Gamification in pharmacy education: a systematic quantitative literature review.

OBJECTIVES: Gamification involves applying game attributes to non-game contexts and its educational use is increasing. It is essential to review the outcomes and the efficacy of gamification to identify evidence to support its use in pharmacy education. THIS ARTICLE: systematically and quantitatively reviews and evaluates the alignment of learning outcomes and the quality of peer-reviewed literature reporting gamification in pharmacy education. KEY FINDINGS: A literature search was undertaken in February 2022 using CINAHL Complete, MEDLINE, Science Direct, Scopus and ERIC databases, via keywords (game* OR gaming OR gamif*) AND pharmac* AND education. Google Scholar was searched using 'gamification of pharmacy education' and 'serious games in pharmacy education'. Data extracted included type of gamified intervention, mode of delivery, game fidelity, intended learning outcomes and outcomes reported. Quality assessments aligned with key aspects of the SQUIRE-EDU Reporting Guidelines. Of 759 abstracts and 95 full-text papers assessed, 66 articles met the inclusion criteria. They described gamification from 12 countries in the education of 8272 pharmacy and health professional students. Gamified interventions ranged from board games to immersive simulations, with escape rooms most frequently reported. Reporting quality was inconsistent, with observed misalignment between intended learning outcomes and outcomes reported, an apparent overreliance on student perceptions as primary data and a lack of reference to reporting guidelines. SUMMARY: Gamification is included in the curricula of many pharmacy degrees, across multiple subject areas. This review identified evidence gaps and reinforces the need for improved quality of gamification research, critical alignment of learning outcomes with evaluation, and use of reporting guidelines.

Optimising database searching in pharmacy education.

OBJECTIVES: To determine the effectiveness of databases in a pharmacy education literature search. METHODS: Six databases (CINAHL, ERIC, Google Scholar, Ovid MEDLINE, Science Direct and Scopus) were compared for effectiveness in identifying pharmacy education literature. Articles were coded for database of retrieval and results cross-referenced. Sensitivity, precision and number of unique retrievals were calculated. KEY FINDINGS: Scopus yielded the highest sensitivity (65%) and precision (47%). The combination of three databases (Scopus, Science Direct and Google Scholar) identified 97% (n = 64) of 66 relevant articles. CONCLUSIONS: Pharmacy education literature searches require more than one database, ideally Scopus, Science Direct and Google Scholar.

Impact of a gamified simulation on pharmacy students' self-assessed competencies.

INTRODUCTION: Competency-based pharmacist education develops robust professional identities and prepares graduates for future practice to ensure optimal patient outcomes. An extended gamified simulation was developed as a capstone activity for a new Australian Bachelor of Pharmacy (BPharm) program. The simulation was designed to consolidate students' knowledge, skills, and behaviors from prior learning. This research aimed to explore whether participation in an extended gamified simulation could influence pharmacy students' perceptions of their professional competencies. METHODS: Data were collected over three years to compare a superseded Master of Pharmacy (MPharm) program with an incoming BPharm program. Final year students were invited to self-assess their professional competencies at the start and end of their final semester of study, using a digital self-assessment tool which replicated Australia's National Competency Standards Framework for Pharmacists. Participants rated their own competency against the 26 competency standards across five domains on a five-point Likert scale (not at all competent to very competent). This provided pre- and post-data to compare the simulation (BPharm intervention) and a traditional semester (MPharm comparison), in addition to final course grades. RESULTS: From 2016 to 2019, 85 (90.4%) of 94 intervention and 50 (83.3%) of 60 comparison students completed the self-assessment of professional competencies. Participation in the gamified simulation significantly improved students' pharmacotherapeutics grades and pre-post change scores for seven of the 26 competency standards, two of the five domains, and all domains combined of the National Competency Standards. CONCLUSIONS: An extended, gamified simulation enhances the development of pharmacy students' self-assessed professional competencies.

Virtualized Gamified Pharmacy Simulation during COVID-19.

