Critical Care Course Research Articles

Physiological Knowledge Loss in Fourth-Year Nursing Students

There is a growing concern that nursing students struggle to retain adequate physiological knowledge throughout their program to meet their entry to practice competencies. However, how much and what knowledge is lost and when this occurs over a four-year undergraduate Bachelor of Science in Nursing program remains to be evaluated. Moreover, physiological knowledge retention has not been studied as extensively as anatomical knowledge retention in health care disciplines, including nursing programs (Narnaware, Y., 2021). Most of these studies are conducted after graduation (Aari et al., 2004) or focused on very limited systems (Pourshanazari et al., 2013). The present study aims to evaluate the level of physiological knowledge loss by nursing students in the fourth year between completing their physiology course in first-year nursing and fourth-year Critical Care nursing course . To evaluate physiological knowledge loss in the fourth year, nursing students were quizzed on ten organ systems using the online quizzing platform- Kahoot. Approximately nine to eleven knowledge and comprehension-level multiple-choice questions were delivered via kahoot. Then, these scores were compared to first-year quiz scores on the same content to determine overall knowledge loss over three years. Using SPSS II, the data was analyzed, and means were compared using 2-sample t-tests. The scores are described for each organ system by reporting the mean and standard deviation (±SD) with statistical significance set at P < 0.05 for all tests. The mean score of questions from all organ systems in year one was 62.89 ± 10.49 (±SD). Comparing that score to matched test items evaluated in the Critical Care course, there is a decrease in the overall mean score from 62.89 ± 10.49 (±SD) to 47.69 ± 8.23 (±SD). This equates to a 15.2% knowledge loss or 84.8% retention rate within three years. Organ-specific knowledge loss was highest for fluid and electrolytes (30.7%), hormones (28.6%), defences (22.5%), and reproductive physiology (22.5%), followed by renal physiology (19.7%). Knowledge loss was comparatively lower for blood (15.9%), inflammation (11.2%), vascular (7.5%) and respiratory physiology (4.7%). However, this loss was lowest for digestive physiology (-3.7%). The results of this study demonstrate a lower level of knowledge loss overall, with variations in loss being system-specific. The level of knowledge loss in the present study was significantly lower than previously reported in medical and allied health students (Pourshanazari et al., 2013) and lowest than anatomical knowledge retention levels in the same population (Narnaware and Neumeier, 2021). However, compared to the third year, knowledge loss in the fourth year is not significantly different (Narnaware et al., 2021). Applied for Teaching Physiology Section- Travel Fellowship Award. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Everyone Is Listening: Podcasts as an Innovative Educational Approach in Graduate Level Education.

Over the past decade, graduate level nursing education has transitioned from synchronous, classroom-based models to hybrid, asynchronous models. This change has increased the amount of screen-time for graduate learners and generated the problem of screen-fatigue. To reduce screen-based learning time, faculty transitioned a didactic critical care course to a podcast-based educational format. This pilot study used a pre-course and post-course survey to evaluate the efficacy of podcasts in delivering course content, meeting course objectives, and understanding learners' perceptions of podcasts in education. Pre-course and post-course survey data demonstrated that podcasts successfully met course objectives and provided content that was equally or more engaging than screen-based lectures. Podcasts can be successfully incorporated into a didactic course as a content delivery modality and are an innovative strategy for engaging adult learners in an asynchronous, distance-friendly format while continuing to meet educational objectives. [J Nurs Educ. 2024;63(5):335-337.].

Promoting Collaborative Learning Through the Design of an Interprofessional Critical Care Course.

Leonard, Christina DNP, RN; Cadavero, Allen PhD, RN; Zomorodi, Meg PhD, RN Author Information

Enhancing Palliative Communication in the Intensive Care Unit Through Simulation: A Quality Improvement Project

BackgroundPalliative communication is a vital aspect of patient and family-centered end-of-life care in the intensive care unit. Despite this, specialty-specific training and education in palliative communication are generally limited for critical care nurses. The purpose of this quality improvement project was to assess the effect of adding a simulation-based learning experience to the existing End of Life Nursing Education Consortium adult critical care course on critical care nurse comfort with palliative communication as a component of end-of-life care. MethodUsing a pretest/post-test design, 11 critical care nurse participants completed a measure of comfort related to end-of-life communication prior to the course and immediately following the simulation experience. ResultA paired-samples t-test showed a statistically increase in comfort with palliative communication from the pretest (M = 56.36, SE = 2.40) to post-test (M = 48.27, SE = 2.97), t (10) = 2.54, p = .30 (two-tailed), The mean decrease in scores was 8.09, 95% CI (0.98, 15.91). Qualitative survey responses indicated that the simulation provided valuable practice of palliative communication techniques. ConclusionA simulation-based learning experience incorporated into an existing palliative care education course is feasible to implement and increased critical care nurse comfort with palliative communication at end-of-life.

