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R Clin Pharm 2024; 2(1): 38-46

Published online June 30, 2024 https://doi.org/10.59931/rcp.24.0007

Copyright © Asian Conference On Clinical Pharmacy.

Integrating Problem-Based Learning and Patient Counseling Competitions to Enhance Pharmacy Students’ Competency in Patient Care and Communication

Suhyeon Moon1* , Hyunju Yoo2* , Haemin Hwang2 , Yoon Seul Cho2 , Je Heon Kim2 , Tae Woo Kim2 , Jeongmin Kang2 , Bowon Hwang2 , Yunseo Lee2 , Minjeong Shin2 , Yeo Jin Choi3 , Sooyoung Shin1,2

1Department of Biohealth Regulatory Science, Graduate School of Ajou University, Suwon, Korea
2Department of Pharmacy, College of Pharmacy, Ajou University, Suwon, Korea
3Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, Korea

Correspondence to:Sooyoung Shin
E-mail syshin@ajou.ac.kr
ORCID
https://orcid.org/0000-0003-2388-1122

Yeo Jin Choi
E-mail yeojin.choi@khu.ac.kr
ORCID
https://orcid.org/0000-0002-0635-4374

* These authors contributed equally to this study.

Received: June 6, 2024; Revised: June 21, 2024; Accepted: June 24, 2024

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: A Pharmacy Competency Enhancement Program, based on problem-based learning (PBL), was developed to empower students in adopting a patient-centered approach and fostering communication skills. The objective of this program is to investigate its impact on students’ self-competency in the Pharmacists’ Patient Care Process components and patient counseling skills.
Methods: This program integrates PBL patient case activities and a patient counseling competition (PCC), specifically designed to prepare students for real-world patient care scenarios. Students were prompted to complete a self-assessment survey at the following three distinct time points: post-didactic courses, post-Advanced Pharmacy Practice Experience (APPE) rotations, and post-PCC; their responses were categorized into the following six constructs: collect (1 item), assess (4 items), plan and implement (5 items), follow-up (7 items), knowledge (4 items), and communication (4 items).
Results: The sum of the Likert-scaled responses for each construct demonstrated consistent improvement in students’ self-efficacy from post-didactic courses to post-APPE rotations to post-PCC. The percentage of students responding “agree” or “strongly agree” increased for each construct, with the most significant improvement observed in “plan and implement” (84.2%) and “knowledge” (82.0%) between post-didactic courses and post-PCC.
Conclusion: The outcomes of this project emphasize the significant positive impact of PBL activities and PCC in cultivating the fundamental skills required for future pharmacists.

KeywordsPharmacists’ Patient Care Process; Problem-based learning; Pharmaceutical care; Patient counseling; Self-efficacy

A growing demand for the transformation of didactic courses to incorporate high-intensity interactive programs has prompted the widespread adoption of problem-based learning (PBL) in pharmacy education, particularly within the pharmacotherapy curriculum, to enhance interaction among students and faculty [1]. The core educational competencies in clinical pharmacy education focus on strengthening patient-centered pharmaceutical expertise and advancing interdisciplinary patient care leadership [2,3]. In line with the 2014 guidelines from the Joint Commission of Pharmacy Practitioners, education in pharmacotherapy is expected to encompass the complete Pharmacists’ Patient Care Process (PPCP): collect, assess, plan, implement, and follow-up (monitor and evaluate) [4-10]. Pharmacists, adopting a patient-centered approach, collaborate with healthcare team members to improve both patient therapeutic outcomes and safety. This collaborative and patient-focused approach can be effectively simulated through PBL-based patient case activities.

In pharmacotherapy courses, a combination of didactic lectures and PBL-based small group activities is often employed to structure the classes. These activities involve patient case reviews where students identify drug-related problems (DRPs) and participate in small group sessions to prioritize and develop clinical pharmaceutical interventions [1]. Specifically designed PBL assignments aim to cultivate competencies aligned with each component of the PPCP within these activities [5-10]. Going beyond competency enhancement programs in pharmacotherapy, there is a concerted effort to foster interdisciplinary collaboration among healthcare professionals in patient drug management [11,12]. This collaborative approach involves designing personalized evidence-based drug therapy plans, monitoring patient drug therapy, evaluating outcomes, and enhancing communication skills with healthcare teams, patients, and caregivers. Furthermore, pharmacotherapy curricula aim to educate students on the effective and safe use of drugs by integrating assessments and interventions in pharmaceutical care, reporting and monitoring adverse drug reactions, and fostering leadership skills in a team-based healthcare environment [12,13]. Continuous self-development and self-evaluation are also emphasized in the pursuit of these goals.

To achieve these educational objectives, we introduced the Pharmacy Competency Enhancement Program at our pharmacy school, designed in collaboration with Advanced Pharmacy Practice Experience (APPE) clinical rotations during the 6th year of pharmacy programs. Our program is structured to include team-based small group meetings for the review and discussion of PBL patient cases that students encountered in real-world healthcare settings. PBL activities involve the collaborative exploration of learning topics among students, self-directed activities for patient care and drug therapy plan development, presentation of evidence-based drug therapy plans and intervention strategies for DRPs within teams. The process includes critical peer evaluations and feedback from instructors on team PBL assignments [14]. Final submissions are made after revisions and improvements based on the provided feedback.

The final assignment of this PBL-based Pharmacy Competency Enhancement Program involves students conducting a simulation of counseling a patient for discharge based on the patient case they followed up during APPE hospital rotations, where they previously performed subjective, objective, assessment, and plan (SOAP) notes or care plan assignments. Students participated in a team-based patient counseling competition (PCC), with two students pairing up as one team. One student assumed the role of a counseling pharmacist, while the other played the part of a patient, and each student was given the opportunity to take on the role of both a pharmacist and a patient. As of now, there hasn’t been an official PCC at the level of pharmacy schools or a nationwide competition event in Korea. Counseling patients in real-world practice settings is important to ensure the effective and safe usage of medications. Through the PCC conducted in conjunction with the Pharmacy Competency Enhancement Program, our goal was to promote patient-centeredness and prepare pharmacy students as effective communicators in real-world patient encounters [15].

In this program, students were prompted to perform self-assessments at three different time points: after completing didactic courses, after participating in APPE rotations at community pharmacies and hospitals, and after completing the PCC linked to the Pharmacy Competency Enhancement Program. The goal of this project is to retrospectively analyze how our PBL-based program has influenced students’ self-competency in PPCP and patient counseling skills at these three distinct stages of their education and training.

Program Design and Participants

Two weeks of PBL-based patient case activities were designed in conjunction with APPE rotations for 6th year pharmacy students. Following clinical rotations at local pharmacies, they proceeded to APPE hospital rotations under the supervision of the pharmacy team at a tertiary medical center affiliated with the program institution in Korea. On day 1, we conducted the program orientation, during which students received guidance on the schedule of PBL activities, which ran concurrently with the final two weeks of APPE hospital rotation. In the first week, students performed SOAP note writing and care planning assignments related to patient cases encountered during the APPE hospital rotation. At the end of the first week, they presented patient cases with their identified DRPs in SOAP note format, prioritized them, and developed pharmaceutical interventions. Students then incorporated feedback from faculty and peers to refine their assignments. Each student selected a patient case for participation in the PCC from those encountered during APPE hospital rotation. During the second week, two students paired up as a team and conducted small-group meetings to practice simulated patient counseling for a discharge, preparing for the PCC, which was held on the last day of the two-week session. This program was implemented as part of education quality improvement initiatives at Ajou University, and the outcomes were assessed retrospectively; therefore, institutional review board (IRB) approval was waived.

