The hidden curriculum of work-based learning for pharmacy students in public sector pharmacies in South Africa

BACKGROUND: The work-based learning environment encompasses a dynamic space where the implementation of theoretical knowledge and skills may prove to be at odds with routine service delivery practices, known as the hidden curriculum. OBJECTIVE: To describe incidents reflective of the hidden curriculum of fourth year pharmacy students from work-based learning experiences at public healthcare facilities. METHOD: A qualitative, descriptive study was conducted. Data from written student reflection reports were thematically analysed. RESULTS: From 35 reports, three primary themes including time, binaries, and students’ personal histories, influenced interactions in the workplace. These themes illustrated how the students’ professional and personal traits interlocked with historical, structural and cultural influences in the workplace as well as larger society. CONCLUSION: Uncovering of the hidden curriculum revealed that the students’ ability to navigate workload pressure, polarisation between groups and their own biases are crucial to firstly survive, and secondly to learn in the workplace

Be Mindful of Your Discomfort: An Approach to Contextualized Learning

Service-learning creates a space for contextualized learning whereby students connect classroom concepts to real-world practices relative to their own frame of reference. These experiences occur within a societal status quo rooted within historical and social inequalities. Affective responses to encounters with inequalities are not routinely addressed within the learning outcomes of formal curricula. Thus, the pedagogy of discomfort calls for an awareness and a critical self-examination among educators and students of how their passive acceptance or non-acceptance of apparent social injustices has been shaped by the status quo. By incorporating affective learning into the reflective process, we realized that contradictions in South African society permeate students’ experiences in ways that are indicative of the status quo. Increased recognition of the potential of affective learning to address social injustices in higher education could enable efforts toward social transformation.

What if students could be transformational resources for pharmacy practice?

The pharmacists’ role in the healthcare system is expanding internationally beyond the traditional roles of compounding and medicine supply management, to providing patientcentred care and updating health care workers on relevant medicine therapies. Pharmacists are pivotal in meeting the medicine-related needs of patients and other health care professionals. Even though pharmacists will remain responsible for medicine supply management, the routine activities associated with this can be handled by qualified pharmacist’s assistants and/or pharmacy technicians, while allowing pharmacists to embark on pharmaceutical care, identifying and solving the risks associated with medicine use and therapeutic drug monitoring. With an increase in the development of new medicines, it has become imperative for pharmacists to be integral members of the multidisciplinary team in order to ensure rational use of these medicines. Patient safety with the use of medicines have become a global concern. Therefore, pharmacists engaging in patientcentred practices could contribute towards better patient outcomes

An assessment of asthmatic patients at four Western Cape community pharmacies

Objectives. To identify the profile of asthmatic patients visiting community pharmacies and to assess the appropriateness of their current asthma therapy.Design. Patients were identified as either chronic, newly diagnosed or undiagnosed. Asthma status was assessed from their current symptom and medication profiles and from performance in an airways responsiveness test. Reversibility of > 15% was suggestive of probable airflow obstruction and such patients were referred to a medical practitioner.Setting. Four community pharmacies located in different socio-economic areas, viz. Khayelitsha, Wynberg, Mitchell's Plain and Vrijzee, were selected.Subjects. Participants over the age of 6 years, who suffered from recurrent cough, wheeze, chest tightness and/or breathlessness and used over-the-counter (OTC) and/or asthma medications, completed a questionnaire and participated in the airways responsiveness test. Outcome measures. Effective control of asthma based on minimal symptoms, appropriate use of bronchodilator and anti-inflammatory therapies and absence of airflow obstruction.Results. Of the 220 participants, 120 were identified as chronic, 7 as newly diagnosed and 93 as undiagnosed. Chronic asthmatics suffered daily symptoms and used inadequate prophylactic anti-inflammatory therapy. Many undiagnosed asthmatics were unaware of their symptoms and took OTC medication indiscriminately. Based on peak expiratory flow rate measurements, > 50% of the screened patients displayed a reversibility of > 15%.Conclusions. Chronic and many undiagnosed asthmatic patients frequent community pharmacies for their medication. Such patients suffer recurrent asthma symptoms and use medication inappropriately, which results in suboptimal lung function. Pharmacists should play a more participatory role in the detection andmanagement of asthma in the community

Service learning in pharmacy: Opportunities for student learning and service delivery

High patient load and understaffing in public health care facilities preclude the provision of optimal pharmaceutical services in South Africa. A Service Learning in Pharmacy (SLIP) programme for the University of the Western Cape's final year pharmacy students was implemented in health care facilities to assist in service provision. Students rotated between a pharmacotherapy (patient-oriented) and pharmaceutical formulation (product-oriented) activities to develop skills in prescription analysis, manufacturing and packaging of hospital pharmaceuticals. Structured focus group sessions were held with students and pharmacists to assess the integrated service learning experiences. Student feedback was positive, as the 'real world' experiences enabled them to adapt to intense work pressures, developed a sense of 'personal responsibility' towards patient health and they were sensitized to issues of social injustice. Students became competent in prescription analyses, counseling on medication use, manufacturing and pre-packing procedures. Pharmacists fully supported increased student involvement in the health services. Service learning in pharmacy schools is needed to contextualize learning and to address health care needs in South Africa

The dissemination and implementation of national asthma guidelines in south africa: the use of outcome mapping

Asthma is an important chronic inflammatory disorder with significant morbidity and mortality in South Africa. The development of national asthma guidelines by the South African Thoracic Society and National Asthma Education Programme has been one approach to try and improve the quality of care. The impact of previous guidelines has been limited and therefore it is hoped that the newly revised 2007 guidelines will have a more effective approach to dissemination, implementation and evaluation. Outcome mapping (OM) is one approach to integrated planning, monitoring and evaluation of projects that intend to contribute to change in complex systems. It has a structured, systematic and logical approach that focuses on changes in behaviour, actions or relationships in the people or organizations that the project is working with. OM has three stages - intentional design, outcome/performance monitoring and evaluation - which are described in this article and illustrated with reference to the Asthma Guideline Implementation Project (AGIP). In the intentional design stage the AGIP created a vision and mission statement to guide the project and then identified seven boundary partners. For each boundary partner the AGIP defined the project's outcome challenge and a series of progress markers to monitor achievement of the outcome. Following this the AGIP conceptualized the strategies and organizational practices that will be engaged with to realize the outcomes. In the monitoring stage the AGIP will regularly document and reflect on the progress markers, strategies and organizational practices using pre-determined structured journals. In the evaluation stage there is the opportunity to plan the evaluation of key aspects of the project in more depth. In the AGIP project the team engaged with the development of a doctoral research project to evaluate the process of implementation in private and public primary care settings in the Cape Town metropole. This article describes the methodology of Outcome Mapping and illustrates this in relation to the Asthma Guidelines Implementation Project. The methodology has the potential to be applied in many other development projects and is also congruent with action research. It is hoped that the readers will find this approach useful in their own settings

Exploring practising pharmacy graduates’ views on improving the effectiveness of pharmacy education at the University of the Western Cape, South Africa

South African health professional education institutions have a mandate to produce graduates who are able to address priority needs of the healthcare system and larger society. However, evidence of the effective use of public resources by health education institutions is not routinely collected. Practising graduates are a target audience who could provide part of this evidence. To explore the views of University of the Western Cape (UWC) pharmacy graduates on the effectiveness of pharmacy education in relation to their current and anticipated practice aspirations. A cross-sectional electronic survey was administered to UWC pharmacy graduates through the university’s alumni office network. Twenty-five graduates responded, of whom 60% were male (average age 38.9 (standard deviation 9.52) years). One of the strongest themes that emerged was the need for exposing pharmacy students from early on in the curriculum to a broad range of pharmacy and healthcare sectors and addressing real issues in these changing and complex environments. Graduates stressed the importance of the development of generic skills, such as interpersonal skills, leadership, advocacy and innovative problem-solving, which are necessary to effect positive change through collaborative and equitable approaches

An assessment of social accountability among South African pharmacy schools from public domain information

Global health education reform requires training institutions to align their education, service and research activities with the values of social accountability, which include relevance, equity, quality and effectiveness. The alignment with these values aims to ensure graduates who are competent to meet society’s priority health needs, especially those of marginalised and underserved communities. This study aimed to qualitatively assess the alignment of activities of the nine South African pharmacy schools with the values of social accountability from information and evidence available in the public domain. Data were collected from pharmacy schools’ websites, and related publications and newsletters. Information was grouped into predetermined categories representing the different values of social accountability. A scoring rubric was adapted that assessed the alignment of the information and evidence collected to the values of relevance equity and quality. Each pharmacy school’s information was initially reviewed and scored by three independent reviewers. Each of the reviewers cross-checked each other’s allocated scores and any variations in scores were settled via consensus between the reviewers. The information of six pharmacy schools was assessed. For relevance, pharmacy schools scored over 50% and above for all their activities. For equity, schools showed most variation in their educational activities, and least variation in their service activities. For quality, schools showed most consistency with education and service activities but most variation occurred in the quality of services. Information from the public domain may be useful in assessing social accountability. The depth of information that schools could share publicly remains a key question.DHE

Quality of asthma care: Western Cape Province, South Africa

Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care. Methods. The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. Results. Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. Conclusion. The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care

Quality of asthma care : Western Cape Province, South Africa

ArticleThe original publication is available at http://www.samj.org.zaBackground. Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care. Methods. The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. Results. Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. Conclusion. The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care.Publishers' versio