Academic journal article American Journal of Pharmaceutical Education

Active-Learning Diabetes Simulation in an Advanced Pharmacy Practice Experience to Develop Patient Empathy

Academic journal article American Journal of Pharmaceutical Education

Active-Learning Diabetes Simulation in an Advanced Pharmacy Practice Experience to Develop Patient Empathy

Article excerpt


Healthcare-related education is shifting from traditional instructor-centered methods of dispensing information to learner-centered approaches of active learning. (1) To further enhance a learner-centered style of education, health-related disciplines have added simulation projects to some courses to further highlight aspects of certain disease states and patient populations. These include disability/rehabilitation, (2) low-vision, (3) schizophrenia, (4) HIV/AIDS, (5) pediatrics, (6) and geriatrics. (7) Such active-learning educational strategies are encouraged within pharmacy curricula, as they are recognized by the Accreditation Council for Pharmacy Education Guidelines (8) as a means of stimulating higher-order cognition, such as problem solving and critical thinking. (9) The simulation exercise related to diabetes mellitus in this report was developed and incorporated into a rural family medicine advanced pharmacy practice experience (APPE) at Auburn University Harrison School of Pharmacy.

Whether student knowledge is acquired through traditional lecture-based educational structures or more novel methods, such as team-based or problem-based learning, completion of a course does not ensure that students will have gained a competency level that includes empathy toward patients with specific diseases. Further, student empathy, altruism, and morality wane by the time a health degree is obtained. (1) Given that empathy is an essential component in the development of caring, therapeutic relationships with patients, empathy-building activities should be a required aspect of all healthcare curricula. (10) Unlike other simulation exercises, many of which are aimed solely at improving student confidence, knowledge base, or problem-solving skills, this active-learning exercise was constructed to improve student pharmacists' empathy for patients with diabetes mellitus. The primary goal was to better prepare them to provide patient-centered diabetes management services, which may likely enhance the provision of clinical pharmacy services for other disease states as well.


The active-learning diabetes simulation experience was integrated into a rural medicine ambulatory care APPE during which student pharmacists participated in patient encounters 4 half-days per week in 2 different rural Alabama counties (Hale and Walker). Clinical pharmacy duties centered on providing diabetes mellitus-focused pharmaceutical care for patients and informational in-service programs to healthcare practitioners. Both clinics functioned as practice experience sites for students of various health-related disciplines.

On the first day of each 5-week practice experience, the preceptor of the rural medicine ambulatory care APPE met with assigned student pharmacists for approximately 1.5 hours. During this orientation, various aspects of the practice experience schedule were addressed, including the completion of the active-learning diabetes-simulation experience. Pharmaceutical companies supplied needed resources for students: a glucometer, 25 testing strips, lancets, a lancing device, a carbohydrate counting book, a demonstration device, and a placebo insulin pen. A standardized documentation log was also provided for each student's use (Appendix 1).

Students were allowed to select any 7-day period during the 5-week practice experience to conduct this diabetes mellitus immersion investigation. By the end of the first week of the APPE, each student was required to have committed to a day on which this experience would commence. On their respective predetermined days, students were expected to begin incorporating the following tasks into their daily routine: check feet daily for circulation, sensation, and integrity; initiate an exercise routine consistent with the American Diabetes Association recommendations; (11) quantify the number of carbohydrates eaten at each meal or snack; and self-monitor blood glucose twice daily before eating meals, 2 hours postprandially 4 times during the week, and at least once at 3:00 AM. …

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