Deliberate practice and cardiopulmonary resuscitation: Integration in the classroom, lab, and simulation

Deliberate practice offers a foundation for learning experiences based on real-life situations through repetition. Single demonstrations of a skill are often ineffective in determining mastery in undergraduate nursing students. Ninety-eight fourth-semester learners enrolled in the critical care course of a pre-baccalaureate program. A deliberate practice approach to learning was implemented in a fourth-semester undergraduate nursing course to evaluate learner knowledge, skills, and performance, as a quality improvement initiative. Multiple activities comprised of skills stations, lecture, an ECG review, and a simulation-based experience were used to allow learners to gain mastery. Evidence revealed that a combined SBE in classroom and simulation lab help learners retain knowledge. Learners reported this approach also improved their ability to critically think and confidence in performance. The implementation of deliberate practice in the simulation environment allows for exposure to real life circumstances in a controlled atmosphere, helping learners preserve information and understanding.

Telehealth as a public health approach to mitigate the COVID-19 pandemic in Pakistan: A narrative review.

Technology is instrumental in delivering health services, especially telehealth during the COVID-19 pandemic. This article aimed to explore the role of telehealth as a public health approach to support responses to address the COVID-19 pandemic in Pakistan. We developed this article by mapping existing telehealth initiatives developed and implemented during the COVID-19 pandemic in Pakistan. The initiatives were identified searching online portals such as Google Scholar, PubMed, and websites of various governmental and non-governmental agencies. The services are categorized into teleconsultation and follow-ups, online vaccine registration, information dissemination, high-risk subset tracking, virtual Health Care Worker (HCW) and medical student training, and tele-psychological counseling. The teleconsultation category offers online registration and follow-ups. Information dissemination services include federal helpline, SMS alerts, and social media campaigns. The high-risk subset tracking services include app-based COVID-19 checks and online surveys. Virtual HCW and medical student training services include tele-ICU support, COVID-19 critical care courses, and COVID management courses. The tele-psychological counseling services offer helplines for emotional support, proactive counseling for COVID-19 patients, and mental health support and psychiatry services. Telehealth interventions provided novel solutions amid health and social crises such as the COVID-19 pandemic. Health care systems need to expand telehealth services and ensure that health care organizations deliver effective and safe medical care. However, future research should focus on assessing the impact of telehealth on population health.

NURSING STUDENTS’ MOTIVATION TOWARD BLENDED LEARNING AT A PRIVATE UNIVERSITY IN TANGERANG

<p>Motivation can be a driving force for learning that is manifested by the attention of students in blended learning. Blended learning is a combination of online learning and face-to-face learning models. Faculty of Nursing at one private university in Tangerang, is currently developing a blended learning model. The learning is applied to several subjects including Emergency and Critical Care and Disaster Management courses. When the pandemic hit Indonesia, the education system suddenly shifted to online learning. It then pushed students and teachers to master the use of technology, in order to ensure the effectiveness of its implementation. It is indeed significant, given that there are several challenges with a blended learning model, such as internet connection, inadequate facilities or devices, and students’ tendency to procrastinate. It is also important to know students’ perception toward blended learning for the better implementation in the future. This study sought to explore the motivation of nursing students at one private university in Tangerang toward blended learning. To achieve the objective, a descriptive quantitative research method was utilized. The sample consisted of 207 third year nursing students who learned with a blended learning method. The data were collected using The Motivated Strategies for Learning Questionnaire (MSLQ) in May 2020 by online survey form. The data were then analyzed using univariate analysis. It showed that 70% students had high learning motivation while the remaining 30% had low learning motivation. Hence, blended learning was assumed to be effective and worth keeping for nursing education. </p>

Utilizing a High-Fidelity COVID-19 Simulation to Develop Collaboration Skills Among Multispecialty Cohorts.

