PHArmacy Students as Educators (PHASE): Implementation and evaluation of an educator's curriculum for pharmacy students.

BACKGROUND AND PURPOSE: Designed to address the Association of Faculties of Pharmacy of Canada's competency "teach pharmacy team members, the public, and other health care professionals," the PHArmacy Students as Educators (PHASE) program was developed by the institute's entry-to-practice doctor of pharmacy program. The program's objective was to support students in developing the necessary skills to fulfill their role as pharmacist-educators. EDUCATIONAL ACTIVITY AND SETTING: We performed a two-year pilot (2017-2019) of the PHASE program which consists of a large-group didactic session followed by an academic half-day (AHD) session. Evaluation was conducted using Likert-scale and qualitative student survey data collected pre- and post-sessions to determine: (1) how the PHASE program supported students as future educators, and (2) students' perceptions and experiences related to teaching and learning. FINDINGS: All students in the 2020 and 2021 graduating cohorts were included in the study following consent. We determined that while respondents agreed to the statement, "A role of a pharmacist includes being an educator" (93.7% and 98.2% for 2020 and 2021 cohorts) at baseline, the proportion of strongly agree responses increased following the didactic session (P < .005). Of note, average Likert-score for respondents' confidence in educating increased following the AHD session (P < .001). Qualitative analysis identified an increase in students' self-rated ability for determining learners' needs, developing and conducting educational sessions, and confidence related to educating others. SUMMARY: Overall, the PHASE program showed positive impact during the first two years of implementation and lessons learned from the pilot are discussed.

Pharmacy Students' Experiences of Self-regulated Learning through Simulated Virtual Patients.

Objective: Virtual patient (VP) cases are a valuable learning tool for students, used to apply classroom knowledge and develop clinical skills. It is unknown whether exposure to multiple VP cases helps students develop self-regulated learning (SRL). We sought to learn more about how students engaged in SRL as they made goals for approaching patient care during repeated exposure to cases. Methods: Second-year students (N=211) were invited to participate in an online survey. Students were surveyed before and/or after completing three VP cases. Each survey consisted of two open-ended questions. Prior to each case, students were asked "How will you change the sequence of your approach to completing the VP assessment today, if at all?" and after each case, "What more do you have to learn in order to approach similar real-life patient assessments?" A thematic analysis was conducted on open-ended survey responses. Results: One hundred and seventy pre-case and 242 post-case responses were received. The most common themes identified in pre-case surveys were a need for a more systematic approach and specific strategies for executing the patient care process. Some students had no plans for approaching VP cases. The most common themes identified in post-case surveys were knowledge gaps of medical conditions, therapeutics, and lab tests. Conclusion: VPs provided students the opportunity to self-identify gaps in knowledge and plan to strengthen their clinical reasoning skills. More research is needed to understand the relationship between VP cases, instructional guidance for supporting SRL and the realities of the intended benefits to students' learning and practice.

Contributing to the hidden curriculum: exploring the role of residents and newly graduated physicians.

The hidden curriculum has been investigated as a powerful force on medical student learning and ongoing physician professional development. Previous studies have largely focused on medical students' experiences as 'receivers' of the hidden curriculum. This study examined how residents and newly graduated physicians conceived of their roles as active participants in the hidden curriculum. An interpretative phenomenological study was employed using individual, semi-structured interviews with residents and newly graduated physicians (n = 5) to examine their roles in perpetuating the hidden curriculum. A thematic analysis was conducted using a reflexive approach. Findings include insight into how residents and newly graduated physicians: (a) navigate the hidden curriculum for their own professional development; (b) intervene in others' enactment of the hidden curriculum; and (c) seek to repair the hidden curriculum for the next generation through their teaching. In light of our findings, we argue that: (a) more research is needed to understand how early career physicians navigate their engagement with the hidden curriculum; (b) students and educators be supported to consider how their agency to impact the hidden curriculum is influenced by the sociocultural context; and (c) residents and early career physicians are poised to powerfully impact the hidden curriculum through the learning environments they create.

Connecting a simulated virtual patient program with experiential practicums: Perspectives from year three students.

