A Pharmacy Practice Experience on Medication Adherence
A Pharmacy Practice Experience on Medication Adherence
The personal simulation with the automated medication dispenser helped students understand how the device worked and allowed them to critically evaluate the device for patient use. In addition, the simulation allowed them to relate their own experience to the patient and increase their confidence when explaining its use. The patient interaction appeared to be essential in increasing the students' confidence in providing patient education and enhancing the students' understanding of the reasons for patient nonadherence. The number, types, and depth of student-identified reasons for patient nonadherence increased after the patient interaction. Students also began to recognize and note the importance of the patients' lifestyle and beliefs, which often differed from their own. This outcome would not have been achieved by simulation alone.
Questions in the survey instruments were not identical, which limited the comparisons that could be made across components of the learning activity, including measurement of changes over time, such as the development of empathy. Regarding the insignificant difference in empathy development between the first and third survey instruments, a high percentage of students rated themselves as empathetic (91.5% agreed/strongly agreed) after their own simulation, perhaps leaving little room for improvement after the patient experience. With respect to understanding the difficulties of adhering to a prescribed regimen, the student simulation was possibly more enlightening than working with a patient. Empathy is discussed in a companion course, which could have contributed to social-desirability bias in the students' responses. Surveying the students' perceptions of their empathy prior to the assignment would have been beneficial in assessing whether the personal simulation or the patient experience resulted in a more significant increase in patient empathy. Item modifications are planned to address these limitations in future experiences.
Promotional materials for the automated medication dispenser were withheld from the students in an attempt to allow them to draw their own conclusions about specific patient populations for which this dispenser might be most appropriate. This dispenser has design features intended for those who are homebound and/or those with visual, hearing, or cognitive impairment. Almost 20% of the students indicated that they were unsure or disagreed that this device would improve a patient's medication adherence. Approximately one third (31.6%) of the patients selected by the students were under 50 years of age and may not have been ideal candidates for this particular device. It would have been interesting to know whether any of the "age 50 and under patients" selected fit any of the target demographic parameters intended for this automated medication dispenser.
Although students were given criteria when selecting a patient, some students had difficulty with the selection process, and in some cases, preceptors provided assistance. Some students commented that their patient was selected because he/she was nice or would be likely to come to a training session with the device and return for later assessments. As a result, the instructor believes that not all patients had true nonadherence issues, which may have influenced students' responses and their learning.
The survey instruments were quite lengthy, which could have contributed to respondent fatigue. When the IPPE assignment was introduced to the students, the survey instruments were discussed and students knew responses would be reviewed. As with any reflective assignment, there is risk that some students put forth more effort than others, potentially influencing the results. Reasons for nonadherence were collected qualitatively to allow students to identify nonadherence without guidance, but this method limited their ability to respond to all cited reasons for nonadherence and contributed to a wide variation in the number and depth of responses.
As is true for all colleges and schools of pharmacy, the amount and quality of each student's previous pharmacy experiences is variable upon entrance into the professional program. Designing early experiences suitable for all students in the early phases of the core curriculum is challenging but important to achieving a level playing field as students progress to the next level of IPPEs. The placement of this experience so early in the curriculum also may have contributed to the wide differences seen in the depth and breadth of the student responses.
Future directions for the assignment include administering a validated empathy questionnaire to better assess changes in empathy from the different assignment components. The instructor also plans to expand the learning objectives based on student responses to questions in survey instrument 3 regarding the "single most important thing you learned." Clearly, the students learned lessons beyond the stated expectations (Table 5), demonstrating the need to incorporate additional discussion at a higher learning level. Consideration will be given regarding where in the curriculum this topic should be further explored.
Discussion
The personal simulation with the automated medication dispenser helped students understand how the device worked and allowed them to critically evaluate the device for patient use. In addition, the simulation allowed them to relate their own experience to the patient and increase their confidence when explaining its use. The patient interaction appeared to be essential in increasing the students' confidence in providing patient education and enhancing the students' understanding of the reasons for patient nonadherence. The number, types, and depth of student-identified reasons for patient nonadherence increased after the patient interaction. Students also began to recognize and note the importance of the patients' lifestyle and beliefs, which often differed from their own. This outcome would not have been achieved by simulation alone.
Questions in the survey instruments were not identical, which limited the comparisons that could be made across components of the learning activity, including measurement of changes over time, such as the development of empathy. Regarding the insignificant difference in empathy development between the first and third survey instruments, a high percentage of students rated themselves as empathetic (91.5% agreed/strongly agreed) after their own simulation, perhaps leaving little room for improvement after the patient experience. With respect to understanding the difficulties of adhering to a prescribed regimen, the student simulation was possibly more enlightening than working with a patient. Empathy is discussed in a companion course, which could have contributed to social-desirability bias in the students' responses. Surveying the students' perceptions of their empathy prior to the assignment would have been beneficial in assessing whether the personal simulation or the patient experience resulted in a more significant increase in patient empathy. Item modifications are planned to address these limitations in future experiences.
Promotional materials for the automated medication dispenser were withheld from the students in an attempt to allow them to draw their own conclusions about specific patient populations for which this dispenser might be most appropriate. This dispenser has design features intended for those who are homebound and/or those with visual, hearing, or cognitive impairment. Almost 20% of the students indicated that they were unsure or disagreed that this device would improve a patient's medication adherence. Approximately one third (31.6%) of the patients selected by the students were under 50 years of age and may not have been ideal candidates for this particular device. It would have been interesting to know whether any of the "age 50 and under patients" selected fit any of the target demographic parameters intended for this automated medication dispenser.
Although students were given criteria when selecting a patient, some students had difficulty with the selection process, and in some cases, preceptors provided assistance. Some students commented that their patient was selected because he/she was nice or would be likely to come to a training session with the device and return for later assessments. As a result, the instructor believes that not all patients had true nonadherence issues, which may have influenced students' responses and their learning.
The survey instruments were quite lengthy, which could have contributed to respondent fatigue. When the IPPE assignment was introduced to the students, the survey instruments were discussed and students knew responses would be reviewed. As with any reflective assignment, there is risk that some students put forth more effort than others, potentially influencing the results. Reasons for nonadherence were collected qualitatively to allow students to identify nonadherence without guidance, but this method limited their ability to respond to all cited reasons for nonadherence and contributed to a wide variation in the number and depth of responses.
As is true for all colleges and schools of pharmacy, the amount and quality of each student's previous pharmacy experiences is variable upon entrance into the professional program. Designing early experiences suitable for all students in the early phases of the core curriculum is challenging but important to achieving a level playing field as students progress to the next level of IPPEs. The placement of this experience so early in the curriculum also may have contributed to the wide differences seen in the depth and breadth of the student responses.
Future directions for the assignment include administering a validated empathy questionnaire to better assess changes in empathy from the different assignment components. The instructor also plans to expand the learning objectives based on student responses to questions in survey instrument 3 regarding the "single most important thing you learned." Clearly, the students learned lessons beyond the stated expectations (Table 5), demonstrating the need to incorporate additional discussion at a higher learning level. Consideration will be given regarding where in the curriculum this topic should be further explored.