Self-Efficacy Evaluation Tool

A retrospective post-activity self-efficacy assessment was designed to be performed at three time points: post-didactic courses, post-APPEs, and post-PCC. The self-efficacy assessment, composed of 25 items in total, was developed to encompass components of the PPCP (collect, assess, plan, implement, and follow-up: monitor and evaluate) [4], therapeutic knowledge, and patient counseling competency (Table 1). The survey was executed through the utilization of Google survey. Participants received an email containing a link to the survey, which they submitted online. A reminder email was sent to all participants two weeks after the initial communication. The survey concluded after a 4-week data collection period, and subsequently, the collected data were entered into an Excel spreadsheet. To ensure participant confidentiality and minimize potential bias, the survey was designed for anonymous completion, with investigators refraining from recording any participant identification information.

Table 1 Components of students’ self-efficacy in relation to constructs encompassing pharmaceutical care skills and professional behavior

Self-assessment itemsPPCP components
Pharmaceutical care skills
1. I can extract and interpret pertinent information from a given patient case.Collect
2. I can assess the appropriateness of drug therapy and logically evaluate whether there are any drug-related problems in a given patient case.Assess
3. I can prioritize identified drug-related problems by evaluating their significance and assigning priorities based on severity.Assess
4. I can interpret a patient’s lab values and evaluate whether there are significant deviations from the normal range.Assess
5. I can effectively utilize a patient’s lab values in evaluating the efficacy and potential side effects of drug therapy.Follow-up
6. I can monitor the progression of a medical condition and the effectiveness of drug therapy based on the patient’s clinical symptoms and information obtained from healthcare professionals or medical records.Follow-up
7. I can verify the information needed to evaluate a patient’s medication adherence during an evaluation.Follow-up
8. I can assess the extent of a patient’s drug response through the evaluation of monitoring variables.Follow-up
9. I can evaluate the presence of drug toxicity reactions in a patient through the assessment of monitoring variables.Follow-up
10. I can critically evaluate a patient’s drug therapy.Follow-up
11. I can develop a rational, patient-centered treatment plan for intervening in drug-related problems.Plan, Implement
12. I can modify pharmaceutical care plans by incorporating updated patient information.Plan, Implement
13. I have a comprehensive understanding of key medical conditions or the specific disease states presented in a given patient case.Knowledge
14. I have an understanding of the physiological and psychological interactions between a patient’s drug therapy and the complex state of comorbid conditions.Knowledge
15. I can actively engage in drug counseling and patient education.Communication
16. I can appropriately conduct patient monitoring to verify and assess the achievement of targeted therapeutic outcomes in drug therapy.Follow-up
17. I can develop personalized drug therapy plans for patients with chronic conditions.Plan, Implement
18. I can explore and discuss fundamental knowledge and information related to the epidemiology, pathophysiology, progression, etiology, symptoms, and signs of major diseases, depending on the specific condition.Knowledge
19. I can explore and discuss knowledge and information related to drug therapy, including drug classes, mechanisms of action, drug dosage, administration routes, pharmacokinetics, pharmacodynamics, adverse reactions, and patient education.Knowledge
20. I can perform a systematic assessment to identify drug-related problems, taking into account patient-specific factors and evidence from the literature.Assess
21. I can create a comprehensive patient-centered care plan which includes evidence-based treatment goals, administration routes, drug dosage and dosing frequencies, treatment duration, and monitoring plans.Plan, Implement
22. I can effectively conduct patient history interviews and patient consultations.Communication
Professional behaviors
23. I can provide evidence-based pharmaceutical care by leveraging my knowledge of drug therapy, practical experience, and independent literature search.Plan, Implement
24. I understand the importance of comprehensive pre-counseling preparation before patient consultations and can maintain a professional attitude during patient consultations as a healthcare professional.Communication
25. I can uphold a professional attitude that respects the dignity of colleagues and patients.Communication

PPCP=Pharmacists’ Patient Care Process.


Data Analysis

For evaluating students’ self-efficacy related to the PPCP components and patient counseling skills, a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) was employed. This scale measured the extent to which students agreed with 25 statements pertaining to PPCP and patient counseling. The data collected from online surveys were transferred to an Excel spreadsheet (Microsoft Corporation, Redmond, WA, USA) and then imported into SAS 9.4 (SAS Institute, Inc., Cary, NC, USA) for descriptive analysis. The self-efficacy ratings of students were presented using means, standard deviations, median, interquartile range, and percentage frequency by survey items. To assess the statistical significance of differences in self-efficacy ratings between different survey time points, a student t-test was employed. Statistical significance for the difference in ratings was determined when the p-value was below 0.05.

A total of 30 6th-year pharmacy students (12 female and 18 male students) completed the retrospective three-point self-efficacy assessment in 2023, achieving an overall response rate of 100%. The participants’ ages ranged from 25 to 39 years, with a mean age of 28.3 years±a standard deviation of 3.1 years. The APPE rotations for participants are composed of 9 weeks of community pharmacy experiences and 10 to 18 weeks of hospital pharmacy experiences.

Students’ Self-Efficacy Evaluation

The self-efficacy results of students for each item, assessed at three different time points—post-didactic courses, post-APPEs, and post-PCC—are presented in Supplementary Tables 1-3 in the supplementary materials. Student responses to each item were categorized into six distinct constructs per PPCP components, therapeutic knowledge, and patient counseling skills: collect (1 item), assess (4 item), plan & implement (5 items), follow-up (7 items), knowledge (4 items), and communication (4 items). The summed counts of students’ Liker-scaled responses for each construct were then presented as bar graphs in Fig. 1. Overall, the students’ self-efficacy demonstrated a tendency to improve over the project period, progressing from the post-didactic courses to post-APPEs and, finally, to post-PCC time point. The percentage of students who responded ‘agree’ or ‘strongly agree’ for the ‘collect’ construct increased from 56.7% to 86.7% and further to 90.0% at the post-didactic courses, post-APPEs, and post-PCC time points, respectively. Similarly, for the ‘assess’ construct, the percentage increased from 58.3% to 83.3% and to 88.3%. The trends continued across other constructs: ‘plan & implement’ increased from 50.7% to 82.0% to 93.3%, ‘follow-up’ increased from 56.2% to 81.9% to 88.1%, ‘knowledge’ increased from 50.8% to 90.0% to 92.5%, and ‘communication’ increased from 61.7% to 86.7% to 93.3%. The greatest improvement in the percentage of students who responded ‘agree’ or ‘strongly agree’ between the post-didactic courses and post-PCC time points was observed for the ‘plan & implement’ construct, with an increase of 84.2%, followed by the ‘knowledge’ construct with an increase of 82.0%.

Figure 1. Student self-efficacy assessment of PPCP components, knowledge, and patient counseling skills: (a) collect–1 item; (b) assess–4 items; (c) plan & implement–5 items; (d) follow-up–7 items; (e) knowledge–4 items; (f) communication–4 items.

