Pharmacy Skills Laboratory Research Articles

Less Points, Less Stress, Better Learning in a Skills Laboratory Course Using Alternative Grading

ObjectiveThe objective of this study was to evaluate the impact of alternative grading strategies on students’ knowledge and confidence in a redesigned pharmacy skills laboratory course. MethodsAlternative grading strategies including revise-and-resubmit assignments, purposeful peer and instructor feedback, and self-reflection were used to partially replace traditional grading strategies. Pre-post knowledge and confidence surveys were administered to 3 consecutive cohorts of students. Cohort 1 (N = 65) was exposed to traditional assessment strategies and was used as the control arm. Cohorts 2 (N = 59) and 3 (N = 51) were exposed to alternative grading strategies and were used as the intervention arms. Cohort 3 completed an additional postsurvey to evaluate students’ perceptions of alternative grading strategies. ResultsStudents enrolled in a pharmacy skills laboratory course at a single institution demonstrated increased pre-to-post knowledge and confidence when assessed using both traditional and alternative grading strategies. Students in the alternative grading cohort entered the course with statistically significant lower levels of knowledge of institutional pharmacy-related topics but exited the course with higher levels of knowledge of institutional pharmacy-related topics as compared to the traditionally graded cohort. ConclusionFindings from the evaluation of a two-year course redesign indicated that transitioning from a traditional to an alternative grading strategy resulted in similar or higher learning outputs and a significant increase in students’ confidence in institutional pharmacy practice skills and abilities.

Student performance and perspective on repeated top drug information assessments in a pharmacy skills laboratory course

Background: A weekly drug quiz policy was implemented in a pharmacy skills laboratory course. Objective: To examine student performance and perspective on weekly top drug information assessments. Methods: Students in the second- and third-professional year of the pharmacy programme were assessed on top drug information through weekly drug quizzes and a final top drug exam in their respective pharmacy skills lab courses. Correlation between student performance in drug quizzes and major assessments in their pharmacy coursework was measured using the Spearman rank correlation analysis. Statistically significant change in student opinion through the term was determined using the Wilcoxon signed rank test. Results: Student scores on weekly quizzes and the final drug exam ranged between 85-99%. A strong positive (ρ ≥ 0.7), significant (p < 0.001) correlation was observed between student performance on their drug information assessments and their scores in all pharmacy courses. Within the second-professional year, a significant improvement (17.7%) in students’ perceived ability for the weekly quizzes to positively impact their course grades in the modules (p = 0.03). Student confidence in matching brand/generic drugs and identifying drugs’ therapeutic classes improved over the term (p < 0.01). Conclusion: Students were overall accepting and had a predominantly positive perspective regarding the repeated top drug information assessment policy.

Evaluation of a murder mystery activity to teach patient communication interviewing skills

IntroductionWhile gamification has been used in pharmacy education, more research is needed to establish that these methods are effective. The objective of our study was to evaluate the effectiveness of a murder mystery activity to teach patient communication and interviewing skills to first year pharmacy students in a pharmacy skills laboratory. MethodsA non-medical murder mystery activity was used to introduce and provide practice on communication techniques needed for obtaining a medical history. These techniques included an introduction, confirmation of patient identity, nonverbal expression, self-expression, empathy, emotional response, question style, organization, and appropriate closure. In groups of three to five, students interviewed five different suspects and were assessed as a group on their second and fifth suspect interviews within one, three-hour laboratory session using a standardized rubric. Assessments were completed by students, standardized patients, and faculty. ResultsA total of 161 students completed the murder mystery exercise over three years. Total student scores all significantly improved from the second to fifth interview. In addition to total scores, each subtotal score significantly improved from the second to fifth interview, regardless of the evaluator. ConclusionsWithin the murder mystery laboratory, students' communication scores improved on a standardized communication rubric. Use of a murder mystery is an effective, engaging way to introduce and practice communication skills that could be adapted by other institutions.

