Creating a Hybrid Model of Introductory Pharmacy Practice Experience (IPPE)
Integrating High Fidelity Simulation and Direct Patient Care
Deepti Vyas PharmD, BCPS and Frank Caligiuri PharmD
The University of Missouri- Kansas City (UMKC) School of Pharmacy has a satellite campus in Columbia, Missouri. The Columbia campus enrolls about 28 Doctor of Pharmacy students in each academic year for a total of 140 students distributed among the 5 year professional program. Students complete all four years of didactic coursework in Columbia including introductory pharmacy practice experiences (IPPE). In this TEG funded study, we studied the inclusion of high fidelity simulation as a component of IPPE as related to the Columbia distance students.
A high fidelity simulation series was introduced in 4 IPPE’s in October of 2009. Fourth year students in Columbia were enrolled in a longitudinal IPPE which provided a total of 160 hours of patient care experiences over 2 semesters. The IPPE ran simultaneously with the capstone therapeutics course (Pharmacotherapy) to provide students with the opportunity to apply didactic principles. The simulation series was held at the Russell D. and Mary B. Shelden Clinical Simulation Center, a 10,000-square foot simulation facility consisting of simulation, observation, and instruction rooms. The simulation scenarios were scheduled to occur every 3 weeks over a 6-week period.
In order to achieve the objectives of IPPEs, 3 distinct simulation scenarios were developed; an asthma exacerbation, acute decompensated heart failure, and infective endocarditis with a subsequent anaphylactic reaction to the antibiotic. These specific diseases were chosen due to the emergent nature of their presentation and the capability of the high-fidelity mannequin to illustrate various signs and symptoms, physiologic changes, and responses to medications administered. Each simulation was scheduled within one week of the corresponding Pharmacotherapy lecture. Simulation scenarios were written by individual faculty members and then revised as a group to establish uniformity.
Students were divided into 10 teams of 2-4 students each. The 3 simulation scenarios consisted of a case preparation period, the clinical encounter, and a debriefing period, each 30 minutes in length. During the case preparation period, students first completed a pre-quiz individually and were then given the patient’s history and physical with instructions to develop an assessment and plan as a group. Students were allowed to use their classroom notes and also received disease state specific guidelines to assist in the development of the treatment plan. During the debriefing, either a pharmacy faculty or pharmacy resident provided observations, shared clinical pearls from the scenario, and answered questions posed by the students regarding the scenarios.
Twenty-eight students were enrolled in the simulation experience. In comparison to pre-simulation, all knowledge-based quiz scores demonstrated statistically significant improvements (p<0.001) at the completion of the series. Knowledge retention was significantly higher among simulation participants compared to non-participating students (50.8% vs 48.7%, p=0.004). Of note, 76% of students felt more confident “making clinical recommendations to a healthcare provider” at the end of the simulation series (P=0.01). 70% of students also felt more confident “identifying the physiologic effects of medications on the human body” post simulation. 96% of participants were in strong agreement that simulations should be offered each year during IPPE and 93% felt simulation training enhanced clinical learning in comparison to standard lectures alone. Additionally, 93% of students were either “satisfied or very satisfied” with the simulation series.
This TEG funded study allowed us to use simulation training to bridge the gap between didactic coursework and “real-life” experiences by putting students in a realistic, controlled environment without compromising patient safety. Additionally, we were able to show that simulation training coupled with direct patient care experiences can provide a suitable model for IPPE and may alleviate some of the burden on experiential sites. The positive response from student evaluations, improvements in students’ confidence in self- perceived skills, as well as improvements in pre- and post-simulation quiz scores indicate that high fidelity simulation is a useful active learning tool for novice learners to apply pharmacotherapeutic concepts and improve self-confidence in clinical skills.