Impact on Students’ Performance

The mean±standard deviation and median (interquartile range) scores on each item pertaining to PPCP components, therapeutic knowledge, and patient counseling skills are summarized in Table 2 and Supplementary Tables 1-3 of the supplementary materials. The mean student self-efficacy scores on the ‘collect’ component increased post-APPEs and PPC compared to post-didactic courses, and the difference was statistically significant in each comparison with a p-value of 0.04 and 0.02, respectively. Similar patterns were observed with the other PPCP components, knowledge, and patient counseling skills. For the ‘assess’ component, student self-efficacy showed a tendency to improve after completing APPEs and PCC when compared the post-didactic courses time point. However, the mean difference between post-APPEs and post-didactic courses time points in two (no. 3 and 20) of the four items was not statistically significant. Notably, student self-efficacy in item no. 3 further improved post-PCC, and its mean difference relative to the post-didactic courses time point was finally statistically significant (p=0.02). With regard to the ‘plan & implement’ component, the increase in mean self-efficacy scores from post-didactic courses to post-APPEs and to post-PCC time points was statistically significant in all five items. Of the seven items on the ‘follow-up’ component, the mean difference between post-APPEs and post-didactic courses was not statistically significant in three items (no. 5, 6, and 8). However, after completing PCC, student self-efficacy further improved, and the mean self-efficacy score became statistically different relative to that of the post-didactic courses time point in all seven items. Both APPEs and PCC were effective in enhancing student self-efficacy in all ‘knowledge’ and ‘communication’ items compared to the time when students had just completed didactic courses. When comparing post-PPC against post-APPEs, the mean student self-efficacy scores tended to be higher post-PCC in all self-assessment items. However, none of the mean differences was associated with a statistical significance.

Table 2 Difference in student self-efficacy pertaining to PPCP components and patient counseling skills between different time points

Self assessment items*Post didactic courses
mean±SD
(n=30)
Post APPEs
mean±SD
(n=30)
Post PCC
mean±SD
(n=30)
Post APPEs vs. post didactic courses
p-value
Post PPC vs. post didactic courses
p-value
Post PPC vs. post APPEs
p-value
PPCP-patient counseling skills
1C3.80±0.964.27±0.784.33±0.660.040.020.72
2A3.77±0.944.30±0.704.33±0.660.020.0090.85
3A3.80±0.964.23±0.734.33±0.710.050.020.59
4A3.77±1.014.33±0.664.40±0.620.010.0050.69
5F3.77±1.014.20±0.894.37±0.720.080.010.43
6F3.70±1.154.13±0.864.30±0.700.100.020.41
7F3.77±1.014.30±0.704.47±0.570.020.0020.32
8F3.67±1.094.10±0.884.23±0.820.100.030.55
9F3.60±1.134.13±0.734.27±0.690.030.0080.47
10F3.57±1.144.17±0.704.27±0.690.020.0060.58
11P, I3.70±1.094.20±0.764.40±0.620.040.0030.27
12P, I3.53±1.044.10±0.804.27±0.690.020.0020.39
13K3.73±0.944.33±0.554.33±0.660.0040.0061.00
14K3.53±1.074.07±0.694.23±0.680.030.0040.35
15Cm3.57±1.104.23±0.734.47±0.630.008<0.0010.19
16F3.63±1.034.23±0.634.37±0.560.0090.0010.39
17P, I3.60±1.044.17±0.754.37±0.610.020.0010.26
18K3.63±1.134.33±0.554.37±0.670.0030.0030.83
19K3.60±0.974.23±0.684.27±0.640.0050.0030.85
20A3.70±1.124.07±0.784.17±0.700.150.060.60
21P, I3.50±1.144.20±0.894.40±0.670.01<0.0010.33
22Cm3.67±1.094.17±0.754.40±0.770.040.0040.24
Professional behaviors
23P, I3.53±1.114.20±0.764.40±0.560.009<0.0010.25
24Cm3.87±1.074.43±0.684.63±0.560.020.0010.22
25Cm3.83±1.154.47±0.634.70±0.600.01<0.0010.15

SD=standard deviation, APPEs=Advanced Pharmacy Practice Experiences, PCC=patient counseling competition, PPCP=Pharmacists' Patient Care Process, C=collect, A=assess, F=follow-up, P=plan, I=implement, K=knowledge, Cm=communication.

*Self-assessment items were evaluated on a scale of 1=poor, 2=below average, 3=fair, 4=good, and 5=excellent.

In our commitment to fostering the competency development of pharmacy students as future healthcare professionals capable of delivering evidence-based pharmaceutical care and patient counseling with empathy, we established a Pharmacy Competency Enhancement Program. This program integrates PBL patient case activities and the PCC, specifically designed to prepare students for real-world patient care scenarios. In this project, we analyzed the program’s impact on students’ self-competency in the PPCP components, therapeutic knowledge, and patient counseling skills. We assessed pharmacy students’ self-efficacy at three time points: post-didactic courses, post-APPEs, and post-PCC, which revealed consistent improvement across all constructs. The percentage of students responding ‘agree’ or ‘strongly agree’ increased for each construct, with the most significant improvement seen in ‘plan & implement’ (84.2%) and ‘knowledge’ (82.0%) between post-didactic courses and post-PCC. These findings highlight the positive impact of the PBL-based patient case activities and PCC on students’ essential skills development.

PBL-based patient case activities play a pivotal role in pharmacy programs, offering a dynamic and interactive approach to pharmacotherapy courses [1]. These activities immerse pharmacy students in realistic, patient-centered scenarios that reflect the complexities encountered in real-world healthcare settings. Actively engaging in the ‘collect,’ ‘assess,’ ‘plan,’ ‘implement,’ and ‘follow-up’ activities, as well as proposing interventions for drug-related problems within the context of patient cases, enables students to not only deepen their understanding of pharmacotherapy but also cultivate essential problem-solving and critical-thinking skills [5-10]. Furthermore, PBL-based patient case activities promote collaboration within teams, simulating interdisciplinary team-work, a crucial aspect of healthcare practice. As students apply theoretical knowledge to practical situations, they enhance their clinical reasoning abilities, preparing them for the challenges of pharmacy practice. Overall, the significance of PBL-based patient case activities lies in their ability to bridge the gap between knowledge and application, promoting holistic learning and better preparing future pharmacists for the complexities of patient care [1,2].

The PCC for pharmacy school students is a valuable initiative that holds significant importance in preparing students for their roles as future healthcare professionals. This competition provides a platform for students to showcase their communication skills, medication knowledge, and patient counseling skills in a simulated scenario that mirror real-world healthcare settings [15]. Participating in such competitions not only hones their clinical knowledge but also nurtures crucial interpersonal and communication skills essential for effective patient interactions. By simulating scenarios where students counsel patients on medication use, potential side effects, and proper administration, the competition mirrors the challenges they will face in their future roles as pharmacists. Additionally, it promotes a patient-centric approach, emphasizing the importance of clear and empathetic communication in ensuring patient understanding and compliance [15]. Overall, the PCC serves as a vital experiential learning opportunity, bridging the gap between classroom education and practical, patient-centered care, thereby shaping well-rounded and competent healthcare professionals.

