The Development and Evaluation of the Interprofessional Education Facilitation Program for Health Professionals Using the Attention, Relevance, Confidence, and Satisfaction (ARCS) Model of Instructional Design.

Background It is important to learn interprofessional education (IPE) facilitation skills to promote interprofessional collaboration in healthcare. Nonetheless, to date, only a handful of IPE facilitation programs have been developed through research. Objective The objective of this study was to create an IPE facilitation program for healthcare professionals who wanted to promote interprofessional collaboration in their organizations based on the tenets of instructional design and evaluate its effectiveness. Methods This study's methodology was a mixed method based on relative subjectivism. We developed a two-day IPE facilitation program to learn IPE facilitation skills and promote interprofessional collaboration in the participants' own organizations. The program was developed based on the instructional design principles of the attention, relevance, confidence, and satisfaction (ARCS) model, measuring the participants' Interprofessional Facilitation Scale (IPFS) scores at three time points: before the first day, after the second day, and approximately one year after the course was completed. A one-way analysis of variance test was used to compare IPFS means at the three time points, and open-ended statements were qualitatively analyzed using thematic analysis. Results Twelve healthcare providers (four physicians, two pharmacists, one nurse, one rehabilitation worker, one medical social worker, one clinical psychologist, one medical secretary, and one other) participated in the completed IPE facilitation program. Their IPFS scores increased significantly from 17.4 ± 16.1 before the program to 38.1 ± 9.4 after the program and remained at 35.1 ± 11.7 for one year (p = 0.008). In addition, qualitative analysis suggested that the knowledge and skills learned in the program could be applied in the participants' workplaces, which helped them maintain their IPE facilitation skills. Conclusion We developed a two-day IPE facilitation program based on the ARCS instructional design model, and the participants' IPE facilitation skills scores increased and were maintained one year later.

Amantadine intoxication despite moderate renal dysfunction: A case of combined use with donepezil.

Amantadine intoxication occurred despite moderate renal dysfunction. This may have been affected by the use of donepezil, and we require careful attention to these combinations.

[The pharmacist-physician collaboration for IPW: from physician's perspective].

Interprofessional work (IPW) is increasingly important in various settings including primary care, in which the role of pharmacists is particularly important. Many studies have shown that in cases of hypertension, diabetes, dyslipidemia, and metabolic syndrome, physician-pharmacist collaboration can improve medication adherence and help to identify drug-related problems. Some surveys and qualitative studies revealed barriers and key factors for effective physician-pharmacist collaboration, including trustworthiness and role clarification. In Japan, some cases of good collaborative work between pharmacists and physicians in hospitals and primary care settings have been reported. Still, community pharmacists in particular have difficulties collaborating with primary care doctors because they have insufficient medical information about patients, they feel hesitant about contacting physicians, and they usually communicate by phone or fax rather than face to face. Essential competencies for good interprofessional collaboration have been proposed by the Canadian Interprofessional Health Collaborative (CIHC): interprofessional communication; patient/client/family/community-centered care; role clarification; team functioning; collaborative leadership; and interprofessional conflict resolution. Our interprofessional education (IPE) team regularly offers educational programs to help health professionals learn interprofessional collaboration skills. We expect many pharmacists to learn those skills and actively to facilitate interprofessional collaboration.

[The pharmacist-nurse collaboration for IPW: from nurse's perspective].

  The concept of interprofessional work (IPW) is becoming increasingly important recently and the role of nurses in IPW seems critical. In Japan, the problem of burnout and turnover of nurses has been recognized, and the solution seems embedded in the scheme of IPW, because it appears to improve their job satisfaction and recognition as health professionals. However, many obstacles lie ahead, such as "tribal conflict" between health professionals including between pharmacists and nurses. Although failure to understand the roles of other professionals or competencies may seem to hamper with the promotion of collaboration, we must realize that even a lack of understanding among nurses exists. The authors believe that the solution is to understand and respect not only other professionals but also colleagues of the same profession.

[Trial of interprofessional education for effective IPW].

  To work collaboratively in healthcare practice, health professionals should learn not only the competencies of their own specialties but also those of other professions so as to promote effective interprofessional work (IPW), thus optimizing patient/client outcomes. For this reason interprofessional education (IPE) is urgently needed. Since the establishment of Centre for the Advancement of Interprofessional Education (CAIPE) in 1987, many IPE programs have been developed and implemented worldwide. Currently, our Japan Society for Instructional Systems in Healthcare (JSISH) IPE program project team is conducting a study to develop an effective and versatile IPE program according to the framework of instructional design (ID). The main categories of learning goals of our program are intellectual skills and attitudes among Gagne's five categories. Therefore we designed our program to start from the drama (skit or video) of a bad example of IPW for learners to see and discuss the barriers of interprofessional collaboration. The drama of IPW seems to enhance attention and relevance for learners; both of which are components of the ARCS model. We expect every health professional including pharmacists to learn about IPW competencies through participating in our IPE program, enabling us further to pursue the ideal patient/client/family-centered care together.