Nursing students rarely have the opportunity to witness nurse-to-nurse collaboration with nurses from differing specialties. Simulation can provide students with an opportunity to practice this important skill. In this simulation, students from a critical care course and students from a maternal/newborn course worked together to care for a pregnant client with COVID-19. The client's condition required expertise from both an obstetrical nurse and a critical care nurse. Although the design of the simulation was aimed at collaboration, various other important observations and teaching moments were uncovered during the implementation of the simulation.

The History of Medical Ethics in India

The History of Medical Ethics in India

Preop to PACU: A Nursing Orientation Program for Preop Nurses to Attain Competency in the Care of the PACU Patient

Background Information Perioperative patient throughput has been affected due to infrastructure changes, increased volume of outpatients, new patient populations, admissions, and recovering inpatients returning to their unit. The extended wait times for placement throughout the hospital and the potential increase in the incidence of operating room (OR) holds prompted training of the preoperative nursing staff to a post anesthesia care unit (PACU) in a large academic medical center. Objectives of Project: Objectives of the project include (1) Prepare and train all preoperative nurses with minimal critical care background with the clinical skills to safely care for all patient populations in PACU. Process of Implementation The perioperative leadership team acknowledged cross-training as a judicious solution maximizing patient throughput. The leadership team and 3 clinical level IV nurses developed a comprehensive, cross- training orientation program for the preoperative nursing staff to ensure competency in caring for the PACU patient. The orientation included a two-day, 10 hours in length, critical care course and an 8 week bedside orientation with identified preceptors. The critical care course content encompassed the didactic components of a comprehensive PACU nursing orientation program based on the Perianesthesia Core Curriculum. The didactic curriculum, along with the bedside orientation process, covered patient progression through both phase I and phase II of the perioperative levels of care. The implementation of simulation and the utilization of case studies, and competency assessment tools provided a multimodal approach to ensuring the preoperative nurses acquired sufficient knowledge and assessment skills in the PACU clinical setting. Training began with the ‘pilot’ orientation of 2 preoperative nurses and one medical-surgical nurse to the PACU setting. The goal was to have all preoperative nurses complete the program. Statement of Successful Practice All nurses completed the orientation program and have been successfully trained to safely care for all PACU patients independently. An anonymous survey administered to all nurses who completed the program expressed that the education and training program prepared them to care for all patient populations in the PACU setting. Implications for Advancing the Practice of Perianesthesia Nursing The orientation program has created a comprehensive nursing team which allows for efficient distribution of staffing to facilitate perioperative patient care and throughput. Perioperative patient throughput has been affected due to infrastructure changes, increased volume of outpatients, new patient populations, admissions, and recovering inpatients returning to their unit. The extended wait times for placement throughout the hospital and the potential increase in the incidence of operating room (OR) holds prompted training of the preoperative nursing staff to a post anesthesia care unit (PACU) in a large academic medical center. (1) Prepare and train all preoperative nurses with minimal critical care background with the clinical skills to safely care for all patient populations in PACU. The perioperative leadership team acknowledged cross-training as a judicious solution maximizing patient throughput. The leadership team and 3 clinical level IV nurses developed a comprehensive, cross- training orientation program for the preoperative nursing staff to ensure competency in caring for the PACU patient. The orientation included a two-day, 10 hours in length, critical care course and an 8 week bedside orientation with identified preceptors. The critical care course content encompassed the didactic components of a comprehensive PACU nursing orientation program based on the Perianesthesia Core Curriculum. The didactic curriculum, along with the bedside orientation process, covered patient progression through both phase I and phase II of the perioperative levels of care. The implementation of simulation and the utilization of case studies, and competency assessment tools provided a multimodal approach to ensuring the preoperative nurses acquired sufficient knowledge and assessment skills in the PACU clinical setting. Training began with the ‘pilot’ orientation of 2 preoperative nurses and one medical-surgical nurse to the PACU setting. The goal was to have all preoperative nurses complete the program. All nurses completed the orientation program and have been successfully trained to safely care for all PACU patients independently. An anonymous survey administered to all nurses who completed the program expressed that the education and training program prepared them to care for all patient populations in the PACU setting. The orientation program has created a comprehensive nursing team which allows for efficient distribution of staffing to facilitate perioperative patient care and throughput.

