Using actual patients in the classroom to develop positive student attitudes toward pharmaceutical care

American Journal of Pharmaceutical Education, Fall 1999 by Chisholm, Marie A, Wade, William E

This study was undertaken to demonstrate the effectiveness of using actual patients in the classroom to develop positive student attitudes toward pharmaceutical care. The Clinical Applications 11 (CAll) course, a required course in the University of Georgia College of Pharmacy's curriculum, involves patients coming to class and discussing their illness and how their illness affects their lives to first-year pharmacy students. To measure the impact that the actual patient discussions (presentations) had on students' attitudes toward pharmaceutical care, all first-year students enrolled in the CAll course in April 1998 (n=96) were given a survey that measures students' pharmaceutical care attitude, referred to as the Pharmaceutical Care Attitude Survey (PCAS), before the first patient's presentation. Students were asked to respond to each of the 13 items of the PCAS (pre-PCAS) by using a five-point Likert scale ranging from 1= "strongly disagree" to 5= "strongly agree." Immediately after the last patient presentation on the last day of the CAll course, students were again given the PCAS (post-PCAS) to complete. Ninety-five students (99 percent response rate) completed the pre and post-PCAS. Pairwise t-tests with Bonferroni's adjustment were used to detect differences between students' pre and post-PCAS scores. Students scored significantly higher on post-PCAS than the pre-PCAS for 12 of the 13 items (M.001). Results of the study document that a course that involved actual patients positively influenced students' pharmaceutical care attitudes.

INTRODUCTION

The challenge for pharmacy educators is to instill in their students not only a strong clinical base and excellent communication skills, but also a high level of motivation and commitment to pharmaceutical care(I-3). Although several professional pharmacy organizations support the concept of pharmaceutical care, there are several barriers to its application(4-6), including deficient clinical knowledge and communication skills and insufficient time. Negative attitudes of pharmacy practitioners toward pharmaceutical care have been identified as a significant barrier interferinp, with its practice(7-10).

The earlier pharmacy students are exposed to actual patients, the more likely they are to develop pharmaceutical care skills and positive pharmaceutical care attitudes. McDonough and colleagues strongly recommended that students interact with patients early in their academic careers to improve interpersonal communication and empathy skills(IO). The opportunity for students to interact with patients and develop practical concepts about the importance of performing pharmaceutical care occurs traditionally in the latter stages of the pharmacy curriculum, during the experiential component. Introducing students to patients early in the pharmacy curriculum provides a demonstration of the importance of performing care. Additionally, these early experiences may help students develop positive attitudes regarding pharmaceutical care activities. Such attitudes will hopefully motivate students to incorporate these concepts into practice.

The Clinical Applications II (CAII) course, a required course at the University of Georgia College of Pharmacy, was designed to teach first-year pharmacy students about disease states and patient care by bringing actual patients into the classroom to present to the students. In addition to learning basic information about disease states, the course was designed to facilitate student-patient interaction and to foster students' attitudes towards pharmaceutical care. Although the participation of actual patients in the classroom to foster the development of positive pharmaceutical care attitudes has not been described in the literature, the designers of the CAII course believed that exposing students to patients early in the pharmacy curriculum would have a favorable impact. Such a course would allow students to begin developing student-patient interaction skills, learning and understanding the important role that pharmacists can play in patient care, and instilling a sense of responsibility for patients' medication outcomes(I 11). Furthermore, with the increasing demands on clinical preceptors to take more and more students on clerkships and yet maintain quality clinical experiences, the coordinator of the CAll course believed that the course would serve as a "bridge" between didactic and experiential training to prepare pharmacy students to start thinking like a pharmaceutical care practitioner early in their didactic education. The purpose of this study was to evaluate the affects of the CAll course on students' har care attitudes.

DESCRIPTION OF THE CLINICAL APPLICATIONS II COURSE The University of Georgia College of Pharmacy implemented a new curriculum in Fall 1995. The CAll course is one of several required courses in the revised first-year pharmacy curriculum at the College of Pharmacy. This course provides one semester-hour credit and meets twice weekly for the last three weeks of each Spring semester. The CAII course involves patients coming to class and discussing their illness and how their illness affects their lives. By using actual patients in this course, the designers and instructors envisioned that student-- patient interaction would not only facilitate knowledge of disease states, but should also help facilitate the development of positive pharmaceutical care attitudes.