Introduction: Medical care requires coordinated teamwork and communication between different disciplines,especially in a complex environment like the ICU; yet, healthcare students are rarelyafforded the opportunity to learn effective interprofessional (IP) communication andteamwork strategies during their education. Hypothesis: We hypothesize that the use of high fidelity simulation (HFS) to teach critical careconcepts will improve students’ IP communication and team skills, and enforce the importanceof IP collaboration. Methods: This was a pilot, prospective, observational study that included medical, pharmacy, nursing,physician assistant, and social work students in the last year of their professionalprograms. Four HFS sessions on critical care concepts were provided during the 4-weeks ofthe ICU interdisciplinary rotation to 8 students. Each HFS was videotaped and viewed by 2independent clinicians who evaluated IP communication and team skills using theCommunication and Teamwork Skills (CATS) Assessment. Students completed an anonymous Likertscale-based survey (1= strongly disagree; 5=strongly agree) after the 4 HFS sessions,evaluating perceived benefit of HFS for IP education. ANOVA with Bonferonni for comparisonbetween groups, and intra-class correlation coefficient (ICC) was used for analysis. Results: CATS scores significantly improved from the HFS session 1 to 2, (p = 0.01), 2 to 3(p=0.035), and overall from session 1 to 4 (p-=0.001), and the inter-rater reliabilitybetween evaluators as high (0.85, 95% CI 0.71, 0.99). Students perceived the HFS improvedtheir ability to communicate with other professionals (Median=4); improved confidence inpatient care in an IP team (median=4); stimulated student interest in IP work (median=4.5);and was an efficient use of student time (median=4.5). Conclusions: High fidelity simulation appears to be an effective tool to increase student IPcommunication and team skills for critically ill patients. It is also accepted positivelyby students and increases confidence in working in an IP environment. This pilot studysuggests HFS should be considered as part of the IP curriculum for schools of the healthsciences.
With the continuing evolution of pharmacy as a clinical profession, the need to prepare well‐trained clinicians beyond the knowledge gained from a doctor of pharmacy degree program is magnified. Such training is afforded by pharmacy residency programs, which have expanded from hospital sites to practice settings as diverse as managed care organizations and public health departments. Although the resident benefits from the intensive training program, the sponsoring institution also derives many benefits from hosting the residency. Fundamentally, residents are licensed pharmacists who provide several contributions to the organization at generally a much‐reduced direct cost. Federal funding for graduate medical education, often referred to as Medicare pass‐through funds, is a common source of support for the conduct of postgraduate year one residency programs in health system settings; other sources of funding may be found in organizational and academic outlets. Residents may be integral in expanding the revenue of an organization by serving as patient care providers, developing or enhancing services, and billing for services delivered. By virtue of the roles they can assume, residents can facilitate the redeployment of existing pharmacists to other areas, tasks, or projects, thus expanding the capabilities of the department. Increasing the capacity to conduct experiential education for pharmacy students, and the compensation for such activity, can be an additional benefit. Practice sites that conduct residency training often experience a greater degree of employee satisfaction and higher employee retention rates. Engaging in quality improvement and assessment activities, assisting in staff development, and supporting innovative approaches to care are additional activities that pharmacy residents can support. This primer from the American College of Clinical Pharmacy was developed to highlight the value an organization can realize by conducting pharmacy residency training.
To the Editor We would like to share with your readers a novel approach to using a mobile application for the enhancement of a student simulation learning experience, which we have found useful. We offer an advanced elective course that combines an online learning module and high-fidelity human patient simulation (HPS) technology.1 This course has been previously described in more detail.1 Instructors use an adult learning approach having pharmacy students review Internet-based learning modules before class to understand current evidence-based drug treatments. Students are then engaged in real-life scenarios using HPS. A major goal of this course is to develop students' critical thinking skills. During HPS cases, students receive a synopsis of the patient's condition and are expected to use critical thinking to evaluate what additional information they need to develop a pharmacotherapy plan. Previously, facilitators used a couple of options to communicate the information requested by students including a simulated paper chart or verbal communication. The simulated paper chart has limitations: (1) All information is given to the students, and this may not necessarily require critically thinking about obtaining pertinent data. (2) The facilitator cannot easily evaluate the students' thinking process supporting their treatment recommendations. The other approach for transferring relevant information to students involves facilitators providing requested information verbally. Although this allows facilitators to evaluate the students' critical thinking process, it is time consuming for students to manually copy all information stated aloud, thus limiting the time available for active learning 1-hour HPS cases. Bump Technologies, Inc (Mountain View, CA) application for mobile devices was used to transfer requested information to students in a form that simulates using an electronic patient chart during the in-class cases. Each file was easily transferred to the student requesting the information by bumping or tapping the facilitator's and the student's electronic