Comparison of Student Pharmacists’ Knowledge Retention Utilizing Electronic Health Records Versus Simultaneously Completing Simulated Experiences

Objective. The purpose of this study was to determine whether the addition of standardized patients or the addition of interprofessional student teams with standardized patients to the use of a simulated electronic health record improved student knowledge retention and perceptions.Methods. This was a prospective cohort study assessing three cohorts of first-year student pharmacists in pharmacy skills laboratory activities that occurred in 2018, 2019, and 2021. The primary objective of the study was to compare knowledge retention of the case material between groups at one month. Each year, an element of simulated experience was added onto the previous year's case. In 2018, students completed the case using only the electronic health record web application. In 2019, the previous year's experience was combined with an objective structured clinical examination (OSCE) with standardized patients. In 2021, the 2019 experience was supplemented with student physician assistants. Case scores and student perceptions were also compared between groups.Results. Of the 260 potential participants, 238 students were included in the primary analysis. Results showed that with the addition of interprofessional team-based care and standardized patients, significant improvement was demonstrated in knowledge retention assessments at one month. Mean knowledge retention assessment scores for the 2018, 2019, and 2021 groups were 63.8%, 71.7%, and 76.1%, respectively. Significant improvement was also found in student perceptions.Conclusion. Adding standardized patients and interprofessional team-based care to a pharmacy skills laboratory that uses a simulated electronic health record significantly improved student knowledge retention and perceptions.

Who killed Mr. Brown? A hospital murder mystery in a pharmacy skills course

Purpose To improve critical thinking skills and enhance team dynamics, a pilot study for inclusion of a murder mystery activity within the pharmacy practice skills laboratory was designed for student pharmacists. Methods In groups, students participated in a murder mystery activity and were assessed via rubrics to critically evaluate potential reasons for a patient’s death and find solutions for process improvements. Through an optional survey, students were asked about their group’s ability to work as part of a healthcare team, which included identification of conflict management techniques. Faculty used an inductive coding process on student feedback to identify strengths and opportunities for growth. Results All groups successfully completed the patient’s cause of death and root cause analysis. Overall, students agreed their teams worked well together in solving this mystery. Communication was found to be both a strength and a weakness among group members and many students were able to self-identify conflict management strategies that were utilized during the activities. Conclusion Use of a murder mystery activity in a pharmacy skills laboratory is a unique approach to foster development of critical thinking skills and highlights the complexity with which a healthcare team must operate together to provide patient care.

The catalyst for change in teaching and assessing virtual laboratory skills

IntroductionHistorically, pharmacy skills laboratory courses have primarily been delivered utilizing in-person instruction; however, changes in methods of healthcare delivery serve as a catalyst to consider best practices for virtual learning in the skills laboratory setting. PerspectiveShifting to a virtual delivery method is valuable for future curriculum and course development. Three specific delivery methods including flipped classroom, virtual formative simulations, and telehealth objective structured clinical examinations, provide examples of the opportunities and challenges instructors may encounter when shifting delivery methods. Furthermore, the examples illuminate the need to deliberately incorporate virtual technology into pharmacy skills laboratory courses to ensure students are practice-ready for the changing methods of delivery in the healthcare environment. ImplicationsSkills laboratory instructors and students must reimagine how patient care skills can be taught and assessed. It is imperative to reassess priorities and adapt skills-based courses to incorporate the virtual learning environment to prepare student pharmacists for future practice.

Educating Pharmacy Students About Underserved Populations Using Patient Speakers and Simulation Activities

Objective. To assess the impact of the Patient Voices series on Doctor of Pharmacy (PharmD) students.Methods. A series of patient speakers and integrated simulation activities focused on underserved populations, otherwise known as the Patient Voices series, was embedded into a pharmacy skills laboratory curriculum. First-year PharmD students' self-ratings of confidence were compared on pre- and post-course surveys. Using evaluations from first-year introductory pharmacy practice experiences (IPPEs), student self-evaluation data were compared to preceptor evaluations of student performance. Open-ended responses to course evaluations from first- and second-year PharmD students and student reflections from third-year PharmD students were assessed using conventional content analysis to identify and characterize student perceptions.Results. Significant increases were observed in first-year students' confidence to show empathy (mean, 4.2 to 4.7) and to interact with patients from underserved communities (mean, 2.2 to 4.2). Preceptor ratings of students' empathy were consistent with the students' self-rated abilities, while students' self-ratings on cultural sensitivity were higher than the preceptors' ratings. Qualitative analysis of course evaluation surveys and reflections revealed common themes identified by students, such as understanding different perspectives, increased empathy for patients, and the value of including this content in the curriculum.Conclusion. Student confidence to interact with patients from a variety of underserved populations increased following introduction of the Patient Voices series into the PharmD curriculum. Students perceived the series to be a valuable learning experience.