Nurses’ motivations and desired learning outcomes of postgraduate critical care studies: A descriptive exploratory study

BackgroundEducation guidelines and professional practice standards inform the design of postgraduate critical care nursing curricula to develop safety and quality competencies for high-quality care in complex environments. Alignment between nurses’ motivations for undertaking postgraduate critical care education, and intended course learning outcomes, may impact students’ success and satisfaction with programs. ObjectivesThe objectives of this study were to explore nurses’ motivations and desired learning outcomes on commencement of a postgraduate critical care course and determine how these align with safety and quality professional attributes. MethodsIn this exploratory descriptive study, qualitative data were extracted from survey responses of four cohorts of students enrolled in a graduate certificate–level critical care course between 2013 and 2016 (N = 390, 93%), at one Australian university. Summative qualitative content analysis was used to code and quantify textual content followed by synthesis to identify themes and subthemes. ResultsFive themes of motivations were identified: (i) Knowledge development; (ii) Skill development, (iii) Personal outcomes, (iv) Personal professional behaviours, and (v) Interpersonal professional behaviours. Most frequently, students' motivations and desired learning outcomes included ‘Understanding’ (329 participants [84%], 652 references), ‘Development of technical skills’ (241 participants [62%], 384 references), ‘Development of confidence’ (178 participants [46%], 220 references), and ‘Career progression’ (149 participants [38%], 168 references). Less frequent were motivations related to safety and quality competencies including teamwork, communication, reflective practice, and research skills. ConclusionFindings suggest students' motivations to undertake postgraduate studies most often related to acquisition of new knowledge and technical skills. Desired skills and behaviours were consistent with many, but not all, of the key course outcomes and attributes specified by health professional education guidelines and nurses' professional practice standards. Understanding the differences between students’ motivations and desired safety- and quality-related course learning outcomes informs course orientation, teaching activities, and student support to optimise achievement of essential learning outcomes.

ACTUALIZACIÓN DEL MANEJO PREHOSPITALARIO DEL PACIENTE CON TRAUMA GRAVE

INTRODUCTION The goals of pre-hospital care for severe trauma are the detection of lifethreatening injuries, the early application of therapeutic measures and the timely transfer to an appropriate hospital centre. The response of the emergency services to major trauma incidents involves different responders with specific functions and in a variety of often challenging contexts. Therefore, a common language, preparation and coordination are essential to ensure compliance with the goals and quality of care. OBJECTIVE To carry out an update on the management of the adult trauma patient based on new evidence and practices. METHODS Literature review search mainly through PubMed. A secondary search on UptoDate and the latest editions of reference books on prehospital and advanced major trauma, and in reference organizations such as Difficult Airway Society, Advanced Trauma Life Support, European Trauma Course, and Anaesthesia, Trauma and Critical Care Course (ATACC). A tertiary search through the references in the UpToDate guidelines to identify new sources. Search terms included: prehospital care, major trauma, difficult airway, permissive hypotension, immobilization, both in Spanish and English. RESULTS The management of catastrophic bleeding is the first step in the primary assessment, because it can cause death even before an obstructed airway. Airway management and ventilation remain a priority. Permissive hypotension is increasingly accepted in the management of major trauma with hypovolemic shock except in the case of patients with head trauma. Prevention and control of the deadly triad (acidosis, hypoxia and hypothermia) improve the prognosis. An “excessive stabilization” approach should be avoided, so that access to definitive treatment is not delayed. CONCLUSIONS Prehospital trauma care is necessarily multidisciplinary, requiring coordination and communication between teams to ensure quality of care.

Critical care nursing role in low and lower middle-income settings: a scoping review

ObjectivesA scoping review was conducted to answer the question: How is critical care nursing (CCN) performed in low-income countries and lower middle-income countries (LICs/LMICs)?DesignScoping review guided by the JBI Manual...