Organizing the PCC in conjunction with APPE rotations offers a significant advantage by seamlessly integrating theoretical knowledge with practical application. By selecting a real-world patient case that students have followed up during their rotations, the competition grounds itself in real-world patient scenarios encountered in clinical settings. This approach not only enhances the relevance of the competition but also underscores the application of learned concepts in patient care. Simulating a patient counseling interaction for a patient about to be discharged provides a valuable opportunity for students to translate their clinical knowledge into effective communication skills [15]. This dynamic competition setting enables students to practice and refine their patient counseling techniques in a controlled environment, fostering competence and confidence.

The incorporation of peer evaluation alongside faculty assessment for students’ patient counseling and team-based presentations of PBL patient case assignments, including SOAP notes and care plans, fosters an interactive learning environment. Peer evaluation not only provides students with diverse perspectives but also cultivates essential skills in teamwork, communication, and critical assessment. This approach encourages a collaborative learning atmosphere where students can exchange constructive feedback and refine their work based on the insights of their colleagues. Allowing students to submit revised versions for final faculty evaluation reinforces the interactive learning process, promoting continuous improvement and fostering a sense of accountability. By combining peer and faculty evaluations, this approach enhances the overall educational experience, preparing students not only for the completeness of their assignments but also for effective collaboration and self-directed learning in their development.

The three-time-point assessment of pharmacy students’ self-efficacy, encompassing key elements of the PPCP (collect, assess, plan, implement, follow-up), as well as therapeutic knowledge and communication skills, revealed a consistent and promising trend of improvement. Following APPE clinical rotations and participation in the PCC, students demonstrated a steady enhancement in their confidence across these critical domains. This structured assessment approach allows educators to monitor the progression of students’ abilities at pivotal stages of their pharmacy education. The observed improvements in self-efficacy signify the positive impact of PBL patient case activities and subsequent simulated patient counseling events, affirming the effectiveness of these components in shaping competent future pharmacists as communication leaders. This three-time-point evaluation not only serves as a valuable tool for assessing student development but also underscores the importance of experiential learning in fostering a comprehensive skill set crucial for patient-centered pharmacy practice.

Providing students with the opportunity to assume the role of a patient, alongside their role as a counseling pharmacist, holds significant merit, especially in situations with limited resources that restrict the use of standardized patient actors. This approach fosters a unique and valuable experiential learning environment, allowing students to develop empathy and a deeper understanding of the patient’s perspective. By actively engaging in the patient role, students gain insights into the challenges and concerns patients may experience, which enhances their ability to provide more patient-centered care in the future. This strategy not only optimizes the available resources but also cultivates well-rounded healthcare professionals capable of approaching patient interactions with a comprehensive and empathetic outlook.

Our project has several limitations. Firstly, the use of a retrospective survey for students’ self-efficacy assessment introduces the potential for recall bias. Participants may have difficulty accurately recalling and reflecting on their self-efficacy at different time points, impacting the reliability of the data. Additionally, the project’s reliance on a single pharmacy school and the associated small sample size may limit the generalizability of our findings to a broader student population. The tool utilized in our study to assess PPCP-based competency goals was developed as part of the education quality improvement initiatives at the study institution, tailored to align with the outcome goals designed for our APPE clinical rotations. Hence, the outcomes and trends observed in this project may not be universally applicable, emphasizing the need for caution when extrapolating results. Future endeavors should aim to address these limitations by employing prospective designs and involving a greater number of participants to enhance the generalizability of the findings.

Aligned with the 6th-year APPE, the Pharmacy Competency Enhancement Program integrated students’ collaborative team-based efforts in both PBL patient case activities and the PCC. This project evaluated the results of self-efficacy surveys among pharmacy students at three pivotal time points: after completing didactic courses, post-APPEs, and post-PCC, revealing a consistent and notable enhancement in students’ self-efficacy across all domains of the PPCP components, therapeutic knowledge, and communication skills following APPEs and the PCC. These findings underscore the advantageous impact of PBL patient case activities and the PCC on the foundational skills development of pharmacy students.

This research was supported by University Research Fund (S-2024-G0001-00149) and by the National Research Foundation of Korea (NRF) grants funded by the Ministry of Science and ICT (No. 2021R1C1C1003735) and the Ministry of Education (No. 2021R1I1A1A01044500).

No potential conflict of interest relevant to this article was reported.

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Article

Original Article

R Clin Pharm 2024; 2(1): 38-46

Published online June 30, 2024 https://doi.org/10.59931/rcp.24.0007

Copyright © Asian Conference On Clinical Pharmacy.

Integrating Problem-Based Learning and Patient Counseling Competitions to Enhance Pharmacy Students’ Competency in Patient Care and Communication

Suhyeon Moon1* , Hyunju Yoo2* , Haemin Hwang2 , Yoon Seul Cho2 , Je Heon Kim2 , Tae Woo Kim2 , Jeongmin Kang2 , Bowon Hwang2 , Yunseo Lee2 , Minjeong Shin2 , Yeo Jin Choi3 , Sooyoung Shin1,2

1Department of Biohealth Regulatory Science, Graduate School of Ajou University, Suwon, Korea
2Department of Pharmacy, College of Pharmacy, Ajou University, Suwon, Korea
3Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, Korea

Correspondence to:Sooyoung Shin
E-mail syshin@ajou.ac.kr
ORCID
https://orcid.org/0000-0003-2388-1122

Yeo Jin Choi
E-mail yeojin.choi@khu.ac.kr
ORCID
https://orcid.org/0000-0002-0635-4374

* These authors contributed equally to this study.

Received: June 6, 2024; Revised: June 21, 2024; Accepted: June 24, 2024

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: A Pharmacy Competency Enhancement Program, based on problem-based learning (PBL), was developed to empower students in adopting a patient-centered approach and fostering communication skills. The objective of this program is to investigate its impact on students’ self-competency in the Pharmacists’ Patient Care Process components and patient counseling skills.
Methods: This program integrates PBL patient case activities and a patient counseling competition (PCC), specifically designed to prepare students for real-world patient care scenarios. Students were prompted to complete a self-assessment survey at the following three distinct time points: post-didactic courses, post-Advanced Pharmacy Practice Experience (APPE) rotations, and post-PCC; their responses were categorized into the following six constructs: collect (1 item), assess (4 items), plan and implement (5 items), follow-up (7 items), knowledge (4 items), and communication (4 items).
Results: The sum of the Likert-scaled responses for each construct demonstrated consistent improvement in students’ self-efficacy from post-didactic courses to post-APPE rotations to post-PCC. The percentage of students responding “agree” or “strongly agree” increased for each construct, with the most significant improvement observed in “plan and implement” (84.2%) and “knowledge” (82.0%) between post-didactic courses and post-PCC.
Conclusion: The outcomes of this project emphasize the significant positive impact of PBL activities and PCC in cultivating the fundamental skills required for future pharmacists.

Keywords: Pharmacists&rsquo, Patient Care Process, Problem-based learning, Pharmaceutical care, Patient counseling, Self-efficacy

Body

A growing demand for the transformation of didactic courses to incorporate high-intensity interactive programs has prompted the widespread adoption of problem-based learning (PBL) in pharmacy education, particularly within the pharmacotherapy curriculum, to enhance interaction among students and faculty [1]. The core educational competencies in clinical pharmacy education focus on strengthening patient-centered pharmaceutical expertise and advancing interdisciplinary patient care leadership [2,3]. In line with the 2014 guidelines from the Joint Commission of Pharmacy Practitioners, education in pharmacotherapy is expected to encompass the complete Pharmacists’ Patient Care Process (PPCP): collect, assess, plan, implement, and follow-up (monitor and evaluate) [4-10]. Pharmacists, adopting a patient-centered approach, collaborate with healthcare team members to improve both patient therapeutic outcomes and safety. This collaborative and patient-focused approach can be effectively simulated through PBL-based patient case activities.