BACKGROUND AND PURPOSE: Research indicates that the simulated learning tools known as virtual patients (VPs) are valued by pharmacy students and impact students' knowledge and confidence. However, research is needed to understand how students can be supported to make intended connections between VP cases and real-life clinical scenarios. The purpose of this study was to examine whether and how VP cases influence students' clinical reasoning skills, confidence, thought processes, and preparedness for their experiential practicums. EDUCATIONAL ACTIVITY AND SETTING: Third-year entry-to-practice doctor of pharmacy students who had completed at least one VP case in second year prior to their experiential practicums were surveyed in fall 2018 after having completed their experiential practicums. Surveys were structured to solicit student perceptions related to how students bridged VP cases and real-life clinical scenarios and were analyzed using a mixed-methods design. FINDINGS: Forty-three students completed the survey. Students perceived that VP cases most significantly impacted their clinical reasoning skills due to the opportunity cases afforded them to explore patient data and navigate relevant information. The largest limitation of VP cases to students' learning was that the cases differed from their experiences. Students' suggestions included opportunities for more practice using VP cases and an expanded repertoire of medical conditions offered through case exposure. SUMMARY: More research is needed to understand how to help students connect VP cases to their experiential practicums to make them more effective learning tools.

Assessing Indigenous Cultural Safety Learning using Modified Reflexive Visual Arts.

Objective: Assessing Indigenous cultural safety learning in pharmacy students using modified reflexive visual arts Innovation: Traditional quantitative assessment methods are often ineffective and impractical for the evaluation of Indigenous cultural safety learning. Existing qualitative assessment methods have shown potential in small-class and experiential environments, but evidence to guide the scalability and use in a large lecture format is sparse. An innovative, visual arts-based qualitative assessment of cultural safety learning was developed and deployed to 223 first-year pharmacy students. The assessment was deployed in a pre- and post-term style in a foundational pharmacy module that included content on Indigenous health and cultural safety. The pre-term assessment included two activities for students: 1) a visual art self-reflection requiring students to use any visual art medium to depict what they think it means to practice as a pharmacist with cultural safety, accompanied by a brief written description and (2) an in-class session with a brief lecture component, small and large group sharing of reflections, debrief of experiences, and student peer review of the visual reflections. The post-term portion included a similar self-reflection activity and an in-class session that now asked students in their small groups to: 1) compare their pre/post reflections, and 2) collectively create a new summative visual that depicts the entire group's thoughts. Surveys and a focus group were used as an additional source of data. Critical Analysis: Survey responses (n=215) indicated that feedback for the assessment was highly positive, with 77% of students recommending the activity for future first-year pharmacy students. Students also validated the utility of the assessment, with 70% strongly or somewhat agreeing that the activity was valuable for their learning, 80% strongly or somewhat agreeing that the activity stimulated their thinking, and 81% strongly or somewhat agreeing the activity accurately reflected their true feelings on practicing cross-culturally.

Necessary but not sufficient: identifying conditions for effective feedback during internal medicine residents' clinical education.

Competency-based medical education and programmatic assessment intend to increase the opportunities for meaningful feedback, yet these conversations remain elusive. By comparing resident and faculty perceptions of feedback opportunities within one internal medicine residency training program, we sought to understand whether and how principles underlying meaningful feedback could be supported or constrained across a variety of feedback opportunities. Using case-study qualitative methodology, interviews and focus groups were conducted to explore 19 internal medicine residents' and 7 faculty members' perceptions of feedback across a variety of feedback opportunities: coaching, mini-CEXs, in-training evaluation reports and routine clinical supervision. Our data analysis moved iteratively between developing conceptual understandings and fine-grained analyses, while attending to both deductive and inductive analysis. Our results suggest that all feedback opportunities, including those created through formalized assessments, can foster meaningful feedback if faculty establish a trusting relationship with the resident, base their feedback on direct observation and support resident learning. However, formalized assessments were often perceived as inhibiting the conditions for meaningful feedback. A coaching program provided a context in which meaningful feedback could arise, in part because faculty were supported in shifting their focus from patient to resident. Meaningful feedback in clinical education may be fostered across a variety of feedback opportunities, however, it is often constrained by assessment. We must consider whether increasing the frequency of formative assessments may inhibit efforts to improve our feedback cultures while, in contrast, freeing up faculty to focus on supporting resident learning could improve these cultures.

Curriculum integration of virtual patients.

