Interinstitutional simulation of patients with COVID-19 during a remote acute-care advanced pharmacy practice experience.

Introduction: Faculty and staff from Duquesne University and the University of Pittsburgh Schools of Pharmacy created a simulation activity focused on the care of critically ill patients with coronavirus disease 2019 (COVID-19). Students on remote, short-term-care advanced pharmacy practice experiences (APPE) rotations from both universities worked in comingled teams and completed two educational electronic health record reviews, complex simulation sessions, and debriefs. Individually, students completed two educational electronic health record reviews and verbal patient presentations before and after the simulation sessions. Objectives: Evaluate the effects of a simulation activity during a remote short-term-care APPE on student confidence and knowledge surrounding the care of a critically ill patient with COVID-19. Methods: Student knowledge surrounding COVID-19 short-term-care treatment principles was assessed through pre-/postcase-based multiple-choice examinations and an intermittent clinical examination (ICE). Student confidence and perceptions were gathered through anonymous pre-/postsurveys. The written examination and patient presentation recordings were compared from baseline to the final assessment using the Wilcoxon signed-rank test. Results: In total, 92 students participated in the activity. There was a statistically significant improvement from baseline to the final assessment (preassessment median [interquartile range (IQR)]: 55.3% [50%-60.5%]; postassessment median [IQR]: 68.4 [60.5%-73.7%]; P < .001) on the written examination. ICE total scores improved from baseline (preassessment median [range]: 33 [28-36] vs postassessment median [range]: 36.5 [29.5-43.52]; P = .004) as well as the objective (P < .001), plan (P < .001), and monitoring (P < .001) subdomain scores. Student confidence reported on surveys improved from baseline in all domains. Conclusion: Remote simulation sessions improve student knowledge and confidence and provide an opportunity for students to experience caring for patients with COVID-19 in a safe environment. Collaboration between schools of pharmacy can be successfully employed to leverage resources and expertise to expand opportunities for students.

Effects of Cross-Training on Medical Teams' Teamwork and Collaboration: Use of Simulation.

Previous research in the US Navy demonstrated that cross-training enhances teamwork and interpersonal collaboration. Limited data exists on cross-training effectiveness in medical education. This research aimed to assess whether cross-training would have similar effects on medical teams. A multidisciplinary pair of resident participants-consisting of one physician and one pharmacist-was randomly assigned to cross-training or current training condition. The training experience involved one video-based content module (training a pharmacist's task of pharmacokinetic dosing and a physician's task of intubation) and one simulation-based practice scenario (collaborative treatment of an unstable critically ill simulated patient). Interprofessional pairs randomized to cross-training condition participated in both the content module and practice scenario in the alternative professional role whereas pairs randomized to current training condition participated in their own professional role. Pairs also participated in pre- and post- training assessment scenarios in their own professional role. Teamwork and interprofessionalism were measured immediately following assessment scenarios. Knowledge assessments were conducted at the start and end of the scenario sequence. Multidisciplinary pairs experiencing cross-training showed a significant improvement in teamwork (increased by 6.11% vs. 3.24%, p < 0.05). All participants demonstrated significant improvement in knowledge scores (increase of 14% cross-training, p < 0.05, and increase of 13.9% control, p < 0.05). Our project suggests that cross-training can improve teamwork in interprofessional medical teams.

Evaluation of pharmacist satisfaction with simulation-based learning in Singapore.

BACKGROUND AND PURPOSE: High fidelity human patient simulation (HPS) has been incorporated in various United States doctor of pharmacy programs with favorable learning experiences, knowledge retention, and problem-solving skills reported. In Singapore, HPS is a novel learning technique as it has not been utilized in the Bachelor of Science (Pharmacy) curriculum or for continuing professional education (CPE). It is necessary to evaluate acceptance of HPS compared to asynchronous online learning (AOL). EDUCATIONAL ACTIVITY AND SETTING: Nineteen participants from two institutions completed the study in Singapore. This was an experimental study design with participants randomized into groups A and B. Group A completed AOL followed by HPS, whereas group B completed them in reverse order. Acceptance of teaching modalities was evaluated with a Likert scale survey and analyzed with Fisher's exact test. Educational content was congestive heart failure and was evaluated externally for equivalency. FINDINGS: All participants enjoyed the HPS activity compared to 13 (68.4%; p = 0.02) for AOL. Eighteen (94.7%) and 15 (78.9%; p = 0.34) participants felt that HPS activity and AOL improved their critical and decision-making skills respectively. Sixteen (84.2%) and 17 (89.5%) agreed that AOL and HPS activity improved their confidence (p = 1.00). DISCUSSION: Participants enjoyed HPS activity significantly more than AOL. HPS activity could be used to achieve improved critical and decision-making skills of learners as there was a trend of more learners perceiving improvement compare to AOL. SUMMARY: High fidelity HPS learning was well received by participants in Singapore and can be implemented in CPE.