EP.TU.1068Developing a Major Trauma Nursing Education Framework in Manchester

Abstract Aims The opening of the Major Trauma Ward (MTW) at Manchester University Hospitals NHS Trust represents a key milestone for managing major adult trauma within the Greater Manchester conurbation. We present an overview of the development of a novel Major Trauma Nursing Education Framework incorporating both the induction and continuing professional development of trauma nurses. Methods The MTW nursing skillset combines elements from acute surgical specialities and rehabilitation medicine. A framework for education was constructed from the Adult Nursing Competencies for the Major Trauma Patient (National Major Trauma Nursing Group) and the Trauma Intermediate Life Support curriculum. An induction programme was developed with a Competencies Workbook for an interim period including external courses for band 5 (Nurse Trauma and Critical Care course) and senior nurses (ALS and Neonatal, Adult and Paediatric Safe Transfer and Retrieval Course). An annual training programme will renew these competencies. Results Feedback from the first cohort for the induction programme has been positive, particularly with the third of nurses who did not feel confident managing trauma patients prior to induction (Wilcoxin-signed rank test, p = 0.00116). Free text comments ranged from the completeness of the topics covered to the delivery methods of the curriculum and how to work effectively within the wider multidisciplinary team. Conclusions The development of a formal Major Trauma Nursing Education Framework is necessary for a modern trauma workforce. Feedback has so far been positive. Continual audit of the framework will be necessary to ensure and improve the quality of delivery of education.

Acute critical care course for interns to develop competence.

Background All medical graduates must know how to stabilize and manage critically ill patients. A 2-day intensive course, called the acute critical care course (ACCC), was conducted to train interns in technical and non-technical skills for managing a patient whose condition is deteriorating. This analysis aims to assess the feasibility and effectiveness of ACCC for interns. Methods We developed and conducted the ACCC to train interns. It included lectures and skill stations. Twenty-four interns participated in the course. Immediate, post-course, quantitative and qualitative feedback was taken online. Qualitative information was also collected verbally and later by email. These data were analysed both quantitatively and qualitatively. Thematic analysis was used to identify, analyse and report the patterns of responses and behaviour. Results The average score for the utility of the course was 4.7 and for the skill stations it was 4.6 on a scale of 5. The qualitative analysis of the feedback emphasized the need for the course before the clinical posting and more skill-based modules rather than lectures. The interactive style of teaching and training in communication using role-play was appreciated. Few suggestions to improve the course were provided. Conclusions Implementing the ACCC needed simulation, interactive discussions, role-play, modified Pendleton's feedback, and reflective exercise that form the basis of a range of educational principles. The blended learning set of objectives of ACCC were the pillars for this successful internship training programme.

Early and late acute kidney injury: temporal profile in the critically ill pediatric patient.

ABSTRACTBackgroundIncreasing AKI diagnosis precision to refine the understanding of associated epidemiology and outcomes is a focus of recent critical care nephrology research. Timing of onset of acute kidney injury (AKI) during pediatric critical illness and impact on outcomes has not been fully explored.MethodsThis was a secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology (AWARE) database. AKI was defined as per Kidney Disease: Improving Global Outcomes criteria. Early AKI was defined as diagnosed at ≤48 h after intensive care unit (ICU) admission, with any diagnosis >48 h denoted as late AKI. Transient AKI was defined as return to baseline serum creatinine ≤48 h of onset, and those without recovery fell into the persistent category. A second incidence of AKI ≥48 h after recovery was denoted as recurrent. Patients were subsequently sorted into distinct phenotypes as early-transient, late-transient, early-persistent, late-persistent and recurrent. Primary outcome was major adverse kidney events (MAKE) at 28 days (MAKE28) or at study exit, with secondary outcomes including AKI-free days, ICU length of stay and inpatient renal replacement therapy.ResultsA total of 1262 patients had AKI and were included. Overall mortality rate was 6.4% (n = 81), with 34.2% (n = 432) fulfilling at least one MAKE28 criteria. The majority of patients fell in the early-transient cohort (n = 704, 55.8%). The early-persistent phenotype had the highest odds of MAKE28 (odds ratio 7.84, 95% confidence interval 5.45–11.3), and the highest mortality rate (18.8%). Oncologic and nephrologic/urologic comorbidities at AKI diagnosis were associated with MAKE28.ConclusionTemporal nature and trajectory of AKI during a critical care course are significantly associated with patient outcomes, with several subtypes at higher risk for poorer outcomes. Stratification of pediatric critical care-associated AKI into distinct phenotypes is possible and may become an important prognostic tool.

Nonintensivist Training to Increase the Staff Capacity of Intensive Care Units During COVID-19 Pandemic Surge in Argentina.