devices together. Facilitators designed the patient chart in separate JPEG files containing pertinent information (eg, medical history, allergies, laboratory results, chest radiograph). An example of a screenshot for laboratory values, culture results, and a chest radiograph that the student received is displayed in Figure 1. Visualization of the information is limited to the student requesting the Bump. Students used their own electronic devices, so a variety of devices were used. This application was chosen because it is easy to use, available to students for use with several brands of mobile smart devices or tablet devices, and free to download.FIGURE 1: Screenshot of files to be sent to students via Bump.Applying Bump technology further enhanced an active learning environment for students. Facilitators noticed that using Bump increased the opportunity for students to think critically in a stepwise fashion as students requested each piece of patient data, thus contributing to their learning. Challenges that arose included occasional Internet service interruption that prevented bumping and font size appearing small on large text files, making visibility on some handhelds difficult. We noticed that limiting the amount of text provided in each file corrected the problem. Students using tablet computers did not have visibility problems. Overall, use of Bump allowed students to (1) apply critical thinking processes that were obvious to the facilitator and (2) have more time for learning compared with other methods of transferring information. Sandra L. Kane-Gill, PharmD, MSc, FCCP, FCCM Center for Pharmacoinformatics and Outcomes Research School of Pharmacy University of Pittsburgh Pittsburgh, PA Department of Pharmacy UPMC Pittsburgh, PA Jeremy P. Post, PharmD School of Pharmacy University of Pittsburgh Pittsburgh, PA Pamela L. Smithburger, PharmD, BCPS School of Pharmacy University of Pittsburgh Pittsburgh, PA Medical Intensive Care Unit UPMC Pittsburgh, PA Amy L. Seybert, PharmD, FASHP Department of Pharmacy and Therapeutics School of Pharmacy University of Pittsburgh Pittsburgh, PA
Anomaly detection methods can be very useful in identifying unusual or interesting patterns in data. A recently proposed conditional anomaly detection framework extends anomaly detection to the problem of identifying anomalous patterns on a subset of attributes in the data. The anomaly always depends (is conditioned) on the value of remaining attributes. The work presented in this paper focuses on instance-based methods for detecting conditional anomalies. The methods rely on the distance metric to identify examples in the dataset that are most critical for detecting the anomaly. We investigate various metrics and metric learning methods to optimize the performance of the instance-based anomaly detection methods. We show the benefits of the instance-based methods on two real-world detection problems: detection of unusual admission decisions for patients with the community-acquired pneumonia and detection of unusual orders of an HPF4 test that is used to confirm Heparin induced thrombocytopenia - a life-threatening condition caused by the Heparin therapy.
Electronic health record (EHR) technology use in the educational setting to advance pharmacy practice skills with patient simulation has not been described previously in the literature. Therefore, the purpose of this study was to evaluate the impact of a virtual EHR on learning efficiency, perceptions of clinical skills, communication, and satisfaction. This was a prospective study conducted in a cardiovascular therapeutics course in the Doctor of Pharmacy curriculum. Students were randomized to use of a virtual EHR with patient simulation or to patient simulation alone (control). The efficiency of learning was assessed by the time to optimal recommendation for each scenario. Surveys (n = 12 questions) were administered electronically to evaluate perceptions of clinical skills, communication, and learning satisfaction. Data were analyzed with the Mann⁻Whitney U or Wilcoxon signed-rank test as appropriate. Use of the virtual EHR decreased the amount of time needed to provide the optimal treatment recommendations by 25% compared to control. The virtual EHR also significantly improved students' perceptions of their clinical skills, communication, and satisfaction compared to control. The virtual EHR demonstrated value in learning efficiency while providing students with an engaging means of practicing essential pharmacist functions in a simulated setting.
Previous research in the US Navy demonstrated that cross-training enhances teamwork and interpersonal collaboration. Limited data exists on cross-training effectiveness in medical education. This research aimed to assess whether cross-training would have similar effects on medical teams. A multidisciplinary pair of resident participants—consisting of one physician and one pharmacist—was randomly assigned to cross-training or current training condition. The training experience involved one video-based content module (training a pharmacist’s task of pharmacokinetic dosing and a physician’s task of intubation) and one simulation-based practice scenario (collaborative treatment of an unstable critically ill simulated patient). Interprofessional pairs randomized to cross-training condition participated in both the content module and practice scenario in the alternative professional role whereas pairs randomized to current training condition participated in their own professional role. Pairs also participated in pre- and post- training assessment scenarios in their own professional role. Teamwork and interprofessionalism were measured immediately following assessment scenarios. Knowledge assessments were conducted at the start and end of the scenario sequence. Multidisciplinary pairs experiencing cross-training showed a significant improvement in teamwork (increased by 6.11% vs. 3.24%, p < 0.05). All participants demonstrated significant improvement in knowledge scores (increase of 14% cross-training, p < 0.05, and increase of 13.9% control, p < 0.05). Our project suggests that cross-training can improve teamwork in interprofessional medical teams.
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