Academic journal article American Journal of Pharmaceutical Education

Using Human Patient Simulation to Prepare Student Pharmacists to Manage Medical Emergencies in an Ambulatory Setting

Academic journal article American Journal of Pharmaceutical Education

Using Human Patient Simulation to Prepare Student Pharmacists to Manage Medical Emergencies in an Ambulatory Setting

Article excerpt

INTRODUCTION

The majority of pharmacists will work in an ambulatory pharmacy setting at some point in their careers (1) and thus may encounter a patient having a medical emergency. As future practitioners, student pharmacists also should be prepared to handle emergencies they may encounter when completing advanced pharmacy practice experiences (APPEs) in ambulatory settings. Yet, 116 pharmacy residency candidates stated in onsite interviews that they felt least prepared to handle medical emergencies compared to other areas of pharmacy practice. (2) Human patient simulation is one approach to training student pharmacists how to respond to medical emergencies in an ambulatory pharmacy environment. The Accreditation Council for Pharmacy Education (ACPE) has approved the use of simulation to satisfy up to 20% (eg, 60 of the 300-hour requirement) for introductory pharmacy practice experiences (IPPEs). (3,4) Thus, human patient simulation could become a more common methodology for providing meaningful patient-focused learning experiences where students can encounter real world patient care scenarios without compromising the care of live patients.

Human patient simulation is used in such medical fields as anesthesiology, critical care, pediatrics, emergency medicine, surgery, trauma, cardiology, nursing, and dentistry. (5,6) Pharmacy education also has adopted human patient simulation as a teaching tool. (7-9) Basic and complex evaluation and management skills, such as blood pressure assessment, intravenous line insertion, and medication administration, can be taught with simulation. Because simulation scenarios usually are driven by specific patient cases, simulation challenges students to think critically when caring for a patient with a complex medical condition. (10) Education with high-fidelity simulators allows educators to provide immediate feedback on student performance with the opportunity for remediation or continued practice until the student performs the task/skill correctly, a controlled environment for students to practice without adverse consequence to their actions, and a variety of realistic experiences permitting students to be exposed to high consequence, low occurrence events like medical emergencies. (11)

For medical emergencies, human patient simulation has been used to train medical professionals in advanced cardiac life support (ACLS), basic life support (BLS), and patient assessment, including vital signs measurement. (7-9,12) In ACLS and BLS scenarios, student pharmacists are placed in a high stress situation where they must apply information previously presented in course lectures. In this environment, students test their knowledge in a safe, learner-centered setting, and have the opportunity to correct deficiencies prior to any real-world experiences. (13) To our knowledge, other than BLS training, simulation of medical emergencies in an ambulatory pharmacy setting has not been documented. When a patient has an emergency in an ambulatory setting, even if it is a rare occurrence, student pharmacists must be prepared to respond.

Our program has integrated human patient simulation using a high fidelity manikin into the pharmacy curriculum in the Applied Patient Care course series since 2007. First-year student pharmacists use the manikin to learn about basic physical assessment skills including vital signs, and various heart and lung sounds. During the third year in the curriculum, student pharmacists frequently work with the simulator to experience responding to a wide variety of inpatient issues including Clostridium difficile disease, community-acquired pneumonia, and acute coronary syndrome, as well as code team training. An elective in emergency preparedness also is offered in which student pharmacists have the opportunity to work through a cyanide toxicity case. (14) To expand the use of simulation beyond teaching physical assessment skills and acute patient care, an ambulatory pharmacy simulation scenario was developed for second-year students. …

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