Comparison of Patient Simulation Methods Used in a Physical Assessment Course
Grice, Gloria R., Wenger, Philip, Brooks, Natalie, Berry, Tricia M., American Journal of Pharmaceutical Education
In the 1980s, approximately 33% of clinical pharmacist faculty members and 20% of clinical pharmacist adjunct faculty members reported performing physical assessment in patient monitoring. (1) Since then, the role of pharmacists in direct patient care has expanded and clinical pharmacists are now routinely using a variety of patient assessment techniques to ensure optimal medication therapy outcomes. (2) Colleges and schools of pharmacy must look beyond current practice and envision the expectations and duties of the pharmacist of the future and prepare students to become pharmacists capable of managing medication therapy. The Accreditation Council for Pharmacy Education (ACPE) requires that physical assessment be taught in the classroom (patient assessment laboratory) and experiential settings. (3) While the need to teach physical assessment has been established, the method for how to teach it has not.
In 2007, Spray and colleagues distributed a 20-item questionnaire to US pharmacy practice department chairs to determine the content, extent, and design of physical assessment training/teaching in the pharmacy curriculum (the TOPAS study). (4) Ninety-six percent of the programs that responded indicated patient assessment skills were taught, mostly for the advancement of the profession of pharmacy and because it was required to meet ACPE standards. The most common topics covered were pulmonary examination, cardiovascular examination, and assessment of vital signs; these results were consistent with previous findings. (4,5) The majority (76%) of colleges and schools used the laboratory setting for instruction; 27% of those in a "simulated clinical setting" and 63% didactically. Their methods did not clearly define the parameters of the simulated clinical setting or whether manikins or standardized patients were used.
Using standardized patients to teach physical assessment has a 95% success rate in students successfully demonstrating the ability to perform the skills. (6) Using standardized patients can provide a more realistic setting and can be potentially less embarrassing than using peers or faculty members to practice physical assessment. (6,7) In general, student pharmacists prefer to practice physical assessment techniques on the following (in decreasing order of preference): standardized patients, peers, instructors, and staff members. (7) In addition to using standardized patients, having a medical facilitator explain and demonstrate the skills and respond to student questions while the students are practicing the skills on the standardized patient is important. (6) Many programs use trained standardized patients for evaluation purposes as well, or at a minimum, patients who are able to provide feedback directly to the student.
While manikins do not offer the same benefits as standardized patients, they are highly effective in training student pharmacists. (8) Seybert and colleagues demonstrated that the majority of student pharmacists participating in a critical care simulation that used manikins (programmed in advance) were extremely satisfied with the experience (88%). Some specific benefits of this approach included that the facilitator could control the learning environment, adapt the simulation to the students' performance level, and conduct debriefing with the students immediately following the session.
Student pharmacists overall find learning physical assessment to be valuable (especially when taught by medical faculty members vs pharmacy faculty members), despite not feeling confident in performing these techniques. (9,10) Given the increasing importance of pharmacists having this skill and that it is an ACPE requirement, determining the best technique for teaching physical assessment is important for colleges and schools of pharmacy.
Student pharmacists at St. Louis College of Pharmacy were required to take a 1-credit course focused on learning basic physical assessment and patient interviewing skills. …