doi:10.5688/ajpe8562

No comments:

Post a Comment