8 September 2015:
Today was the first Pharmaceutical Care Skills Lab (PCSL) for both the new 3rd year and 4th year Pharmacy Students. In Uganda, the basic pharmacy degree required for practice is a Bachelors of Pharmacy (BPharm) and it is a 4 year program that starts right after secondary school (equivalent to High School in the USA- except they have 13 grades compared to our 12). At Makerere University, all of the Health Professions students, medical, dental, nursing, pharmacy, etc. start classes together for their first 2 years. It isn’t until the 3rd year that the students are split up to be taught together as just a pharmacy class. Another intersting fact about Higher Education in Uganda, and actually most of the rest of the world, is that once enrolled in a University, you take only coursework related to your discipline/major. There are no Liberal Arts requirements. So if you are a Pharmacy major, you will not take any Humantities courses and if you are an English major, you will not take any Science courses. In fact, in secondary school, the last two years are are also devoid of coursework out of your intended University major. This fact helps explains how these students are incredibly awesome in their knowledge of basic sciences. This has been their primary focus for years.
The type of learning in Pharmacy school that has been weak in the Ugandan system has been the “application” of the theory and the teaching of the skills of application. This is what helps Pharmacists to directly interact with patients, evaluate their medication regimens, and convey recommendations for ameliorating and drug therapy problems encountered to the physicians and other healthcare practitioners involved in the care of the patient. This type of interaction helps to create a team-approach to patient care which has been shown to improve health outcomes. So, the new PCSL curriculum that I helped to develop last year and am teaching this year has been designed to fill this gap.
For today’s class, I came up with what I thought was a good idea but after seeing how both classes engaged in the activity, I realized it was a brillant idea. I had the 4th year students work in groups to complete the OSCE scenarios that were used as an assessment last April. An OSCE is an Objective Standardized Clinical Examination where students enter a room by themselves and have to interact with an actor playing a patient to demonstrate their pharmaceutical care skills while being evaluated by an assessor. As you can imagine, it is a little scary. Anyway, most of the time the students don’t receive feedback from OSCEs because they are like final examinations. But, I know that students learn best when they receive feedback about how they did. How will they know what to improve if they are never told about how they should do it better? So, today I had the students get in groups and one student was given a script and role-played the patient. The other students interacted with the patient to complete the scenario while the other group members watched silently. Each member went successively and then once all group members participated, they were allowed to talk as a group to come up with the best possible way to interact with the patient. In this way they were allowed to learn from each other. The scenarios were things such as a patient needing a prescription filled and then education about how to take the regimen. Or perhaps it was a patient requesting malaria medicine but the pharmacist had to decide if it was safe to give it to them or if they should refer the patient to a healthcare center. After all groups worked through their scenarios, they demonstrated in front of the class. All of the groups did so much better with their collective wisdom versus most students alone. Of course, eventually they will need to be able to do this on their own, but improvement only comes with practice and it is helpful to have a good model to practice.
I also ran a similar activity with the 3rd years today which went equally well. Although the 3rd years haven’t had much pharmacy-specific training yet, all of them have purchased medications in pharmacies and some already work in pharmacies. I wanted to run them thru the OSCE exercise to see what their baseline attempt at interacting with the patient would be PRIOR to being taught anything specific. For this group, they all worked on a very simple prescription dispensing OSCE which was different from what the 4th years did today. Boy, I can’t express how impressed I was with their work. Of course, the interactions weren’t perfect, but again, together they came up with pretty good “best ways” to complete the activity. This showed me how I can build on what they already know instead of start at the very beginning. Also, my goal for the activity was to engage them in a process where they had to be responsible for the decision-making. It is in active engagement in their own learning that really creates lasting abilities.