Keep it Real: Optimizing Patient Encounters in Pharmacy Education

By: Jordan Millin, PharmD

 As a pharmacy student, my experience with patients began in the practice lab with simple counseling activities that gradually developed into complex disease state management encounters. Most of my “patients” in the classroom were pleasant and knowledgeable, giving me all the information I needed to make recommendations and address their chief concerns successfully. However, as I began my clinical rotations, I felt uncomfortable when I counseled the frustrated gentleman picking up his new prescription, interviewed the confused woman who could not recall her medications, and over the phone, consoled the suicidal patient who was suffering from depression. Why was my education not preparing me for reality? 

Current Challenges to Providing Students with Realistic Patient Encounters in the Classroom

Exposure to realistic patient scenarios in the classroom is imperative, but such encounters are often limited by the need for a controlled learning environment. Students require observation and assessment as well as constructive feedback to facilitate learning. Instructors must balance finite time and resources to meet learning objectives. For faculty, creating diverse patient case scenarios is complicated by the risk of introducing bias or inaccurately portraying patient populations. In addition, feedback specific to clinical pharmacy knowledge may be limited by the number of facilitators available to the students during these interactions. Similarly, patient-perceived feedback may be biased if the simulated patients are pharmacists or pharmacy students. 

How can we maximize active learning strategies in the pharmacy practice laboratory to provide complex, realistic patient encounters?

• Telehealth Technology: Preparing students to practice telehealth through mock video or telephone calls with patients provides a unique way to deliver realistic patient experiences to pharmacy students. Telehealth communication could be implemented within the lab using computers and phones to simulate encounters. The American Society of Health-Systems Pharmacists (ASHP) advocates for telehealth utilization in pharmacy operations and patient care.² Because it is a non-traditional means to communicate with patients, telehealth may present challenges to developing patient relationships. Adding opportunities to engage with telehealth modalities in the practice lab is key to helping students develop communication skills that will transcend the technology barrier to forge meaningful relationships with patients in practice.  

• Diverse Patient Encounters: Standardized patients are an excellent opportunity to foster student learning under conditions that mimic clinical practice. A standardized patient could be a pharmacist, pharmacy student, or actor who has been trained to portray a character or a patient problem as described in a scripted case who can deliver consistent, similar performances with every student.³ Importantly, these patients expose students to clinical scenarios in a safe and predictable learning environment.³ To make these encounters more realistic, the patient case could be adapted to present the student with various scenarios: patients with behavioral problems, limited knowledge of their prescriptions or conditions, food insecurity or limited resources, insurance concerns, et. The risk of inaccurately portraying patient populations in these activities could be reduced by using actual encounters experienced by faculty to inspire these lab cases. The key opportunity with encounters in the lab is enhancing the scripts and cases of the standardized patients to reflect realistic patient scenarios that will likely be encountered in pharmacy practice. 

• Simulations: High-fidelity human patient simulators (HPS) provide a unique opportunity in pharmacy education.⁴ HPS provides students with a hands-on experience similar to real-life clinical settings. They allow students to gather patient data, make real-time decisions, learn about interprofessional roles, and implement interventions without potential patient harm.⁴ One study compared HPS to case-based learning (CBL) in undergraduate pharmacy students learning about diabetic ketoacidosis and thyroid storm.⁴  More than 60% of the students strongly agreed that HPS improved their understanding of the cases, and nearly 80% felt that HPS sessions should be incorporated into the pharmacy curriculum.⁴ The key opportunity with simulations is bringing the real-world clinical atmosphere into the classroom. 

• Virtual Reality: Another exciting application of technology for simulations is virtual reality (VR). VR creates a virtual environment that mimics the sensations and stimuli experienced in real life, where one’s actions can directly impact that virtual environment in real time. VR headsets have become increasingly popular and have the ability to flawlessly transition between different simulations, presenting countless opportunities for hands-on learning without leaving the classroom. Currently, only a handful of educational VR programs exist, including The BodyVR, Engage, and Human Anatomy VR.⁵ The key opportunity with VR technology is allowing students to immerse themselves in a myriad of realistic experiences that mimic clinical practice, expanding the scope of exposure to such scenarios within a safe learning space. 

How will you create and innovate unique, challenging, and realistic learning experiences to propel pharmacy students into successful patient encounters in the real world?

Acknowledgments:  David Matthews, PharmD, BCACP

References:

1. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. Guidelines Version 2.0. 2011. 
2. Begnoche BR, David Butler C, Carson PH, et al. ASHP Statement on Telehealth Pharmacy Practice. Am J Health Syst Pharm. 2022;79(19):1728-1735. doi:10.1093/ajhp/zxac188.
3. Smithson J, Bellingan M, Glass B, Mills J. Standardized patients in pharmacy education: An integrative literature review. Curr Pharm Teach Learn. 2015;7(6):851-863. doi: https://doi.org/10.1016/j.cptl.2015.08.002.
4. Lee Chin K, Ling Yap Y, Leng Lee W, Chang Soh Y. Comparing effectiveness of high-fidelity human patient simulation vs case-based learning in pharmacy education. Am J Pharm Educ. 2014;78(8):153. doi:10.5688/ajpe788153.
5. Coyne L, Merritt TA, Parmentier BL, Sharpton RA, Takemoto JK. The Past, Present, and Future of Virtual Reality in Pharmacy Education. Am J Pharm Educ. 2019;83(3):7456. doi:10.5688/ajpe7456.

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Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning