Virtual patient educational programme to teach counselling to clinical pharmacists: development and proof of concept

Pharmacist–patient counselling can benefit patients and optimise care, but appropriate training is required. A virtual patient (VP) tool to teach pharmacists non-vitamin K oral anticoagulant counselling was developed; the VP may be used for continuing professional development. The objective was to develop and show proof of concept of the VP. A cyclic development approach was adopted whereby the client, developers and a steering group informed VP design, content and aesthetic. This included formal and informal evaluation; ethical approval was not required. The VP received varied feedback. Positive feedback concerned the technology and the high-standard of animations. Negative elements concerned international VP use and differences in practice, also technological comments, regarding VP delivery and usability on various electronic devices. The VP was reported to be ‘valuable’ and realistic with high-quality animations. The steering group commented on VP’s clinical appropriateness, cultural relevance and usability. Areas highlighted for improvement were rectified during development, including the incorporation of printable feedback. European considerations concerned differences in culture and practice. The development process successfully developed the VP and the proof of the concept was demonstrated. This will inform future VP development; a large-scale VP evaluation is underway

Virtual patients as a tool for training pre-registration pharmacists and increasing their preparedness to practice: A qualitative study

Virtual patients are an active learning pedagogical tool which simulate clinical scenarios in a three-dimensional environment. Their use in pharmacy education is under-researched in comparison to other healthcare professions. In the United Kingdom, pre-registration training refers to a year of workplace based training which pharmacy graduates must complete prior to professional registration as pharmacists. This study aimed to evaluate pre-registration pharmacists’ perceptions on the integration, usefulness and enjoyment of completing virtual patient simulations or non-interactive case studies as part of their training. Pre-registration trainees completed three virtual patient simulations or three non-interactive case studies on the topics of: emergency hormonal contraception, renal function and childhood illnesses. Telephone interviews were conducted with twenty pre-registration pharmacists, exploring their perspectives on the use of the virtual patient or non-interactive case studies. Data was analysed using the five-stage framework approach. Four main themes emerged from the data: case study design; usefulness of the case studies as a training tool; support in pre-registration training; utility of the learning tools. Trainees also identified technical issues they had experienced while completing the virtual patient simulations, specifically with keyword recognition. Pre-registration trainees who used the virtual patients provided comments relating to the novelty, realism and enjoyment in completing them. Trainees in both groups reported developing knowledge and skills from completing the case studies; those who used the virtual patient commented on the development of communication skills and an increase in confidence for practice and those who used the non-interactive cases focused on knowledge acquisition and numeracy. Participants were enthusiastic about virtual patients as a novel training tool which provided an opportunity for learners to practice realistic scenarios in a safe environment. Virtual patients offer the potential to ‘bridge the gap’ in pharmacist pre-registration sector-related training variation, promote learning through reflection on doing and increase overall preparedness for practice

Actual vs. Perceived Competency Development-How Can Virtual Patients Impact Pharmacist Pre-Registration Training?

Virtual patients are an active learning pedagogical tool that simulate clinical scenarios. There is an established disparity in pre-registration examination pass rates depending on whether individuals complete their training in a community or hospital pharmacy. This study aimed to evaluate virtual patient (VP) and non-interactive (NI) case studies, concerning knowledge, skill and confidence development of pre-registration pharmacist trainees. A quasi-experimental evaluation was conducted. Pre-registration pharmacists completed three VP or NI case studies. Each case study was associated with a pre-and post-knowledge quiz. Pre-registration trainees were invited to complete a questionnaire consisting of Likert ranking statements and open-ended questions on the case study features, usability and individual development. Both learning tools significantly improved trainees' knowledge on the topic areas (except for the NI group in case study 3). Although no significant differences in knowledge improvement were identified between the learning tools, trainees who used the VP reported the development of a wider knowledge base and skill set, an increase in confidence for practice and an opportunity to apply their learning. The sector in which pre-registration pharmacists were completing their training (community or hospital) had a significant impact on knowledge improvement in the three case studies. Future research evaluating VPs with pre-registration and qualified pharmacists should be conducted to explore their benefits and establish their effectiveness as learning tools

Perceptions of leadership in undergraduate pharmacy students through a mixed methods study

Poster abstract from Conference; Royal Pharmaceutical Society Winter Summit 2017

Shock interactions, turbulence, and the origin of the stellar mass spectrum

Supersonic turbulence is an essential element in understanding how structure within interstellar gas is created and shaped. In the context of star formation, many computational studies show that the mass spectrum of density and velocity fluctuations within dense clouds, as well as the distribution of their angular momenta, trace their origin to the statistical and physical properties of gas that is lashed with shock waves. In this article, we review the observations, simulations, and theories of how turbulent-like processes can account for structures we see in molecular clouds. We then compare traditional ideas of supersonic turbulence with a simpler physical model involving the effects of multiple shock waves and their interaction in the interstellar medium. Planar intersecting shock waves produce dense filaments, and generate vortex sheets that are essential to create the broad range of density and velocity structure in clouds. As an example, the lower mass behaviour of the stellar initial mass function can be traced to the tendency of a collection of shock waves to build-up a log-normal density distribution (or column density). Vorticity - which is essential to produce velocity structure over a very broad range of length scales in shocked clouds - can also be generated by the passage of curved shocks or intersecting planar shocks through such media. Two major additional physical forces affect the structure of star forming gas - gravity and feedback processes from young stars. Both of these can produce power-law tails at the high mass end of the IMF.Comment: 20 pages, 5 figures, to appear in theme issue "Turbulent Mixing" of the Philosophical Transactions of the Royal Society A, Snezhana I. Abarzhi, Serge Gauthier, and Katepalli R. Sreenivasan (Guest Editors), accepted for publicatio

Improving Shared Decision Making Between Patients and Clinicians: Design and Development of a Virtual Patient Simulation Tool.

BACKGROUND: Shared decision making (SDM) involves the formation of a collaborative partnership between the patient and clinician combining both of their expertise in order to benefit decision making. In order for clinicians to be able to carry out this skilled task, they require practice. Virtual reality, in the form of a virtual patient, could offer a potential method of facilitating this. OBJECTIVE: The objective of this study was to create a virtual patient that simulated a primary care consultation, affording the opportunity to practice SDM. A second aim was to involve patients in the design of a virtual patient simulation and report the process of the design. METHODS: We employed a multistep design process drawing on patient and expert involvement. RESULTS: A virtual patient, following a narrative style, was built, which allows a user to practice and receive feedback; both clinical and communication skills are required for the simulation. The patient group provided multiple insights, which the academic team had overlooked. They pertained mostly to issues concerning the patient experience. CONCLUSIONS: It is possible to design a virtual patient that allows a learner to practice their ability to conduct SDM. Patient input into the design of virtual patient simulations can be a worthwhile activity

Differences in UK healthcare professionals" knowledge,,attitude and practice towards infliximab and insulin glargine biosimilars

Objectives To investigate knowledge and attitudes of different healthcare professionals in UK towards infliximab and insulin glargine biosimilars. Methods UK medical consultants/registrars, nurses and pharmacists participated in anonymised, self‐administered web‐based survey distributed by professional associations. Key findings There were 234 respondents: medical consultants/registrars (150), nurses (58) and pharmacists (26). 76% of medical consultants/registrars, 84% of pharmacists and 53% of nurses understood what biosimilars were. Medical consultants/registrars and pharmacists had safety and efficacy concerns when switching patients compared to initiation. Nurses had similar levels of safety and efficacy concerns about initiation. Conclusion Healthcare professionals were more comfortable with the initiation of biosimilars than switching current patients. Medical consultants/registrars and pharmacists were more informed than nurses

Virtual patient technology to educate pharmacists and pharmacy students on patient communication: a systematic review

Background Virtual patients (VPs) are a sub-type of healthcare simulation that have been underutilised in health education. Their use is increasing, but applications are varied, as are designs, definitions and evaluations. Previous reviews have been broad, spanning multiple professions not accounting for design differences. Objectives The objective was to undertake a systematic narrative review to establish and evaluate VP use in pharmacy. This included VPs that were used to develop or contribute to communication or counselling skills in pharmacy undergraduates, pre-registration pharmacists and qualified pharmacists. Study selection Eight studies were identified using EBSCO and were quality assessed. The eligibility criteria did not discriminate between study design or outcomes but focused on the design and purpose of the VP. All the included studies used different VP applications and outcomes. Findings Four themes were identified from the studies: knowledge and skills, confidence, engagement with learning, and satisfaction. Results favoured the VPs but not all studies demonstrated this statistically due to the methods. VP potential and usability are advantageous, but technological problems can limit use. VPs can help transition knowledge to practice. Conclusions VPs are an additional valuable resource to develop communication and counselling skills for pharmacy students; use in other pharmacy populations could not be established. Individual applications require evaluation to demonstrate value due to different designs and technologies; quality standards may help to contribute to standardised development and implementation in varied professions. Many studies are small scale without robust findings; consequently, further quality research is required. This should focus on implementation and user perspectives