A Cardiovascular Pharmacotherapy Elective Course to Enhance Pharmacy Students' Literature Evaluation Skills and Ability to Apply Clinical Evidence

Article excerpt

INTRODUCTION

Traditional pharmacotherapeutics curriculum generally presented pharmacy students with treatment guidelines and a disease management approach without providing in-depth discussion of the clinical evidence supporting the therapeutic recommendations. Because of time limitations and the amount of materials that needed to be covered, often only the treatment overview was presented and issues regarding therapy selection, dosing, and monitoring were not discussed in depth. Sometimes, students were left to explore these areas for the first time in case study workshops or even during clinical practice experiences, which could be overwhelming.

With the shift in health care practice to an interdisciplinary team approach, pharmacists now play a critical role in the evidence-based decision-making process, serving as a source of scientifically valid information, and experts on best practices in the appropriate use of medications. Thus, the need to develop pharmacy students' skills in literature evaluation and application of clinical evidence in practice is crucial. According to the latest accreditation standards and guidelines published by the Accreditation Council for Pharmacy Education on February 14, 2011, pharmacy graduates must be able to evaluate the quality of basic science and clinical research evidence to appropriately apply study results to practice decisions. (1)

The practice of evidence-based medicine was usually introduced to pharmacy students as part of drug information, literature evaluation, research design, or similar courses. The skill set used in acquiring, interpreting, and applying evidence-based medicine practices was formally taught in a required course in only 42% of US colleges and schools of pharmacy. (2) Furthermore, there were few opportunities in the classroom curriculum to reinforce these skills prior to beginning clinical clerkships. Only a few studies have evaluated these courses. (3-5) Medical students who were given a 2-hour instructional session on evidence-based practice were able to obtain more relevant and complete search results compared to students who did not receive training. (3) Likewise, active-learning strategies (2-hour weekly literature search activities) in a drug information and literature evaluation course resulted in improvement in pharmacy students' ability and confidence to perform the course objectives. (4) Third-year medical students who received four 2-hour sessions on evidence-based medicine increased their ability to critically appraise the literature and their tendency to rely on original research articles to solve clinical problems. (5) It is, therefore, not only important to introduce students to evidence-based practice, but also to incorporate other strategies earlier in the curriculum to reinforce these concepts prior to beginning practice experiences.

Cardiovascular diseases management is probably one of the most evidence-based areas of medicine and pharmacy practice. The results of new clinical studies require pharmacy practice guidelines to be updated every 2 to 3 years. It is important for students to develop and assume responsibility for their own lifelong learning skills in this area. Being able to evaluate clinical evidence and apply the results to practice is an important component. This manuscript describes the development and implementation of a cardiovascular pharmacotherapy elective course to develop these skills.

DESIGN

The overall goal of the cardiovascular pharmacotherapy elective course was to enhance pharmacy students' ability to evaluate medical literature and to apply clinical evidence to practice via the in-depth study of management of cardiovascular diseases. In addition, the course also discussed "clinical pearls" that were not normally discussed in the required curriculum, for example: (1) how to replace and monitor potassium in patients on high-dose diuretics; (2) how to switch from unfractionated heparin to low molecular weight heparin or other antithrombotics; and (3) how to concentrate all intravenous medications so as to minimize fluid intake in a patient with heart failure and fluid overload. …