A Modified Delphi Involving Laboratory Faculty to Define Essential Skills for Pharmacy Graduates

Objective. To define essential skills for Doctor of Pharmacy (PharmD) graduates that are needed in the four most common sectors of pharmacy practice as determined by expert faculty who instruct within pharmacy skills laboratories.Methods. A three-round Delphi method was used to establish consensus. In the first round, participants were asked what skills were needed by students at entry to practice in community, health-system, ambulatory care, and managed care pharmacy settings. In rounds two and three, participants were asked to rate each skill with a level of importance using a 10-point Likert scale (1=not important to 10=very important).Results. In round one, participants produced a collective list of 289 essential skills. These skill statements were sent to participants in rounds two and three to assign a level of importance. After the third round, participants reached consensus using a mean level of importance for a final list of 69 community pharmacy skills, 47 health-system, 60 ambulatory care, and 15 managed care skills. These skills were then mapped to entrustable professional activities domains for schools and colleges pharmacy to use as a resource when assessing core competency development in the curriculum.Conclusion. The Delphi technique was used successfully with expert pharmacy skills laboratory faculty to identify laboratory-focused essential skills that recent PharmD graduates should have prior to entering community, health-system, ambulatory care, or managed care pharmacy practice. These essential skills can be used to guide curriculum development, develop milestone markers, and help ensure students are practice ready.

Assessing pharmacy students' knowledge and perceptions of urine drug testing following a pharmacy skills laboratory

IntroductionUrine drug tests (UDTs) are commonly used in the healthcare setting to monitor adherence, abuse, and diversion of controlled substances. The goal of our study was to assess the knowledge and perceptions of third-year pharmacy students on UDTs following an educational experience. MethodsThird-year pharmacy students completed pre- and post-questionnaires following a skills laboratory focused on the use of UDTs in clinical settings. The 34-item questionnaires consisted of three domains: demographics, knowledge regarding UDTs, and personal perceptions of UDTs. A pre-lab teaching podcast was assigned prior to the laboratory session, and two clinical cases were discussed during the live UDT segment. Descriptive statistics were used to assess demographics, and changes in knowledge and perceptions of UDTs were evaluated using chi-square and Mann-Whitney U, respectively, with an a priori alpha of 0.05. ResultsOne hundred twenty students were included in the analysis. Students in the laboratory were predominately female (n = 72, 60%), Caucasian (n = 84, 70%), and had no prior training with UDTs (n = 104, 86.7%). Student knowledge of UDT interpretation significantly increased from 57% to 71% (four and five correct answers out of seven, respectively). Confidence interpreting UDTs and answering questions related to UDTs also increased significantly. Students felt the laboratory experience was valuable, with 84.2% agreeing or strongly agreeing. ConclusionsEducational programming focused on UDTs improves student confidence interpreting results and knowledge related to the use of UDTs.

Establishing a successful teaching assistant program in pharmacy skills laboratory courses

IntroductionLaboratory-based courses often require more manpower than faculty can provide to facilitate active learning activities in the classroom as well as skills-based assessments. PerspectivePharmacy and graduate student and resident teaching assistants (TAs) can be incorporated into laboratory-based courses to help meet this need. Before using student and resident TAs in laboratory-based courses, a number of items need to be considered. This paper will discuss how to recruit, train, and evaluate student and resident TAs. It will also detail the benefits to the faculty, the students in the classroom, and the TAs themselves. Finally, lessons learned from five schools of pharmacy who use student and/or resident TAs will be shared. ImplicationsSchools of pharmacy should implement a formalized process for utilizing student and resident TAs in laboratory-based courses especially where faculty manpower limitations exist.

Impact of a teaching objective structured clinical examination (TOSCE) on student confidence in a pharmacy skills laboratory

ObjectiveTo describe the relationship between the use of a teaching objective structured clinical examination (TOSCE) and student confidence in a pharmacy skills laboratory. MethodsTo develop students’ abilities in providing recommendations and patient education on selected drug products, third-year pharmacy students participated in a TOSCE in a men's and women's health laboratory. A 19-item, 5-point Likert scale survey was administered longitudinally to assess student confidence (1 = not all confident to 5 = extremely confident). An additional seven items (1 = strongly disagree to 5 = strongly agree) were added to the original 19-item survey to measure changes in confidence and attitude before and after a problem-based assessment. ResultsSeventy-two students completed all five surveys administered throughout the semester. Students’ confidence improved in multiple areas within the clinical skills and interpersonal communication skills categories. Students also indicated their confidence in using primary literature, electronic drug references, and package inserts to answer medication-related questions improved after the TOSCE implementation. Students agreed that the feedback they received from the TOSCE was beneficial to their performance on a problem-based assessment. ConclusionsA TOSCE is a formative assessment that has the potential to improve student confidence in core competency areas immediately after an activity. However, its benefit may be short-term when a time gap exists. Further study is needed to assess long-term sustainability in student confidence over multiple laboratory activities throughout a semester.

