Pharmaceutical Care Plan Examinations to Identify Students at Risk for Poor Performance in Advanced Pharmacy Practice Experiences

Article excerpt

Objectives. To evaluate early predictors of advanced pharmacy practice experience (APPE) performance using either timed pharmaceutical care plan (TPCP) reports of 4 case histories or traditional lecture-based pharmacotherapy course examinations.

Methods. Statistical process control (SPC) methods were used to identify a group of third-year pharmacy students "at risk" for poor APPE performance (defined as an APPE grade point average of < 3.0). Examination scores from an integrated lecture-based pharmacotherapy sequence were used for comparison.

Results. TPCP scores but not lecture-based examination scores successfully identified 6 of 10 students who ultimately performed poorly in their APPEs.

Conclusion. Adaptation of SPC methods to assess student performance during problem-based learning (PBL) case reports is a useful technique for identifying students "at risk" for poor APPE performance.

Keywords: problem-solving, problem-based learning, assessment, advanced pharmacy practice experience, pharmaceutical care, performance

INTRODUCTION

The skills and abilities necessary for competent clinical practice include an extensive pharmacotherapy knowledge base, good critical thinking and problem-solving abilities, and strong communication skills. To this end, pharmacy education has been gradually transitioning from largely didactic, instructor-based teaching to more active, student-centered learning, including development of problem-based learning (PBL) curricula. Cisneros et al summarized the status of PBL within pharmacy and medical education, including a review of PBL research efforts by pharmacy educators. (1) PBL activities within pharmacy schools and colleges improve GPA, (2) examination scores, (3) and student perceptions of enhanced critical thinking, (4) problem-solving, (5) self-learning skills, (6) and preparation for advanced pharmacy practice experiences (APPE). (7) Need for more research has been cited by numerous authors to include the development of valid and reliable measures to assess PBL outcomes as well as different methodologic approaches to provide multiple perspectives. (1,3,6)

This analysis retrospectively evaluated the use of 4 TPCP reports performed as part of a 2-semester PBL curricular sequence. The primary objective was to evaluate the use of statistical process control (SPC) methods to predict students "at risk" for poor performance during their subsequent APPE curriculum. Additionally, the utility of this PBL examination method was compared to a subset of traditional lecture-based pharmacotherapy course examinations for predicting APPE performance.

METHODS

The PBL curricular sequence, a 4 semester case-based problem-solving recitation (Introduction to Clinical Problem-solving, PHAR 905 and Case Studies in Pharmacy, PHAR 906, 907, and 908) met for 2 hours twice a week beginning in the spring semester of the first year (P1) through the third year (P3) fall semester. The first 2 semesters were taught by basic science faculty members and the last 2 by clinical faculty members. This study evaluated spring P2 and fall P3 students for the years 2003-2005 (ie, graduating classes of 2005-2007). The course requirements included a midterm and final examination each semester in which students were presented with a new patient case history (ie, chief complaint, history of present illness, past medical history, etc) and allowed 2 hours to research, identify, and document a TPCP. Online and/or textbook reference materials were freely accessible during the examination period. The examination cases were developed by clinical faculty members involved in the course, and an attempt was made to gauge the case to the appropriate student level (ie, P3 examinations are less focused and more complicated than P2 examinations). Medical diagnoses were provided, but all drug-related problems were the student's responsibility to correctly identify and resolve. …

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