Pharmacy students enrolled in a Pharmaceutical Care and Dispensing laboratory course were included in this study. A control group enrolled in the course delivered in spring 2016, before it was revised, and an intervention group enrolled in the revised course in spring 2017. In both groups, the course spanned the spring semester of the second professional pharmacy year. In this two-credit course, which consisted of eleven three-hour sessions comprising 12 students per session, students were taught how to accurately interpret and fill prescriptions, analyze patient cases and safely dispense prescription and over the counter medicinal products and effectively communicate with patients and other healthcare professionals in both the in-hospital and community settings.
In this panel study, a survey was developed and administered to the control and intervention groups. The intervention group received the survey at three time-periods, prior to taking the course (time one, T1), at the end of the course (time two, T2), and then following the completion of their experiential training course (time three, T3). The control group received the same survey administered to the intervention group at T3, following the completion of their experiential training course, to facilitate an intergroup comparison with the intervention cohort.
The survey was paper and pencil based and composed of questions addressing the preparedness of students to perform the PPCP related skillsets (collect, assess, plan, implement, and follow up) (figure 1). The survey adopted a four point Likert scale (yes definitely, yes sometimes/somehow, no not much, no not at all) and was estimated to require about five minutes to be completed by students. The purpose of the survey was to assess students’ perception regarding their preparedness to apply the PPCP related skillsets during introductory experiential education rotations during P3. Figure 1 represents mapping of the survey questions to each of the PPCP steps ‘collect, assess, plan, implement, follow up. The first question addressed students’ perception on the PPCP in general, followed by specific questions directly linked to each component of the PPCP. For instance, the question “the laboratory prepared me to collect relevant patient information from the prescription and patient profile in order to understand the patient's clinical status” is a direct mapping of the first step of PPCP on ‘collect’. Also, the two questions ‘the laboratory prepared me to implement the care plan in collaboration with other healthcare professionals’, and then ‘to tactfully counsel a patient’, are directly mapped to the forth step of PPCP on ‘implement’. In the control group, the survey was completed with answers provided anonymously. In the intervention group, students included their identification numbers in order to match the surveys for a before and after assessment.
The revised course was offered for the first time. It differed from the original course in its higher degree of active learning, simulation, and its focus on critical thinking, communication and interdisciplinary practice. Several pharmacy practice laboratory activities which have been shown to boost student engagement, learning and confidence were implemented . This course was facilitated by three faculty members from the department of Pharmacy Practice and two teaching assistants who all contributed to the preparation of the course content and delivery.
The first laboratory session consisted of a didactic lecture which explained how to apply the PPCP model while carrying out the different activities within the dispensing and pharmaceutical care process using the provided course material and documents. These included simulated paper-based physician order forms or prescriptions, patient profiles, a PPCP worksheet and medication errors reporting form. A worksheet was developed to reflect the PPCP systematic approach to patient care and the medication error reporting form used is an amended version of a previous published form [13,14]. Students were asked to collect necessary patient information in order to initiate appropriate medication screening, and to perform a pharmacotherapeutic assessment to resolve medication related problems prior to drug dispensing. Students were expected to complete and submit the PPCP worksheet by the end of each laboratory session.
During the subsequent laboratory sessions, students were divided into four groups, each composed of three to four students working as a team of pharmacists within a simulated pharmacy setting. Each student had a set of predefined activities to perform every week. All students had the opportunity to rotate and practice the different activities as per a predefined schedule throughout the semester. These consisted of 1) prescription screening, identification and resolution of medication related problems and order entry into the medication profile, 2) prescription filling and labeling, 3) identifying alternative drug availability on the market or in the institution, 4) checking a filled prescription, 5) answering drug information questions in response to patients or other health care professionals, 6) providing patient education and counseling, and 7) writing and communicating an SBAR (Situation, Background, Assessment, Recommendation) note. The activities were selected to reflect the different PPCP model steps. All students used computers to access the internet/library databases and other resources. Various active learning strategies and simulation were adopted to enrich the course delivery and enhance students’ learning of the PPCP model. The adopted strategies included “Case Studies”, “Student Presentations” and “Role Play” and Minutes Writes”. “Minutes Writes” was applied by embedding open-ended drug information questions raised by nurses, physicians or patients within the laboratory patient cases [3,15]. Students were then given a few minutes to perform their research and write down their answers. In “Case studies”, student groups were provided with a medication profile including patient specific information, a prescription or a set of physician orders, and were instructed to identify potential medication errors through data collection, literature evaluation and critical assessment of pharmacotherapy. After identifying medication related problems, students performed “Student Presentations” by writing and presenting a brief SBAR (Situation, Background, Assessment, Recommendation) note addressed to another healthcare professional (ie nurse, physician). Finally, “Role Play” was applied whereby students were given the opportunity to practice their interprofessional communication and patient counseling skills within a situational context. Finally, faculty assigned one student in each group to perform a self-evaluation of the group’s performance using a PPCP based evaluation form. The study was approved by the Lebanese American University (LAU) Institutional Review Board (IRB).
Statistical analyses were performed using SPSS version 25 software. Answers on the four points Likert scale were regrouped into binary response levels. Then results were summarized using frequencies and percentages. Differences in proportions of students agreeing to a certain statements between the different groups were tested using the Pearson’s chi-square when the groups were independent, and the McNemar Chi-square when the groups were dependent. All analyses were carried out at the 0.05 significance level.