Extended and immersive gamified pharmacy simulation has been demonstrated to provide transformative learning in pharmacy education, preparing graduates for real-world practice. An international consortium of universities has implemented local adaptations of the Pharmacy Game into their curricula. From early 2020, pharmacy academics modified the delivery of gamified simulation in response to the COVID-19 pandemic, while still aiming to deliver the important learning outcomes of enhanced communication, collaboration, confidence and competence. Australian universities went into full lockdown from March 2020, and the critical gamified simulation at Griffith University was delivered entirely virtually in 2020. An array of synchronous and asynchronous approaches and software platforms was employed, including Microsoft Teams, Forms and Stream plus the online interview platform Big Interview. These allowed for the simulation activities, including dispensing, counselling and clinical cases, to be conducted by students online. In 2021, Griffith University conducted hybrid delivery of its Pharmacy Game, balancing student participation both in person and online. Microsoft Power Apps was added to the hosting platform to enhance the simulation interface, and Power Virtual Agent artificial intelligence chatbots, with natural language processing, were used to enable asynchronous clinical interaction. The combination of learning technologies provided the means to deliver successful gamified simulation in the virtual and hybrid environments while still achieving outstanding learning outcomes from the capstone activity. This paper details the technologies used to virtualize the Australian Pharmacy Game and the analytics available to educators to assess student participation, engagement and performance.

Sustainability via PebblePad digitization of pharmacy practice resources.

INTRODUCTION: Digitization of learning and teaching resources allows for paper-free, digitally-enabled approaches to learning. While PebblePad is well recognized as an electronic portfolio platform, this study aimed to evaluate PebblePad for delivery of foundational workshop materials to provide sustainable and ongoing student access. METHODS: From 2017, all workshops in a foundational pharmacy practice course were transferred from a paper-based manual to a modular digitized format hosted in PebblePad. An electronic survey tool assessed students' experiences with the platform. The voluntary and anonymous survey sought participant opinions on use, usability, ways of using, and reflection on using PebblePad on a five-point Likert-type scale (strongly disagree to strongly agree). Participants were asked to identify techniques they used to become familiar with PebblePad and the ways in which they used the platform. RESULTS: From 2017 to 2019, 81 (45.3%) of 179  second-year pharmacy students participated in the research. Students most strongly agreed with statements related to comfort with online technologies for learning (n = 46/80, 57.5%), ease of use of PebblePad (n = 41/80, 51.3%), and having sufficient support from teaching staff (n = 39/78, 50%). The primary technique for becoming familiar with PebblePad was individual guidance from the teacher. The main use was to complete required workbook templates. Free-text comments demonstrated overwhelming support for PebblePad used in this teaching context. CONCLUSIONS: PebblePad provided a valuable and sustainable platform for hosting digitized foundational pharmacy practice workshop resources.

The International Pharmacy Game: A Comparison of Implementation in Seven Universities World-Wide.

The utilization of serious games and simulations in health professional education has increased. The Pharmacy Game is one such concept that intersects gamification and simulation, in which pharmacy student teams competitively manage simulated pharmacies; a concept included in the pharmacy curricula of seven international universities. This study aimed to compare the implementation and conduct of the Pharmacy Game of participant universities and their students' performance in the same educational task. Data were collected via a questionnaire completed by academic staff in April 2020, and the collation of results of the same patient case was conducted at each university (April 2020 to March 2021). The main results reflected differences in the game frequencies and the curricular approach (standalone or integrated course) and in the learning outcomes for the Pharmacy Game. Other differences were identified in the extent to which students of other professions were part of the game such as medical students or pharmacy assistants. Student case outcomes revealed similar strengths across the universities in patient communication and focus on safety, with variations identified as areas for improvement. Collation of the international utilization of the Pharmacy Game identified a broad spectrum of similar learning outcomes, inspiring a model of international core and aspirational learning outcomes. While the Pharmacy Game has been implemented with flexibility regarding the numbers of teams (4-10) and the duration of activity (12-36 days), all universities reported positive experiences and student outcomes, suggesting that the intervention represents a potential tool to deliver capstone learning experiences, promote interprofessional education, reinforce patient safety, and prepare pharmacy graduates for future practice.

Experiential Learning in a Gamified Pharmacy Simulation: A Qualitative Exploration Guided by Semantic Analysis.

Experiential learning is an important component of pharmacist education and is primarily achieved through supervised placement or simulation. This study explored senior pharmacy students' experiential learning in an extended, immersive, gamified simulation, conducted as a capstone learning activity toward the end of their final year of study, consolidating all prior learning and preparing students for intern practice. The simulation aimed to enhance student confidence, competence and collaboration. The three-week activity involved student teams competitively managing simulated pharmacies, assuming the role of pharmacists to complete all scaffolded assessments, including dispensing prescriptions, clinical cases, verbal counselling, simulated patient cases, interprofessional collaboration, and assignments. Assessments were marked continuously, with consequences of practice acknowledged through gain or loss of 'patients' for the pharmacy. From 2016 to 2018, 123 students completed multiple individual reflective journals (n = 733). Reflective journals were analyzed to explore the student experience, using a mixed methods approach. Initial Leximancer® 4.51 semantic analysis guided thematic analysis, conducted in NVivo® 12. The major themes that emerged were teamwork, patient-centeredness, medicines provision, future practice, and the learning experience. Student participants reported an intense and emotional experience in the gamified simulation, with many students revealing transformation in their skills, behaviors and attitudes over its duration.

