Evaluation of Pharmacy Students' Blood Pressure and Heart Rate Measurement Skills After Completion of a Patient Assessment Course

American Journal of Pharmaceutical Education, 2007 by McCall, Kenneth L, Raehl, Cynthia, Nelson, Sherida, Haase, Krystal, Fike, David S

Objectives. To evaluate pharmacy students' skills at measuring brachial artery blood pressure and radial heart rate at the completion of a patient assessment course in the second-professional year of a doctor of pharmacy (PharmD) program.

Methods. Students enrolled in a required patient assessment laboratory course (n = 83) participated in this study. Each student was randomly matched with a classmate and manually measured the classmate's blood pressure by auscultation of the brachial artery and heart rate by palpation of the radial pulse.

Results. The student-device absolute disagreement was 6.5 ± 4.8 mmHg for systolic blood pressure (SBP), 6.2 ± 4.5 mmHg for diastolic blood pressure (DBP), and 5.3 ± 4.0 beats per minute (BPM) for heart rate. Student and machine measurements of SBP, DBP, and HR significantly correlated.

Conclusions. Pharmacy students in the second-professional year of a PharmD program demonstrated competence in but not mastery of manual blood pressure and heart rate measurement. These skills need further refinement during third- and fourth-professional year APPEs.

Keywords: vital signs, blood pressure, heart rate, physical assessment, pharmacy students

INTRODUCTION

New accreditation standards and guidelines for doctor of pharmacy degree programs in the United States were adopted on January 15, 2006, by the Accreditation Council for Pharmacy Education.1 Standard number 15 of the new guidelines addresses ''Assessment and Evaluation of Student Learning and Curricular Effectiveness.'' Guideline 15.2 under this standard states: ''A system of evaluation of curricular effectiveness must be developed that, in general, should. . . foster data-driven continuous improvement of curricular structure, content, process, and outcomes.'' To this end, members of the Patient Assessment course teaching team at the Texas Tech School of Pharmacy proposed a data-driven assessment of the accuracy of 2 skills attained by second-professional year pharmacy students near the completion of this course. These skills were manual blood pressure measurement and heart rate measurement taken by palpation of a radial pulse.

A 1995 survey of physical assessment course offerings in US schools and colleges of pharmacy revealed that 75% of responding entry-level doctor of pharmacy (PharmD) degree curricula had offered a separate course devoted to this topic.2 Sixty percent of the programs responding to this survey indicated that students are required ''. . .to demonstrate competency in the use of a stethoscope, sphygmomanometer, ophthalmo-/otoscope, tuning fork, and reflex hammer.''2 However, only 37.5% of these programs had a formal mechanism for evaluating these skills. Unfortunately, the survey instrument did not solicit information about how such competencies were assessed.

A survey of community and hospital pharmacists who also served as preceptors for the St Louis College of Pharmacy revealed several perceived areas in which student competencies needed improvement.3 According to this survey, the preceptor assessment of student competencies on a 5-point Likert scale (1=low competency to 5=high competency) included a mean score of less than 3 for only 2 skills: use of home diagnostic devices (mean 2.9) and physical patient assessment (mean 2.8). With this feedback in mind, the authors revised the pharmacy practice laboratory in order to enhance, among other things, patient assessment skills. This study provided an excellent example of a subjective instrument to improve instructional design. The goal of our study was to improve objective instructional assessment of student skills and then similarly use this information as a tool to improve instructional design. To our knowledge, accuracy of manual blood pressure and heart rate measurements by pharmacy students has not been evaluated.

METHODS

The Texas Tech University Health Sciences Center (TTUHSC) School of Pharmacy has offered a 4-year doctor of pharmacy (PharmD) degree as its single professional degree since the first class was admitted in 1996. The Patient Assessment course is a 2 semester-credit hour course in the spring semester of the second-professional year. Upon completion of this course, a successful student is able to obtain a medical and medication history, evaluate that history in the context of physical examination and laboratory findings, identify drug-related problems, and develop a pharmaceutical care plan with the goal of improving health outcomes of the patient. Among the physical examination skills taught in this course, vital signs are especially emphasized. The process of teaching these vital sign skills in Patient Assessment course involves a didactic lecture on technique, a laboratory session solely focused on practicing vital sign techniques with their peers, 7 laboratory sessions where vital sign skills are rehearsed in addition to other skills with their peers, 2 midterm examinations whereby student skills are demonstrated and assessed by faculty members' direct observation and using a procedure checklist, and 2 laboratory sessions in which students practice these skills on standardized patients who follow a script. All laboratory sessions and midterms are facilitated and evaluated by faculty members.