BACKGROUND AND PURPOSE: Virtual patients (VP) offer an enhanced learning experience for students to assume the role of health professional and make therapeutic decisions in a simulated environment. While VPs are valued by students and offer benefits to the learner, little is known about how best to implement them in pharmacy education curricula. The purpose of our study was to investigate students' perceptions of VPs and build understanding about how to optimally implement them in the future. EDUCATIONAL ACTIVITY AND SETTING: Four VP cases were implemented over the first three years of the entry to practice doctor of pharmacy program. Each case was focused on a different condition and implemented in one of three settings (i.e. integration activities, large lecture setting, or independent review). Students were invited to complete a survey and participate in a focus group after completing the patient case. FINDINGS: One-hundred eighty students completed the survey and six students participated in a focus group. Ninety-four percent of respondents strongly agreed/agreed that VPs were valuable for their learning. Students preferred the VP cases be implemented in small-group settings and be relevantly timed with course material. Students found helpful that cases were realistic, clear, comprehensive, engaging, and incorporated feedback. Perceived benefits included enhanced learning about medical conditions, development of clinical reasoning skills and processes for working through cases. SUMMARY: VPs continue to be identified as a valuable learning experience. When implemented it is important to consider the learner setting in order to get the greatest value from their use.

Understanding Professional Identity Formation in Early Clerkship: A Novel Framework.

PURPOSE: Medical educators should foster students' professional attitudes because individuals are more likely to act in accordance with medicine's professional values if these values have been internalized. Still, there is much to be learned about how students examine and negotiate their emerging identities. This study examined third-year medical students' experiences of professional identity formation (PIF) during clinical clerkship. METHOD: The authors relied on an interpretivist perspective, informed by a grounded theory approach, to analyze data, which were collected from a pilot course designed to support medical students' efforts to "unhide" the hidden curriculum in relation to their development as medical students and emerging professionals. RESULTS: Twelve third-year medical students engaged in 10 collaborative discussions with 3 faculty members, a resident, and a fourth-year student (2015-2016). Discussions facilitated students' reflection on their professional journeys. Analysis of transcribed discussions resulted in a conceptual framework useful for exploring and understanding students' reflections on their PIF. Through analyzing students' experiences, the authors identified 4 components that constituted PIF stories: context, focus, catalyst, process. CONCLUSIONS: The analysis resulted in the development of a conceptual framework and distinct identity formation themes. Discrete reflections focused on either students' current identity (being) or their sense of future self (becoming). The study identified catalysts that sparked participants' introspection about, or their processing of, identity. The moments that generate profound feelings of awareness in students are often moments that would not be recognizable (even post hoc) as remarkable by others.

Investigating conditions for meaningful feedback in the context of an evidence-based feedback programme.

CONTEXT: We developed, implemented and evaluated an evidence-based programme of feedback designed to address limitations identified in the current literature. OBJECTIVES: We sought to advance understanding about how and why feedback processes might be more effective in clinical education. METHODS: Three faculty members and nine first-year internal medicine residents participated in the pilot programme. To counter challenges identified in the literature, feedback was based on direct observation, grounded in longitudinal faculty-resident relationships, and devoid of summative assessment. We used a qualitative case study design to address three research questions: (i) What benefits did the participants describe? (ii) What elements of the programme facilitated these benefits? (iii) What were the limitations and challenges of the programme? Collected data included audiotapes of interactions between faculty members and residents, field notes written during observations, and semi-structured interviews and focus groups with resident participants. Data analysis moved cyclically and iteratively through inductive and deductive analysis. RESULTS: Residents described benefits relating to their ways of working (clinical skills), ways of learning (accountability for learning) and ways of feeling (emotional well-being). According to participants, specific elements of the programme that achieved these benefits included the direct observation of authentic clinical work, the longitudinal relationship with a faculty member and the emergence of feedback as a conversation between the faculty member and learner. CONCLUSIONS: We conclude that the conditions established within our pilot feedback programme influenced the learning culture for first-year internal medicine residents by grounding direct observation in authentic clinical work and setting the observations in the context of a longitudinal, non-assessment-based relationship between a faculty member and resident. These conditions appeared to influence residents' participation in the feedback process, their ways of approaching their daily clinical work, their emotional well-being and their engagement in their own learning.