Use of a script concordance test to evaluate the impact of a targeted educational strategy on clinical reasoning in advanced pharmacy practice experiential students.

BACKGROUND AND PURPOSE: It is unclear how clinical reasoning is impacted by a single advanced pharmacy practice experience (APPE) and how preceptors can further develop these skills. EDUCATIONAL ACTIVITY AND SETTING: Students completing an APPE within four sites were invited to participate. To assess clinical reasoning skills, students completed a 30 item script concordance test (SCT) during week 1 and week 5 of a rotation. Students were divided into control and intervention groups. The intervention group participated in a clinical reasoning discussion, during which students presented a case and led a discussion on how to reason through treatment options. FINDINGS: Change in mean SCT scores between week 1 and week 5 were 0.84 (2.8%) and 1.23 (4.1%) in the control (n = 15) and intervention groups (n = 28), respectively. There was no significant change in scores in the control group (P = .07, CI -0.34, 2.01). The change in scores was statistically significant in the intervention group (P = .02, CI 0.23, 2.23). An independent samples t-test comparing the SCT score change for the control and intervention group showed no significant difference (P = .62, CI -1.18, 1.96). SUMMARY: This study demonstrated the feasibility of implementing a SCT in experiential education. SCT scores did not significantly improve beyond the standard APPE in response to the focused educational intervention, but investigators found that the discussion facilitated rich conversations about patient cases and was valuable for assessing a student's thinking pattern.

Faculty preceptors' strategies for teaching clinical reasoning skills in the advanced pharmacy practice experience setting.

INTRODUCTION: Clinical reasoning is essential to providing quality patient care. However, advanced pharmacy practice experience (APPE) students may struggle with the real-life aspects of patient care, and it may be difficult to quickly identify these students in order to make meaningful interventions. The purpose of this study was to explore pharmacy faculty preceptors' strategies for identifying gaps and teaching clinical reasoning in the APPE setting. METHODS: A qualitative study utilizing 30-min, one-on-one phone interviews was conducted with faculty members from two schools of pharmacy. Faculty participants were invited based on their APPE preceptor role and expertise in adult general medicine. Interview questions collected faculty demographics and reflections on evaluation and instruction of clinical reasoning skills. Demographics were analyzed using descriptive statistics. Thematic analysis was completed to identify themes from qualitative interview data. RESULTS: Fifteen faculty preceptors participated. The cohort had an average of 17.1 pharmacy practice years and an average of 11.9 faculty member years. Interviews yielded a 7735-word document for data analysis, which resulted in 11 themes. CONCLUSIONS: This study explored pharmacy faculty preceptors' strategies for identifying gaps in clinical reasoning and their instructional methods to improve those skills, which resulted in 11 themes. Future directions include implementation of a standardized clinical reasoning assessment tool in the APPE setting and exploration of targeted educational interventions.

What do I eat? Impact of an interactive teaching method for improving pharmacy students' diabetes nutrition knowledge and comfort in providing nutrition counseling.

BACKGROUND AND PURPOSE: Didactic approaches for instructing students about diabetes nutrition and self-management have been described previously in the pharmacy education literature. There is a need for diabetes nutrition active learning approaches that can be incorporated into the advanced pharmacy practice experience (APPE) setting so students can apply previous didactic learning in a real world setting. The goal was to add to students' knowledge of diabetes nutrition thereby increasing their comfort in discussing nutrition with patients. EDUCATIONAL ACTIVITY AND SETTING: The nutrition tour activity was implemented in the APPE setting and involved pharmacy students on ambulatory and inpatient rotations. The nutrition tour included several active learning exercises such as evaluation of nutrition labels and development of a day-long carbohydrate-consistent meal plan to encourage student engagement and application of information. Student pre- and post-activity survey data was collected two weeks before and two weeks after the tour to assess retention of knowledge of diabetes nutrition and comfort in diabetes nutrition education. Changes in knowledge and comfort were assessed using t-tests. FINDINGS: Fifty-five pharmacy students participated in the nutrition tour with 45 completing the pre-activity survey and 40 completing the post-activity survey. Comparison of student pre- and post-activity survey scores identified statistically significant increases in both total nutrition knowledge (p < 0.001) and student comfort in counseling on diabetes nutrition (p < 0.001). DISCUSSION AND SUMMARY: A diabetes nutrition tour guided by a pharmacy preceptor for APPE students was associated with increased diabetes nutrition knowledge and comfort in educating on diabetes nutrition.

Impact of debates on student perceptions and competency scores in the advanced pharmacy practice setting.

BACKGROUND AND PURPOSE: Advanced pharmacy practice experience (APPE) students are faced with the difficult reality that there is rarely one correct answer to a patient care question. Faculty preceptors developed a clinical debate activity to provide students with an opportunity to explore pharmacy topics with competing viewpoints. EDUCATIONAL ACTIVITY AND SETTING: The clinical debate activity was implemented in the APPE setting as a collaboration between three faculty preceptors from Drake University and University of Iowa. Student pre-debate and post-debate survey data was collected to assess the perceived impact of clinical debates on student confidence in skills related to the debate. Students were also asked to provide which skills were developed through the debate, whether participation in the debate changed their opinion on the issue, and if debates should be used as a teaching tool. Faculty preceptor scores on midpoint and final evaluations for applicable APPE competencies were also evaluated. FINDINGS: Forty-two students participated in a clinical debate over a 12-month period. Students demonstrated improved confidence in almost all areas assessed, and 90.5% of students felt debates should be used as a teaching tool. Assessment of faculty midpoint (pre-debate) and final (post-debate) evaluation scores revealed statistically significant improvements in competencies related to literature evaluation and communication skills. DISCUSSION AND CONCLUSIONS: Clinical debates have had a positive impact on both subjective and objective results in this APPE setting. Preceptors are encouraged to consider implementing a similar activity. Debates are a useful teaching tool in developing confidence and skills.