Australian community pharmacists' perceptions of public health before the COVID-19 pandemic.

BACKGROUND: Consensus is lacking regarding delivery of public health services in community pharmacy. OBJECTIVE: The objective of this study was to explore pharmacists' perspectives on public health initiatives in community practice. METHOD: Australian community pharmacists were randomly sampled to participate in face-to-face, semi-structured interviews to explore public health definitions and perceptions. KEY FINDINGS: Nine pharmacists participated early 2020, pre-COVID-19. Mean interview duration was 23 min. Results revealed little distinction between individual and public health services. Barriers to service provision were lack of time, remuneration, training, standards and privacy. Enablers opposed barriers, namely accessibility, improved funding, education, standardised services and consulting rooms. CONCLUSION: Improved clarity is required regarding the role that community pharmacists can assume in provision of public health.

Hospital pharmacists' ethical exposure and decision-making.

BACKGROUND: Studies have explored community pharmacy ethical dilemmas; however, limited research exists on hospital pharmacy ethical issues and pharmacists' ethical decision-making processes. Research exploring this is timely, considering developments in hospital pharmacy practices, new hospital pharmacist roles, and evolving responsibilities. AIM/OBJECTIVES: To explore hospital pharmacists' ethical decision-making and processes for managing ethical challenges in the context of evolving Australian hospital pharmacy practices. METHODS: Face-to-face semi-structured interviews with 20 purposively-selected hospital pharmacists from four Queensland Health hospitals. An interview guide with 11 open-ended questions and prompts was developed, validated, and trialed. Pharmacists who consented received the guide prior to interviews. Interviews were audio recorded, transcribed verbatim, and compared with field notes. Transcribed data were imported into NVivo 12 to facilitate coding and thematic analysis. RESULTS: Participants were interviewed January to April 2019; median interview duration was 17.45 min. Data saturation was reached. Participants' experiences ranged from junior level pharmacists to senior management positions, in clinical and non-clinical roles. Emerging themes were: 1) influences on the development of ethical decision-making skills, 2) ethical decision-making is an integral part of the hospital pharmacist's role, and 3) institutional requirements and settings impact on ethical exposure. A wide range of contemporary ethical issues unique to hospital pharmacy practice, mostly involving complex medication management safety, supply, and cost scenarios, were identified. Junior pharmacists indicated they would benefit from additional training, mentorship, and availability of hospital-specific targeted ethics resources. CONCLUSION: The findings highlighted that hospital pharmacists are regularly faced with ethical issues unique to the hospital pharmacy practice context. Application of sound and structured ethical reasoning and decision-making is, therefore, required in this setting. Participants identified many interrelated factors that impacted their ethical reasoning and behaviour. This study identified gaps that, once addressed, will better support ethical reasoning in hospital pharmacy settings.

Australian pharmacists: ready for increased non-prescription medicines reclassification.

OBJECTIVES: Reclassification of medicines from prescription to non-prescription increases timely access to treatment, promotes self-management of minor ailments and relieves healthcare system burden. Previous research identified that Australia lagged behind the United Kingdom and New Zealand in medicines reclassification. This study aimed to identify Australian pharmacists' opinions on the current state of medicines reclassification; the prescription medicines consumers requested without prescription; the medicines pharmacists believed should and should not be considered for reclassification; and perceived barriers to reclassification. METHODS: A 2016 national online survey that sought pharmacists' opinions on the state of reclassification, perceived barriers to reclassification and readiness of the profession for further reclassification. Pharmacists' comments were invited through open-ended questions. KEY FINDINGS: Two hundred and thirty-five valid surveys were completed. Respondents practised in community, hospital, consultant and academic contexts, and the majority were female (58.7%, n = 138). More than two thirds (70.66%, n = 166) of pharmacists reported receiving daily or weekly requests for non-prescription access to prescription medicines. The majority of pharmacists (71.7%) agreed that the Australian pharmacy profession is ready for further medicines reclassification, guided by patient safety, harm minimisation and medication continuance. The most prominent barrier to further reclassification was opposition from other healthcare professionals. CONCLUSIONS: Australian pharmacists believe that their profession has the capacity to safely and effectively manage a wider range of non-prescription medicines through increased reclassification in the contexts of patient safety and risk mitigation. This study has contributed to the global conversation on non-prescription medicines access, providing momentum for practice and policy change.