In pharmacotherapy courses, a combination of didactic lectures and PBL-based small group activities is often employed to structure the classes. These activities involve patient case reviews where students identify drug-related problems (DRPs) and participate in small group sessions to prioritize and develop clinical pharmaceutical interventions [1]. Specifically designed PBL assignments aim to cultivate competencies aligned with each component of the PPCP within these activities [5-10]. Going beyond competency enhancement programs in pharmacotherapy, there is a concerted effort to foster interdisciplinary collaboration among healthcare professionals in patient drug management [11,12]. This collaborative approach involves designing personalized evidence-based drug therapy plans, monitoring patient drug therapy, evaluating outcomes, and enhancing communication skills with healthcare teams, patients, and caregivers. Furthermore, pharmacotherapy curricula aim to educate students on the effective and safe use of drugs by integrating assessments and interventions in pharmaceutical care, reporting and monitoring adverse drug reactions, and fostering leadership skills in a team-based healthcare environment [12,13]. Continuous self-development and self-evaluation are also emphasized in the pursuit of these goals.

To achieve these educational objectives, we introduced the Pharmacy Competency Enhancement Program at our pharmacy school, designed in collaboration with Advanced Pharmacy Practice Experience (APPE) clinical rotations during the 6th year of pharmacy programs. Our program is structured to include team-based small group meetings for the review and discussion of PBL patient cases that students encountered in real-world healthcare settings. PBL activities involve the collaborative exploration of learning topics among students, self-directed activities for patient care and drug therapy plan development, presentation of evidence-based drug therapy plans and intervention strategies for DRPs within teams. The process includes critical peer evaluations and feedback from instructors on team PBL assignments [14]. Final submissions are made after revisions and improvements based on the provided feedback.

The final assignment of this PBL-based Pharmacy Competency Enhancement Program involves students conducting a simulation of counseling a patient for discharge based on the patient case they followed up during APPE hospital rotations, where they previously performed subjective, objective, assessment, and plan (SOAP) notes or care plan assignments. Students participated in a team-based patient counseling competition (PCC), with two students pairing up as one team. One student assumed the role of a counseling pharmacist, while the other played the part of a patient, and each student was given the opportunity to take on the role of both a pharmacist and a patient. As of now, there hasn’t been an official PCC at the level of pharmacy schools or a nationwide competition event in Korea. Counseling patients in real-world practice settings is important to ensure the effective and safe usage of medications. Through the PCC conducted in conjunction with the Pharmacy Competency Enhancement Program, our goal was to promote patient-centeredness and prepare pharmacy students as effective communicators in real-world patient encounters [15].

In this program, students were prompted to perform self-assessments at three different time points: after completing didactic courses, after participating in APPE rotations at community pharmacies and hospitals, and after completing the PCC linked to the Pharmacy Competency Enhancement Program. The goal of this project is to retrospectively analyze how our PBL-based program has influenced students’ self-competency in PPCP and patient counseling skills at these three distinct stages of their education and training.

METHODS

Program Design and Participants

Two weeks of PBL-based patient case activities were designed in conjunction with APPE rotations for 6th year pharmacy students. Following clinical rotations at local pharmacies, they proceeded to APPE hospital rotations under the supervision of the pharmacy team at a tertiary medical center affiliated with the program institution in Korea. On day 1, we conducted the program orientation, during which students received guidance on the schedule of PBL activities, which ran concurrently with the final two weeks of APPE hospital rotation. In the first week, students performed SOAP note writing and care planning assignments related to patient cases encountered during the APPE hospital rotation. At the end of the first week, they presented patient cases with their identified DRPs in SOAP note format, prioritized them, and developed pharmaceutical interventions. Students then incorporated feedback from faculty and peers to refine their assignments. Each student selected a patient case for participation in the PCC from those encountered during APPE hospital rotation. During the second week, two students paired up as a team and conducted small-group meetings to practice simulated patient counseling for a discharge, preparing for the PCC, which was held on the last day of the two-week session. This program was implemented as part of education quality improvement initiatives at Ajou University, and the outcomes were assessed retrospectively; therefore, institutional review board (IRB) approval was waived.

Self-Efficacy Evaluation Tool

A retrospective post-activity self-efficacy assessment was designed to be performed at three time points: post-didactic courses, post-APPEs, and post-PCC. The self-efficacy assessment, composed of 25 items in total, was developed to encompass components of the PPCP (collect, assess, plan, implement, and follow-up: monitor and evaluate) [4], therapeutic knowledge, and patient counseling competency (Table 1). The survey was executed through the utilization of Google survey. Participants received an email containing a link to the survey, which they submitted online. A reminder email was sent to all participants two weeks after the initial communication. The survey concluded after a 4-week data collection period, and subsequently, the collected data were entered into an Excel spreadsheet. To ensure participant confidentiality and minimize potential bias, the survey was designed for anonymous completion, with investigators refraining from recording any participant identification information.

Table 1 . Components of students’ self-efficacy in relation to constructs encompassing pharmaceutical care skills and professional behavior.

Self-assessment itemsPPCP components
Pharmaceutical care skills
1. I can extract and interpret pertinent information from a given patient case.Collect
2. I can assess the appropriateness of drug therapy and logically evaluate whether there are any drug-related problems in a given patient case.Assess
3. I can prioritize identified drug-related problems by evaluating their significance and assigning priorities based on severity.Assess
4. I can interpret a patient’s lab values and evaluate whether there are significant deviations from the normal range.Assess
5. I can effectively utilize a patient’s lab values in evaluating the efficacy and potential side effects of drug therapy.Follow-up
6. I can monitor the progression of a medical condition and the effectiveness of drug therapy based on the patient’s clinical symptoms and information obtained from healthcare professionals or medical records.Follow-up
7. I can verify the information needed to evaluate a patient’s medication adherence during an evaluation.Follow-up
8. I can assess the extent of a patient’s drug response through the evaluation of monitoring variables.Follow-up
9. I can evaluate the presence of drug toxicity reactions in a patient through the assessment of monitoring variables.Follow-up
10. I can critically evaluate a patient’s drug therapy.Follow-up
11. I can develop a rational, patient-centered treatment plan for intervening in drug-related problems.Plan, Implement
12. I can modify pharmaceutical care plans by incorporating updated patient information.Plan, Implement
13. I have a comprehensive understanding of key medical conditions or the specific disease states presented in a given patient case.Knowledge
14. I have an understanding of the physiological and psychological interactions between a patient’s drug therapy and the complex state of comorbid conditions.Knowledge
15. I can actively engage in drug counseling and patient education.Communication
16. I can appropriately conduct patient monitoring to verify and assess the achievement of targeted therapeutic outcomes in drug therapy.Follow-up
17. I can develop personalized drug therapy plans for patients with chronic conditions.Plan, Implement
18. I can explore and discuss fundamental knowledge and information related to the epidemiology, pathophysiology, progression, etiology, symptoms, and signs of major diseases, depending on the specific condition.Knowledge
19. I can explore and discuss knowledge and information related to drug therapy, including drug classes, mechanisms of action, drug dosage, administration routes, pharmacokinetics, pharmacodynamics, adverse reactions, and patient education.Knowledge
20. I can perform a systematic assessment to identify drug-related problems, taking into account patient-specific factors and evidence from the literature.Assess
21. I can create a comprehensive patient-centered care plan which includes evidence-based treatment goals, administration routes, drug dosage and dosing frequencies, treatment duration, and monitoring plans.Plan, Implement
22. I can effectively conduct patient history interviews and patient consultations.Communication
Professional behaviors
23. I can provide evidence-based pharmaceutical care by leveraging my knowledge of drug therapy, practical experience, and independent literature search.Plan, Implement
24. I understand the importance of comprehensive pre-counseling preparation before patient consultations and can maintain a professional attitude during patient consultations as a healthcare professional.Communication
25. I can uphold a professional attitude that respects the dignity of colleagues and patients.Communication

PPCP=Pharmacists’ Patient Care Process..