[Elucidating obstructive factors for IPW from the pharmacist position in clinical practice].

  In Japan, many health professionals do not seem to have adequate understandings of the competencies and specialties of other professionals. The competencies of pharmacists are especially overlooked because their expected roles have been changing rapidly in recent years and may vary depending on context in various settings. Due to this lack of understanding physicians themselves often perform therapeutic drug monitoring (TDM), and pharmacists sometimes suggest unnecessary prescription proposals to physicians without considering their treatment plans. Although "community and hospital pharmacist collaboration" has been emphasized for many years, many pharmacists in both settings still do not understand one another's situation. How can we make pharmacists' competencies appropriately understood and respected by other health professionals? What should we do to promote interprofessional work (IPW) with more incorporation of pharmacists so as to pursue patient/client/family-centered care? The key to success in IPW seems to lie in the answers to these questions.

Evaluation of pharmacy practice program in the 6-year pharmaceutical education curriculum in Japan: hospital pharmacy practice program.

BACKGROUND: The objective of this study was to clarify the state of national pharmacy practice program in the 6-year course of pharmaceutical education from the students' point of view. We will suggest the points for improvement and issues of the current pharmacy practice programs to enhance the educational effects of the pharmacy practice program. METHODS: The survey conducted from September 2011 to March 2012 (hereinafter referred to as "2011") and from September 2012 to March 2013 (hereinafter referred to as "2012") comprised 1,607 pharmacy students, who had completed the pharmacy practice program. They were asked to fill out a self-descriptive questionnaire for the purpose of investigating the content of the pharmacy practice that the students themselves experienced, guidance provided by the supervising pharmacists, and support by the university faculty staff. RESULTS: In order to clarify the factor structure of the overall results, four factors were extracted through an exploratory analysis: "satisfactory learning", "support system of the training site (hospital)", "support system of university", and "dialogue with patients". When we compared the score for each four factors between 2011 and 2012 and we found that 2012 was evaluated as significantly higher for all factors. Furthermore, opportunities for discussion and reflection with the students led to observation that 2012 exhibited significantly better results than 2011. CONCLUSIONS: The students evaluations for the quality of hospital pharmacy practice have improved in 2012 compared to evaluations in 2011. Regarding the four factors of "satisfactory learning", "support system of the training site", "support system of university", and "dialogue with patients", significant differences in the results from 2011 and 2012 were observed, indicating their marked improvement.

Evaluation of the pharmacy practice program in the 6-year pharmaceutical education curriculum in Japan: community pharmacy practice program.

BACKGROUND: The purpose of this study was to highlight concerns with the current pharmacy practice program and suggest aspects for improvement. A further aim of the study was to enhance the educational effects of the program, from the students' point of view. METHODS: We surveyed 1,607 pharmacy students in Japan who had completed the pharmacy practice program in either 2010 or 2011. The students completed a self-descriptive questionnaire comprising 48 questions examining their experience of the pharmacy practice program. RESULTS: For community pharmacy practice, four factors were extracted through exploratory analysis: "satisfactory learning (pharmacy)," "support system of the university," "creation and clarification of the training plan," and "dialogue with patients." When comparing the mean values for each of the four factors between 2011 and 2012, the 2012 group scored significantly higher (p < 0.001) on "support system of the university" only. In the free responses, it became apparent that, for the joint training held in certain regions, students evaluated such training to be useful and effective. Moreover, we conducted an overall evaluation of the pharmacy practice programs. From the results of McNemar's test, from 2011 to 2012, there was a significant decrease in the number of students who were unable to experience "charge system of patients" at neither hospitals nor pharmacies (p < 0.01). CONCLUSIONS: For community pharmacy practice, there were no significant differences found for the factors, with the exception of the "support system of the university." In addition, to accomplish the learning objectives, community pharmacy practice program introduced some initiatives. Furthermore, conducting training at multiple facilities deepens student learning and assists with the correction of problems, such as the disparities within the teaching system and learning content at each of the training facilities.

An advanced objective structured clinical examination using patient simulators to evaluate pharmacy students' skills in physical assessment.

OBJECTIVE: To implement an advanced objective structured clinical examination (OSCE) in the curriculum and to evaluate Japanese pharmacy students' skills in physical assessment such as measuring pulse and blood pressure, and assessing heart, lung, and intestinal sounds. DESIGN: An advanced OSCE was implemented in a hospital pharmacy seminar as a compulsory subject. We programmed patient simulators with 21 different patient cases in which normal and abnormal physiological conditions were produced. The virtual patients were then used to evaluate the physical assessment skills of fifth-year pharmacy students. ASSESSMENT: Significant differences were observed between the average of all the detailed evaluations and the mean results for the following skills: pulse measurement, blood pressure measurement, deflating the cuff at a rate of 2-3 mmHg/sec, listening to heart sounds, and listening to lung sounds. CONCLUSION: Administering an advanced OSCE using virtual patients was an effective way of assessing pharmacy students' skills in a realistic setting. Several areas in which pharmacy students require further training were identified.