Academic journal article American Journal of Pharmaceutical Education

Pharmacy Student Knowledge Retention after Completing Either a Simulated or Written Patient Case

Academic journal article American Journal of Pharmaceutical Education

Pharmacy Student Knowledge Retention after Completing Either a Simulated or Written Patient Case

Article excerpt


The Accreditation Council for Pharmacy Education standards allow for the structured use of simulation as part of pharmacy students' required introductory pharmacy practice experiences. (1) Additionally, simulation is offered as a tool to facilitate interprofessional interaction. Simulations create a realistic setting in which standardized scenarios allow students to safely and repeatedly practice skills in a consistent environment. (2) The literature regarding the use of simulation mannequins in the doctor of pharmacy (PharmD) curriculum has focused on teaching interdisciplinary team skills and practicing advanced cardiovascular life support (ACLS). (3,4) Simulation technology also has been used to evaluate pharmacy students' competency in performing physical assessments and providing therapeutic recommendations. (5-7) There has been minimal research investigating student retention of knowledge acquired through participation in mannequin-based simulations.

A mannequin-based simulation course was used to teach and evaluate ACLS protocols in second-year internal medicine medical residents. (8,9) The study showed improvement in residents' knowledge and skills from baseline, and follow-up studies at 6 months and 14 months found no significant deterioration in residents' ability to implement ACLS protocols. Nurse anesthetists' knowledge and skill of ACLS protocols were evaluated before, immediately after, and 3 months after a brief ACLS course using a simulation mannequin. (10) The study found significant immediate improvements in knowledge and skills; however, after 3 months, the nurse anesthetists' scores reverted to pre-course levels.

There is no published research comparing outcomes from participation in simulation-based patient cases with participation in written patient cases in the PharmD curriculum. Prior to this study, there was no elective course at the University of Tennessee College of Pharmacy using simulation to allow students to practice clinical scenarios in an active-learning format. The Drug-Induced Disease elective course used team-based learning to teach identification and management of commonly encountered drug-induced diseases. This seemed the most appropriate course in which to conduct this study, as it would allow students to take active-learning a step farther than discussing clinical scenarios. The primary aim of this study was to determine whether completing a patient case using a high-fidelity mannequin results in greater student knowledge retention than completing a similar written patient case. The secondary objective was to determine whether students' comfort level with completing the patient case was influenced by the type of learning format used.


This study was an IRB exempt, parallel-group, randomized controlled trial. All fourth-year PharmD students enrolled in the month-long Drug-Induced Disease elective in February 2011 were included in the study. Teams of 2 to 3 students were randomly assigned to 1 of 2 teaching methods: written case or simulated patient case using a high-fidelity mannequin. The case that the students were asked to complete involved a patient who had taken an overdose of a narcotic and acetaminophen (Appendix 1). Prior to study participation, students were asked to read 2 articles on the use of acetylcysteine and naloxone to prepare them to complete the patient case. Students were excluded from the study if they were absent on the day on which the exercise or study case took place.

The Drug-Induced Disease course is a month-long elective course offered to fourth-year PharmD students. This course provides students with an organ-system approach to recognizing and treating adverse drug reactions. This patient case was incorporated into the course to give students the opportunity to treat an acute drug misadventure. Because of the team-based learning format used in the course, students were accustomed to being given a required reading assignment prior to the class session and taking a quiz at the beginning of each class. …

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