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An investigation into student experience and perceptions of clinical simulation as a teaching method for pharmacy undergraduate education at the University of Portsmouth

Student thesis: Doctoral Thesis

Background:
The role of a pharmacist has changed over many years. The General Practice Five Year Forward View alongside the Pharmacy Integration Fund provided funding for extended clinical roles for registered pharmacists which were not commonplace ten years ago. Such roles have a reduced emphasis on supply of medicines and increased emphasis on patient and clinical care, including pharmacist prescribing and the development of new roles within general practice and accident and emergency departments. Such changes required adaptation of and innovation in pharmacy undergraduate and postgraduate curricula. Recent curricula innovations included increased emphasis on clinical skill development such as manual blood pressure measurement and vaccination. At undergraduate level, simulation-based education has the potential to enhance the learning experience for clinical skills in ways not seen with traditional teaching methods. Also, the impact of simulation-based education may be more significant in pharmacy education compared with other healthcare profession programmes where placement hours and work-based learning opportunities are significantly greater. Presently simulation is used inconsistently across Schools of Pharmacy in the UK.

Aim and objectives:
This investigation sought to identify pharmacy undergraduate students’ experiences and perceptions of simulation-based education based on a newly created simulation workshop as part of the MPharm at Portsmouth. Specific objectives were to understand the effect simulation has on pharmacy students’ understanding of the role of the pharmacist, describe the effect simulation has on their learning and elicit how students engage with simulation when compared to other teaching methods.

Method:
A year-one, level-four simulation workshop was designed and first delivered in the 2009/2010 academic year incorporating use of high-fidelity manikins and simulated patient actors. An inductive mixed-method approach to this investigation was followed, utilising purposive sampling. A fourteen-point questionnaire was developed in 2009, piloted in 2010 and administered at the end of the simulation workshop in years 2011, 2012 and 2013. Student attendance at one of six semi-structured focus groups was also investigated, one week after the workshop.

Numerical results of the questionnaire were analysed using descriptive statistics with hypothesis testing using chi square. Free text responses from the questionnaire and focus group data were analysed using thematic analysis.

Results:
An overall response rate for questionnaire completion of n=296 (76.5%) was obtained from 387 students registered on the MPharm course. 98.9% of respondents indicated that simulation is a useful way of learning about communication skills, 98.6% of respondents felt that simulation was a useful way of learning about drug – device counselling.

88.5% of 292 respondents felt that simulation was useful for learning about drug-dose calculations, but more examples were needed alongside thorough discussion of methods, with some students stating calculations could be learned anywhere. Students described how they prepared differently for simulation and 94.1% of 285 respondents indicated that they would like more simulations of this type. Neither sex of respondents nor year of data collection had any effect on Likert scale responses to the questionnaire data from the overall population sampled.

Conclusions:
Simulation was seen by students as being acceptable and useful in their learning but also commenting that traditional teaching methods are important to outline theory and knowledge required for completion of the task or skill before undertaking simulation. Students prepared more rigorously for simulation when compared to traditional workshops and appreciated that simulation fosters active learning in addition to allowing demonstration and application of knowledge and skills. Not only was having simulated patients seen as important but also the environment they are placed in, both adding perceived reality to the student experience.

Staff commitment to simulation was time consuming, but students valued the 1-2-1 feedback on their consultations and saw this as directly relevant to their assessment preparation. Students would have liked at least one simulation per year that involves communication with a simulated patient in a simulated environment that meets learning outcomes for the relevant year of the MPharm programme (similar to the session being investigated). More simulation sessions have been introduced into the MPharm at Portsmouth as a result of these findings.

This investigation produced similar findings to those of established literature in Medicine, Nursing and the limited number of pharmacy projects which have been published.
Original languageEnglish
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Award dateApr 2019
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