Lessons learned from an investigation exploring association between grit and student performance in a pharmacy skills laboratory course

BackgroundA challenge for many pharmacy educators is early identification of students who may struggle with various aspects of the pharmacy curriculum. While grade point average, demographic factors, and personality traits may be helpful considerations, we felt there was a need to further explore methods for readily identifying at-risk students who may benefit from early intervention. The Grit Scale has recently been explored, presented, and published in academic pharmacy. The goal of this study was to determine if there was an association between students’ grit scores and performance on a laboratory practical examination. However, it became apparent that there were substantial limitations leading to difficulties analyzing and interpreting our study data and results. ImpactThe interpretation of data was confounded due to study design limitations, including use of the Grit-O scale (rather than Grit-S), low response rate, and lack of validation evidence for laboratory practical assessments. RecommendationsThoughtful consideration during the design of the study may have produced better data for analysis. Psychometric considerations are paramount, both for the instrument (Grit-O) and the dependent/outcome variable (laboratory practical assessment). DiscussionWhile this study did not yield meaningful results for interpretation, it highlighted important lessons for investigators at the college to use moving forward. We hope that the lessons learned from this investigation might support the academy in improving design and rigor of educational research.

Incorporating age-related special populations into a pharmacy skills laboratory course sequence

Background and purposeThe purpose was this study was to evaluate the incorporation of geriatric and pediatric therapeutic concepts into a pharmacy skills laboratory (PSL) course sequence. Secondary outcomes were to describe the incorporation and evaluate the assessment effectiveness of these topics. Educational activity and settingTeaching materials and assessment data from the PSL course were evaluated for inclusion of content regarding age-related special populations. FindingsMaterials reviewed from 205 PSL sessions held over four years demonstrated 89 (41.5%) sessions incorporated age-related topics using a variety of methods. Quiz and exam item performance was acceptable with an average difficulty index of 77.2% ± 21.3 and 85.8% ± 12.8, respectively. The average objective structured clinical exam (OSCE) score was also satisfactory at 83.2% ± 3. Discussion and conclusionsAge-related topics were included in several PSL sessions. These incorporation strategies were deemed to be effective as students performed well on written assessments and OSCEs. Additional PSL sessions were identified as potential targets for incorporating age-related special populations into future PSL offerings.

Students’ Perception of Self-Efficacy Following Medicinal Chemistry Skills Laboratory Exercises

Objective. To analyze student perceptions of self-efficacy in meeting medicinal chemistry course related educational outcomes and skills following a medicinal chemistry skills laboratory. Methods. Four activities were implemented in a pharmacy skills laboratory (PSL) for second-year pharmacy students. Students (n=121) worked individually on exercises for three of the four activities. Pre/post-laboratory surveys on self-efficacy were administered. The McNemar test was performed to evaluate students' self-efficacy above 70% related to course outcomes before and after the exercises in each activity. An independent t test was conducted to compare the mean of students' responses on meeting course outcomes based on the 70% anchor for the perspective confidence on meeting course outcomes. Results. The post-PSL scores on all self-efficacy questions improved. The majority of students reported skill development in all exercises. Students and clinical faculty qualitative responses indicated they felt exercises were effective. Conclusion. A PSL can serve as a valuable opportunity to address course related educational outcomes and specific skill development and can help students assess their self-efficacy in meeting them.

Evaluating the Effects of Flexible Learning about Aseptic Compounding on First-year Students in a Pharmacy Skills Laboratory

To evaluate how flexible learning via online video review affects the ability and confidence of first-year (P1) pharmacy students to accurately compound aseptic preparations. Customary instructions and assignments for aseptic compounding were provided to students, who were given unlimited access to 5 short review videos in addition to customary instruction. Student self-confidence was assessed online, and faculty members evaluated students' aseptic technique at the conclusion of the semester. No significant difference on final assessment scores was observed between those who viewed videos and those who did not. Student self-confidence scores increased significantly from baseline, but were not significantly higher for those who viewed videos than for those who did not. First-year students performed well on final aseptic compounding assessments, and those who viewed videos had a slight advantage. Student self-confidence improved over the semester regardless of whether or not students accessed review videos.

