Design of a new professional practice laboratory course using standardized patients

American Journal of Pharmaceutical Education, Fall 1998 by Austin, Zubin, Tabak, Diana

At the University of Toronto, a course was developed for senior level students emphasizing the direct patient care aspect of practice. The first section outlines principles behind the design of the course. The second presents the seminar format, a series of student-directed activities involving peer teaching and simulated patient care. The third addresses assessment of the student including global performance rating, case writeups and documentation. The fourth addresses strengths and problems encountered, especially related to organization, logistics and workload. A course outline and description of the `Family Tree,' which provides the foundation for the course, are appended. An example case illustrates the nature, depth and complexity of cases. Students stated in their course evaluation summary and anecdotal feedback that patient care simulations better equipped them for the demands of clerkship rotations than traditional paper cases did. They found the course relevant, preparing them well for pharmacy practice in the future.

BACKGROUND

In 1994, the Faculty of Pharmacy at the University of Toronto began a new 4 1 year undergraduate pharmacy program, leading to the entry level degree for practice, the BSc Pharm. The relative emphasis in the new curriculum focused upon the provision of pharmaceutical care as one of its main objectives. A sequenced curriculum was developed, involving courses in the pharmaceutical sciences, social and administrative sciences and in pharmacy practice. In developing this new curriculum, particular attention was paid to the needs of practitioners who would provide direct, primary care to patients.

New courses were developed, in all four years, with a strong emphasis on pharmacy practice and social-administrative pharmacy courses, in order to equip students with the skills necessary to carry out the responsibilities implied by pharmaceutical care. The didactic, faculty-based portion of the curriculum is complemented by the final Structured Practical Experience Program (SPEP), consisting of two eight-week clinical placements in the final semester of the program.

To facilitate the transition from the faculty-based program to the SPEP, and to consolidate learning from the previous three and a half years of the program, a new course was developed. Pharmacy Practice Seminar is a continuation of the professional practice and pharmaceutical care series of courses. It is an integrated course drawing upon materials from all four years of the pharmacy program in which students must recall and apply material from a variety of courses, including, Clinical Biochemistry/Pathology/ Pathophysiology, Pharmaceutics, Jurisprudence and the Social-Administrative Pharmacy courses.

Upon completion of the course, students are expected to be able to assume direct, supervised care responsibilities in community and hospital pharmacy practices. The purpose of the course is to provide students with an opportunity to learn and practice patient care skills in a controlled manner with standardized patients (SPs) (see Appendix A) acting as patients and facilitated by trained pharmacist teaching assistants (TAs). SPs (actors) also provide feedback on patient management issues as well as the communication technique and interpersonal skills of the student. TAs provide feedback on pharmacotherapeutic decision making.

SPs have been used extensively in medical education since the mid-1970s(1) in response to concerns regarding assessment of basic clinical skills of medical students and licentiates. Traditionally, SPs have been used within the confines of an Objective Structured Clinical Exam (OSCE) as a way of assessing clinical competency(2). To improve inter-rater reliability and validity of observer ratings, examiners use a checklist of items expected to be demonstrated by a candidate which they mark while observing each individual performance(3). Given the resource intensive nature of SPs, their use initially was limited to summative evaluation in medicine.

The use of SPs in pharmacy education was reported in the early 1980s(4) as a teaching tool. In providing formative as well as summative evaluation to pharmacy students, the potential role for SPs within undergraduate health sciences education was expanded. While they continue to be used as one method for the evaluation of clinical skills(5), the possibility of using SPs as teachers intrigued us. Despite being traditionally seen in a high-stakes evaluative setting, such as licensing exams or continuing competency reviews(6), students are generally positive about their role in undergraduate education(7). Consequently, when developing a new professional practice laboratory course for senior-level undergraduate students, we were aware of the role SPs could play in providing both summative and formative assessment.

SEMINAR FORMAT

The seminar format is unique. It differs substantially from previous professional practice courses which tend to be "dispensing lab" focused. Students work in groups of ten, each group with a trained pharmacist-TA. Each week, for ten consecutive weeks, a specific therapeutic topic, physiological system or cluster of conditions is studied. (See Appendix B for course outline.) Prior to attending each seminar, students are expected to complete a pre-seminar assignment-a series of guided discovery questions, which provide a structured review of material pertaining to the topic. These questions draw upon material from a wide variety of courses. They focus not simply on therapeutics, but also pharmaceutics, clinical biochemistry, pathology, pharmacology and jurisprudence. A sample case and prompt is shown in Appendix C.