Pharmacy ethical reasoning: a comparison of Australian pharmacists and interns.

Background Ethical reasoning informs decision making and professional judgement, is guided by codes of ethics and conduct, and requires navigation through a regulatory framework. Ethical reasoning should evolve throughout the pharmacy internship year and prepare interns for independent practice. Objective To explore the ethical reasoning and processes of Australian pharmacists and pharmacy interns. Setting Queensland community pharmacists and interns. Method A survey to determine use of resources to guide ethical decisions, management of ethical dilemmas, and exposure to potential practice privacy breaches. Participants were recruited at pharmacy intern training events, a pharmacist education session and through telephone contact of randomised community pharmacies. Main outcome measure Comparison between pharmacist and intern responses using 5-point Likert scales, listings and prioritising. Results In total 218 completed surveys were analysed: 121 pharmacy interns and 97 pharmacists. The Code of Ethics was identified as the resource most frequently consulted when faced with ethical dilemmas. Interns were more likely to consult legislation and regulatory authorities whereas pharmacists with colleagues. Responses to ethical vignette scenarios and exposure to privacy breaches varied between interns and pharmacists, with some scenarios revealing significant differences. Most participants had been exposed to a variety of potential privacy breaches in practice. Conclusion Interns focussed on legislation and guidelines when presented with hypothetical ethical dilemmas. In contrast to this positivist approach, pharmacists reported using a social constructionist approach with peers as a reference. Pharmacists avoided ethical scenario options that required complex management. Interns reported more exposure to potential practice privacy breaches.

Asynchronous Medicines Legislation for Non-Medical Prescribing.

National registration of Australian health practitioners aimed to facilitate workforce mobility. Non-medical prescribers, including nurses, podiatrists and optometrists, are overseen by National Boards which, in some cases, specify a formulary from which their health practitioners may prescribe. All prescribers must comply with their respective State or Territory's legislation. If prescribing a medicine that is a benefit under the Pharmaceutical Benefits Scheme (PBS), additional restrictions may apply. National Board and PBS prescribing formularies were compared and State and Territory medicines legislation was interrogated regarding non-medical prescribing. Discrepancies were identified between the approved formularies for non-medical prescribers, PBS prescribing formularies and medicines allowed to be prescribed under jurisdictional legislation. Asynchronous medicines legislation provides potential for health professionals to either inadvertently or knowingly breach legislation following national changes to health policy. Consideration should be given to the development of consistent legislation and its uniform commencement across all Australian jurisdictions.

Interstate dispensing: a case for uniform, intuitive legislation.

Australian health practitioner registration is national, whereas legislation regarding the handling of medicines is governed by individual States and Territories. To align with the July 2010 national registration scheme some legislative modifications were made concerning scheduled drugs and poisons, but many differences between jurisdictions remain. In Queensland, the Health (Drugs and Poisons) Regulation 1996 (Qld) allows for dispensing of controlled drugs written by interstate prescribers but not lower scheduled specified restricted and regulated restricted drugs. The aim of this study was to assess awareness of seemingly counterintuitive legislation by pharmacists practising in South-East Queensland. Of 125 Gold Coast pharmacies contacted, 54 (43.2%) agreed to participate. The majority of pharmacists (88.9%) had good knowledge regarding controlled drugs. In contrast, they demonstrated confusion regarding specified restricted and regulated restricted drugs (51.9% correct awareness). Uniform legislation between jurisdictions or more intuitive legislation would ease practitioner confusion.

Responses of pharmacy students to hypothetical refusal of emergency hormonal contraception.

OBJECTIVES: To explore pharmacy students' ethical behaviour and care towards patients in relation to the provision of emergency hormonal contraception (EHC). METHODS: Three hundred and forty-seven pharmacy students were presented a hypothetical scenario involving refusal of EHC, based on religious or moral grounds, and asked to write responses as to how the patient should be managed; 270 (77.8%) responded. KEY FINDINGS: Of all respondents, 90.4% referred the patient to another health professional to facilitate continuity of care, with referrals increasing as students progressed through the programme. Religion had no influence on referral, while female gender was related to increased referral. CONCLUSIONS: Gender difference, if continued into practice, has the potential to negatively impact on patient care.