The aim of this study was to report the results of a nationwide critical-care course for non-intensivists to increase staff capacity of intensive care units (ICUs) during the coronavirus disease 2019 (COVID-19) pandemic in Argentina. Three academic organizations, with special funding from 55 private companies, developed a short virtual course comprised of Web-based videos, virtual tutorials, and a forum chat. Each state assigned scholarships to non-ICU staff from public hospitals. Students received active follow-up for the completion of the course and took a survey upon course completion. After 4 m, there were 10,123 students registered from 661 hospitals in 328 cities. Of these, 67.8% passed the course, 29.1% were still ongoing, and 3.1% were inactive. Most students were female (74.2%) with a median of 37 y old (IQR 31-44). The group was composed of 56.5% nurses, 36.2% physicians, and 7.4% physiotherapists, of whom 48.3% did not have any experience in critical care. Mean overall satisfaction was 4.4/5 (standard deviation, 0.9), and 90.7% considered they were able to apply the contents to their practice. This course was effective for rapid training of non-ICU personnel. The assignment strategy, the educational techniques, and the close follow-up led to low dropout and high success rates and satisfaction.

Rapid training of non-intensivists using an online critical care course during COVID-19

Rapid training of non-intensivists using an online critical care course during COVID-19

Extracorporeal Cardiopulmonary Resuscitation in Indian Scenario: A Web-based Survey.

BackgroundPractice and knowledge of extracorporeal cardiopulmonary resuscitation (ECPR) in an Indian setting is not known. The etiology could be multifactorial, such as lack of awareness, lack of facilities, and lack of finances. Unless we identify and rectify the underlying problems, utilization of this aspect of extracorporeal membrane oxygenation (ECMO) support would be difficult.Materials and methodsThis cross-sectional observational study was done over 6 months in three phases: (A) Formation of questionnaire/tool kit by Delphi method for 1 month (July 2019), (B) circulation of questionnaire to participants in the form of Google Forms and data collection for 2 months (August and October 2019), and (C) analysis, compilation of data, and writing the final report over 1 month (November 2019).ResultsSixty-four participants responded. The majority of the respondents were intensivists (50%). Only six respondents (9.5%) had done ECPR at their center with median ECPRs per year of 2 (1–10). All ECPRs were being done in private sector hospitals. The most common indication for initiation was conventional cardiopulmonary resuscitation (CPR) for more than 10 minutes without return of spontaneous circulation (ROSC)(n = 4, 66%). In all cases, the intensivists took decision for the initiation of ECPR. The rest 57 did not have the experience of ECPR at their center due to lack of equipment and experience (50%) and financial issues (50%).Conclusion and clinical significanceThere is a huge need to increase the awareness of the ECPR program and teams to be trained in India. We also suggest that the tertiary care medical institutions in public sector as well as the private sector that is offering critical care courses should train fellows on ECPR to employ it at times when needed to improve the outcomes of critically ill patients.How to cite this articleGulla K M, Sahoo T, Pooboni S K, et al. Extracorporeal Cardiopulmonary Resuscitation in Indian Scenario: A Web-based Survey. Indian J Crit Care Med 2021;25(6):675–679.

Implementing cognitive apprenticeship theory into the design of a doctor of pharmacy course

Background and purposeCognitive apprenticeship theory is a model instructors can use to develop expert thinking in a classroom setting. Cognitive apprenticeship theory has been discussed in the literature; however, descriptions of its application in the classroom setting are lacking. We describe how cognitive apprenticeship guided the development and implementation of a new critical care course with a goal of making expert thinking “visible” to students. Educational activity and settingA four-credit-hour course implemented in the 2018–2019 academic year was developed around the dimensions of cognitive apprenticeship. Clinical pharmacists with the affiliated healthcare system contributed to the design and implementation. Elements of the course in which cognitive apprenticeship theory guided the design included pre-class work, in-class group work, and an attending-facilitated discussion session. FindingsAll four dimensions of cognitive apprenticeship were incorporated throughout the course. The course coordinator perceived that student questions and the quality of the discussion were higher level than in previous years. SummaryCognitive apprenticeship theory can be used to design and implement a professional doctor of pharmacy course that prepares students for the types of thinking required in practice. We believe this model could be successfully implemented at other schools of pharmacy.