Academic journal article American Journal of Pharmaceutical Education

Assessing Pharmacy Students' Ability to Accurately Measure Blood Pressure Using a Blood Pressure Simulator Arm

Academic journal article American Journal of Pharmaceutical Education

Assessing Pharmacy Students' Ability to Accurately Measure Blood Pressure Using a Blood Pressure Simulator Arm

Article excerpt


Cardiovascular disease remains the leading cause of mortality in the United States. (1) Approximately 68 million Americans have hypertension, and the prevalence of this condition is increasing. (2) In several published studies, pharmacists have been shown to improve care for patients with cardiovascular disease, notably patients with hypertension. (3-7) In order to prepare students for clinical practice, colleges and schools of pharmacy are tasked with teaching about the management of hypertension as well as fostering the skill of blood pressure assessment.

One way of helping students to achieve this skill set is through patient simulation, a teaching approach that is being used by medical and nursing schools but has yet to be widely used by many colleges and schools of pharmacy. Additionally, the Accrediting Council for Pharmacy Education supports the use of active learning, such as simulation (Guideline 11.2). (8)

Although several reports of simulation in pharmacy education have been published, reports on the use of patient simulation are limited. (9-13) Simulation-based learning was used to teach blood-pressure measurement to doctor of pharmacy (PharmD) students. (14) The investigators assessed student knowledge and attitudes before and after they participated in classroom lectures and practical sessions using a high-fidelity computerized patient simulator and found significant improvement in clinical skills performance and knowledge of hypertension pharmacotherapy as well as high levels of satisfaction with this type of learning experience. However, accuracy of student blood-pressure measurements was not reported.

The aim of this study was to expand on this previous investigation. One of the challenges with traditional methods of blood pressure training programs is the inability to objectively verify the accuracy of each reading. Options include instructors taking a consecutive blood pressure after the student's measurement or using training stethoscopes with dual headpieces. Patient simulation provides a precisely controlled environment wherein the simulator's blood pressure reading can be adjusted and set to exact numbers. Prior to this study, pharmacy students have been assessing blood pressure measurements on healthy adults who are normotensive. Students do not gain much practice assessing either abnormally low or high blood pressure measurements before they enter their introductory or advanced pharmacy practice experiences (IPPEs or APPEs). The objective of this project was to compare student accuracy of only normal and high blood pressure measurements using a simulator arm.


This study was designed as a prospective, single-blind, crossover study. Third-year pharmacy students who were enrolled in a required laboratory-based advanced pharmacy practice and skills course had the opportunity to participate in the study. All students were required to complete the activity as part of the course and were given credit for participation; however, students were not penalized for inaccurate blood pressure measurements. Participation in the study was voluntary, and students had the option to decide whether their data would be included. Informed consent was obtained, and the study was approved by the Drake University Institutional Review Board for the Protection of Human Subjects.

All students received the same baseline training in standard blood pressure assessment in an earlier part of the course series during their first and second years. Students were previously taught appropriate techniques for blood pressure measurement using the arm of a live subject (ie, a fellow student). They had been given opportunities to practice on their peers approximately 15 times in the previous 2 years and had been tested on their technique 4 times prior to the study. In this study, the students assessed blood pressure on simulator arms (Laerdal Medical Corporation, Stavanger, Norway), in which systolic and diastolic number, heart rate, and volume settings were preset using an external control panel. …

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