Simulation-based learning versus problem-based learning in an acute care pharmacotherapy course.

INTRODUCTION: There is a lack of comparative data with simulation-based learning (SBL) and other types of learning. The objective of the study was to determine whether high-fidelity simulation is superior to problem-based learning (PBL) for training pharmacy students in an acute care elective. METHODS: Twenty-nine pharmacy students enrolled in the Acute Care Pharmacotherapy Simulation course over 2 years voluntarily participated in this randomized, crossover study. Students were randomized to group 1 or 2. The SBL group consisted of students in group 1 who had SBL during study week 1 and group 2 students who had SBL in week 2. The PBL group consisted of students in group 1 who had PBL cases during study week 2 and group 2 students who had PBL cases in week 1. The topics covered were management of dysrhythmias (week 1) and heart failure (week 2). RESULTS: The SBL group significantly improved compared with the PBL on postquiz scores. The SBL group performed at least 15% better in the clinical assessment (P = 0.013). Students in the SBL group performed significantly better in their critical thinking skills for problem list, pharmacotherapy plan, and monitoring plan. CONCLUSIONS: Learning was enhanced with the use of SBL compared with PBL.

Impact of simulation-based learning on medication error rates in critically ill patients.

PURPOSE: To compare medication administration error rates before and after the provision of educational sessions using either traditional didactic lecture or simulation-based training. METHODS: A single-center, parallel, controlled, prospective study conducted in adult coronary critical care (CCU) and medical intensive care units (MICU). Twenty-four nurses were observed administering medications. Documentation included drug name, dose, route, time and technique during observation and active medication orders in the patient's chart. A direct observation method was completed at baseline and repeated twice after the interventions. Data obtained during observation were analyzed for medication administration error rates. Interventions were two types of educational sessions with content developed from baseline medication administration error data: simulation-based training for CCU nurses and a didactic lecture for MICU nurses. Quizzes completed before and after the interventions were used to assess knowledge. RESULTS: A total of 880 doses (402 CCU, 478 MICU) were observed. After the simulation-based educational intervention in the CCU, medication administration error rates decreased from 30.8 to 4.0% (p < 0.001) in the initial post-intervention observation and were sustained in the final post-intervention observation (30.8 to 6.2%; p < 0.001). The error rate in the MICU after the didactic lecture intervention was not significantly different from the baseline and increased in the final post-intervention observation from 20.8 to 36.7% (p = 0.002). Mean quiz scores were significantly improved after education sessions in both ICUs. CONCLUSIONS: Simulation-based learning provides a significant advantage to patient care through the reduction of medication administration errors compared to lecture style education.

Human patient simulation in a pharmacotherapy course.

OBJECTIVE: To incorporate human patient simulation (HPS) into a pharmacotherapy course and evaluate its impact on students' satisfaction and mastery of course objectives. DESIGN: Various levels of HPS were used for clinical skills assessments, reinforcement of concepts previously introduced in class, and presentation of simulated patient case scenarios requiring critical-thinking and problem-solving abilities. Pre- and post-simulation examinations and a satisfaction survey instrument were administered. ASSESSMENT: Significant improvement was seen in students' knowledge on post-simulation examinations. On problem-solving skills, the majority of student groups received a final case grade >95%. Students indicated high levels of satisfaction with the use of HPS in the course and showed increased levels of confidence in their pharmacotherapy/patient care skills. CONCLUSION: Human patient simulation provided a unique opportunity for students to apply what they learned and allowed them to practice problem-solving skills. Students grew in confidence and knowledge through exposure to realistic simulation of clinical scenarios. Students showed improvement in knowledge and ability to resolve patient treatment problems, as well as in self-confidence.