Comparison of Low- and Higher-Fidelity Simulation to Train and Assess Pharmacy Students' Injection Technique

By Skoy, Elizabeth T.; Eukel, Heidi N. et al. | American Journal of Pharmaceutical Education, March 2013 | Go to article overview
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Comparison of Low- and Higher-Fidelity Simulation to Train and Assess Pharmacy Students' Injection Technique

Skoy, Elizabeth T., Eukel, Heidi N., Frenzel, Jeanne E., American Journal of Pharmaceutical Education


All 50 states, the District of Columbia, and Puerto Rico authorize pharmacists to administer vaccinations. (1) As health professionals qualified to administer vaccines, pharmacists must support public health initiatives by promoting vaccinations and providing immunization services. (2) Pharmacist-provided patient education and immunization services align with the Healthy People 2020 goal to "increase immunization rates and reduce preventable infectious disease." (3)

Immunization rates remain low in the United States. One answer to this problem is to educate future pharmacists through the promotion of immunization-related public health initiatives within the pharmacy curriculum. The American Association of Colleges of Pharmacy Center for the Advancement of Pharmaceutical Education (CAPE) Advisory Panel on Educational Outcomes has defined criteria for promoting public health. The CAPE outcomes state that doctor of pharmacy (PharmD) graduates must possess the ability to promote public health initiatives including the ability to promote patient wellness and health improvement, and prevention of disease. (4)

As the need for immunizing pharmacists expands, pharmacy colleges and schools are called upon to make immunization training part of their required curriculum. (2) Training can be enhanced through the use of simulation, which allows students to develop patient care skills in a controlled environment. (5,6) The use of patient simulators in education increases student confidence, enhances knowledge, and ensures accuracy of patient care activities. (5,7) Simulation can also be used to meet introductory pharmacy practice experience requirements. (8)

Patient simulators are available in low, medium, and high fidelity and vary widely in cost. (9) Thus, one must consider which simulation technology will result in the best student learning outcomes for the expenditure. Faculty members at North Dakota State University currently use 2 types of simulation to teach students injection technique. The objective of this study was to determine if one type of simulation is superior to another for injection administration training, and if either had an effect on students' learning outcomes or self-ratings of proficiency, confidence, and anxiety.


The PharmD program at North Dakota State University is a 4-year program. During the second semester of the third year, students are required to complete an immunization certificate training program. Prior to this training, students do not receive any formal training or clinical experience related to immunization or injection administration. This certificate training course is completed in 2 parts. Students are enrolled in a 1-credit classroom course which focuses on immunization schedules, state laws, rules and regulations, emergency procedures, vaccination storage and handling, and immunization service implementation. Students are simultaneously enrolled in a 1-credit pharmaceutical care laboratory where they are taught proper subcutaneous and intramuscular injection techniques. The primary learning objective for the laboratory portion is to ensure students' ability to properly administer a subcutaneous and intramuscular injection to a peer. Upon successful completion of the classroom and laboratory courses, students receive an immunization administration certificate, which authorizes them to administer immunizations to patients. This immunization certificate training program was developed by North Dakota State University College of Pharmacy, Nursing, and Allied Sciences and is accredited by the Accreditation Council for Pharmacy Education.

Injection technique was taught and evaluated in Pharmaceutical Care Laboratory IV, which is part of a 4-semester laboratory series. Eight 2-hour laboratory sections taught by 4 pharmacist faculty members were offered each week, with 12 third-year students enrolled in each section.

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Comparison of Low- and Higher-Fidelity Simulation to Train and Assess Pharmacy Students' Injection Technique


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