By Xiaoxue Nehrbass,
Pharm.D., PGY1 Pharmacy Resident, Johns Hopkins Bayview Medical Center
What is simulation? According to the Accreditation Council for
Pharmacy Education (ACPE), simulation is an activity or event replicating
pharmacy practice.1 Simulation experiences may include the use of
high- or medium-fidelity manikins, standardized patients, standardized
colleagues, role play, and computer-based exercises.1 Benefits of these experiences may include
enhancements in student knowledge and clinical performance, improvements in
critical thinking and student confidence, as well as reductions in medication errors.2
In the latest version of its Accreditation Standards and Guidelines, ACPE states
that colleges and schools of pharmacy may choose to incorporate simulation into
introductory pharmacy practice experiences (IPPEs) but it can not exceed 20% (60
hours) of the total IPPE requirement (300 hours).1
In April of 2011, watching the first Inter-professional Critical Care
Simulation that took place at Universities at Shady Grove, I was impressed by
how high-fidelity simulation technology brought the health professional disciplines
on our campus together. I learned first-hand
the importance of interdisciplinary collaboration in a healthcare setting to
optimize patient care. High-fidelity simulation has been widely used in other
health professional schools, such as medical and nursing education. The
high-fidelity manikin mimics a real patient with computerized programmable
physiological responses to disease states and medication treatments.2
Similar to a real patient, the manikin can talk and breathe, has heart sounds
and palpable pulses. Simulations can
include cardiac and pulmonary arrest, anaphylactic reactions, myocardial
infarction, stroke and other scenarios.2 In one recent study, a
group of fourth-year pharmacy students (in a five year program) used high-fidelity
simulation in a series of courses.3 The scenarios included various
exercises such as drug-drug interactions, intravenous drip rate calculations,
medication recommendation, physiological changes, as well as patient education.3
In addition to the patient (manikin) and pharmacy students, these scenarios
also included role plays with physicians, nurses, and family members.
Interestingly, the role of family member was played by a standardized patient,
who displayed certain emotional responses during the simulation in response to
the care provided to patient (manikin). The study showed that when compared to
students who did not participate in the simulations, students who experienced
the simulations felt more confident in making recommendations to other
healthcare providers.3 Additionally, over ninety percent of students
reported that simulation enhanced their learning compared to didactic lecture
alone.3 As this study has shown, high-fidelity simulations can help
to enhance clinical knowledge in various acute care scenarios, improve
communication skills and build confidence. But high-fidelity manikins aren’t cheap! The cost can range from $16,000 to $90,000
depending on the model.2
Computer-based virtual patient technology offers another type of
simulation experience. At the end of the ACLS/BLS training program I completed a
few months ago, online simulation technology allowed me to practice the skills
and knowledge I had learned, and to make assessments and decisions in a virtual
environment. I valued the simulation component of the program because it allowed
me to use newly acquired knowledge to create solutions during plausible
situations. Throughout each simulation scenario, I learned quickly what I did
wrong and the potential (positive or negative) consequences my decisions may
have had on my virtual patient. According Jabbur-Lopes and colleagues, one
advantage of using virtual patients in patient counseling is that a virtual
patient can exhibit various psychological states, such as angry, anxiety,
ambivalence, passivity, assertiveness, and persuasiveness.4 Through
the use of virtual patient technology, students can practice counseling skills
with a wide range of patients. Despite these benefits, Jabbur-Lopes and
colleagues found that this type of simulation is underutilized in pharmacy education.4
For me, the most realistic patient counseling simulation experiences were
my encounters with standardized patients. As actors who have been trained to
play the role of real patients in specific scenarios, standardized patients not
only perform, but in many cases, evaluate the student’s interviewing skills
during the counseling session. My personal encounter with standardized patients
came during the University of Maryland’s required Objective Structure Clinical
Exam (OSCE), a comprehensive assessment that required students to use a wide
range of knowledge and skills learned throughout pharmacy school. The
counseling sessions were taped and standardized patients evaluated our
performance.
To best serve students, programs must evaluate each type of simulation
for its strengths and weaknesses. High-fidelity simulation may be an effective
teaching tool in an urgent care scenario occurring in the acute care setting.
It allows participants to enhance interpersonal skills through team building
exercises. The high costs of this simulation tool may, however, be a barrier at
some institutions. In addition, it may not be appropriate or efficient to use
high-fidelity simulation in less acute situations which do not require close
monitoring of the patient, such as counseling on management of chronic disease
states. On the other hand, virtual patient technology offers an advantage of
accessibility and convenience. It also provides hands-on experience students
may need when learning a complicated concept or procedure. Finally,
standardized patients may be most beneficial when used in assessing students’
interviewing skills and clinical knowledge. This experience will also prepare them
to enter the profession and face real world situations.
With the continued expansion of pharmacy schools and ACPE’s increased
acceptance of simulation has part of the IPPEs, simulation experiences should
play a larger role in pharmacy education. Using these types of teaching tools helps
students gain the skills and confidence to enter advance pharmacy practice
experiences. Simulations are an
innovative and effective way of providing training in an evolving academic
landscape.
References:
1. Accreditation Council for
Pharmacy Education. Accreditationstandards and guidelines for the professional program in pharmacy leading tothe doctor of pharmacy degree. Chicago: Accreditation Council
for Pharmacy Education; 2011. [cited 2012 Oct 29]
2. Seybert
AL. Patient simulation in pharmacy education. Am J Pharm Educ 2011; 75(9):
Article 187. [cited 2012 Oct 29]
3. Vyas D, Wombwell
E, Russell E et al. High-fidelitypatient simulation series to supplement introductory pharmacy practice experiences. Am J Pharm Educ 2010; 74(9):
Article
169. [cited 2012 Oct 29]
4. Jabbur-Lopes MO,
Mesquita AR, Silva LM et al. Virtual patientsin pharmacy education. Am J Pharm Educ 2012; 76(5): Article 92. [cited 2012
Oct 29]