Data Analysis

For evaluating students’ self-efficacy related to the PPCP components and patient counseling skills, a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) was employed. This scale measured the extent to which students agreed with 25 statements pertaining to PPCP and patient counseling. The data collected from online surveys were transferred to an Excel spreadsheet (Microsoft Corporation, Redmond, WA, USA) and then imported into SAS 9.4 (SAS Institute, Inc., Cary, NC, USA) for descriptive analysis. The self-efficacy ratings of students were presented using means, standard deviations, median, interquartile range, and percentage frequency by survey items. To assess the statistical significance of differences in self-efficacy ratings between different survey time points, a student t-test was employed. Statistical significance for the difference in ratings was determined when the p-value was below 0.05.

RESULTS

A total of 30 6th-year pharmacy students (12 female and 18 male students) completed the retrospective three-point self-efficacy assessment in 2023, achieving an overall response rate of 100%. The participants’ ages ranged from 25 to 39 years, with a mean age of 28.3 years±a standard deviation of 3.1 years. The APPE rotations for participants are composed of 9 weeks of community pharmacy experiences and 10 to 18 weeks of hospital pharmacy experiences.

Students’ Self-Efficacy Evaluation

The self-efficacy results of students for each item, assessed at three different time points—post-didactic courses, post-APPEs, and post-PCC—are presented in Supplementary Tables 1-3 in the supplementary materials. Student responses to each item were categorized into six distinct constructs per PPCP components, therapeutic knowledge, and patient counseling skills: collect (1 item), assess (4 item), plan & implement (5 items), follow-up (7 items), knowledge (4 items), and communication (4 items). The summed counts of students’ Liker-scaled responses for each construct were then presented as bar graphs in Fig. 1. Overall, the students’ self-efficacy demonstrated a tendency to improve over the project period, progressing from the post-didactic courses to post-APPEs and, finally, to post-PCC time point. The percentage of students who responded ‘agree’ or ‘strongly agree’ for the ‘collect’ construct increased from 56.7% to 86.7% and further to 90.0% at the post-didactic courses, post-APPEs, and post-PCC time points, respectively. Similarly, for the ‘assess’ construct, the percentage increased from 58.3% to 83.3% and to 88.3%. The trends continued across other constructs: ‘plan & implement’ increased from 50.7% to 82.0% to 93.3%, ‘follow-up’ increased from 56.2% to 81.9% to 88.1%, ‘knowledge’ increased from 50.8% to 90.0% to 92.5%, and ‘communication’ increased from 61.7% to 86.7% to 93.3%. The greatest improvement in the percentage of students who responded ‘agree’ or ‘strongly agree’ between the post-didactic courses and post-PCC time points was observed for the ‘plan & implement’ construct, with an increase of 84.2%, followed by the ‘knowledge’ construct with an increase of 82.0%.

Figure 1. Student self-efficacy assessment of PPCP components, knowledge, and patient counseling skills: (a) collect–1 item; (b) assess–4 items; (c) plan & implement–5 items; (d) follow-up–7 items; (e) knowledge–4 items; (f) communication–4 items.

Impact on Students’ Performance

The mean±standard deviation and median (interquartile range) scores on each item pertaining to PPCP components, therapeutic knowledge, and patient counseling skills are summarized in Table 2 and Supplementary Tables 1-3 of the supplementary materials. The mean student self-efficacy scores on the ‘collect’ component increased post-APPEs and PPC compared to post-didactic courses, and the difference was statistically significant in each comparison with a p-value of 0.04 and 0.02, respectively. Similar patterns were observed with the other PPCP components, knowledge, and patient counseling skills. For the ‘assess’ component, student self-efficacy showed a tendency to improve after completing APPEs and PCC when compared the post-didactic courses time point. However, the mean difference between post-APPEs and post-didactic courses time points in two (no. 3 and 20) of the four items was not statistically significant. Notably, student self-efficacy in item no. 3 further improved post-PCC, and its mean difference relative to the post-didactic courses time point was finally statistically significant (p=0.02). With regard to the ‘plan & implement’ component, the increase in mean self-efficacy scores from post-didactic courses to post-APPEs and to post-PCC time points was statistically significant in all five items. Of the seven items on the ‘follow-up’ component, the mean difference between post-APPEs and post-didactic courses was not statistically significant in three items (no. 5, 6, and 8). However, after completing PCC, student self-efficacy further improved, and the mean self-efficacy score became statistically different relative to that of the post-didactic courses time point in all seven items. Both APPEs and PCC were effective in enhancing student self-efficacy in all ‘knowledge’ and ‘communication’ items compared to the time when students had just completed didactic courses. When comparing post-PPC against post-APPEs, the mean student self-efficacy scores tended to be higher post-PCC in all self-assessment items. However, none of the mean differences was associated with a statistical significance.

Table 2 . Difference in student self-efficacy pertaining to PPCP components and patient counseling skills between different time points.

Self assessment items*Post didactic courses
mean±SD
(n=30)
Post APPEs
mean±SD
(n=30)
Post PCC
mean±SD
(n=30)
Post APPEs vs. post didactic courses
p-value
Post PPC vs. post didactic courses
p-value
Post PPC vs. post APPEs
p-value
PPCP-patient counseling skills
1C3.80±0.964.27±0.784.33±0.660.040.020.72
2A3.77±0.944.30±0.704.33±0.660.020.0090.85
3A3.80±0.964.23±0.734.33±0.710.050.020.59
4A3.77±1.014.33±0.664.40±0.620.010.0050.69
5F3.77±1.014.20±0.894.37±0.720.080.010.43
6F3.70±1.154.13±0.864.30±0.700.100.020.41
7F3.77±1.014.30±0.704.47±0.570.020.0020.32
8F3.67±1.094.10±0.884.23±0.820.100.030.55
9F3.60±1.134.13±0.734.27±0.690.030.0080.47
10F3.57±1.144.17±0.704.27±0.690.020.0060.58
11P, I3.70±1.094.20±0.764.40±0.620.040.0030.27
12P, I3.53±1.044.10±0.804.27±0.690.020.0020.39
13K3.73±0.944.33±0.554.33±0.660.0040.0061.00
14K3.53±1.074.07±0.694.23±0.680.030.0040.35
15Cm3.57±1.104.23±0.734.47±0.630.008<0.0010.19
16F3.63±1.034.23±0.634.37±0.560.0090.0010.39
17P, I3.60±1.044.17±0.754.37±0.610.020.0010.26
18K3.63±1.134.33±0.554.37±0.670.0030.0030.83
19K3.60±0.974.23±0.684.27±0.640.0050.0030.85
20A3.70±1.124.07±0.784.17±0.700.150.060.60
21P, I3.50±1.144.20±0.894.40±0.670.01<0.0010.33
22Cm3.67±1.094.17±0.754.40±0.770.040.0040.24
Professional behaviors
23P, I3.53±1.114.20±0.764.40±0.560.009<0.0010.25
24Cm3.87±1.074.43±0.684.63±0.560.020.0010.22
25Cm3.83±1.154.47±0.634.70±0.600.01<0.0010.15

SD=standard deviation, APPEs=Advanced Pharmacy Practice Experiences, PCC=patient counseling competition, PPCP=Pharmacists' Patient Care Process, C=collect, A=assess, F=follow-up, P=plan, I=implement, K=knowledge, Cm=communication..

