Ji-Yeon ‘Lis’ Kim
PGY-1 Pharmacy Resident
Sinai Hospital of Baltimore (Lifebridge Health)
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
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