Pharmacy Students' Preferences for Various Types of Simulated Patients

American Journal of Pharmaceutical Education,  2008  by Gallimore, Casey,  George, Angela K,  Brown, Michael C

• E-mail
• Print
• Link

Objective. To evaluate pharmacy students' preferences for various types of simulated patients.

Methods. Second-professional year (P2) pharmacy students participated in 7 learning activities that used simulated patients including community volunteers, College administrative staff, course instructors, and student peers. Students ranked each simulated patient type according to believability, skill development, and preference using a 5-point Likert scale.

Results. One-hundred seven of 155 students (69%) completed the survey instrument. Students preferred community volunteers as simulated patients (mean rank 1.39), followed by peers (2.22), instructors (2.63), and staff members (2.81) (p

Conclusions. Although pharmacy students found value in interactions will all types of simulated patients, they preferred community volunteers over staff members and their peers. Future scholarship should explore the relationship among simulated patient types and student learning outcomes.

Key words: simulated patient, survey, practice laboratory

INTRODUCTION

The use of standardized patients has become widespread in medical education curricula.1 This is largely based on the demonstrated value of standardized patients in the assessment and clinical training of medical students. 2 Standardized patients provide a standard assessment tool that can be used to evaluate pre-established educational objectives.3,4 The performance of medical students on standardized patient assessments has been correlated with performance during the first year of residency. 5-7 In addition, standardized patients provide a consistent medium through which medical students can apply, practice, and develop clinical skills. Current doctor of pharmacy (PharmD) curricula also commonly engage pharmacy students in learning and assessment activities involving standardized or simulated patients based on similar education benefits.8-13 While the benefit of using simulated patients has been well documented in both the medical and pharmacy education literature,2-12 less attention has been focused on the comparison of various simulated patient types. (Note: this manuscript uses the term simulated patient, which is more specific to people who are trained to represent a patient with a history and laboratory profile, rather than the broader term of standardized patient.2) The objective of this manuscript is to describe pharmacy students' preferences for various simulated patient types, as well as describe students' perceptions of learning from each type.

METHODS

Pharmaceutical Care Skills III and IV are consecutive required laboratory courses offered during the second-professional year in the University of Minnesota College of Pharmacy PharmD curriculum. Table 1 lists the 7 separate laboratory activities in the 2 courses that use simulated patients. It also summarizes the types of patients used, the simulated patient care activities completed, and the approximate length of the patient interaction. All comprehensive patient interviews required students to acquire (1) demographic data, (2) past medical history and history of present illnesses, (3) medication history, (4) status of any previously identified drug therapy problems, and (5) review of systems and other pertinent health history. All care plan delivery sessions included (1) review of current conditions with focus on those with drug therapy problems, (2) discussion of any new therapeutic plans including medication education, and (3) discussion of follow-up plan. Each of the activities represented a different independent scenario with a different patient except for the first 3 activities of the spring semester in which students were exposed to the same simulated patient through a progression of health problems, from dyslipidemia and hypertension, to coronary artery disease, to atrial fibrillation with warfarin anticoagulation. For each activity, students were either observed live or through the use of streaming video by an instructor and graded using an evaluation rubric. In addition, during the spring activities, the simulated patients provided feedback to students using a separate evaluation tool; this feedback was not associated with any score or grade. All simulated patients, regardless of type, met with the course coordinator and received approximately 30 minutes of training prior to serving as a simulated patient. Training was done with all simulated patients in the same session whenever possible, although this was not always logistically feasible. Training included an orientation of the learning activity, reading through the case/scenario, and discussing anticipated student questions and responses.

A survey tool was developed as part of the endof year course evaluation process to evaluate students' preferences and experiences working with the different types of simulated patients throughout the fall and spring semesters. One member of the teaching team (C.G.) drafted the original survey instrument and all co-authors provided feedback and subsequent revisions. The survey instrument was administered during a lecture period following the completion of all laboratory activities. Completion of the survey instrument was not a requirement of the course but was encouraged (standard procedure for our College of Pharmacy course evaluations process). Students were instructed to complete the survey instrument anonymously. On the survey instrument, students were asked to rank the 4 types of simulated patients on a scale from 1 to 4, with 1 being the best and 4 being the least optimal. Students were instructed to only rank the patient types with which they had experience during the course, and they were allowed to give multiple patient types the same ranking if they deemed them equal. If a student worked with a given patient type at some point during the previous year, they were also asked to respond to a list of 9 statements regarding their perceptions of that specific patient type using a Likert scale of strongly disagree, disagree, neutral, agree, and strongly agree (Appendix 1). Space was provided for students to include additional comments regarding the use of specific simulated patient types or to provide insight into any of their survey responses.