*Self-assessment items were evaluated on a scale of 1=poor, 2=below average, 3=fair, 4=good, and 5=excellent..


DISCUSSION

In our commitment to fostering the competency development of pharmacy students as future healthcare professionals capable of delivering evidence-based pharmaceutical care and patient counseling with empathy, we established a Pharmacy Competency Enhancement Program. This program integrates PBL patient case activities and the PCC, specifically designed to prepare students for real-world patient care scenarios. In this project, we analyzed the program’s impact on students’ self-competency in the PPCP components, therapeutic knowledge, and patient counseling skills. We assessed pharmacy students’ self-efficacy at three time points: post-didactic courses, post-APPEs, and post-PCC, which revealed consistent improvement across all constructs. The percentage of students responding ‘agree’ or ‘strongly agree’ increased for each construct, with the most significant improvement seen in ‘plan & implement’ (84.2%) and ‘knowledge’ (82.0%) between post-didactic courses and post-PCC. These findings highlight the positive impact of the PBL-based patient case activities and PCC on students’ essential skills development.

PBL-based patient case activities play a pivotal role in pharmacy programs, offering a dynamic and interactive approach to pharmacotherapy courses [1]. These activities immerse pharmacy students in realistic, patient-centered scenarios that reflect the complexities encountered in real-world healthcare settings. Actively engaging in the ‘collect,’ ‘assess,’ ‘plan,’ ‘implement,’ and ‘follow-up’ activities, as well as proposing interventions for drug-related problems within the context of patient cases, enables students to not only deepen their understanding of pharmacotherapy but also cultivate essential problem-solving and critical-thinking skills [5-10]. Furthermore, PBL-based patient case activities promote collaboration within teams, simulating interdisciplinary team-work, a crucial aspect of healthcare practice. As students apply theoretical knowledge to practical situations, they enhance their clinical reasoning abilities, preparing them for the challenges of pharmacy practice. Overall, the significance of PBL-based patient case activities lies in their ability to bridge the gap between knowledge and application, promoting holistic learning and better preparing future pharmacists for the complexities of patient care [1,2].

The PCC for pharmacy school students is a valuable initiative that holds significant importance in preparing students for their roles as future healthcare professionals. This competition provides a platform for students to showcase their communication skills, medication knowledge, and patient counseling skills in a simulated scenario that mirror real-world healthcare settings [15]. Participating in such competitions not only hones their clinical knowledge but also nurtures crucial interpersonal and communication skills essential for effective patient interactions. By simulating scenarios where students counsel patients on medication use, potential side effects, and proper administration, the competition mirrors the challenges they will face in their future roles as pharmacists. Additionally, it promotes a patient-centric approach, emphasizing the importance of clear and empathetic communication in ensuring patient understanding and compliance [15]. Overall, the PCC serves as a vital experiential learning opportunity, bridging the gap between classroom education and practical, patient-centered care, thereby shaping well-rounded and competent healthcare professionals.

Organizing the PCC in conjunction with APPE rotations offers a significant advantage by seamlessly integrating theoretical knowledge with practical application. By selecting a real-world patient case that students have followed up during their rotations, the competition grounds itself in real-world patient scenarios encountered in clinical settings. This approach not only enhances the relevance of the competition but also underscores the application of learned concepts in patient care. Simulating a patient counseling interaction for a patient about to be discharged provides a valuable opportunity for students to translate their clinical knowledge into effective communication skills [15]. This dynamic competition setting enables students to practice and refine their patient counseling techniques in a controlled environment, fostering competence and confidence.

The incorporation of peer evaluation alongside faculty assessment for students’ patient counseling and team-based presentations of PBL patient case assignments, including SOAP notes and care plans, fosters an interactive learning environment. Peer evaluation not only provides students with diverse perspectives but also cultivates essential skills in teamwork, communication, and critical assessment. This approach encourages a collaborative learning atmosphere where students can exchange constructive feedback and refine their work based on the insights of their colleagues. Allowing students to submit revised versions for final faculty evaluation reinforces the interactive learning process, promoting continuous improvement and fostering a sense of accountability. By combining peer and faculty evaluations, this approach enhances the overall educational experience, preparing students not only for the completeness of their assignments but also for effective collaboration and self-directed learning in their development.

The three-time-point assessment of pharmacy students’ self-efficacy, encompassing key elements of the PPCP (collect, assess, plan, implement, follow-up), as well as therapeutic knowledge and communication skills, revealed a consistent and promising trend of improvement. Following APPE clinical rotations and participation in the PCC, students demonstrated a steady enhancement in their confidence across these critical domains. This structured assessment approach allows educators to monitor the progression of students’ abilities at pivotal stages of their pharmacy education. The observed improvements in self-efficacy signify the positive impact of PBL patient case activities and subsequent simulated patient counseling events, affirming the effectiveness of these components in shaping competent future pharmacists as communication leaders. This three-time-point evaluation not only serves as a valuable tool for assessing student development but also underscores the importance of experiential learning in fostering a comprehensive skill set crucial for patient-centered pharmacy practice.

Providing students with the opportunity to assume the role of a patient, alongside their role as a counseling pharmacist, holds significant merit, especially in situations with limited resources that restrict the use of standardized patient actors. This approach fosters a unique and valuable experiential learning environment, allowing students to develop empathy and a deeper understanding of the patient’s perspective. By actively engaging in the patient role, students gain insights into the challenges and concerns patients may experience, which enhances their ability to provide more patient-centered care in the future. This strategy not only optimizes the available resources but also cultivates well-rounded healthcare professionals capable of approaching patient interactions with a comprehensive and empathetic outlook.

Our project has several limitations. Firstly, the use of a retrospective survey for students’ self-efficacy assessment introduces the potential for recall bias. Participants may have difficulty accurately recalling and reflecting on their self-efficacy at different time points, impacting the reliability of the data. Additionally, the project’s reliance on a single pharmacy school and the associated small sample size may limit the generalizability of our findings to a broader student population. The tool utilized in our study to assess PPCP-based competency goals was developed as part of the education quality improvement initiatives at the study institution, tailored to align with the outcome goals designed for our APPE clinical rotations. Hence, the outcomes and trends observed in this project may not be universally applicable, emphasizing the need for caution when extrapolating results. Future endeavors should aim to address these limitations by employing prospective designs and involving a greater number of participants to enhance the generalizability of the findings.

