Physical assessment training enables pharmacists to optimize medications ... Category. Points Descriptor. Online. Module. Points Periodontal. Clinic. Points.
Pre-operative screening of patients at a university-affiliated periodontal clinic carried out by pharmacy students trained in the performance and interpretation of findings from a physical assessment of vital signs Christine Leong PharmD1, Anastasia Cholakis DMD, Christopher Louizos BScPharm1, Neal Davies PhD1, Douglas Brothwell DMD2 1Faculty of Pharmacy, Apotex Centre, University of Manitoba, 750 McDermot Avenue, Winnipeg, MB, Canada R3E 0T5 2Faculty of Dentistry, 780 Bannatyne Avenue, University of Manitoba, Winnipeg, MB, Canada R3T 2N2
Background
Results
• The application of skills in physical assessment is increasingly recognized as an important part of providing pharmaceutical care.1-4
• Physical assessment training enables pharmacists to optimize medications more effectively, promote better communication among healthcare practitioners, and improve overall understanding of patient care.4
• Few pharmacy schools in Canada provide formal training in this area.4 However, the incorporation of a physical assessment module into the pharmacy curricula aligns with the educational outcomes (1.2, 1.8) and accreditation standards (27.5) set out by the Association of Faculties of Pharmacy of Canada and the Canadian Council for Accreditation of Pharmacy Programs, respectively. 1,2 • The objective of this study is to describe the integration of a pre-operative screening of vital signs carried out by pharmacy students who completed this module at a periodontal clinic.
Design • Forty-eight third-year pharmacy students during the 2013-14 academic year were enrolled in the program.
• The module consisted of three components developed by a practicing clinical pharmacist and Assistant Professor from the Faculty of Pharmacy (Table 1). Students attended the periodontal clinic exposure in groups of three throughout the academic year. • Each student performed a blood pressure reading, using an automated or manual sphygmomanometer, and a heart rate reading on a patient prior to their dental operation. •Students reviewed patient charts and medications prior to approaching the patient and practiced the pharmaceutical care thought process while working collaboratively with a periodontics resident from the Faculty of Dentistry. • Students provided feedback on the module and their perspectives on the educational exposure at the end of the program.
Table 2 – Student Comments / Themes
Theme
2. Skills Workshop (Time: 3.5 hours) 3. Experiential Practice Site (Periodontal Clinic) (Time: 1 hour)
Student 7: “This was a very valuable experience. Really enjoyed med reviews and I wish we could do med reviews on patients more often.”
2. Negative Comments on Educational Experience
Student 19: “There is only a limited number of patients, we only got to take vital signs for one patient each.”
8
Student 3: “Noticed discrepancy on medication chart and got it changed.”
4. Comments on limited patient interaction exposure and/or impact on care
Student 20: “Wasn’t sure what to say about the medications when I reviewed the medication list because the patient was healthy and were not taking very much.”
5. Comments on Interprofessional Education Experience
Student 6: “It was a little intimidating taking the med history, BP, and pulse with a room full of dental students, dentists, periodontists, and nurses.”
10
4
7
Student 21: “Residents went over which medications to watch out for and what they do with hypertension medications given a specific blood pressure reading pre-surgery.” Figure 1 – Student response to confidence, comfort, and knowledge about performing a physical assessment of vitals on a patient after completing the module (n=40)
Evaluation • In-class quiz • 30 multiple choice • 5 short-answer
• Participation
30
28
25
26
20 15
13 4
5 0
0 0 0
1 1 0
Strongly Disagree
Disagree
6
Points Descriptor
PROCESS P1 Level of interactivity P2 Number of facilitators from different professions P3 Number of professions represented in student participation P4 Frequency of interactions across the learning activity Process Sub-Total CONTENT C1 Realistic and authentic learning activity (performance-based) C2 Explicit IPE learning outcomes – number of IPE constructs C3 Debrief period with students and facilitators after IPE learning activity C4 Case-based learning
Online Module
Points
Periodontal Clinic
Points
Didactic One
0 0
Interactive Two
10 5
Three
5
Two
0
Zero
0
One
0
5
15
See/Hear
0
Do/Real Life
10
1
0
2
5
None
0
None
0
None
0
Dedicated case presentation
10
Content Sub-Total Total Learning Activity Points
0 5
25 40
Conclusions and Implications • The periodontal clinic exposure provided students with a unique opportunity to apply physical assessment skills in a specialized practice setting.
23
10
Category
• Designing a physical assessment course is a relatively new and important area of interest to pharmacy educators.
35
• Vital sign measurement on a classmate • Final evaluation of (blood pressure, pulse rate, respiratory blood pressure rate, tympanic temperature) technique • Vital sign measurement on a patient • Review patient chart and medications • Work collaboratively with Periodontal Clinic team (Faculty of Dentistry)
Qty 14
Table 3 – Points for Interprofessional Education System (PIPES)5
3. Comments on positive patient interaction exposure and/or impact on care
Frequency
Description • Three online lectures: • Introduction to Physical Assessment • Blood Pressure • Other Vital Signs • Five-question quiz post-lecture (online) • Recommended videos
Example Comment(s)
1. Positive Comments on Educational Experience
Table 1 – Components of the Physical Assessment Module Component 1. Online Content (Time: 60 minutes)
Figure 2 – Student-rated knowledge of physical assessment skills before and after module (1 being least,10 being most) (n=36)
7 7
• These findings will facilitate the development of an interprofessional practical skills workshop involving students from Dentistry, Dental Hygiene, and Pharmacy for teaching skills in physical assessment.
4
References Neutral
Agree
Strongly Agree
I feel confident in performing a physical assessment of vitals on a patient I feel comfortable with conducting a physical assessment of vitals on a patient I feel knowledgeable about skills in physical assessment
1. Association of Faculties of Pharmacy of Canada. Educational outcomes for first professional degree programs in pharmacy (Entry-to-Practice Pharmacy Programs) in Canada. Vancouver (BC): Association of Faculties of Pharmacy of Canada; 2010. Available: http://www.afpc.info/downloads/1/AFPC_Education_Outcomes_AGM_June_2010.pdf. (accessed August 1, 2013). 2. The Canadian Council for Accreditation of Pharmacy Programs. Accreditation Standards for the First Professional Degree in Pharmacy Programs. Effective January 2013. Available: http://www.ccapp-accredit.ca/site/pdfs/university/CCAPP_accred_standards_degree_2012.pdf. (accessed November 13, 2013). 3. Da Camara C, et al. Survey of physical assessment course offerings in American colleges of pharmacy. Am J Pharm Educ. 1996;60(4):343-47. 4. Barry AR, et al. An evaluation of teaching physical examination to pharmacists. CPJ 2012;145(4):174-180. 5. Points for Interprofessoinal Education System (PIPES) Allocation. University of Toronto IPE Curriculum. Available: http://umanitoba.ca/programs/ interprofessional/media/PIPEs_Allocation_Accompanying_Document__March_2009_with_(C)__(2).pdf. (accessed: November 18, 2013).
