The Practical Disconnect: Why Students Can’t Define a Source

By Urvi J. Patel, PharmD, MPH

It was my first day as a PGY1 pharmacy practice resident in a clinical rotation. I was eager to become part of the team and prove my worth when a question came up during rounds. I answered it with confidence knowing exactly what that one slide on that one PowerPoint taught by that one professor said, but then I was asked where that information came from. I knew better than to say “from my lecture,” but in that exact moment I did not know what reference that information was linked to.

This student disconnect between the knowledge base and the evidence from which it came from is something that I have witnessed time and time again.

Why is this a problem?
The American College of Clinical Pharmacy states that clinical pharmacists serve as a source of objective and evidence-based therapeutic information and provide recommendations that promote the rational use of drugs.1 These functions require pharmacists to actively practice evidence-based medicine (EBM), which requires the development and utilization of skills that require a unique approach to learning. These skills include performing efficient literature searches and applying the formal rules of biostatistics and rating of evidence in evaluating the medical literature. The integration of EBM into daily practice is key to ensuring pharmacists serve a critical role in evidence-based, patient-centered care within an interdisciplinary team.

Although the Accreditation Council for Pharmacy Education states that PharmD graduates must be educated to deliver patient-centered care using evidence-based principles, there is no true guidance as to how these concepts should be delivered.2 This leads to the numerous schools and colleges of pharmacy across the nation offering variant levels of breadth and depth of EBM curricula, leading to variant levels of student aptitude.

What can we do about it?
Pharmacy education, just like the practice of pharmacy is in an ever-evolving state. In order to produce the most competent and effective pharmacists, the didactic model has to incorporate coursework that teaches students the skills needed to practice EBM. Easier said than done, right?

As a recent graduate and current trainee there are some factors that, if integrated into the PharmD curriculum, would have provided me with a more robust foundation of skills to utilize as a practitioner. Below is a list of small ways to help future generations of pharmacists work toward building a practice model centered in EBM.

  • Set the stage.3
    • Teaching and learning EBM is difficult as it requires both teachers and learners to process information in a manner that requires analytical evaluation of the strengths and weaknesses of the evidence and the application of the information gained to a specific patient population.
    • In order to prepare students to be able to critically analyze scientific information and determine its practical application, they must be oriented to the EBM process.
    • Orientation to the EBM process involves two components4:
      • Explain what EBM is: the integration of key factors that allow a provider to make the most clinically relevant decision for a patient

  • Steps involved in EBM4:

  • Define the reference.
    • Faculty do a great job of summarizing guidelines, primary literature, and clinical experience when teaching content. Unfortunately, this strategy can lead to a “this is how it is done” mentality versus a “scientific data states that this is the best approach to practice” mindset.
    • When teaching lecture material, in addition to summarizing the data to make the information more student-friendly, it is equally important to reinforce the resources from which the data was derived.
    • By directly referencing the data that should be used to make clinical decisions, professors will offer learners the opportunity to build a resource library.
  • Reinforce the practical application of evidence based medicine3
    • Students are sponges that absorb and implement strategies that they are exposed to.
    • By exposing them to the application of EBM, they are able to see the thought process and evidence evaluation that is involved in making a clinical decision that impacts patient care.
    • It is important to utilize real-life experiences through patient cases and drug information questions that require students to actively apply the processes that are being taught so they are able to develop efficient evidence-based decision making systems of their own.

What are your thoughts?

Let’s continue the conversation! Do you believe that there is a benefit in a specific EBM teaching model? How would you incorporate EBM into your teaching?


Acknowledgements
Special thanks to Jeff Cain, EdD, MS for his guidance and support on this article.


References

  1. American College of Clinical Pharmacy. The definition of clinical pharmacy. Pharmacotherapy. 2008;28(6):216-217.
  2. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. 2015.
  3. Bookstaver PB, Rudisill CN, Bickley AR, McAbee C, Miller AD, Piro CC, Schulz R. An evidence-based medicine elective course to improve student performance in advanced pharmacy practice experiences. Am J Pharm Educ. 2011;75(1):Article 9.
  4. Pediatric Residents: EBM Review and Practice. University of North Carolina Health Sciences Library. https://guides.lib.unc.edu/c.php?g=204275&p=1347818

Dr. Urvi Patel received her Doctor of Pharmacy degree from the University of Kentucky College of Pharmacy and her Master of Public Health degree from the University of Kentucky College of Public Health. Her professional interests include hematology/oncology and programmatic approaches to population health. Urvi completed a PGY1 Pharmacy Practice Residency at Emory University Hospital in Atlanta, GA and is continuing her training at this site as a PGY2 in hematology/oncology. She hopes her training and interest in academia will lead to future as a clinical specialist at an academic medical center affiliated with a college of pharmacy.


Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

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