This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.
The OSCE Assessment event (Objective Standardized Clinical Examination) on Thursday and Friday for the 3rd and 4th year Makerere University Pharmacy Students went really well. Of course there were a few little issues, the biggest one for me being that we ran behind both days by about an hour. And, since the event was to go all day, running an hour behind meant we didn’t finish until after 6pm on Thursday and 5:30pm on Friday. I understand the reason for Thursday’s event because we started late, but on Friday, we got off to a start that was only about 15min late. The stations were timed to no more than 7 minutes for each student and I planned 1 minute in between stations, but that wasn’t timed. We ended up being short on faculty to assess the stations so I had to participate and therefore there was only one helper to coordinate sending students from station to station. I think in the future, we need 2 helpers to make sure people aren’t taking more than 1 minute between stations. Oh, I think I just figured out the issue. Before every station, the students are handed a “student stem” which explains what they will be walking into when they open the station door. That way they know if it is a community pharmacy situation or if it is a hospital situation. I just realized that we didn’t time this part and at my station, I just told the students to read the stem and come in when ready. I’m sure that is where we picked up the extra time.
So another one of the problems that I had anticipated is that we would not be able to get enough faculty to participate to run all of the stations. Unfortunately, last week on the OSCE days, there were 2 other events that took the pharmacy faculty away from campus. These things had been planned in advance and the OSCE days couldn’t really be changed due to the time constraints of my trip here, so we dealt with it. We decided to run only 4 stations, rather than the planned 5. The students did pretty well on 3 of them, but the 4th one, the hospital case, stumped many of them. I think this was because they really didn’t get to practice using the drug information references that were provided for the OSCEs in class as much as I would have liked. The 2 references that are required books for the Pharmacy School are the BNF (British National Formulary) and the UCG (Uganda Clinical Guidelines). The BNF is a reference with details about drug products including dosing, indications, general drug interactions, etc. The UCG hasn’t been updated since 2012 but included the basic guidelines for the treatment of all disease conditions in Uganda. For example, if you look up Malaria you will find guidelines on the diagnosis of Malaria, the classification, types, initial treatment strategies, including doses, and monitoring parameters. I had thought these would be very familiar to the students since they were the required texts, but it turns out the Ugandan students are no different from the American students and they see “required” as “optional”. Many of the Ugandan students now have smart phones and in class, they used their phone apps. But not every student has a smart phone and to allow the use of medical apps for the OSCEs wouldn’t be fair. So, I wrote the cases specifically using the BNF and UCG, and these were provided at each station, only to find out that many students appeared to have limited knowledge on how to use these sources. Planning more PCSL sessions around using and interpreting drug information resources will definitely be required for the future. But the issue of using appropriate resources is still to be addressed. I suppose the Pharmacy School could somehow hold the students accountable for purchasing the BNF and UCG, but I’m not certain this is the best move. First of all, the UCG is very out-of-date. The BNF is a British source and doesn’t include all of the Ugandan drugs. Using other Western sources would create the same problem. Fortunately, there is a group of medical personnel, including a lot of the pharmacy faculty, who are creating a Ugandan National Formulary and I’ve heard the UCG is undergoing a revision. So, hopefully those will be done by next year.
I want to sincerely thank all of the Faculty and Staff who helped out with the OSCEs, both during the development process as well as during the actual event. This could not have been pulled off without the team approach. In addition, because a few were intimately involved in the process, they now have the experience to lead the development of more OSCE’s in the future, if it is felt that this was an appropriate way to assess the students Pharmaceutical Care Skills. The faculty and the students are taking surveys to help determine this.
I have come to my last day in Uganda for this Fulbright Project. I was here the months of March, September, and November and I thoroughly enjoyed having the time to focus on the needs of Pharmacy Education at Makerere University. I got a chance to get to know more faculty than ever before and I worked closely with both the 3rd and 4th year students, loving every minute of it. It really seems that both faculty and students have embraced the new curriculum and the changes I’m seeing are exciting. Besides helping to teach new skills to the Pharmacy Students, I have tried to instill in them and in the Pharmacy Interns at Mulago a vision of “what could be” if Pharmacists took a more active role in the direct care of patients. I believe that the hospital would manage their limited drug supply much more efficiently so that more drugs are available for all patients, patients would better understand how to take their medications so they can get the most benefits, a closer eye would be kept by pharmacists to make sure the patients are getting the appropriate drugs and doses for their illnesses, and I truly believe patient care will be improved. So as I leave them now to fend for themselves, I challenge Students, Faculty, and Interns to continue the road forward. Don’t be complacent. Don’t let the new skills go to waste. Use them, hone them, and make a difference for Ugandan patients. Continue to interact with other healthcare professionals in a team approach to improve patient care. I’m coming back in April 2015 with my Wilkes Pharmacy Students and I’m really eager to see the progress that will be made. If any of them ever need some advice, they all have my email address and I’m only a computer click away. In the meantime, from Stateside, I will be doing my best to outline a project proposal to fund the next phase of the project to Advance Pharmacy Practice in Uganda.
One final thanks to all of the people who have sought me out over the past few days to tell me how much they value my work in Uganda with Makerere University and Mulago Hospital. It’s really nice to be appreciated and to know that the success of the program I’ve felt myself is mutual. And I’ve really gained just as much as the Ugandans from my involvement here. I am continually amazed that I have had the fortune to be here in Uganda for the 6th time doing work that is challenging and rewarding. Before 2008, I never even conceived of any involvement in Africa, but fast forward 6 years and here I am. God willing, this is still just the start of a long and fruitful collaboration. So, my friends, farewell for now, but I’ll be back in April and really excited to see your progress!