CONCLUSION

Aligned with the 6th-year APPE, the Pharmacy Competency Enhancement Program integrated students’ collaborative team-based efforts in both PBL patient case activities and the PCC. This project evaluated the results of self-efficacy surveys among pharmacy students at three pivotal time points: after completing didactic courses, post-APPEs, and post-PCC, revealing a consistent and notable enhancement in students’ self-efficacy across all domains of the PPCP components, therapeutic knowledge, and communication skills following APPEs and the PCC. These findings underscore the advantageous impact of PBL patient case activities and the PCC on the foundational skills development of pharmacy students.

FUNDING

This research was supported by University Research Fund (S-2024-G0001-00149) and by the National Research Foundation of Korea (NRF) grants funded by the Ministry of Science and ICT (No. 2021R1C1C1003735) and the Ministry of Education (No. 2021R1I1A1A01044500).

ACKNOWLEDGMENTS

None.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

SUPPLEMENTARY MATERIALS

Supplementary materials can be found via https://doi.org/10.59931/rcp.24.0007.

rcp-2-1-38-supple.pdf

Fig 1.

Figure 1.Student self-efficacy assessment of PPCP components, knowledge, and patient counseling skills: (a) collect–1 item; (b) assess–4 items; (c) plan & implement–5 items; (d) follow-up–7 items; (e) knowledge–4 items; (f) communication–4 items.
Research in Clinical Pharmacy 2024; 2: 38-46https://doi.org/10.59931/rcp.24.0007

Table 1 Components of students’ self-efficacy in relation to constructs encompassing pharmaceutical care skills and professional behavior

Self-assessment itemsPPCP components
Pharmaceutical care skills
1. I can extract and interpret pertinent information from a given patient case.Collect
2. I can assess the appropriateness of drug therapy and logically evaluate whether there are any drug-related problems in a given patient case.Assess
3. I can prioritize identified drug-related problems by evaluating their significance and assigning priorities based on severity.Assess
4. I can interpret a patient’s lab values and evaluate whether there are significant deviations from the normal range.Assess
5. I can effectively utilize a patient’s lab values in evaluating the efficacy and potential side effects of drug therapy.Follow-up
6. I can monitor the progression of a medical condition and the effectiveness of drug therapy based on the patient’s clinical symptoms and information obtained from healthcare professionals or medical records.Follow-up
7. I can verify the information needed to evaluate a patient’s medication adherence during an evaluation.Follow-up
8. I can assess the extent of a patient’s drug response through the evaluation of monitoring variables.Follow-up
9. I can evaluate the presence of drug toxicity reactions in a patient through the assessment of monitoring variables.Follow-up
10. I can critically evaluate a patient’s drug therapy.Follow-up
11. I can develop a rational, patient-centered treatment plan for intervening in drug-related problems.Plan, Implement
12. I can modify pharmaceutical care plans by incorporating updated patient information.Plan, Implement
13. I have a comprehensive understanding of key medical conditions or the specific disease states presented in a given patient case.Knowledge
14. I have an understanding of the physiological and psychological interactions between a patient’s drug therapy and the complex state of comorbid conditions.Knowledge
15. I can actively engage in drug counseling and patient education.Communication
16. I can appropriately conduct patient monitoring to verify and assess the achievement of targeted therapeutic outcomes in drug therapy.Follow-up
17. I can develop personalized drug therapy plans for patients with chronic conditions.Plan, Implement
18. I can explore and discuss fundamental knowledge and information related to the epidemiology, pathophysiology, progression, etiology, symptoms, and signs of major diseases, depending on the specific condition.Knowledge
19. I can explore and discuss knowledge and information related to drug therapy, including drug classes, mechanisms of action, drug dosage, administration routes, pharmacokinetics, pharmacodynamics, adverse reactions, and patient education.Knowledge
20. I can perform a systematic assessment to identify drug-related problems, taking into account patient-specific factors and evidence from the literature.Assess
21. I can create a comprehensive patient-centered care plan which includes evidence-based treatment goals, administration routes, drug dosage and dosing frequencies, treatment duration, and monitoring plans.Plan, Implement
22. I can effectively conduct patient history interviews and patient consultations.Communication
Professional behaviors
23. I can provide evidence-based pharmaceutical care by leveraging my knowledge of drug therapy, practical experience, and independent literature search.Plan, Implement
24. I understand the importance of comprehensive pre-counseling preparation before patient consultations and can maintain a professional attitude during patient consultations as a healthcare professional.Communication
25. I can uphold a professional attitude that respects the dignity of colleagues and patients.Communication

PPCP=Pharmacists’ Patient Care Process.


Table 2 Difference in student self-efficacy pertaining to PPCP components and patient counseling skills between different time points

Self assessment items*Post didactic courses
mean±SD
(n=30)
Post APPEs
mean±SD
(n=30)
Post PCC
mean±SD
(n=30)
Post APPEs vs. post didactic courses
p-value
Post PPC vs. post didactic courses
p-value
Post PPC vs. post APPEs
p-value
PPCP-patient counseling skills
1C3.80±0.964.27±0.784.33±0.660.040.020.72
2A3.77±0.944.30±0.704.33±0.660.020.0090.85
3A3.80±0.964.23±0.734.33±0.710.050.020.59
4A3.77±1.014.33±0.664.40±0.620.010.0050.69
5F3.77±1.014.20±0.894.37±0.720.080.010.43
6F3.70±1.154.13±0.864.30±0.700.100.020.41
7F3.77±1.014.30±0.704.47±0.570.020.0020.32
8F3.67±1.094.10±0.884.23±0.820.100.030.55
9F3.60±1.134.13±0.734.27±0.690.030.0080.47
10F3.57±1.144.17±0.704.27±0.690.020.0060.58
11P, I3.70±1.094.20±0.764.40±0.620.040.0030.27
12P, I3.53±1.044.10±0.804.27±0.690.020.0020.39
13K3.73±0.944.33±0.554.33±0.660.0040.0061.00
14K3.53±1.074.07±0.694.23±0.680.030.0040.35
15Cm3.57±1.104.23±0.734.47±0.630.008<0.0010.19
16F3.63±1.034.23±0.634.37±0.560.0090.0010.39
17P, I3.60±1.044.17±0.754.37±0.610.020.0010.26
18K3.63±1.134.33±0.554.37±0.670.0030.0030.83
19K3.60±0.974.23±0.684.27±0.640.0050.0030.85
20A3.70±1.124.07±0.784.17±0.700.150.060.60
21P, I3.50±1.144.20±0.894.40±0.670.01<0.0010.33
22Cm3.67±1.094.17±0.754.40±0.770.040.0040.24
Professional behaviors
23P, I3.53±1.114.20±0.764.40±0.560.009<0.0010.25
24Cm3.87±1.074.43±0.684.63±0.560.020.0010.22
25Cm3.83±1.154.47±0.634.70±0.600.01<0.0010.15

SD=standard deviation, APPEs=Advanced Pharmacy Practice Experiences, PCC=patient counseling competition, PPCP=Pharmacists' Patient Care Process, C=collect, A=assess, F=follow-up, P=plan, I=implement, K=knowledge, Cm=communication.

*Self-assessment items were evaluated on a scale of 1=poor, 2=below average, 3=fair, 4=good, and 5=excellent.


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Asian Conference On Clinical Pharmacy

Vol.2 No.2
December 2024

eISSN 2983-0745
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