Outcomes of Individualized Formative Assessments in a Pharmacy Skills Laboratory

To determine the effectiveness of an individualized teaching method in a pharmacy skills laboratory. All third-year students enrolled in an Accreditation Council for Pharmacy Education (ACPE) accredited doctor of pharmacy program (n=150) received an individual formative assessment from clinical pharmacists on communication skills and clinical competency after the students counseled standardized mock glaucoma patients during a laboratory focused on alternative dosing formulations. Objective structured clinical examination (OSCE) scores for this station from the 2012 and 2013 classes were compared before and after the intervention. Ophthalmic OSCE station scores were higher after the individual formative feedback intervention. Students in 2013 had a mean score of 83.2 ± 8.3% compared to a mean of 74.3 ± 12.9% in 2012 for this OSCE station. The percentage of students receiving an "A" on the OSCE station increased from 8.1% to 31.3% after the intervention. Individualized formative teaching methods benefited students in both their communication skills and clinical assessment. Future research should focus on wider implementation and overcoming obstacles, such as increased facilitator needs.

Improved Knowledge Retention Among Clinical Pharmacy Students Using an Anthropology Classroom Assessment Technique

To adapt a classroom assessment technique (CAT) from an anthropology course to a diabetes module in a clinical pharmacy skills laboratory and to determine student knowledge retention from baseline. Diabetes item stems, focused on module objectives, replaced anthropology terms. Answer choices, coded to Bloom's Taxonomy, were expanded to include higher-order thinking. Students completed the online 5-item probe 4 times: prelaboratory lecture, postlaboratory, and at 6 months and 12 months after laboratory. Statistical analyses utilized a single factor, repeated measures design using rank transformations of means with a Mann-Whitney-Wilcoxon test. The CAT revealed a significant increase in knowledge from prelaboratory compared to all postlaboratory measurements (p<0.0001). Significant knowledge retention was maintained with basic terms, but declined with complex terms between 6 and 12 months. The anthropology assessment tool was effectively adapted using Bloom's Taxonomy as a guide and, when used repeatedly, demonstrated knowledge retention. Minimal time was devoted to application of the probe making it an easily adaptable CAT.

Pharmacy Students’ Attitudes About Treating Patients With Alcohol Addiction After Attending a Required Mutual Support Group

To implement required attendance at mutual support groups for addiction recovery as a pharmacy skills laboratory exercise, and to evaluate how attendance affected pharmacy students' attitudes about caring for patients with addiction. Third-year (P3) pharmacy students enrolled in a Pharmacy Skills Laboratory course were required to watch an introductory video about Alcoholics Anonymous (AA) and then attend 2 "open meetings" during the semester. Students submitted a written reflection as proof of attendance. Pharmacy students who agreed to participate in the study completed the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ) during the course orientation and again at the end of the semester. Mutual support group attendance significantly affected the students' attitudes within the domains of role adequacy, task specific self-esteem, and work satisfaction. Significant changes were not observed within the domains of motivation and role legitimacy. Mutual support group attendance exposed pharmacy students to the negative effects of alcohol abuse and increased their self-confidence to provide care to patients with alcohol addiction.

“Brown Bag” Simulations to Teach Drug Utilization Review

To teach drug utilization review (DUR) skills to pharmacy students and assess their abilities and confidence before and after training. Profile reviews and online and live drug-utilization-review activities of increasing difficulty were incorporated into the first (P1), second (P2), and third (P3) years of the Pharmacy Skills Training Laboratory sequence in a doctor of pharmacy (PharmD) curriculum. An online survey instrument was administered to gauge how comfortable students were with specific DUR skills before and after the activities. Students' confidence in performing specific DUR skills improved after completing the activities. Profile reviews, as well as online and live medication reviews, gave students numerous opportunities to practice drug utilization review skills throughout the first 3 years of the pharmacy curriculum. Students' confidence in performing specific drug utilization review skills improved after the activities. Students' ability to perform the skills also improved as measured with the developed checklist in section V and VI of the Pharmacy Skills Laboratory sequence.

Asthma Education in the Student Laboratory

The Integrated Pharmacy Skills Laboratory (IPSL) at South University School of Pharmacy is dedicated to providing future pharmacists with the necessary knowledge and skills to care for asthma patients. Asthma is a chronic respiratory disorder that is characterized by airway inflammation, hyper responsive airways, and bronchoconstriction. It affects more than 30 million people and accounts for $30 billion in health care costs. Therefore, it is vital for our students to be educated in asthma management including medications and devices to improve patient outcomes. Students, as future pharmacist, learn to manage asthma patients in the community setting, the hospital setting, and the clinic setting through various laboratory experiences.